The document provides an extensive overview of cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS), detailing techniques and protocols for treating cardiac arrest and other emergencies. It outlines procedures for performing CPR, including chest compressions, airway management, and the use of automated external defibrillators (AEDs), emphasizing the importance of effective positioning and techniques. Additionally, the document highlights the use of medications and the post-cardiac arrest care objectives aimed at optimizing patient outcomes.

1. “Cardiopulmonary resuscitation (CPR)”
Prepared by
Mr.Abhay Rajpoot
HOD (Dep. of Medical Surgical)
abhayrajpoot5591@gmail.com

2. DEFINITION
Cardiopulmonary resuscitation (CPR) is the manual application of chest
compressions and ventilations to patients in cardiac arrest, done with an
effort to maintain viability

3. ADVANCED CARDIAC LIFE SUPPORT
Advanced cardiac life support or advanced cardiovascular life support
(ACLS) refers to a set of clinical interventions for the urgent
treatment of cardiac arrest and other life-threatening medical
emergencies, as well as the knowledge and skills to deploy those
interventions.

4.  ACLS is a series of evidence based responses simple enough to be
committed to memory and recall under moments of stress.
 AMERICAN HEART ASSOCIATION (AHA) protocols are considered
to be the GOLD standard ACLS protocols
 It gets reviewed every 5 year, now latest advancements in
ecgguidelines.health.org

5. INDICATION:
 Road Traffic Accident
 Drowning
 Electric Shock
 Airway Obstruction
 Cardiac Arrest

6. CONTRAINDICATION:
 Do-not-resuscitate (DNR)

7. CHAIN OF SURVIVAL:

9. POSITIONING
Positioning for CPR:
 CPR is most easily and effectively performed by laying the patient supine
on a relatively hard surface, which allows effective compression of the
sternum.
 Delivery of CPR on a mattress or other soft material is generally less
effective.
 The person giving compressions should be positioned high enough above
the patient to achieve sufficient leverage, so that he or she can use body
weight to adequately compress the chest.

10. Remember to spell C-A-B
Compressions: Restore blood circulation
1. Place the heel of one hand over the center of the person's chest,
between the nipples. Place other hand on top of the first hand. Keep
elbows straight and position shoulders directly above hands.
2. Use upper body weight (not just arms) as pushing straight down on
(compress) the chest

11. CONTI…
Compression rate:
 In adult victims of cardiac arrest, it is reasonable for rescuers to
perform chest compressions at a rate of 100 to 120/min.
Compression depth:
 During manual CPR, rescuers should perform chest compressions to a
depth of at least 2 inches (5 cm) for an average adult, while avoiding
excessive chest compression depths (greater than 2.4 inches [6 cm])
Chest recoil:
 It is reasonable for rescuers to avoid leaning on the chest between
compressions, to allow full chest wall recoil for adults in cardiac arrest.
 If not trained in CPR, continue chest compressions until there are signs
of movement or until emergency medical personnel take over.

13. Airway: Open the airway
Some signs of obstructed airway include poor air exchange, high pitch
noise while breathing and inability to speak.
If rescuer trained in CPR and performed 30 chest compressions, open the
person's airway using the head-tilt, chin-lift maneuver. Put palm on the
person's forehead and gently tilt the head back. Then with the other hand,
gently lift the chin forward to open the airway.

14. Breathing: Breathe for the person
 Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose
breathing if the mouth is seriously injured or can't be opened.
 With the airway open (using the head-tilt, chin-lift maneuver), pinch
the nostrils shut for mouth-to-mouth breathing and cover the person's
mouth with yours, making a seal.
 Prepare to give two rescue breaths. Give the first rescue breath
lasting one

16. Cont.…
 It may be reasonable for the provider to deliver 1 breath every 6
seconds (10 breaths per minute) while continuous chest compressions
are being performed (i.e., during CPR with an advanced airway).
 The adequacy of breath given can be determined by observing for rise
in victims chest.
 Continue CPR until there are signs of movement or emergency medical
personnel take over

17. recovery position
The recovery position refers to one of a series of variations on
a lateral recumbent or three-quarters prone position of the body. If
a person is unconscious but is breathing and has no other life-
threatening conditions, they should be placed in the recovery
position. Putting someone in the recovery position will keep their
airway clear and open. It also ensures that any vomit or fluid won't
cause them to choke.

19. DEMONSTRATION

20. STEPS
Before you begin
Immediately upon seeing the victim and Before starting CPR, check:
 Is the environment safe for the person?
 Is the person conscious or unconscious?
 If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are
you OK?“
 Check carotid pulse for 10 seconds.
 If the person doesn't respond and two people are available, have one person call 108 or the
local emergency number and have the other person begin CPR.
 If alone and have immediate access to a telephone, call 108 or local emergency number
before beginning CPR. Get the AED, if one is available.
 As soon as an AED is available, deliver one shock if instructed by the device, then begin
CPR.
 Put the person on his or her back on a firm surface.
 Kneel next to the person's neck and shoulders.

