1. CPR Handbook
First Edition January 2010
Published by
Netpeckers National Foundation
An ISO 9001:2008 compliant organization
(An NGO supported by Netpeckers Consulting P Ltd.)
A-410. Supath- II Complex, Opp. Old Wadaj Bus Stop, Ashram Road, Ahmedabad-380013,
Gujarat Website:- www.netpeckers.net Tele/Fax -079-27569176, 27551238
Email ID:- customer.care@netpeckers.net Central Customer Support No. 09227184410
,
110 Slides
Rs.500/-
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2. Dedication
• “We dedicate this first edition of
First Aid Handbook to all first
aiders and first aid trainers for
their services and support to
Humanity”
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3. Primary requirement to be a First
Aider
• It is very important “to
understand Human
Body to give effective
First Aid”
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4. Table of contents
• Topic 1- Human Anatomy
• Topic 2- Cardio Pulmonary Resuscitation

5. First aid Hand book
Topic 1- Human Anatomy
By
NETPECKERS NATIONAL FOUNDATION

6. SKELETAL SYSTEM
• The skeleton is the
framework of the
human anatomy,
supporting the body
and protecting its
internal organs. Two
hundred and six bones
compose the skeleton,
about half of which
are in the hands and
feet.
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7. MUSCULAR SYSTEM
• The human body
contains more than
650 individual muscles
anchored to the
skeleton, which
provide pulling power
so that you can move
around. These
muscles constitute
about 40% of your
total body weight.
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8. DIGESTIVE SYSTEM
• The digestive system is
responsible for processing
food, breaking it down
into usable proteins,
carbohydrates, minerals,
fats, and other
substances, and
introducing these into the
bloodstream so that they
can be used by the body.
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9. Human Digestive System
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10. RESPIRATORY SYSTEM.
• The respiratory system
is responsible for
supplying oxygen to
the blood and
expelling waste gases,
of which carbon
dioxide is the primary
constituent, from the
body.
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11. Practical demonstration by faculty
• Please select your partner for demonstration
– Pulse verification on hand
– Pulse verification on throat
– Heart beat verification
– Eye ball verification
– Hands and toe verification

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13. CARDIOVASCULAR SYSTEM
• In order for the body to
stay alive, each of its cells
must receive a continuous
supply of food and
oxygen. At the same time,
carbon dioxide and other
materials produced by the
cells must be picked up
for removal from the
body. This process is
continually maintained by
the body's circulatory
system..
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14. THE HUMAN HEART.
• The heart is a hollow
pear-shaped muscular
organ placed between
the lungs in the
middle of the chest
that pumps blood
through the body,
supplying cells with
oxygen and nutrients.
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15. Heart Anatomy
From the body National Foundation
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16. SKIN
• The skin has the
largest surface area of
any organ in the body
and is the heaviest.
On the surface are the
sensitive papillae, and
within are certain
organs with special
functions, the sweat
glands, hair follicles,
and sebaceous glands.
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17. Skin Diagram
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18. NERVOUS SYSTEM
• The nervous system of the
human anatomy is responsible
for sending, receiving, and
processing nerve impulses. All
of the body's muscles and
organs rely upon these nerve
impulses to function. Three
systems work together to carry
out the mission of the nervous
system: the central, the
peripheral, and the autonomic
nervous systems
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20. Structure of the human body:
Skeleton forms the supporting
framework of the body
• The skull
• The back bone of spine
• The ribs and breast bone
• The upper limbs
• The pelvis
• The lower limbs bones
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21. Joints
Joints are at the junction of two or more
bones.
• Types of joints
–Moveable joints
• ball & socket type of joints
• hinge type of joints
• Slightly moveable joints
–Immoveable joints
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22. Muscles
To produce movement of limb and organ
• Voluntary muscles :
Movement under the control of will.
• Involuntary muscles :
which work even without the control
of the will - Like heart.
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23. Heart and circulation of blood
Blood :
Red blood cell
White blood cell
Platelets
• Pulse
Average adult has an average
pulse rate of 72 per minute
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24. THE BRAIN
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25. STRUCTURE AND FUNCTION OF THE HUMAN
BRAIN
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26. SIZE OF THE HUMAN BRAIN
• The average human brain weighs about 3 pounds
(1300-1400 g).
• At birth, the human brain weighs less than a pound
(0.78-0.88 pounds or 350-400 g). As a child grows,
the number of cell remains relatively stable, but the
cells grow in size and the number of connections
increases. The human brain reaches its full size at
about 6 years of age.
