CARDIO PULMONARY RESUSCITATION

Cardiopulmonary resuscitation (CPR) is a life saving technique useful in many emergencies,

including heart attack or near drowning, in which someone's breathing or heartbeat has
stopped. The American Heart Association recommends that everyone untrained bystanders
and medical personnel alike begin CPR with chest compressions.
Cardiopulmonary resuscitation (CPR) 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
C-A-B
The American Heart Association uses the acronym of CAB compressions, airway,
breathing to help remember the order to perform the steps of CPR.
Compressions: Restore blood circulation
1.

Put the person on his or her back on a firm

surface.

2.

Kneel next to the person's neck and shoulders.

3.

Place the heel of one hand over the center of

the person's chest, between the nipples. Place your other hand on top of the first hand.
Keep your elbows straight and position your shoulders directly above your hands.

4.

Use upper body weight (not just your arms) as

you push straight down on (compress) the chest at least 2 inches (approximately 5
centimetres). Push hard at a rate of about 100 compressions a minute.

5.

If you haven't been trained in CPR, continue

chest compressions until there are signs of movement or until emergency medical
personnel take over. If you have been trained in CPR, go on to checking the airway and
rescue breathing.

Airway: Clear the airway

1.

If you're trained in CPR and you've performed 30 chest compressions, open the
person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's

forehead and gently tilt the head back. Then with the other hand, gently lift the chin
forward to open the airway.
2.

Check for normal breathing, taking no more than five or 10 seconds. Look for chest
motion, listen for normal breath sounds, and feel for the person's breath on your cheek
and ear. Gasping is not considered to be normal breathing. If the person isn't breathing
normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe
the person is unconscious from a heart attack and you haven't been trained in
emergency procedures, skip mouth-to-mouth breathing and continue chest
compressions.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth
is seriously injured or can't be opened.
1.

With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut
for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

2.

Prepare to give two rescue breaths. Give the first rescue breath lasting one second
and watch to see if the chest rises. If it does rise, give the second breath. If the chest
doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
Thirty chest compressions followed by two rescue breaths is considered one cycle.

3.

Resume chest compressions to restore circulation.

4.

If the person has not begun moving after five cycles (about two minutes) and an
automated external defibrillator (AED) is available, apply it and follow the prompts.
Administer one shock, then resume CPR starting with chest compressions for two
more minutes before administering a second shock. If you're not trained to use an AED,
a 911 or other emergency medical operator may be able to guide you in its use. If an
AED isn't available, go to step 5 below.

5.

Continue CPR until there are signs of movement or emergency medical personnel
take over.

INDICATION
Cardiac arrest
Ventricular fibrillation (VF)
Ventricular tachycardia (VT)
A systole
Pulse less electrical activity
Respiratory arrest

Drowning
Stroke
Foreign body in throat
Smoke inhalation
Drug over dose
Suffocation
Accident, injury
Coma
epiglottis paralysis

CPR Chain of Survival

The term Chain of Survival provides a useful metaphor for the elements of the ECC systems
concept.
The 5 links in the adult Chain of Survival are

Immediate recognition of cardiac arrest and activation of the emergency response

system

Early cardiopulmonary resuscitation (CPR) with an emphasis on chest

compressions

Rapid defibrillation

Effective advanced life support

Integrated post-cardiac arrest care

A strong Chain of Survival can improve chances of survival and recovery for victims of heart
attack, stroke and other emergencies.
ASSESSMENT

Overview of the steps of CPR

Step
1
2
3
4

Action
Asses the victim for a response and look for normal or abnormal breathing. if
there is no response and no breathing or no normal breathing ,shout for help
If you are alone, active the emergency response system and get an AED if
available and return to the victim.
Check the victim pulse (take at least 5 but no more than 10 second)
If you do not definitely feel a pulse within 10 seconds ,perform 5 cycle of
compression and breaths (30:2)starting with compression (C-A-B sequence)

Steps 1
Step
1
2
3

Action
Make sure the scene is safe for you and the victim. You do not want become a
victim yourself.
Tap the victims shoulder and safe and shout, are you all right/
Check to see if the victim is breathing .if a victim is not breathing or not
breathing normally you must activate the emergency response system

Steps 2: if you are alone and active the emergency response system and get an AED if
available and return to the victim.
Step 3: Pulse check
Step
1
2
3

Action
Locate the trachea ,using 2 or 3 fingers
Slide these 2 or 3 fingers into the groove between the trachea and the muscles at
the side of the neck , where you can feel the carotid pulse
Feel for a pulse for at least 5 but no more than 10 seconds .if you do not
definitely feel pulse , begin CPR , starting with chest compressions

