Cardiopulmonary resuscitation is an emergency procedure.

1. DEFINITION
 It is an emergency life saving procedure performed when the heart
stops breathing.
 CPR can be initiated anytime an individual cannot adequately
oxygenate or perfuse vital organs- not only following cardiac or
respiratory arrest.
 CPR is an emergency procedure that combines chest compressions with
artificial ventilation in an effort to manually intact brain function until
further measures to restore spontaneous blood circulation and breathing
in a person who is in cardiac arrest.
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2. HISTORY
 1732- First medical BLS by William Tossach
 1780- First attempt of newborn resuscitation by blowing
 1858- method of restoring natural breathing by Dr. H.R. Silvester
 1992- First attempt of external chest compression
 1949- First report of mouth to mouth ventilation to cardiac arrest
victim by James
 1991- Chain of survival by AHA
 2000- First International CPR Guidelines by ILCOR
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3. PURPOSES
 To maintain an clear and open airway.
 To maintain breathing by external ventilation.
 To maintain blood circulation by external cardiac massage.
 To save life of the patient.
 To provide basic life support till advanced and medical life
support arrives.
 To reverse the initiating pathophysiological event.
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4. WHEN TO GIVE? WHEN NOT TO GIVE?
 Unconscious
 Person not breathing
 Has an abnormal pulse
rate
 Heart abruptly stopped
beating
 Neither scene nor
victim and rescuer is
safe
 Patient has developed
rigor mortis
 Normal pulse and
breathing
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5. INDICATIONS
 Acute Myocardial Infarction
 Cardiomyopathy
 Congestive heart failure
 Cardiac temponade
 Acute coronary syndrome
 Hypoxia
 Tension pneumothorax
 Cardiogenic Shock
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6. GOLDEN RULES TO BE KEPT IN
MIND
 Optimise chest compressions rate : 100-125 compression per
minute.
 Optimise compression depth : 50mm
 Minimise interruptions
 Promote full chest recoil
 Control breathing and ventilation
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7. TYPES
CPR
BLS
ACLS
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8. BLS ( BASIC LIFE SUPPORT)
 BLS is the foundation of saving lives after cardiac arrest.
 A level of medical care which is used for victims of life
threatening illnesses or injuries until thwy can be given full
medical care at the hospital.
 Provided by a trained health professional.
 Includes psychomotor skills to perform high quality CPR , using
an AED and relieve an obstructed airway.
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9. OBJECTIVES OF BLS
 It is primary medical aid provided in an emergency medical
situation.
 Objective here is not to “treat” the person but to buy some
valuable time until the emergency team arrives.
 BLS is performed by anyone who knows how to do it, anywhere,
immediately without any other equipment.
 To reverse the initiating pathophysiological condition.
 To “save hearts too good to die” while preventing irreversible
cerebral damage from anoxia.
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10. SEQUENCE
 C- compression
 A- airway
 B- breathing
 A- airway
 B- breathing
 C- compression
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11. WHY C-A-B??
 To emphasize the simplest but the most important step.
 To increase survival rate in sudden cardiac arrest.
 Patient’s blood stays oxygenated for 4-6 minutes after last breath
but circulation should be restarted at the earliest.
 Rescue breathing almost always delays chest compressions.
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12. COMPONENTS
Ensure scene safety
Check for response and
assessment
Call for help
Activate EMS
Chest compressions
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13. INITIAL STEPS
Level of consciousness:
 Tap person gently on the shoulder
 Shout “ Are you okay?”
Circulation and breathing:
 Check for carotid pulsation for not more than 10 seconds but 5 seconds
 Check for respiration, if there is at all any sign of it
 Agonal breaths
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14. CONTD.
Call for help:
 Seek help from bystanders, other providers or from any trained individual.
Activate EMS:
 Dial up 102/108 for EMS.
 Activate CODE BLUE for in-patients.
 Kolkata Accident Response and Medical Assistance(KARMA)
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15. CONTD.
Outcome
assessment
Normal
breathing,
pulse felt
monitor
No normal
breathing,
pulse felt
No normal
breathing,
pulse absent
Start CPR
immediately
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16. CHEST COMPRESSIONS
 It is foundation of CPR.
 Continued emphasis on providing high quality CPR.
 Push hard, push fast.
 Hands-only CPR.
 Rescuer should be at victim’s side.
 Patient should be supine on flat, firm surface.
 Chest is exposed adequately.
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17. CONTD.
 Heel of the hand is placed in the centre of the chest on the lower
half of sternum.
 Other hand is placed on top.
 Fingers are interlaced.
 Arms are kept as straight as possible. Shoulder directly over the
hands. Elbows are locked.
 Movement of the rescuer should be from the hip joint.
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19. HIGH QUALITY CPR(ADULT)
 Push hard (at least 2 inches) and fast (100-120/min)
 Allow complete chest recoil.
 Minimize interruptions in compressions.
 Avoid excessive ventilation.
 Change compressor every 2 minutes, or sooner if fatigued.
 If no advanced airway, 30:2 compression-ventilation ratio.
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20. AIRWAY ASSESSMENT AND BREATHING
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22. RESCUE BREATH
Mouth to mouth:
 Open airway- Pinch the nose seal mouth to mouth contact- Blow
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23. CONTD.
Mouth to barrier device breathing:
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