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27. The Spinal Cord
• The spinal cord is a bundle of nerves that connects
the brain to other parts of the body. It is protected
by a series of doughnut-shaped bones called
vertebrae, which surround the spinal cord.
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28. Spinal Cord Vertebrae
• 7 cervical (neck) segments
• 12 thoracic segments
• 5 lumbar segments
• 5 sacral segments
• 4 fused coccygeal segment
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29. The Spine and Skull
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30. Various parts of spine & skull
7 cervical vertebrae - 7 vertebrae located in the
neck, below the skull.
Coccyx - 4 fused vertebrae located below the
sacrum.
5 lumbar vertebrae - 5 vertebrae located below the
thoracic vertebra and above the sacrum.
sacrum - 5 fused vertebrae located below the lumbar
region and above the coccyx.
skull - the bones in the head that protect the brain.
12 thoracic vertebrae - 12 vertebrae in the mid-back,
below the cervical vertebra and above the lumbar
vertebrae
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31. Teeth
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32. Tooth Anatomy
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33. The Eye
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34. The Mouth
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35. Ear Anatomy
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36. Topic 2
Cardio Pulmonary Resuscitation CPR
By
NETPECKERS NATIONAL FOUNDATION
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37. CARDIO PULMONARY
RESUSCITATION
Cardio-Pulmonary Resuscitation = CPR
• Cardio = Heart
• Pulmonary = Lungs
• Resuscitation = To Revive
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38. CARDIO PULMONARY
RESUSCITATION
• Human body needs continuous supply of oxygen
and blood to sustain life heart & lungs work
uninterrupted
• Brain utilizes 20% of total blood supply
• If human brain does not receive blood supply
for more than 4 minutes, it can stop working
with disastrous consequences
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39. CARDIAC ARREST & CPR
Total incidence : 5213
• At Home: 3725 (71%)
• At Public Place: 1077 (21%)
• At Nursing Home: 411 ( 8%)
• Male/Female: 69/31
• Arrest before arrival of EMS: 90%
• CPR given by bystanders: 56%
• Immediate Survival after CPR: 32%
(by bystander)
Cardiac resuscitation, M. Eisenberg et al, NEJM, 344,April 2001
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40. A QUICK REVIEW REVISION OF A.B.C & L.L.F.
UNCONCIOUSNESS ?? A QUICK,EASY AND
GOOD METHOD FOR
FOLLOW A.B.C – A.B.C TO SAVE TIME.
---------------------------------
A - CHECK AIRWAY
L - LOOK !
B - CHECK BREATHING
L - LISTEN !
C - CHECK CIRCULATION
F - FEEL !
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41. WHILE FOLLOWING A.B.C OR L.L.F YOU MAY FIND THE FOLLOWING
CONDITIONS
BREATHING PULSE CONDITION
☺
NEED FOR ARTIFICIAL RESPIRATION
URGENT NEED FOR C.P.R.
CONDITION NOT POSSIBLE
QUESTIONS :
(1) FREQUENCY OF HEART-BEATS IN A NORMAL ADULT HEALTY
PERSON? 60-80 BEATSMIN
(2) FREQUENCY OF BREATHS IN ONE MINUTE OFA ADULT
HEALTHY PERSON? 15-20 / MIN
(3) NORMAL BODY TEMPERATURE ?Netpeckers National Foundation
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42. CARDIO PULMONARY RESUSCITATION
SEVEN STEPS OF C.P.R
To verify the unconscious
Call for help
To check whether the person is breathing(follow
A.B. – L.L.F)
Give two times artificial respiration –
Mouth to Mouth , Mouth to Nose or Mouth to
Mouth / Nose.
Check the pulse
Apply pressure 30 times on the chest (at
appropriate area)
Then give two times artificial respiration & 30 time
pressure on chest..Till the patient responds
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43. PRINCIPLES OF BLS (Basic Life support)
• TO ESTABLISH UNRESPONSIVENESS
• TO PROVIDE OXYGEN TO THE BRAIN
• TO MAINTAIN CIRCULATION
• EARLY DEFIBRILLATION USING AED
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44. BASIC CPR
•It is an attempt to restore
spontaneous circulation by
using chest wall compressions
and pulmonary ventilation.
