Cpr

2. CPR stands for
• C = Cardio (heart)
• P = Pulmonary (lungs)
• R = Resuscitation (recover)

3. Cardiopulmonary Resuscitation
• CPR or Cardiopulmonary Resuscitation – is an
emergency lifesaving procedure performed when
the heart stops beating. Immediate CPR can double
or triple chances of survival after cardiac arrest.
• 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.

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

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

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

7. Principles of CPR
• 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.

8. PHASES OF THE CARDIO PULMONARY
RESUSCITATION
• Phase-1
– Basic life support
• C= circulation
• A= Airway
• B= Breathing
• Phase-2
– Advance cardiac life support
• D= Drugs
• E= ECG
• F= fibrillation
• Phase-3
– Prolonged life support
• Post resuscitation care

9. • What is basic life support (BLS)?
– It is life support without the use of special
equipment.
• What is Advanced Life Support (ACLS)?
– It is life support with the use of special equipment
(eg. Airway, endotracheal tube, defibrillator).

10. Basic Life Support
(Phase 1)
• SEQUENCES OF PROCEDURES PERFORMED TO
RESTORE THECIRCULATION OF OXYGENATED BLOOD
AFTER A SUDDEN PULMONARY AND/OR CARDIAC
ARREST.
– Approach safely
– Check response
– Shout for help
– Chest compressions
– Open airway
– Check breathing
– Call Medical Emergency
– 2 rescue breaths

11. Basic Life Support
(Phase 1)
• Approach safely
– WATCH
– OBSERVE

12. Basic Life Support
(Phase 1)
• CHECK RESPONSE
– Shake shoulders
– Gently Ask “Are you all right?”
– No breathing or no normal breathing (i.e, only
gasping)
– No pulse felt within 10 seconds

13. Basic Life Support
(Phase 1)
• Shout for Help
• Chest Compression
– 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
• Sternum must be depressed atleast 5 cm in adults, and 2-4 cm in children, 1-2
cm in infants
• Equal compression : relaxation
• 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 must not be interrupted for ventilation
• When possible change CPR operator every 2 min

14. Basic Life Support
(Phase 1)
• Chest Compression
– Assessment of the adequacy of chest compressions
– Systolic BP: 60-80 mmHg
– Diastolic BP: > 40 mmHg
– COP = 30% of normal
• PROBLEMS AND COMPLICATIONS OF CHEST COMPRESSIONS
– RIB FRACTURES
– FRACTURE STERNUM
– RIB SEPARATION
– PNEUMOTHORAX
– HEMOTHORAX
– LUNG CONTUSIONS
– LIVER LACERATIONS
– FAT EMBOLI
– HIV, HEPATITIS
– INFECTIONS
• MANAGE ACCORDINGLY BUT CONTINUE CPR 30

15. Basic Life Support
(Phase 1)
• Open Airway
– Head tilt and chin lift
– Jaw thrust
• lay rescuers
• Non-healthcare rescuers
– No need for finger sweep
• unless solid material can be seen in the airway

16. Basic Life Support
(Phase 1)
• CHECK BREATHING
– Look, listen and feel for NORMAL breathing
– Do not confuse agonal breathing with normal
breathing
– Agonal Breathing
• 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

17. Basic Life Support
(Phase 1)
• Rescue Breath
– 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

18. Basic Life Support
(Phase 1)
• RESCUE BREATHS RECOMMENDATIONS
– Tidal volume
• 500 – 600 ml
– Respiratory rate
• Give each breaths over about 1s with enough volume
to make the victim’s chest rise

19. Assessment of restoration of breathing and
circulation
• Contraction of pupil
• Improved color of the skin
• Free movement of the chest wall
• Swallowing attempts
• Struggling movement

20. When to terminate BLS
• Pulse and respiration returns
• Emergency medical help arrives
• Physician declared patient is deceased
• In a non health setting ,another indication to
stop BLS would be that the rescuer was
exhausted and physically unable to continue to
perform BLS

21. ADVANCED LIFE SUPPORT
(Phase 2)
• ADVANCED LIFE SUPPORT includes
– Circulation by cardiac massage
– Airway management by equipments
– Breathing by advanced techniques
– Defibrillation by manual defibrillator
– Drugs

22. ADVANCED LIFE SUPPORT
(Phase 2)
• Circulation by cardiac massage
– CHEST COMPRESSION

23. ADVANCED LIFE SUPPORT
(Phase 2)
• Advanced techniques for airway patency
– Face Mask
– Oropharyngeal airway
– Nasopharyngeal airway
– Laryngeal mask (LMA)
– Endotracheal tube
– Combitube
– Cricothyrotomy
– Tracheostomy (Surgical Airway)

24. ADVANCED LIFE SUPPORT
(Phase 2)
• Advanced breathing techniques include
– Self-inflating resuscitation bag (Ambu bag)
– Mechanical ventilator in OR or in ICU

25. ADVANCED LIFE SUPPORT
(Phase 2)
• DEFIBRILLATION
– Defibrillation consists of delivering a therapeutic dose of
electrical energy to the affected heart with a device called
a defibrillator 58
– In cardiac arrest,the associated heart rhythms can be
categorised into two groups
• Shockable rhythm: VT/VF
• Non shockable rhythm: asystole and PEA 59
– The basic difference in the treatment of these two groups
of arrythmia is the need for defibrillation in patients with
VT/VF

26. Medical Management
• Adrenalin
– 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

27. Prolonged life support
• Post resuscitation care
– Maintain Airway and Breathing
– Check for Circulation
– Disability optimising neurological recovery
– Sedation
– Control of seizure
– Temperature control
– Treatment of hyperpyrexia
– Treatment of hypothermia
– Blood glucose leve