Cardiopulmonary resuscitation (CPR) involves restoring breathing and circulation in a patient whose heart has stopped. CPR has three main steps - airway, breathing, and circulation. For airway, techniques like head tilt and jaw thrust are used to open the airway. For breathing, mouth-to-mouth or bag-mask ventilation is provided. For circulation, chest compressions are given at a rate of 100-120 per minute to manually pump the heart and circulate blood to vital organs. Advanced CPR techniques involve use of equipment like endotracheal tubes, defibrillators, and drugs to further support breathing and restore heart rhythm. The goal of CPR is to prevent irreversible brain
A presentation used to train medical professionals to perform BLS in emergency condition. it will provide a better understanding about the steps of BLS and the order in which it should be perfomed.
A presentation used to train medical professionals to perform BLS in emergency condition. it will provide a better understanding about the steps of BLS and the order in which it should be perfomed.
CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support
CPR with both compression & rescue breath is critical for victim in emergency situation
BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS
Performed by a medical professional or an ordinary citizen who trained on it
ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person
In cardiopulmonary resuscitation procedure there are various institutes all over the world who send trained professional to go door to door to give CPR training to people, usually with audio/visual stimulation. In an attempt to get more people to perform CPR, there are some guidelines which help you to performing CPR better.
High Performance-High Density- Pit Crew- Team CPRDavid Hiltz
Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)
Basic CPR competency is a foudational skill in both basic and advanced life support training and ample data supports the need to improve ongoing maintenance of competency. Many out-of-hospital cardiac arrest victims do not receive CPR before the arrival of professional rescuers. Video-based instruction effectively trains students more quickly than traditional classroom based courses and evidence suggests ongoing refresher training benefits skill retention. Real time feedback devices improve CPR quality in both training and actual resuscitation. Devkunwar Salam "Cardiopulmonary Resuscitation" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21417.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21417/cardiopulmonary-resuscitation/devkunwar-salam
CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support
CPR with both compression & rescue breath is critical for victim in emergency situation
BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS
Performed by a medical professional or an ordinary citizen who trained on it
ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person
In cardiopulmonary resuscitation procedure there are various institutes all over the world who send trained professional to go door to door to give CPR training to people, usually with audio/visual stimulation. In an attempt to get more people to perform CPR, there are some guidelines which help you to performing CPR better.
High Performance-High Density- Pit Crew- Team CPRDavid Hiltz
Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)
Basic CPR competency is a foudational skill in both basic and advanced life support training and ample data supports the need to improve ongoing maintenance of competency. Many out-of-hospital cardiac arrest victims do not receive CPR before the arrival of professional rescuers. Video-based instruction effectively trains students more quickly than traditional classroom based courses and evidence suggests ongoing refresher training benefits skill retention. Real time feedback devices improve CPR quality in both training and actual resuscitation. Devkunwar Salam "Cardiopulmonary Resuscitation" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21417.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21417/cardiopulmonary-resuscitation/devkunwar-salam
Cardiopulmonary resuscitation is a technique of basic & advanced life support for purpose of oxygenating the brain & heart until appropriate definitive medical treatment can restore normal heart & Ventilatory action. Cardiopulmonary resuscitation is a life saving technique used to restore life of the people.
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
2. WHAT DOES CPR STANDS FOR?
C = Cardio (heart)
P = Pulmonary (lungs)
R = Resuscitation (recover)
2
3. DEFINITION OF CPR
A series of well-defined steps and protocol to revive a collapsed patient
to deliver oxygen to the heart and brain to restore native circulation and
ventilation
A series of steps used to establish artificial ventilation and circulation in
the patient who is not breathing and has no pulse
• Restore cardiopulmonary functioning
• Prevent irreversible brain damage from anoxia
4. INDICATION
Cardiac arrest
Respiratory arrest
Combination of both
Diagnosis:
1) Loss of consciousness
2) Loss of apical & central pulsations (carotid, femoral)
3) Apnea
4
5. DIAGNOSIS OF CARDIAC ARREST
Blood pressure measurement
Taking the pulse on peripheral arteries
Auscultation of cardiac tones
Loss of time
9. STAGES OF CPR
What is basic cardiac life support (BCLS)?
