IT COVERS ALL ASPECTS OF CPR

1. MR.D.MUTHUKUMARAN
LECTURER
SMVNC,PUDUCHERRY

2. DEFINITION OF CARDIAC ARREST:
It is loss of cardiac function, breathing, and loss of
consciousness.
DIAGNOSIS OF CARDIAC ARREST: (TRIAD)
1) LOSS OF CONSCIOUSNESS
2) LOSS OF APICAL & CENTRAL PULSATIONS
3) APNEA

3. TYPES OF CARDIAC ARREST:
• ASYSTOLE (ISOELECTRIC LINE)
• Check that all leads are attached.
• Adrenaline 1 mg IV every 4 mins (2 cycles) (until a
shockable rhythm is achieved).

4. Ventricular fibrillation (VF)
• Bizarre irregular waveform.
• No recognizable QRS complexes.
• Random frequency and amplitude.
• Coarse / fine.
• Exclude artifact:
• movement
• electrical interference

5. Pulse less Ventricular tachycardia (VT)
• Broad bizarre-shaped complexes.
• Rapid rate: 120-250/min.
• Regular.
• Precordial thump: Rapid treatment of a witnessed and monitored
VF/VT cardiac arrest.

6. 4)PEA: pulseless electrical activity:
• Exclude / treat reversible causes.
• Adrenaline 1 mg IV every 4 mins (2 cycles) (until a
shockable rhythm is reached).

7. Causes of cardiac arrest (6 H & 4 T):
• Hypoxia.
• Hypotension.
• Hypothermia.
• Hypoglycemia.
• Acidosis (H+).
• Hypokalemia (electrolyte disturbance).

8. Causes of cardiac arrest (6 H & 4 T):
• Cardiac Tamponade.
• Tension pneumothorax.
• Thromboembolism (pulmonary, coronary).
• Toxicity (eg. digoxin, local anesthetics, TCA, insecticides).

9. • Cardiopulmonary resuscitation (CPR) is a
lifesaving technique useful in many
emergencies, including heart attack or near
drowning, in which someone's breathing or
heartbeat has stopped.

12. • Cardio Pulmonary Resuscitation is a
technique of basic life support for
oxygenating the brain and heart until
appropriate, definitive medical treatment
can restore normal heart and ventilatory
action.

13. • Cpr consists of the use of chest
compressions and artificial ventilation to
maintain circulatory flow and
oxygenation during cardiac arrest.

14. • To maintain an open and clear airway (A).
• To maintain breathing by external ventilation
(B).
• To maintain Blood circulation by external
cardiac massages (C).
• To save life of the Patient.
• To provide basic life support till medical and
advanced life support arrives.

15. • DIAGNOSIS OF CARDIO PULMONARY ARREST:
CARDIAC ARREST:
• Absence of pulse in major arteries (carotid or femoral in older
children and femoral or brachial in infants as carotid is
difficult to palpate due to short neck.)
• Absence of Heart Sounds on Auscultation.
• Asystole/ventricular fibrillation on ECG.

16. • RESPIRATORY ARREST:
Absence Of Respiration On Looking (Absent
Chest Movement), Listening (Absent Air Flow On
Bringing Ears In Front Of Mouth Or Nose).

17. Cardiac Arrest
• Ventricular fibrillation (VF)
• Ventricular tachycardia (VT)
• Asystole
• Pulse less electrical activity

18. Respiratory Arrest
• This may be result of following:
• Drowning
• Stroke
• Foreign body in throat
• Smoke inhalation
• Drug overdose
• Suffocation
• Accident, injury
• Coma
• Epiglottis paralysis

19. • To restore effective circulation and
ventilation.
• To prevent irreversible cerebral damage
due to anoxia. When the heart fails to
maintain the cerebral circulation for
approximately four minutes the brain
may suffer irreversible damage.

20. BASIC TECHNIQUES OF AIRWAY
PATENCY

21. (A) 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.

22. 2) Jaw thrust:

23. • 3) Finger sweep: Sweep out foreign body in the
mouth by index finger (in unconscious pt only. This
is NOT advised in a conscious or convulsing patient).

24. • 4) Heimlich manoeuvre: if the pt is conscious or the
foreign body cannot be removed by a finger sweep. It
is done while the pt 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
his can be done by a series of blows on he back and
chest thrusts.

