This document discusses cardiopulmonary resuscitation (CPR), including its definition, procedures, ethical issues, and criteria for not starting CPR. It defines CPR as using chest compressions and artificial ventilation during cardiac arrest. The procedures for CPR are described in three steps: checking for airway obstructions, delivering chest compressions at 100 per minute, and providing mouth-to-mouth ventilation. Ethical issues around initiating, not initiating, terminating, and withdrawing life support during resuscitation are also addressed. The document concludes by discussing the complexity of decision making during resuscitation and emphasizing erring on the side of patient benefit when in doubt.

2. Objectives
 Definition
 Procedure
 Ethical issues
 DNAR
 Criteria for not starting CPR
 Conclusion
 Case

3. Definition
 Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions and
artificial ventilation to maintain circulatory flow and oxygenation during cardiac
arrest

4. How to administer
 1st step: check the airways if there is any obstruction

5. 2nd STEP
Delivery of chest compressions. Note the overlapping hands placed on the center of the sternum, with the rescuer's arms extended. Chest
compressions are to be delivered at a rate of at least 100 compressions per minute

6. 3rd step
Delivery of mouth-to-mouth ventilation

7. Cardiopulmonary Resuscitation: Ethical
Issues
1. To initiate resuscitation.
2. NOT to initiate resuscitation.
3. To terminate resuscitation
4. To withdraw life support system

8. Do Not Attempt Resuscitation
Order(DNAR)
 DNAR order means that in the event of cardiopulmonary arrest, CPR should not be
attempted at all.
 Other treatment should be continued, such as; pain relief, sedation on required
basis in terminal illness

9. Criteria for not starting CPR
 A valid DNAR is presented
 A person with obvious clinical signs of irreversible death(e.g. rigor mortis,
dependent lividity, decapitation, decomposition)
 Attempts to perform would place the rescuer at risk of danger and physical injuries
 Futility; no physiological benefit expected

10. Decision making in CPR can be very complex due to the diversity of the cases
It may be made in matters of seconds!
If in doubt, always err on the patient’s benefit.

12. CASE
A patient, who had a history of pulmonary disease, lived at a nursing home but was
found intoxicated and unconscious on the street and brought to Jackson Memorial.
He arrived with no identification, no family or friends, and no way to tell doctors
whether he wanted to live or die.
The man had an infection that led to septic shock, which causes organ failure and
extremely low blood pressure.
When his blood pressure started to drop, emergency room doctors called a doctor,
who specializes in pulmonary disease — and they first agreed not to honor the tattoo,
“invoking the principle of not choosing an irreversible path when faced with
uncertainty.”