Cardiopulmonary resuscitation (CPR) is a critical series of actions to enhance survival rates during cardiac arrest, with techniques varying based on the rescuer's training. The steps of basic life support (BLS) involve ensuring scene safety, checking for responsiveness, activating emergency medical services, and performing chest compressions. Advanced cardiac life support (ACLS) follows BLS when the victim is responsive, involving more complex interventions and drug therapies to treat underlying causes of cardiac arrest.

1. Basic Life Support

2. What is CPR
• Cardiopulmonary resuscitation (CPR) is a
series of life saving actions that improve the
chance of survival following cardiac arrest.
• The optimal approach to CPR vary with
rescuer, victim, and available resources
• The fundamental challenge however is to
achieve early and effective CPR.

3. Chain of survival

4. Rescuer and Victim
Rescuer – all, regardless of training, should provide
chest compression.
a)Untrained Lay Rescuer–Hands Only CPR
b)Trained Lay Rescuer – Chest compression ± rescue
breaths
c)Health Care Provider– Chest compression + rescue
breaths , coordinate teamwork. Coordinate
teamwork. Likely cause ?
Victim –
Adult : cardiac cause - chest compression
Child/ Drowning : asphyxial cause - ventilation

5. • CPR can be performed by
ANYONE who knows how to do it,
ANYWHERE,
IMMEDIATELY,
WITHOUT any EQUIPMENT

6. Basic Life Support (BLS)
1. Ensure scene safety
2. Check for response
3. Activate EMS (Call for help)
4. Check breathing and pulse
5. Chest compressions
6. Open airway and ventilate
7. Defibrillate (when AED arrives)

7. Steps of BLS

10. 1.Ensure scene safety
• Of Self
• Of Patient

11. 2.Check Responsiveness
• Lay rescuer-
Victim unconscious / unresponsive, with
absent / abnormal breathing
Assume cardiac arrest and begin COCPR
• HCP-
Victim unconscious / unresponsive, with
absent / abnormal breathing check pulse for
no more than 10s - no definite pulse - Assume
cardiac arrest

12. 3.Activate Emergency Medical Services
• Shout for nearby help
• Phone or ask someone to phone EMS
• Phone/caller with the phone remains at
victim’s side- phone on speaker mode

13. Chest Compressions
• Effectively performed by laying the
patient supine on a relatively hard
surface, allow effective
compression of the sternum
• Select a point that is over the
lower half of sternum
• Place the heel of one hand
• Place the heel of another hand on
top
• Interlace the fingers
• Rescuer’s buttocks above those of
the patient, elbows locked,
shoulders at 90 degrees
• Count 1,2, 3… 30

14. High Quality CPR!
• Push hard and push fast
• Lower half of sternum, centre of chest, between
the nipples
• Rate : 100 -120 / min
• Depth : atleast 2 inches (5 cm)
• Allow complete chest recoil between compression
• Do not lean on victim
• Minimal interruptions

15. Correct Technique
• Firm surface
• Kneel beside victimʼs
chest or stand beside bed
• Heel of one hand on
intermammary line
• Heel of other hand on
top
• Lock elbows

16. Opening the Airway-head tilt chin
lift
• Trained lay rescuer-
confident in
compressions and
ventilation –open
the airway using a
head tilt– chin lift-
when no cervical
spine injury
suspected
HCP – should use
head tilt–chin lift
maneuver to open
the airway of a
patient when no
cervical spine
injury suspected.

17. Head tilt- chin lift

18. Jaw thrust
•In trauma patients
•By trained rescuer only
•Use head tilt- chin lift, if jaw
thrust does not adequately
open the airway

19. Breathing
• Give breaths over 1 sec
• Visible chest rise
• Compression: ventilation ratio - 30 : 2 ( in 18
seconds )
• If no chest rise , re-position head , ensure tight
seal
• Avoid forceful or rapid breaths
• Advanced airway : 10 breaths/min.

20. Rescue breaths
• Open airway as described
• Deliver 1 tidal breath over 1
second
• Allow the chest to recoil for 1
second
• Deliver the second tidal breath
over another second
• Allow the chest to recoil over
another second
• Do not hyperventilate

21. Mouth to mouth Mouth to mask
Bag & Mask

22. IF VICTIM STARTS TO BREATHE NORMALLY
PLACE IN RECOVERY POSITION

24. Defibrillation Vs CPR first?
• Witnessed arrest, AED available at site -
OHCA - immed CPR , Defib asap !
IHCA - immed CPR , Defib asap !
• AED not available at site - CPR continued till
AED arrives.

25. Resuscitate until
• Arrival of qualified help arrives
• Victim starts breathing normally
• Rescuer becomes exhausted
• Scene becomes unsafe
• Physician directs to stop CPR

26. IHCA BLS & ACLS

27. 2020 American Heart Association
Chains of Survival for IHCA

28. BLS & ACLS Survey in In-Hospital
Cardiac Arrest
• Healthcare providers (HCPs) must be able to
competently and quickly assist victims who are in
cardiac arrest.
• The aim is to:
1. improve survival rates
2. ensure positive, high-quality outcomes.
• Systematic strategies should be formulated that
allow HCPs to provide immediate care using BLS
and ACLS surveys.

29. • If a patient is unresponsive the BLS survey
should be utilized at first.
• After the completion of the BLS survey or
when the victim is responsive and awake, the
ACLS survey is the next step that entails
providing advanced treatment approaches.