Step 4:
Chest compression technique:
Step
1
2

Action
Position yourself at the victims side
Make sure the victim is lying face up on a firm surface. If the victim is lying
face down carefully roll him face up. If you suspect the victim has head or neck
injury try to keep the head and , neck in a line when rolling the victim to a face
up

3
4
5
6

Put the heel of one hand on the centre of the victims chest on the lower half of
the breastbone
Put the heel of your other hand on top of the first hand
Straighten your arms and position your shoulders directly over your hands
Push hard and fast
Press down at least 5 cm(2 inches) with each compression. For each
compression make sure you push straight down on the victims breast bone
Deliver compressions in a smooth fashion at a rate of at least 100/ mts.
At the end of each compression make sure you allow the chets to recil
completely. Chest recoil allows the chest the blood to flow into the heart and is
necessary for chest compression to create blood flow.
Minimize interruptions.

OPENING OF THE AIRWAY

There are two methods for opening the airway to provide breath; head tilt-chin lift and
jaw thrust two rescuers are generally needed to perform a jaw thrust and provide breaths with
a bag mask device. This is discussed in the 2- rescuer adult BLTS/team CPR sequence
section.

STEPS
Step
1
2
3

Action
Place one hand on the victims forehead and push with your palm to tilt the head
back.
Place the fingers of the other hand under the bony part of the lower jaw near the
chin
Lift the jaw to bring the chin forward

Giving mouth to mask breathing

Step
1
2
3

Action
Position yourself at the victims side
Place the mask on the victims face using the bridge of the nose as the guide for
correct position
Seal the mask against the face

4
5
6

Using the hand that is closer to the top of the victims head place your index
finger and thumb along the edge of the mask.
Place the thumb of your second hand along the bottom edge of the mask.
Place the remaining fingers of your second hand along the bony margin of the
jaw and lift the jaw. Perform head tilt chin lift to open the airway
While you lift the jaw press firmly and completely around the outside edge of
the mask to seal the mask against the face.
Deliver air over 1 second to make the victims chest rise.

Disseminated intravascular coagulation

What is dic ?
Is considered an acquired bleeding disorder
Is not a disease entity but an event that can accompany various disease processes
Is an alteration in the blood clotting mechanism:abnormal acceleration of the
coagulation cascade, resulting in thrombosis
As a result of the depletion of clotting factors, hemorrhage occurs simultaneously
Is a Paradoxical Clinical Presentation clotting and hemorrhage
Definition
Disseminated intravascular coagulation is an acquired thrombotic and hemorrhagic
syndrome characterized by abnormal activation of the clotting factors and accelerated
fibrinolysis. This results in wide spread clotting in small blood vessels with
consumptions of clotting factors and platelets, so bleeding and thrombosis can occur
simultaneously.
Predisposing factors
Acute DIC
Shock : hemorrhagic, cardiogenic, anaphylactic
Septicemia
Hemolytic process: transfusion of mismatched blood, acute hemolysis from infection,
immunological disorders
Obstetric conditions: abruptio placenta, amniotic fluid embolism, septic abortion

 Tissue damage: excessive burns and trauma, heat stroke, severe head injury, transplant
rejection, postoperative damage, fat and pulmonary emboli.
Sub acute DIC
Malignant diseases
Acute leukemias
Metastatic cancers
Obstetrics
Retainer dead fetus
Chronic DIC
Liver disease
SLE
Localize malignancy
Pathophysiology
Thrombosis-brief period of hypercoagulability
1) Coagulation cascade is initiated, causing widespread fibrin formation
2) Microthrombi are deposited throughout he microcirculatory
3) Fibrin deposits result in tissue ischemia, hypoxia, necrosis
4) Leads to multi organ dysfunction
Fibrinolysis-period of hypocoagulability (the hemorrhagic phase)
1) Activates the complement system
2) Byproducts of fibrinolysis (fibrin/fibrin degradation products(FDP)) further enhance
bleeding by interfering with platelet aggregation, fibrin polymerization, & thrombin
activity
3) Leads to Hemorrhage

Clinical manifestation
Bleeding
Integumentary : pallor, peticheai, oozing blood, venipuncture site bleeding,
hematoma, occult blood.
Respiratory : tachypnea, hemoptysis, orthopnea
Cardiovascular : tachycardia and hypotension
GI system: upper and lower GI bleeding
Test
Platelet count
Fibrin degradation product (FDP)
Factor assay
Prothrombin time (PT)
Activated PTT
Throbimn time
Fibrinogen
D-dimer
Antithrombin
Treatment
Treat the underlying cause
Provide supportive management of complications
Support organ function
Stop abnormal coagulation and control bleeding by replacement of depleted blood and
clotting components (FFP, Platelets, PRBC)
Medications can be used and choice depends on the patients condition (Heparin,
Antithrombin III (ATIII), Fibrinolytic inhibitors)