CARDIOPULMONARY

RESUSCITATION (CPR)
OBJECTIVES
By the end of this lecture, the students would be able to:
 List the sequence of CPR.
 Explain the procedures for performing CPR.
 Demonstrate CPR.
 Know when to terminate CPR.
 CPR is a life-saving technique.
 Time is critical in starting CPR.
 CPR is indicated whenever heart and/or breathing stop
(cardiac and/or respiratory arrest).
 CPR can keep a person alive until more advanced
procedures (such as defibrillation - an electric shock to
the chest) can treat the cardiac arrest.
 CPR steps are called CAB (Chest Compression, Airway,
and then Breathing).
 Providing artificial circulation via chest
compressions.
 Opening and maintaining the airway.
 Providing artificial ventilation through artificial
breathing.
 CPR provides circulation of blood to the brain and air to
the lungs in order to prevent damage to the brain.
 If breathing stops → brain damage occurs within few
minutes usually 4 minutes, and brain death could
occur within 8-10 minutes.
STEPS BEFORE STARTING CPR
 Within 5 to 10 seconds, check for (1) responsiveness
and for (2) no breathing [or only gasping].
 Check responsiveness by gently tapping on shoulders
and asking loudly “Are you OK?” or “Do you hear
me?”
 Note: In infants (i.e., less than 1 year of age)

victims, you should tap on the heel of the foot.

IN CPR, VICTIMS ARE DIVIDED INTO 3
CATEGORIES:
 Adults (involves all adults and children who reached the
puberty.)
 Puberty is defined as chest or underarm hair on males, or any
breast development on females.

 Children (victims from the age of 1 to puberty.)

 Infants (involves victims with less than 1 year of age.)

WHAT TO DO IF THE VICTIM IS
UNRESPONSIVE AND NOT
BREATHING OR NOT BREATHING
NORMALLY (ONLY GASPING)?
 If the victim is unresponsive and not breathing or not
breathing normally (only gasping), and he/she is an
Adult:
 activate the EMS system (997) and get a nearby

Automated External Defibrillator (AED).

 If the victim is unresponsive and not breathing or not
breathing normally (only gasping), and he/she is a Child
or an Infant:
 If you did not witness the arrest and you are alone
(single rescuer), you should perform 5 cycles (about 2
minutes) of CPR before leaving to activate the EMS and
to bring an AED.
 If the arrest is sudden and witnessed, leave the victim,

activate the EMS and get the AED and then return to the
victim. However, if someone else is present, you may
ask him/her to activate the EMS and to bring an AED.
CPR SEQUENCE (C-A-B)
CHEST COMPRESSION STEP
(ALSO CALLED CIRCULATION STEP)
o Check for the presence of pulse:

o For adults, carotid artery pulse may be used.

o For children, carotid artery pulse OR femoral artery

pulse may be used.

o For infants, brachial artery pulse may be used.

o If there is no pulse, then this victim needs
cardiopulmonary resuscitation (CPR).
o In infants, if the pulse is less then 60 beats/minute, this victim
also needs cardiopulmonary resuscitation (CPR).

o Careful! If you are not trained to perform CPR, then find

someone who is trained.
CAROTID ARTERY CHECKING
FEMORAL ARTERY
CHECKING
BRACHIAL ARTERY
CHECKING
Hands Placements for Compressions:
 For Adults
 Put the heel of one hand on the center of bared chest
over the lower half of the breastbone, then put the
heel of the other hand over the top of the first.
 Your shoulder should be right over your hands and
your elbows should be straight/extended.
 Key Messages: You should deliver compressions in a
smooth fashion at a rate of at least 100 compressions
per minute. At the end of each compression, allow the
chest to recoil completely.
Hands Placements for Compressions:
 For Children
 Similar to the Adults; but you have the option to use 1
or 2 hands.
 Remember: You should deliver compressions in a
smooth fashion at a rate of at least 100 compressions
per minute. At the end of each compression, allow the
chest to recoil completely.
Hands Placements for Compressions:
 For Infants
 1-rescure CPR
 Use 2 fingers of one hand.

