CPR & FIRST AID

Life support systems

Lungs – breathing
Absorbs oxygen

Heart – circulation
Pumps & circulates oxygenated blood

Brain – system controller

Brain damage after 4-6 minutes
Damage is irreversible
Sudden Death
Cardiac / Respiratory arrest

Unconsciousness

No breathing

No pulse
CAUSES OF SUDDEN DEATH
Heart Attack
Stroke
Electrocution
Poisoning
Drowning
Suffocation
Severe Allergic Reaction
Trauma
Definition of CPR
C ardio

P ulmonary

R esuscitation
Purpose of CPR
Critical emergency intervention
BLS – Basic Life Support

Performed for cardiac or

respiratory arrest
Artificially pumps heart to keep
circulation to brain

Provides a vital link in CHAIN

OF SURVIVAL
Chain of Survival
Series of actions to maximize survival

Each action is time-critical and linked

Missing link will result in poor outcome/survival

AHA Adult Chain of Survival -
New
Adult CPR
Algorithm
D anger
R esponse
C ompression
A irway
B reathing
D anger
Check scene

Ensure safety for –

Self
Victim
R esponse
Check for response –
Tap
Call
Activation

Get help

Emergency number –
 Fixed line
 H/phone

 Hospital
Activation – call for help
New CPR Sequence
Compressions
A compression is the act of pushing on the
chest
People often don’t push hard enough because
they’re afraid of hurting the victim
An injury is unlikely, but it is better than death
It is better to push too hard than not hard
enough
Compressions
Lock fingers
Correct
posture
Chest Compression
Technique –
Position – center of chest / nipple line
Depth – 1.5 – 2 ” deep
Rate – ‘push hard & push fast’
→ approx. 100-120 times/min
Ratio – 30 compressions : 2 breaths

*Check pulse after every 5 cycles or

2 minutes
A irway
Open airway –
Head tilt, chin lift
Jaw thrust

Check mouth for foreign body –

Dentures
Jaw thrust
Head tilt, chin lift – to open airway
Opening Airway to lift up tongue

BEFORE AFTER
Open the Airway
Give Breaths
Compressions are the most important part
of CPR
If you are also able to give breaths, you will
help even more
Your breaths need to make the chest rise
When the chest rises, you know the person
has taken in enough air
Give Breaths
B reathing
Look
Check
Breathing Listen

Feel

Check for 5-10 seconds

LOOK for chest movement LISTEN for breathing sound
FEEL for air breathe out
B reathing
If no breathing –
Give 2 rescue breaths
Check for chest rise
Routes –
mouth-to-mouth

mouth-to-nose

mouth-to-tracheostomy

mouth-to-mask
Mouth-to-mouth
Face shield Face mask
Pocket Mask
C irculation
Check carotid pulse

Feel for 5-10 seconds

Check carotid pulse
 C irculation
If pulse present but NO breathing –

Commence RESCUE BREATHING

Rate – 10-12 breaths / minutes

Recheck pulse after every 2 minutes

Recovery position
If pulse & breathing present –

place in Recovery position

Recovery position
Recovery position – step 1
Recovery position – step 2
Recovery position – step 3
Recovery position – step 4
When to stop CPR?
Victim revives

Another trained rescuer takes over

Medical assistance arrives

You are exhausted

Hazards of CPR
Incorrect chest compressions –
Fractures – ribs & xiphoid
Lacerations – liver, spleen & lungs

Incorrect rescue breath volumes –

Gastric distension
Vomiting
Other concerns
Victim who vomits

Wearing dentures

Chest compressions only

If I am alone?
Paediatric CPR
Age groups –

Child – age 1 – puberty

Infant – newborn to 1 year old

Prevention Early Access

Basic CPR Early

Advanced Life
Support
Paediatric CPR - algorithm
Danger
Response
Airway
Breathing
Circulation
Defibrillation
Child CPR
D anger
Assess situation

Ensure safety
R esponse
Check response –

Tap

Call

Call for help

A irway
Open airway –
Head tilt, chin lift
Jaw thrust

Observe for foreign body –

Remove only if seen
B reathing
Look
Check
breathing Listen

Feel

Assess for 5-10 seconds

B reathing
If no breathing –
Give 2 rescue breaths
C irculation
Check carotid pulse

Check for 5-10 seconds

C irculation
If no pulse or pulse < 60 bpm

Start chest compressions –

1 hand

2 hands
Chest Compression
Technique –
Position – center of chest / nipple line
Depth – 1 – 1.5 ” deep
Rate – approx. 100 times/min
Ratio – 30 compressions : 2 breaths

*Check pulse after every 5 cycles or

2 minutes
C irculation
If pulse present (> 60 bpm) but no breathing –

Rescue breathing @ 12 – 20 breaths/min

Recheck pulse after 2 minutes

Recovery position
If pulse & breathing present –
Recovery position
D efibrillation
AED – Automated external defibrillator

For 1-8 years old –

Use Paediatric pads
D efibrillation
Check rhythm

> 1 year old –

First shock – after 5 cycles of CPR
if rhythm is shockable

Resume CPR after 1 shock (4 J/kg bw)

Check rhythm after every 5 cycles of

Compression : Breaths
Infant CPR
D anger
Assess situation

Ensure safety
R esponse
Check response –

Tap

Call

Call for help

A irway
Open airway –
Head tilt, chin list
Jaw thrust

Observe for foreign body –

Remove only if seen
B reathing
Look

Check breathing Listen

Feel

Assess for 5-10 seconds

B reathing
If not breathing –
Give 2 rescue breaths
C irculation
Check brachial pulse

Check for 5-10 seconds

Checking brachial pulse
C irculation
If no pulse or < 60 bpm

Start chest compression –

2 fingers technique
2 fingers technique
Compression : breathing – 30:2
C irculation
Technique for infant CPR –
Position – center of chest / nipple line
Rate – 100 / min
Depth – ½ to 1” deep
Ratio – 30 compression : 2 breaths

* Check pulse after 5 cycles / 2 minutes

Rescue breathing
If pulse present (> 60 bpm) but no breathing
–

Rescue breathing @ 12 – 20 breaths/min

Recheck pulse after 2 minutes

Recovery position

If pulse & breathing present –

Recovery position
Cardiopulmonary Resuscitation
Primary survey – BLS
Focus on basic CPR & defibrillation

Secondary survey – ACLS

Focus on intubation, IV access, rhythm,
drugs & cause of arrest
BLS – Basic Life Support
Airway –
 examine mouth for foreign body, vomitus or blood
 handling patient with cervical spine injury

Breathing –
 airway or using mask & ambubag

Circulation –
 Correct sequence of compression / breathing

Defibrillation –
 Shockable rhythm deliver 360 J (Monophasic)
 Resuscitation
 Confirm no pulse / respiration
 Activate Code Blue
 Commence CPR
 Arrival of resuscitation equipment
 Arrival of resuscitation team
 Identify team leader
 Rhythm diagnosis
 Prompt defibrillation
 Intubation & IV access & Drugs
 Resuscitation
Identify underlying cause
Ongoing assessment for response to Tx
Documentation
Family notification
Transfer to CCU (if successful)
Clearing up & checking equipment
Emergency Trolley
 Top shelf

Emergency  Equipment

1st Drawer
Trolley  Drugs

2nd Drawer
 Medical supplies

3rd Drawer
 Laryngoscope & Airway (Intubation)

Bottom Drawer
 IV Fluid / Ambubag / O2 equipment
Bag-Valve-Mask

(Ambubag)
Using an ambubag
Holding
an
ambubag