It is life support without the use of special equipment (domestic level)
What is Advanced cardiac Life Support (ACLS)?
It is life support with the use of advance techniques and special
equipment (eg. Airway, endotracheal tube, defibrillator and drugs)
(Hospital)
11. CPR TEAM
During cardiac arrest the team leader should allocate and assign the
various roles and tasks to the team members
Assign one person for each of the following roles:
Airway management & ventilation (Eg.bag & mask. Intubation).
Chest compressions
IV drug administration.
Defibrillation (DC shock)
Timing and documentation.
12. CPR TEAM
The person responsible for the airway may take turns with the person
responsible for chest compressions in order to diminish fatigue &
exhaustion.
It is also the responsibility of the team leader to use the 2-minute periods
of chest compressions to plan tasks, give orders and eliminate & exclude/
correct the reversible causes of cardiac arrest
13. BCLS
► 3S steps before the initiation of
resuscitation for management of
a collapsed patient
1) Ensure your own Safety.
2) Check the level of
responsiveness by gently
Shaking the patient and
Shouting: “are you alright?”
3) Shout for help.
► Then check for carotid pulsations
for 10 seconds (unilaterally)
14. BCLS
► Apnea (cessation of respiration) is
confirmed by (For at least 10
seconds):
1) Look: to see chest wall movement.
Seesaw (paradoxical) movement of
the chest wall indicates airway
obstruction.
2) Listen: breath of sounds from the
mouth.
3) Feel: air flow from nose
15. CHAIN OF SURVIVAL
There are 4 corner stones for optimising the outcome following cardiac
arrest:
Early recognition & call for help: to prevent cardiac arrest.
Early CPR (with minimal interruptions):
Early defibrillation: to restart the heart.
Post resuscitation care: to restore quality of life & minimize
neurological insult.
18. AIR WAY
The human brain cannot survive more than 3 minutes with lack of
circulation. So chest compressions must be started immediately for any
patient with absent central pulsations
Loss of consciousness often results in airway obstruction due to loss of
tone in the muscles of the airway and falling back of the tongue
19. AIR WAY
Basic techniques for airway patency:
1. Head tilt, chin lift: one hand is placed on the forehead and the other
on the chin, the head is tilted upwards to cause anterior
displacement of the tongue.
2. Jaw thrust: mandibular angle
3. Finger sweep: Sweep out foreign body in the mouth by index finger
(in unconscious patients only. This is NOT advised in a conscious or
convulsing patient.
21. AIR WAY
4. Heimlich manoeuvre:
If the patient is conscious or the
foreign body cannot be removed by a
finger sweep. It is done while the
patient is standing up or lying down
This is a sub diaphragmatic abdominal
thrust that elevates the diaphragm
expelling a blast of air from the lungs
that displaces the foreign body
In infants it can be done by a series of
blows on he back and chest thrusts
22.
23. BREATHING
1. Mouth to mouth breathing: with the airway held open, pinch the
nostrils closed, take a deep breath and seal your lips over he patients
mouth. Blow steadily into the patients mouth watching the chest rise.
2. Mouth to nose breathing: seal the mouth shut and breathe steadily
though the nose.
3. Mouth to mouth and nose: is used in infants and small children.
Expired air contains 16% O2, so supplemental 100% O2 should be used
as soon as possible.
Successful breathing is achieved by delivery of a tidal volume of 800-
1200 ml in adults at a rate of 10-12 breaths/min
24. CIRCULATION
Chest compressions (cardiac massage):
The human brain cannot survive more than 3 minutes with
lack of circulation
So chest compressions must be started immediately for any
patient with absent central pulsations
25. CIRCULATION
Technique of chest compressions:
- Patient must be placed on a hard surface (wooden board).
- The palm of one hand is placed in the concavity of the lower half of the
sternum 2 fingers above the xiphoid process. (Avoid xiphisternal injury)
The other hand is placed over the hand on the sternum.
Shoulders should be positioned directly over the hands with the elbows
locked straight and arms extended.