 Place the middle and index fingers on the

breastbone just below the nipple line.

 2-rescuer CPR
 The compressor will place both thumbs side-by-

side in the center of the chest on the lower half of

the breastbone [nearby the nipple line]. This
technique is also called:
2-thumb encircling hands technique.
HANDS
PLACEMENT IN
ADULTS
Key Considerations
 Checking the pulse should occur within a minimum 5
seconds and a maximum 10 seconds.
 Each set of 30 compressions should be done in
approximately 18 seconds.
 A ventilator (the rescuer who provides ventilations):

1. can check for a pulse during compressions to make

sure they are effective by feeling a pulse every
compression.
2. should observe for correct delivery of compressions
by the compressor.
AIRWAY STEP
 Put the victim on his back on a firm surface.
 Kneel close to the victim neck or shoulders.

 To open the airway, tilt the forehead backward and the chin
upward (called head-tilt/chin-lift maneuver)
 Careful!
 In victims with suspected head, neck or back injuries,
use a method called: jaw-thrust maneuver :‫ع‬:‫طريقة رف‬
‫سفلي‬::‫فك لا‬::‫ لا‬.
BREATHING STEP
 Close the nostril and give 2 breaths (mouth to mouth)
and observe the chest rises.
 Give each breath over one second to allow chest recoil.
AFTER TWO (2) MINUTES OF
“COMPRESSION:VENTILATION CPR CYCLES”,
 If the victim has no pulse, give chest compressions and
resume CPR.
 Check for a pulse every approximately 2 minutes.
AFTER TWO (2) MINUTES OF
“COMPRESSION:VENTILATION CPR CYCLES”,
 If the pulse is present BUT breathing is absent, continue
artificial breathing only (called rescue breathing).
 In adults:
 Give 1 breath every 5‐6 seconds for about 10‐12

breaths/minute.
 Each breath should be delivered over 1 second,

making the chest rise.

 Re-check the pulse every two minutes.
AFTER TWO (2) MINUTES OF
“COMPRESSION:VENTILATION CPR CYCLES”,
 If the pulse is present BUT breathing is absent, continue
artificial breathing only (called rescue breathing).
 In infants and children:
 Give 1 breath every 3‐5 seconds for about 12‐20

breaths/minute.
 Each breath should be delivered over 1 second,

making the chest rise.

 Re-check the pulse every two minutes.
AFTER TWO (2) MINUTES OF
“COMPRESSION:VENTILATION CPR CYCLES”,
 If the pulse and breathing returned to normal, place the
victim in recovery position.
1 2

3 4
USING AN AED
USING AN AED
 Put an AED on victim as soon as it arrives and turn it
on.
 When an AED is analyzing the victim's data, no one
should touch the victim.
WHEN CAN I STOP CPR?
 The victim revives.
 Trained help arrives.

 You are too exhausted to continue.

 The victim is pronounced dead.

 The cardiac arrest continues for 30 minutes

(controversial).
WHY CPR MAY FAIL?
 Delay in starting.
 Improper procedures (example, forget to pinch nose).

 Delay in defibrillation.

 Improper techniques.

 Terminal disease or unmanageable disease (massive

heart attack).
MORE INFORMATION
 The first rescuer reaches the victim should ensure safety
at the scene quickly.
 Hands-only CPR should be encouraged where untrained
caregivers are involved.
 Performing CPR compressions on the xiphoid process
can cause internal organ damage.
 Always, switch roles (compressor to ventilator, and vice-
versa) when an AED starts analyzing the rhythm.
 In 2-rescure adult CPR, switch roles (compressor to
ventilator, and vice-versa) every 5 cycles or 2 minutes,
taking less than 5 seconds, to prevent fatigue.

 In 2-rescure child or infant CPR, switch roles

(compressor to ventilator, and vice-versa) every 10
cycles or 2 minutes, taking less than 5 seconds, to
prevent fatigue.
 Note: During this 2-rescuer CPR, you are doing the CPR
cycles at 15:2 not 30:2.