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45. CARDIO PULMONARY
RESUSCITATION
• Time is the most important aspect of
CPR
• EMERGENCY chaos and mismanagement
• Effective CPR possible with methodical training
and practice
• CPR can be effectively carried out in 7 steps
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46. 7 STEPS of CPR
1. Check Unresponsiveness
2. Call for help / Dial for emergency
medical services
3. Check for Breathing
4. Mouth to Mouth OR
Mouth to Nose Breathing
5. Check for Circulation
6. Chest Compression
7. Alternate Chest Compression &
Mouth to Mouth Breathing
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47. STEP 1
Check Unresponsiveness
• Encounter a person lying motionless anywhere
• Make sure that he/she is not in any dangerous situation i.e.
electrical injury by a live wire, choking by a gas leakage
• Shift him with the help of wooden/rubber equipments
• Rapid check of head and neck to rule out any injury
• Make the patient lie in supine position, preferably on a hard
surface – taking precautions of holding head and neck
• Shake the patient and shout “Oye wake up, what is wrong with
you..? Kya hua bhai?”
If there is no response be prompt for the next step
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48. STEP 2
Call for help / Dial for emergency
medical services
• CPR not possible single handedly
• Shout loudly in first 5 seconds for help
Divert back your attention to the victim
and prepare for the next step
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49. STEP 3
Check for Breathing
• Proper position to the victim
• Check for breathing → look, listen and feel – by kneeling at
the patient’s head, keeping the eyes on patient’s chest, ear
and check the patient’s nose.
• If no indication for breathing, promptly tilt the head and lift
the chin to clear the airway
• The helper on the right side of the victim uses his left hand
to tilt the head and right hand to lift the chin
• Open the lower jaw with right hand and move fingers
(preferably covered with gloves or handkerchief) and remove
any foreign body, froth, vomitus material.
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50. STEP 4
Mouth to Mouth OR Mouth to Nose Breathing
• Give head tilt and chin lift position
• Open the victim’s lower jaw and mouth with right
hand
• Close the nostril with left hand and place mouth
shield
• Take one deep breath outside and exhale
forcefully into the victim’s mouth
• Wait for 2 second to allow for exhalation by the
victim
• Give one more deep breath in to the patients
mouth.
• If victim’s mouth cannot be opened, the helper
may exhale into patient’s nose forcefully
• After giving two mouth to mouth breaths, quickly
turn to check for circulation. National Foundation
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51. STEP 5
Check for Circulation
• Palpate the pulsation of major blood vessels like
carotid artery in the neck
• Trace the thyroid cartilage in midline, put two
fingers on the last side of the cartilage near the
right lower mandible and feel for pulsation
• Never attempt to palpate both the carotids at a
time.
If no indication of presence of circulation quickly
move to the sixth step
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52. STEP 6
Chest Compression
• Establish circulation at the earliest
• Possible only by external chest compression
• Position on the right side of victim near
right upper arm
• Trace the sternum bone and place your right
hand (ball of palm) on the lower part of the
sternum NOT XIPHISTERNUM
• Put left hand over the right hand and lock
the fingers also lock the elbow joints
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53. STEP 6
Chest Compression
• Give compressions over the sternum to compress
the sternum by at least 1.5 to 2 inches
• Speak 1, 2, 3 aloud and give 15 chest compressions
• 2 breaths and 15 chest compression completes
the first cycle of CPR
• If the heart and lungs have not responded repeat
the cycle again and again to sustain life.
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54. STEP 7
Alternate Chest Compression &
Mouth to Mouth Breathing
• If no help has arrived yet
• Carry out step no. 4 & 6 alternately
• Give two breaths of two seconds each change the
position and give 15 chest compressions
• After completing 4 such cycles of 15:2 check for
circulation
• If no indication of establishment of circulation,
step no. 7 repeated till the help arrives
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55. CPR by Two Persons
• If two trained persons present
• One assumes the role of a leader
• The leader carries out all the 7 steps first
• The second person performs step no. 4 i.e.
Mouth to Mouth breathing
• The second person give two breaths of two
seconds each and the leader must resume chest
compression for 15 times
• If delay in arrival of help both the persons
alternate their positions..
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56. Practical demonstration by faculty
• How to position the casualty
• Practical demonstration of CPR with
computerized manikin

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58. EARLY ACCESS
• CHECK FOR UNRESPONSIVENESS
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59. •ACTIVATE EMERGENCY
MEDICAL SERVICES
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60. A=AIRWAY
• HEAD TILT CHIN LIFT
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61. A=AIRWAY
LOOK LISTEN
AND FEEL
(For 5-10 Secs )
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62. B= BREATHING
• Take a normal breath
• GIVE 2 RESCUE BREATHS
• Each over 1 sec
• Each breath should make the
chest rise
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63. C=CIRCULATION
Check the pulse
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64. C=CIRCULATION
Place the hands on the breast bone at the nipple line
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65. C=CIRCULATION
GIVE CHEST COMPRESSION
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66. Chest Compression Skills
• Rescuers SHOULD push Hard and Fast
• Compress at the rate of 100/ min. for all victims.