Sternum must be depressed 4-5 cm in adults, and 2-4 cm in children, 1-2
cm in infants
26. CIRCULATION
Must be performed at a rate of
100-120/min
During CPR the ratio of chest
compressions to ventilation
should be as follows:
Single rescuer = 30:2
In the presence of 2 rescuers
chest compressions should not
be interrupted for ventilation
28. CIRCULATION
Complications of chest compressions:
Fractured ribs (MOST commonly).
Pneumothorax.
Sternal fracture.
Anterior mediastinal hemmorrhage.
Injury to abdominal viscera (liver laceration or rupture).
Rarely injury to the heart and great vessels (myocardial contusion)
AVOIDABLE by performing the technique correctly.
29. ASSESSMENT OF RESTORATION
Contraction of pupil
Improved color of the skin
Free movement of the chest wall
Swallowing attempts
Struggling movements
31. ALS COMPONENTS
Circulation by cardiac massage
Airway management by equipments
Breathing by advanced techniques
Defibrillation by manual defibrillator
Drugs
32. AIRWAY PATENCY
1. Face Mask
Advantages:
Easy. Does not require
skilled personnel
Transparent to detect
regurgitation
Disadvantages:
Stomach inflation
Not protective against
regurgitation & aspiration of
gastric contents
33. AIRWAY PATENCY
2. Oropharyngeal (Geudal) airway:
Advantages:
Easy. Does not require highly skilled personnel.
Disadvantages:
Not protective against regurgitation & aspiration of gastric contents
Poorly tolerated by conscious patients (gag reflex)
34.
35. AIRWAY PATENCY
3. Nasopharyngeal airway:
Lubricated and inserted through the nose.
Better tolerated in conscious patients.
Contraindicated:
Fractured skull base
Coagulopathy
► Disadvantages:
Not protective against regurgitation & aspiration of gastric contents.
36. AIRWAY PATENCY
4. Laryngeal mask airway (LMA):
Available in a variety of pediatric and
adult sizes.
Advantages:
Easy. Does not require highly skilled
personnel
Disadvantages:
Stomach inflation
Not protective against regurgitation &
aspiration of gastric contents
37. AIRWAY PATENCY
5. Endotracheal tube:
Advantages:
Ensures proper lung ventilation
No gastric inflation
No regurgitation or aspiration of gastric contents.
Disadvantages: Requires insertion by highly skilled personnel
39. AIRWAY PATENCY
7. Cricothyrotomy (Surgical Airway)
It is done either by a commercially available cannula in a specialized
cricothyrotomy set or a large bore IV cannula 12-14 gauge.
Is done in case of difficult endotracheal intubation.
Nu-trake cannula is specially designed to allow ventilation by a self-
inflating bag (AMBU-automated manual breathing unit)
An IV cannula needs a special connection to a high pressure source to
generate sufficient gas flow (trans-tracheal jet ventilation)
42. BREATHING
1. Self-inflating resuscitation bag (AMBU bag):
When used without a source of O2 (room air) gives 21% O2.
When connected to a source of O2 (10-15 L/min) gives 45% O2.
If a reservoir bag is added it can give up to 85% O2.
2. Mechanical ventilator:
45. ASSESSMENT OF THE ADEQUACY OF
CHEST COMPRESSIONS
Capnography:
End-tidal (expired CO2)
Successful CPR is indicated by expired CO2 > 20 mmHg
Central venous saturation >30%
Pulsation in the big arteries
Chest compressions must be continued for 2 minutes before re-
assessment of cardiac rhythm (2 minutes = equivalent to 5 cycles
30:2)
46. ASSESSMENT OF THE ADEQUACY OF
CHEST COMPRESSIONS
Golden rules:
Ensure high quality chest compressions: rate, depth, recoil.
Plan actions before interrupting CPR.
Minimize interruption of chest compressions.