30. The BLS Survey
• HCPs must be able to demonstrate both one-
and two-responder resuscitation skills.
• Emphasis should be placed on performing
several actions simultaneously during the
resuscitation process as two responders are
often available.

32. ACLS Survey
• After completing the BLS survey, or if the
victim is responsive, conscious, or awake, the
responder should begin the ACLS survey.
• Focus needs to be placed on identifying and
treating the underlying cause of the victim’s
problem.

34. Drug therapy
• Epinephrine IV/IO dose:
- 1mg every 3-5 minutes,
- Early administration improves survival in non-
shockable rhythms
• Amiodarone IV/IO dose:
- First dose: 300 mg bolus
- Second dose: 150 mg
- Recommended for refractory VF/VT

35. Or
• Lidocaine IV/IO dose:
- First dose: 1-1.5 mg/kg
- Second dose: 0.5-0.75 mg/kg
- Recommended for refractory VF/VT

36. Reversible causes of cardiac arrest
5H&5T ACC/AHA guidelines
recommendation

37. • Reversible causes of cardiac arrest
5H 5T
Hypothermia Tension Pneumothorax
Hypovolemia Cardiac tamponade
Hypoxia Toxins
Hydrogen ion (Acidosis) Thrombosis,
pulmonary
Hypo/ hyperkalemia Thrombosis , cardiac

38. Anaphylaxis
• Removal of the inciting cause
• Call for help
• Intramuscular (IM) injection of epinephrine at the
earliest, followed by additional epinephrine by IM or
intravenous (IV) injection as needed.
• Place patient in supine position with the lower
extremities elevated
• Supplemental oxygen
• Two wide bore iv lines for volume resuscitation with IV
fluids (1-2 lt NS)

39. • The recommended dose of epinephrine in
anaphylaxis is 0.2 to 0.5 mg (1:1000)
intramuscularly, to be repeated every 5 to 15 min as
needed
• In patients with anaphylactic shock, close
hemodynamic monitoring is recommended.
• When an IV line is in place, it is reasonable to
consider the IV route for epinephrine in anaphylactic
shock, at a dose of infusion at 0.1 mcg/kg/minute

40. • IV infusion of epinephrine is a reasonable
alternative to IV boluses for treatment of
anaphylaxis in patients not in cardiac arrest.
• There is development of oropharyngeal or
laryngeal edema, immediate referral to a health
professional with expertise in advanced airway
placement, including surgical airway
management, is recommended.

41. • Adjunct drugs
– H1 antihistamines Eg Cetirizine Diphenhydramine
– H2 antihistamines Eg famotidine
– Bronchodilators Eg theophylline
– Glucocorticoids

42. Toxicity: Local Anesthetics
Central Nervous System Toxicity
Early Stage
• Lightheadedness and dizziness
• Visual disturbances
• Disorientation
• Drowsiness

43. Late stage
• Shivering muscular twitching & tremors
• Generalized tonic clonic convulsions
• If sufficiently large or rapid dose is administered
intravenously, the initial signs of CNS excitation
are rapidly followed by state of generalized CNS
depression.
• Respiratory depression and later on respiratory
arrest.

44. Cardiovascular Toxicity
• Direct action on both the heart and the
peripheral blood vessels.
• Indirect action on the circulation by blockade
of sympathetic and parasympathetic efferent
activity.

45. • Initial phase- hypertension and tachycardia
• Intermediate phase- myocardial depression
and hypotension.
• Terminal phase- peripheral vasodilatation,
severe hypotension, and variety of
arrhythmias.

46. Bupivacaine induced cardiotoxicity
• It depresses the rapid phase of depolarization
in purkinje fibers & ventricular muscle more
than lignocaine.
• The rate of recovery from a use-dependent
block is slower in bupivacaine treated
papillary muscles than in lignocaine treated
muscles.

47. • The ratio of dose required for irreversible
cardiovascular collapse and the dose that will
produce CNS toxicity is lower for bupivacaine than
lignocaine.
• Ventricular arryrthmias can occur more often
after the rapid iv administration of a large dose of
bupivacaine but far less frequent with lignocaine.
• Cardiac resuscitation is more difficult after
bupivacaine induced CV collapse

48. Mx for LA toxicity
• STOP injecting local anaesthetic
• Get help
• Initial focus
– Airway Mx- ventilate with 100% O2
– Control Seizures- BZD preferred
– Avoid propofol sp in hemodynamically unstable pt

49. Mx of cardiac arrythmias
• Basic and advanced cardiac life support
• Avoid vasopresin, CCB, beta blockers & LA
• Reduce individual epinephrine dose to less
than 1mcg/Kg

50. • Lipid emulsion

51. Diamox (Acetazolamide)
Contraindications Associated With Acetazolamide
– Poor LFT or Renal Impairment
– Hypokalemia
– Hyperchloremic acidosis
– Sulfonamide allergy
– patients using anti-folate medications such as Mtx
and Trimethoprim

52. Symptoms of sulfa allergy
– skin rash or hives
– itchy eyes and skin
– congestion
– swelling of the mouth and throat
– Breathing difficulty
– serious complications, including anaphylaxis and
Stevens-Johnson syndrome.

53. Management of toxicity
– no particular antidote for Acetazolamide, treatment
is supportive
– Maintain iv line
– Antihistaminics (Pheniramine)
– Corticosteroids (Hydrocortisone)
– Bronchodilator (Theophylline)
No diagnostic tests for sulfa allergy -- just
thorough history

54. THANK YOU!