(except new born)
• Allow chest to recoil completely after each
compression.
• Try to limit chest interruptions in compressions
• Depth of compression should be 11/2 – 2 inches.
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67. Compression – Ventilation Ratio
should be 30:2 for all age
groups (except newborn)
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68. 7 STEPS OF
C.P.R.
To verify the
unconscious
Call for help
To check whether the
person is breathing
(follow A.B.C – L.L.F)
Give two times
artificial respiration –
M to M , M to N or M
to M-N.
Check the pulse
Apply pressure 15/30
times on the chest (at
appropriate area)
Then give two times
artificial respiration &
15/30 time pressure on
chest..Till…..
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69. PROPER HAND PLACEMENT FOR INFANTS ADOPT : M-M/N A.R AND 3 FINGER
FOR CPR PRESSING.OTHER CONDITIONS REMAIAN SAME.
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71. Netpeckers National Foundation
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72. Adult Chain of Survival
Early Early Early Early
Access CPR Defibrillation Advanced
Care
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73. • What will you do when you have to deal with
cardiac arrest victim
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74. Chain of Survival
• Early Access (Call a CODE), call
108
• Provides the additional assistance of medical
professionals.
• Allows adjuncts to be brought to the patient.
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75. Chain of Survival
• Early CPR
• BCLS (Basic cardiac life support) is the
hallmark treatment of cardiac arrest.
• Adequate deployment of a BMV(bag mask
ventilation) or mouth to mouth ventilation
• Proper performance of CPR.
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76. Evidence based Medicine
• Immediate bystander CPR and defibrillation within 3-5 min of
collapse have resulted in survival rates of 41-74% for victims of
witnessed VF.
• The most frequent rhythm for the adult in cardiac arrest is
ventricular fibrillation.
• AED(automatic external defibrillator) deployment has the
greatest impact on out of hospital survival
survival.
• Immediate bystander CPR can double the VF survival rate at any
interval to defibrillator.
• Early CPR and early defibrillation with AED can double survival over
that resulting from early CPR alone.
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77. Chain of Survival
• Early ACLS(advanced cardiac life
support)
• The culmination of advanced airway,
pharmacology, and advanced therapies.
• BCLS is always the first step in proficient ACLS.
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78. THE ABCD of CPR
• First access for unresponsiveness
– Shake and Shout
• Be aware that your patient may be hypertensive,
bradycardic
– Immediately call for help
• In hospital call a code
• Out of hospital call Emergency Medical Service -108
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79. Check responsiveness
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80. ADULT Airway & Breathing
• Airway
• Head tilt-chin lift will open the airway
• Jaw thrust for suspected C-spine
• Breathing
• Access for breathing
• Look, Listen & Feel for the breaths.
• Provide 2 slow breaths just enough to see the
chest rise with Bag Mask Ventilation / mouth to
nose /mouth to mouth.
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81. Open airway by Head tilt chin lift
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82. Mouth to mouth ventilation
Oral airway: inserts in
First open the airway by head tilt chin lift.
patient
Pinch the nose and close it
Take a normal breath and give a breath just
enough to give a visible chest rise of victim.
Give such 2 breaths within 10 secs.
Chances of infection very minimal.
Can be given safely to a known
person but if safety concerns are
there just skip ventilation and
directly go to circulation.
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83. Mouth-to-Mask Ventilation
Fingers: jaw thrust upward Fingers: head tilt–chin lift
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84. C GRIP WITH Bag Mask Ventilator
84
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85. Bag mask ventilation (BMV)
85
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86. ADULT Circulation
• Circulation
• Access Carotid Pulse 5-10 sec
• Compress at Lower half of sternum, between
nipples
• Compression ventilation ratio 30:2
• HARD(4-5cms chest depression) & FAST @ rate of
100/min
• Minimize interruption of compressions
• Allow full chest recoil.
• -Complete 5 cycles of 30 chest compression and 2
ventilation in 2 minutes.
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87. Carotid & Brachial check
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88. Chest compressions
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89. Defibrillate with AED(if available)
• SUMMARY
• Access Call a Code
• A- Airway = H / T Chin Lift
• B- Breathing = 2 slow breaths
• C- Circulation = 30:2
Hard/Fast.
• D-Defibrillation with AED.
• Complete 5 cycles of 30:2 in
2 minutes.
