Cardiopulmonary

Resuscitation
Introductuion

• Imagine you were walking and you found a person lying on the floor
and seems unconscious what should you do?
•Definition
Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that
maintains circulation in patients with sudden cardiac arrest until cardiac
function can be restored. Sudden cardiac arrest presents with
unconsciousness, apnea ,and pulselessness.
When to do CPR ?

CPR is done for patients

who are:
1. unresponsive
2. has stopped breathing (
respiratory arrest ) or has
abnormal breathing
3. and/or whose heart has
stopped (cardiac arrest).
 Purpose

• 1. To maintain blood circulation (C).

• 2. To maintain an open and clear airway (A).
• 3. To maintain breathing by artificial/external ventilation (B).
• 4. To save the life of the patient.
• 5. To provide Basic Life Support (BLS) until medical and Advanced
Cardiovascular Life Support (ACLS) arrives.
 BLS & ACLS
• Basic life support
• 1. Anyone can do it
• 2. In any place
• Advanced Cardiovascular Life
support
• 1. Needs well-trained person
• 2. Mostly done in hospitals
BASIC LIFE SUPPORT
DANGER

Assess scene for Danger to both

patient/yourself

Ensure use of personal protective

equipment at all times (
gloves/masks …)

Move patient to a safer place if

needed, but try to avoid moving
them if possible in case of other
injuries
Response

• A response can usually be quickly established by the shouting at the

casualty, or by gently shaking their shoulders.
 CALL FOR HELP
• Send for help
• Ensure the closest Automatic
External Defibrillator (AED) has
been retrieved
 Circulation

•1. Check for pulses :

• Check pulse : palpate a carotid pulse.
• Side 2 to 3 fingers into the groove between the trachea
and the muscles of that side of the neck for 10 seconds
check the pulse.
• NOTE: In infants we palpate the brachial pulse because
the neck is small and difficult to check the carotid pulse.
• Don ’t use your thumb in pulse palpation, as it have
already pulse in

•2. If no signs of life

commence chest
compressions.
HIGH QUALITY CPR

• Depth : adult 5-6 cm (2 inches) , children, infants > 1/3 depth of the chest

• Hard and fast pushes with palm

• Rate 100/120 compressions / minute

• Give 30 compressions then 2 rescue breaths in adults, 15 compressions then 2 rescue

breaths in children

• DO NOT apply pressure over the ribs or abdomen

• Infants ---- > compress with 2 fingers in the center of chest

• Don’t interrupt chest compression

• Allow to complete chest recoil in each one (contraction and relaxation)

 BREATHING

• To check for breathing place your cheek in front

of the victim’s mouth (about 3-5 cm away)
• Look, listen and feel for NORMAL breathing for
10 seconds.
METHODS OF RESCUE BREATHING

• Mouth-to-mouth breathing method

• Mouth to mouth and nose in infants

• Mouth to mask
AIRWAY

Look in mouth for obstruction

- Assess the airway, ensuring it is

open and clear by one of two
maneuvers :
• 1. Head-tilt Chin-lift (place a hand
on the victims’ forehead,
fingertips to the point of the chin
”sniffing position “ , gently tilt the
head and lift the chin to open the
airway)

• 2. Jaw Thrust maneuver (If

suspected spinal cord injury)
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• AFTER 5 CYCLES , CHECK

PULSE AND BREATH

No Pulse, No If there is pulse à

breathing à CPR check breath
again

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Pulse + Breathing à stop Pulse – Breathing à give

CPR, recovery position rescue breath each 6 sec
and monitoring
RECOVERY POSITION
WHEN WE STOP CPR?

• Victim shows signs of life.

• Emergency medical services (EMS) personnel take over.(moved from

basic to advanced)

• You become too tired to continue or you put yourself in danger by

continuing.

• If Automated External Defibrillator (AED) is available.

 Automated External
Defibrillator
Is a lightweight, portable device that delivers an electric shock
through the chest to the heart
The shock can potentially stop an irregular heart beat (arrhythmia)
and allow a normal rhythm to resume following sudden cardiac arrest
(SCA)
For use by trained first aiders
AED’s accurately diagnose cardiac rhythms and separate them into
two groups :
1. those responsive to defibrillation
2. those unresponsive to defibrillation
Will only ‘shock’ a shockable rhythm
USE OF AED
• Voltage of electricity discharge used :

•In pediatrics : 2-4joule / kg

•In adults 120 –200 joule on biphasic,

360 joule on monophasic
 • is a set of life-saving protocols and skills that
extend basic life support to further support the
circulation and provide an open airway and
adequate ventilation (breathing).

ADVANCED • 1. Airway management : perform endotracheal

intubation or use other airway
CARDIAC • 2. Breathing management entails the administration
LIFE of oxygen and assessment of the need for ventilatory
support with positive pressure. ( mechanical
ventilation, capnogram)
SUPPORT
• 3. Circulatory management :
-Intravenous access : delivery of fluids and
medications required for resuscitation
-Electrocardiographic / cardiac monitoring
•
4- Others :
-Laboratory studies
-Bladder catheterization
- Nasogastric tube placement
• Patients classified into 2 groups :

Non-
Shockable
shockable
Ventricular
Fibrillation Asystole
(VF)

Ventricular Pulseless
Tachycardia electrical
(VT) activity (PEA)
Management of SHOCKABLE pts:
Commence CPR for 2 min. immediately after delivering the shock
1.

(continue chest compression with one breath every 6 seconds)

2. Stop, Switch(between the one who does compression and the other one
who gives breath) , Analyze (check pulse and rhythm for 10 sec.)
3. If still shockable, give the second shock then CPR for 2 min. and start
giving adrenaline (IV and rise pt’s hand, give fluid(10 cc normal saline), stop
switch analyze.
4. If still shockable, give the third shock then CPR for 2 min. and start giving
amiodarone .
5. Continue in the same way but in the 4th shock we give adrenaline and in
the 5th one we give 150gm of amiodarone
6. After 5th shock we continue CPR + shock + adrenaline every 5-3 minute
7. In PEA we look for reversible causes of cardiac arrest
8. If he becomes non-shockable we stop this and continue as in the next
slide
I F T H E P T. I S N O N - S H O C K A B L E :

Commence CPR (continues chest compression with one breath

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every 6 second) for 2 min. , Check pulse for 10 sec. , give

adrenaline every 3-5 min. As long as the pt. isn't shockable .

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If the pt. becomes shockable we start from the ZERO shock .

Drugs used in CPR :

• Shockable :
1st shock à cycle à no medication
2nd shock à cycle à Adrenaline (0.01 mg/kg)
3rd shock à cycle à Amiodarone (300 mg)
4th shock à cycle à Adrenaline (0.01 mg/kg)
5th shock à cycle à Amiodarone (150 mg)

• Non-shockable
• Adrenaline every 3-5 min. (0.01 mg/kg)