Early defibrillation of shockable rhythm
47. IV ACCESS
A pre-existing central venous line is ideal in CPR, but if it is not present
it will be time-consuming
Drug administration must be followed by 10 ml IV fluid bolus
Peripheral IV line is associated with significant delay between drug
administration and delivery to the heart, since peripheral blood flow is
drastically reduced during resuscitation
So drug administration must be followed by 20 ml IV fluid bolus in
adults and elevation of the limb to ensure delivery to the central
circulation
In case of difficult venous access, intra-osseous drug and fluid
administration can be performed.
52. DEFIBRILLATION
PEA: Pulseless Electrical Activity: non-shockable
Exclude / treat reversible causes.
Adrenaline 1 mg IV every 4 minutes (2 cycles) (until a shockable
rhythm is reached).
53. DEFIBRILLATION
Position of Paddles:
One paddle is placed in the right infraclavicular region, while the other is
placed in the left 5th-6th intercostal space anterior axillary line
Biphasic
V/T and V/F 120-200J
Better: low burn incidence
Monophasic
200-360J
54. PRECAUTIONS
Make sure the paddles have conducting gel on them: (Why??)
1. The electricity will not be properly transmitted to the chest wall without it.
2. Even with the gel, these paddles will often cause a second-degree skin burn.
Make sure that you have cleared the bed:
1. make sure that no one is in contact with the bed otherwise this person may be
electrocuted and develop VT or VF
Hold the paddles down firmly: 25 pounds of pressure = 11 kg)
1. Chest compressions must be continued for 2 minutes after DC shock before
reassessment of cardiac rhythm.
Complications of defibrillation:
1. Skin burn, injury to myocardium and elevation of cardiac enzymes,
electrocution of person in contact with the bed.
55. DRUGS
Adrenaline:
Given as a vasopressor
Dose: 1 mg (0.01 mg/kg) IV every 4 minutes (alternating cycles) while
continuing CPR
Immediately in non-shockable rhythm (non-VT/VF)
In VF or VT given after the 3rd shock.
Once adrenaline → ALWAYS adrenaline
56. DRUGS
Amiodarone:
Dose: 300 mg IV bolus (5 mg/kg)
In shockable rhythm after the 3rd shock.
If unavailable give lidocaine 100 mg IV (1-1.5 mg/kg)
Magnesium:
Dose: 2 g IV
VF / VT with hypomagnesaemia
Digoxin toxicity
57. DRUGS
Vasopressin : 40 IU single dose once.
Calcium:
Dose: 10 ml of 10% Calcium chloride IV.
Indications: PEA caused by: hyperkalemia, hypocalcemia,
hypermagnesemia, and overdose of calcium channel blockers
Do NOT give calcium solutions and NaHCO3 simultaneously by the
same route
58. DRUGS
IV Fluids:
Infuse fluids rapidly if hypovolemia is suspected
Use normal saline (0.9% NaCl) or Ringer’s solution.
Avoid dextrose which is redistributed away from the intravascular
space rapidly and causes hyperglycaemia which may worsen
neurological outcome after cardiac arrest
Dextrose is indicated only if there is documented hypoglycaemia
59. DRUGS
Thrombolytic:
Fibrinolytic therapy is considered when cardiac arrest is caused by proven
or suspected acute pulmonary embolism
If a fibrinolytic drug is used in these circumstances consider performing
CPR for at least 60-90 minutes before termination of resuscitation attempts
Atropine:
Its routine use in PEA and asystole is not beneficial
Indicated: sinus Bradycardia or AV block causing hemodynamic instability.
Dose: 0.5 mg IV. Repeated up to a maximum of 3 mg (full atropinization)
60. DRUGS
Sodium bicarbonate:
1. Severe metabolic acidosis (pH < 7.1)
2. Life-threatening hyperkalemia.
3. Tricyclic antidepressant overdose
Avoid its routine use due to its complications:
1- Increases CO2 load
2- Inhibits release of O2 to tissues
3- Impairs myocardial contractility
4- Causes hypernatremia
61. POST RESUSCITATION CARE
Maintain Airway and Breathing
Check for Circulation
Disability optimizing neurological recovery
Sedation
Control of seizure
Temperature control
Treatment of hyperpyrexia
Treatment of hypothermia
Blood glucose level
61