21. DEFIBRILLATION
Biphasic wave form: 120- 200 J
Monophasic wave form: 360 J
AED- device specific
 Failure of a single adequate shock to restore a pulse should be
followed by continued CPR and second shock delivered after five
cycles of CPR

23. HOW TO USE DEFIBRILLATOR
 SAFETY
If patient not intubated remove o2 delivery devices
If intubated either leave bag valve resuscitator attached to
ET or remove it
If available use self adhesive defibrillation pads
Do not place over pacemakers
Remove transdermal patches.

24. PROCEDURE
 Place sternal paddle over right of the sternum below clavicle
 Place apical paddle in mid axillary line in 5th IC space
 Switch on the defibrillator
 Charge the defibrillator to 200J or 360J
 Warn all other rescuers to stand clear- ‘ARE YOU CLEAR’
 Visually check all are clear
 Ensure yourself you are not touching patient or bed ‘I AM CLEAR’
 Deliver shock
 Restart CPR with out checking pulse.

26. Automatic External Defibrillator (AED)
An automated external defibrillator (AED) is a portable electronic device
that automatically diagnoses the life-threatening cardiac arrhythmias of
ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is
able to treat them through defibrillation Switch onAED.
 Attach electrode pads.
 Place electrodes as that of manual one
 Follow voice commands
 Make sure no one in contact with patient
 Push shock button.

28. BREATHING DEVICES
BASICAIRWAYS
 Oropharyngeal airway
 Nasopharyngeal airway
ADVANCED
 Endotracheal tube
 Laryngeal mask airway
 Laryngeal tube
 Oesophageal tracheal tube

29. Nasopharyngeal airway

30. OROPHARYNGEALAIRWAY

32. ENDOTRACHEALTUBE

34. Laryngeal mask airway

36. Laryngeal tube

38. Oesophageal tracheal tube

39. Routes of Administration
 Peripheral IV – must followed by 20 ml NS push Central IV –
fast onset of action, but do not wait or waste time for CV line
Intraosseous – alternative IV route in peds, also in Adult
Intratracheally (down an ET tube)- not
recommended now a days

40.  Oxygen
 IV Fluids

41. Lidocaine
Indications:
 VT, VF
 Can be toxic so no longer given prophylactically
 IV dose :
 1-1.5 mg/kg bolus then continuous infusion of 2-4 mg/min
 Can be given down ET tube
 Signs of toxicity:
 slurred speech, seizures, altered consciousness

42. Magnesium
 Used for refractory VF or VT caused by hypomagnesemia and Torsades de
Pointes
 Dose:
 1-2 grams over 2 minutes
 Side Effects
 Hypotension
 Asystole

43. Propranolol/ Esmolol
• Beta blocker that may be useful for VF and VT that has not responded to other
therapies
 Very useful for patients whose cardiac emergency was precipitated by
hypertension

44. Epinephrine
Alpha, beta-1, and beta-2 stimulation
 Increases heart rate, stroke volume and blood pressure
 IV Dose:
 1 mg every 3-5 minutes
 May increase ischemia because of increased O2 demand by the heart

45. Sodium Bicarbonate
METABOLIC acidosis / hyperkalemia
Airway and ventilation have to be functional
IV Dose:
 – 1 mEq/kg
Side effects:
Metabolic alkalosis
Increased CO2 production

46. ADENOSINE
 Slows conduction time through the A-V node, can interrupt the reentry
pathways through the A-V node
 Potassium channel opener and hyperpolarization
 IV Dose:
 6 mg rapid iv push, follow with NS flush..
 Second dose 12 mg
 Side effects:- Flushing of face, bronchospasm

47. POST CARDIACARREST CARE

48. Objectives
Optimize cardiopulmonary function and vital organ perfusion.
After out-of-hospital cardiac arrest, transport patient to an
appropriate hospital with a comprehensive post–cardiac arrest
treatment
Transport the in-hospital post– cardiac arrest patient to an
appropriate critical-care unit
Try to identify and treat the precipitating causes of the arrest and
prevent recurrent arrest

49. CONCLUSION
Cardiopulmonary arrest is loss of airway, breathing, or
meaningful circulation. Cardiopulmonary resuscitation (CPR) is
the use of therapeutic interventions, primarily BLS that are
designed to restore spontaneous circulation following cardiac or
pulmonary arrest.

50. BIBLIOGRAPHY:
 https://cpr.heart.org/AHAECC/CPRAndECC/Training/HealthcareProfess
ional/BasicLifeSupportBLS/UCM_473189_Basic-Life-Support-BLS.jsp
 https://www.heart.org/en/cpr
 https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600
 https://www.nationalcprassociation.com/free-cpr-study-guide
 https://eccguidelines.heart.org/wp-content/uploads/2018/10/2018-
Focused-Updates_Highlights.pdf