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90. Pocket-Mask Devices
1-way valve
Port to attach O2 source
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91. Mouth-to-Mask Ventilation
• Advantages
– Eliminates direct contact
– Enables positive-pressure
ventilation
– Oxygenates well if
O2 attached
– Easier to perform than
bag-mask ventilation
– Best for small-handed rescuers • 1-rescuer technique; performed from side
• Rescuer slides over for chest
compressions
• Fingers: head tilt–chin lift
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92. Bag-Mask Ventilation
• Advantages
– Provides immediate ventilation and oxygenation
– Operator gets sense of compliance and airway resistance
– May provide excellent short-term support of ventilation
– High oxygen concentrations are possible
– Can be used to assist spontaneous respirations
• Potential complications
– Hypoventilation (due to lack of an adequate seal)
– Gastric inflation
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93. Bag-Mask Ventilation C/E Grip
• Key—ventilation volume: “enough to produce
obvious chest rise”
1-Person: 2-Person:
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94. BCLS Topics
• Team CPR:
• Ideal is a minimum of 3 providers.
• 2 for airway management
• 1 for compressions
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95. Effect of Time to Defibrillation on Survival From
Witnessed VF Cardiac Arrest
100
90
Percent survival
80
70
60
50
40
30
20
10
0
Cummins 1989
1 MIN 2 MIN 3 MIN 4 MIN 5 MIN 6 MIN 7 MIN 8 MIN 9 MIN 10 MIN
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96. Respiratory Arrest
Rescue Breathing
• If pulse present but breathing is absent provide rescue
breathing 1 breath every 5-6seconds.
• In case of rescue breath for CPR with advanced
airway(endo-tube) give 1 breath every 6-8 seconds
• Avoid Hyperventilation
• Use OPA(orophararngeal airway) to assist in airway
management
• Recheck pulse about every 2 minutes in pts of respiratory
arrest.
• Look for underlying causes
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97. Automatic external defibrillator
AED
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98. AEDs and
Ventricular Fibrillation
• VF is the most frequent initial rhythm in
sudden cardiac arrest
• VF is a useless quivering of the heart that
results in no blood flow
• Defibrillation is the only
effective treatment for VF
• Successful electrical
defibrillation diminishes
rapidly over time
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99. Priorities and the AED
A – Airway
B – Breathing
C – Circulation
D – Defibrillation
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100. Operation of AED
• POWER ON
• ATTACH pads
• ANALYZE rhythm
• SHOCK (if advised)
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101. Electrode Pad Placement
• Right electrode pad
– To the right of the
breastbone
– Below the collarbone
above the right nipple
• Left electrode pad
– Outside the left nipple,
upper edge of the pad
several inches below the
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102. Effective Adherence of Pads
• Sweaty chest
– Dry with a towel
– Do not use alcohol
• Hairy chest
– Shaving may be
needed
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103. AED Safety
• No patient contact during
analysis and shock
• Warn bystanders:
– “I’m clear”
– “You’re clear”
– “Everybody’s clear”
• Perform a visual inspection
• Press to shock
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104. Key Point of AEDs
ON
Turn the power on follow prompts
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105. Chest compressions must be continued
when pads are attached
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106. AED in witnessed vs unwitnessed fall
• Witnessed arrest should receive AED as quickly as
possible.
• Un-witnessed, the rescuer should provide 5 cycles of
CPR prior to AED to hyperoxygenate the heart prior to
electrical therapy
• 2005 guidelines recommend single shock treatment
with AED to reduce interruption in CPR and Increase
blood flow to the vital organs
• Immediate CPR is started after shock
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107. Conclusions
• Early CPR within seconds has the potential to save a
life.
• Universal ratio of 30 chest compressions and 2
ventilations
• Chest compressions have to be hard, fast@100/min,
with minimal interruptions and allowing full chest
recoil.
• Complete 5 cycles of 30 chest compressions and 2
ventilations in 2 minutes.
• After a single shock of AED immediately start
CPR(previously 3 shocks were given)
• Early CPR & early defibrillation(AED) has the highest
potential to save a life
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108. FAQs - CPR
• In which situations one encounters Cardiopulmonary
arrest?
• What is CPR?
• How difficult it is to learn CPR?
• Who can give CPR?
• To whom CPR should be given?
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109. FAQs - CPR
• Within how many minutes CPR is to be started?
• What are the contraindications of CPR?
• Is there any risk of transmission of disease to CPR
provider?
• If during CPR victim dies can there be any legal
problems for the CPR provider?
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110. Netpeckers National Foundation
(An NGO supported by Netpeckers Consulting P Ltd.)
Suggestions for continual improvement of this
Hand book can be sent on customer.care@netpeckers.net
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