27. • Advanced techniques for airway patency:
1) Face Mask:

28. 2) Oropharyngeal airway:

29. 3)Nasopharyngeal airway:

30. 5)Laryngeal mask (LMA):

31. • 5) Endotracheal tube:

32. 7)Cricothyrotomy (Surgical Airway):

33. 8)Tracheostomy (Surgical Airway):

35. Sequences of procedures performed to restore the
circulation of oxygenated blood after a sudden
pulmonary and/or cardiac arrest.
Chest Compressions And Pulmonary Ventilation
Performed By Anyone Who Knows How To Do It,
Anywhere, Immediately, Without Any Other
Equipment

36. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

37. APPROACH SAFELY!
WATCH
OBSERVE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

38. CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

39. Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE

40. SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

41. OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

42. OPEN AIRWAY
Head tilt and chin lift
- lay rescuers
- non-healthcare rescuers
No need for finger sweep
unless solid material can be seen
in the airway

43. OPEN AIRWAY
Head tilt, chin lift + jaw thrust

44. CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

45. CHECK BREATHING
• Look, listen and feel for
NORMAL breathing
• Do not confuse agonal
breathing with
NORMAL breathing

46. • Occurs shortly after the heart stops
in up to 40% of cardiac arrests
• Described as barely, heavy, noisy or
gasping breathing
• Recognise as a sign of cardiac arrest

47. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

48. 30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

49. • Place the heel of one hand in the
centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm (1.5 to 2 inch)
– Equal compression :
relaxation
• When possible change CPR
operator every 2 min
CHEST COMPRESSIONS

50. RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

51. • Pinch the nose
• Take a normal breath
• Place lips over mouth
• Blow until the chest
rises
• Take about 1 second
• Allow chest to fall
• Repeat

52. RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise
- Chest-compression-only
continuously at a rate of 100 min

53. CONTINUE CPR
30 2

55. DRUGS USED IN CPR
1. ADRENALINE:
Epinephrine is a direct-acting sympathomimetic drug that acts as an
agonist at alpha and beta-adrenergic receptors. It produces
vasoconstriction to counteract the vasodilation and resulting
hypotension associated with anaphylaxis.
Epinephrine hydrochloride produces beneficial effects in patients
during cardiac arrest, primarily because of its α-adrenergic
receptor–stimulating properties. The adrenergic effects
of epinephrine increase myocardial and cerebral blood flow during
CPR.
Given immediately in non shockable rhythm (non VT-VF)
In VF and VT given after the 3 rd shock
REPEATED IN ALTERNATE CYCLE (EVERY 4 MINUTES)
DOSE: 1 mg IV for every 4 minutes

56. DRUGS USED IN CPR
2. AMIODARONE:
It also shows beta blocker-like and calcium channel blocker-
like actions on the SA and AV nodes, increases the refractory period
via sodium- and potassium-channel effects, and slows intra-cardiac
conduction of the cardiac action potential, via sodium-
channel effects.
DOSE: 300 mg IV bolus (5mg/kg)
Given in shockable rhythm after the 3rd shock
If unavailable give lidocaine 100mg IV (1-1.5 mg/kg)
(Blocking sodium channels in the conduction system, as well as the
muscle cells of the heart, raises the depolarization threshold, making
the heart less likely to initiate or conduct early action potentials that
may cause an arrhythmia.)

57. DRUGS USED IN CPR
3. NACHO3:
sodium bicarbonate dissociates to provide sodium (Na+) and
bicarbonate (HCO3
−) anions. Bicarbonate anions can consume
hydrogen ions (H+) and thereby be converted to carbonic
acid (H2CO3), which can subsequently be converted to water (H2O)
and carbon dioxide (CO2) which can be excreted by the lungs.
DOSE: 1 mEq/kg stat and 0.5 mEq/kg every 10 min
Avoid routine use due to complications:
1. Increases co2 load
2. Inhibits release of O2 to tissues
3. Impairs myocardial contractility

58. DRUGS USED IN CPR
4. IV FLUIDS:
Infuse fluids rapidly if hypovolemia suspected
Use normal or ringer lactate solution
5. THROMBOLYTICS
6. VASOPRESSIN
a pituitary hormone which acts to promote the retention of water by
the kidneys and increase blood pressure.

59. • Coronary vessel injury
• Diaphragm injury
• Hemopericardium
• Hemothorax

60. • Liver injury
• Myocardial injury
• Pneumothorax
• Rib fractures
• Spleen injury
• Sternal fracture

61. Adrenaline
• Adrenaline (epinephrine) is the main drug used
during resuscitation from cardiac arrest.
Atropine
• Atropine as a single dose of 3mg is sufficient to block
vagal tone completely and should be used once in
cases of Asystole. It is also indicated for symptomatic
bradycardia in a dose of 0.5mg - 1mg.
Amiodarone
• It is an antiarrhythmic drug.

62. • Maintains airway patency with use of airway
adjuncts as required (suction, high flow oxygen
with O2 or bag valve mask ventilation).
• Assist with intubation and securing of ETT
• Inserts gastric tube and/or facilitates gastric
decompression post intubation as required.
• Assists with ongoing management of airway
patency and adequate ventilation

63. • Supports less experienced staff by
coaching/guidance e.g. drug preparation
• If a shockable rhythm is present (VF/VT)
ensure manual defibrillator pads are
applied and connected.
• If CPR is in progress, prepare and
independently double check and label 3
doses of adrenaline
• Prepare and administer IV fluids
• Document medications administered
(including time)