CARDIO PULMONARY

RESUSICATION
GOAL

• Maintain oxygen and blood supply to vital organs

• Restore spontaneous circulation
• Minimize post resuscitation organ injury
• Improve the patient’s survival and neurologic outcome.
• Cardiac output during CPR with effective, uninterrupted chest
compression is at best 25% to 30% of the normal spontaneous
circulation.
 CHAIN OF SURVIVAL
• Identifies a sequence of five critical actions that increase
survival rates from sudden cardiac arrest (SCA)
OUTSIDE HOSPITAL CARDIAC ARREST
INSIDE HOSPITAL CARDIAC ARREST
 Why abc changed to cab?

• Blood flow rather than arterial oxygen content is the limiting factor for
oxygen delivery to coronary, cerebral, and systemic circulation during
CPR.
• Thus rescue breaths are less important than initiating effective chest
compressions as soon as possible after SCA.
CHEST COMPRESSIONS
 airway
• Bag-mask ventilation with a head tilt–chin lift or head tilt–jaw
thrust manoeuvre is recommended for initial airway control in most
circumstances.
• Triple manoeuvre: head tilt- chin lift , mouth open, jaw thrust
 ADVANCED AIRWAY
• DEPENDING ON THE LEVEL OF
EXPERTISE OF THE CPR PROVIDER
• ENDOTRACHEAL TUBE
• LARYNGEAL MASK AIRWAY
• COMBITUBE

• “ UNDER NO CIRCUMSTANCES
SHOULD THE INSERTION OF
ADVANCED AIRWAY COMPROMISE THE
CHEST COMPRESSIONS”
 breathing

WITH PULSE WITHOUT PULSE

10-12 BREATHS PER UNSECURED SECURED

MIN AIRWAY AIRWAY
(RESCUE BREATHS)

30: 2
COMPRESSION 10 BREATHS PER
TO VENTILATION MIN
 DEFIBRILLATOR

MANUAL
DEFIBRILLATOR

AUTOMATED
EXTERNAL
DEFIBRILLATOR
• When using AEDs, one electrode
pad is placed beside the upper
right sternal border, just below the
clavicle, and the other pad is
placed just lateral to the left
nipple.

• In a child or infant an AED pad is

placed anterior and posterior.
 DEFIBRILLATION

• Defibrillation delivers an electrical current passing through the

myocardium to interrupt disorganized cardiac activity and restore an orga-
nized cardiac rhythm
• If a monophasic defibrillator is available, then a single 360 joule (J) shock
should be delivered.
• With biphasic defibrillators, a much lower energy level (120-200 J) is
usually sufficient to terminate the arrhythmia
• If the rescuer is unfamiliar with the waveform used or the manufacturer
recommendations, then the maximal available energy should be used as
the default energy
• Pediatric patients: 1st shock : 2-4 J\kg---subsequent shocks 4 J\kg ( MAX
10J\kg)
 Definition of age in cpr

• NEONATE: 1ST 30 DAYS AFTER BIRTH ( PRECORDIAL AUSCULTATION\ 3 LEAD ECG)

• INFANT : 30 DAYS TO 1 YEAR AFTER BIRTH ( BRACHIAL ARTERY)
• CHILD : 1YEAR TO PUBERTY* ( FEMORAL\ CAROTID ARTERY)
• ADULT \ ADOLOCENT: AFTER PUBERTY ( CAROTID)

• PUBERTY: FEMALE: BREAST DEVELOPMENT +

MALE: AXILLARY HAIR +
 DIFFERENCE IN ADULT AND PEDIATRIC CPR

1. ACTIVATION OF EMERGENCY RESPONSE SYSTEM

2. COMPRESSION TO VENTILATION RATIO WITHOUT ADVANCED AIRWAY

3. DEPTH OF COMPRESSION

4. HAND PLACEMENT
 ROUTES OF ACCESS
• Intraosseous (IO) route is now preferred when IV access is not available.
• Endotracheal route is least preferred
• INTRAVENOUS ROUTE
• If a drug is given via peripheral route of administration, do the following:
1. Intravenously push bolus injection (unless otherwise indicated).
2. Flush with 20 mL of fluid or saline.
3. Raise extremity for 10 to 20 seconds to enhance delivery of drug to circulation.
• INTRAOSSEOUS ROUTE: most common is lower end of femur or upper end of tibia
• ENDOTRACHEAL ROUTE: least preferred
• Dose is 2-2.5 times the iv dose
• 5 drugs can be given through this route : naloxone, adrenaline, vasopressin, atropine,
lignocaine ( NAVAL)
 DRUG THERAPY IN CPR
Epinephrine
• Cardiac Arrest
• Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg
(1:1000) ETT every 3 to 5 min
• Maintain: 0.1 to 0.5 mcg/kg/min
• Give via central line when possible
Pediatric: 0.01-0.03 mg\kg
• Anaphylaxis
Amiodarone
• VF/pulseless VT / VT with pulse /Tachy rate
control
• VF/VT: 300 mg dilute in 20 to 30 mL, may repeat
150 mg in 3 to 5 min
• Anticipate hypotension, bradycardia, and
gastrointestinal toxicity
• Continuous cardiac monitoring
• Do not administer via the ET tube route

• 500 mcg IM
• Repeat every five minutes as needed
• Symptomatic bradycardia/Shock
• 2 to 10 mcg/min infusion
• Titrate to response
POST CARDIAC ARREST CARE