CARDIOPULMONARY

RESUSTICATION
By :-
Dr.Gopal Krushna Nayak(P.T)
 INTRODUCTION
 In people under the age of 38, the commonest causes are
traumatic, due to accident or violence. In such instances
death may be prevented if airway obstruction can be
reversed, apnoea or hypoventilation avoided, blood loss
prevented or corrected and the person not allowed to be
pulseless or hypoxic for more than 2 or 3 minutes.
 If, however, there is circulatory arrest for more than a
few minutes, or if blood loss or severe hypoxia remain
uncorrected, irreversible brain damage may result.
 Immediate resuscitation is capable of preventing death
and brain damage. The techniques required may be
used anywhere, with or without equipment, and by
anyone, from the lay public to medical specialists,
provided they have been appropriately trained.
 Resuscitation may be divided into three phases:
1. Basic Life Support using little or no equipment.
2. When equipment and drugs become available
Advanced Life Support may start, in which a
spontaneous circulation is restored.
3. Prolonged Life Support which is usually conducted in
an intensive therapy unit and is directed towards
salvaging cerebral function in the comatose patient,
maintaining a stable circulation, restoring oxygenation
to normal and other aspects of intensive care.
 WHAT TO DO

 When confronted by an apparently unconscious

patient, first establish that they are unconscious
by shaking him and shouting at him.
 Then call for help without leaving the patient.
 ABC
OF
RESUSTICATION
 BASIC LIFE SUPPORT

A. AIRWAY

1. Ensure that the patient has a patent airway

2. Remove fluid and debris from the mouth using
fingers and, suction as necessary.
3. Insert a pharyngeal airway if necessary and
available.
B. BREATHING
1. Maintain a patent airway.

2. If the patient is breathing roll him on to his side into a stable position with the head tilted back.
Maintain a patent airway and check that breathing does not stop. Check his pulse.

3. If the patient is not breathing leave him on his back and;

4. Inflate the patients lungs rapidly 3 to 5 times using one of the following methods:
› Use mouth to mouth or mouth to nose ventilation.
› Insert a Brook airway, give mouth to airway ventilation.
› Ventilate the patient using a bag and mask.

5. Look for the rise of the patients chest with each ventilation. If this is not seen there may be
› an obstruction in the airway,
› a poor seal with the patient’s airways during inflation,
› simply not enough air being blown into the patient.

6. Feel for the carotid pulse.

7. If the pulse is present, but no spontaneous ventilation, then continue 12 lung inflations per minute.
C. CIRCULATION

 If the pulse is present and there is obvious external

haemorrhage, control bleeding by applying pressure to
the bleeding point and elevating it if appropriate.
 If the pulse is absent, and If there is no spontaneous
breathing, then Transfer the patient to the floor, if he is
not already on a hard surface, and start external
cardiac massage
 Single operator: Alternate 2 quick lung inflations with
15 sternal compressions. Compress the sternum at a
rate of 80/min.

 Two operators: Alternate 1 lung inflation with 5

sternal compressions. Compress at a rate of 60/min.
 The lower third of the sternum should be compressed
about 5cm (2in) each time.

 Resuscitation should be continued until a spontaneous

pulse returns.
 ADVANCED LIFE SUPPORT

D. DRUGS

1. Cardiac compression and ventilation of the lungs should not be interrupted.

2. A central or peripheral intravenous catheter or needle should be inserted if not already
in place.
3. The trachea should be intubated. Not only will this make maintenance of the patency
of the airway much easier, it will also protect the airway to some extent from
contamination by fluid or vomitus, and make artificial ventilation much easier to
perform effectively.
 The following drugs may be used:
› adrenaline 0.5-img, repeated every 3-5 minutes as necessary.
› sodium bicarbonate 1mEquiv/kg body-weight. This is repeated every 10 minutes of arrest time.
For adults an 8.4% bicarbonate solution is used. Children, should be given 4.2% solution.
› intravenous fluids as required, e.g. blood or plasma.
 If intravenous access is not established, drugs may be given down the endotracheal
tube directly into the patient’s airway.
 As a last resort, drugs such as adrenaline may be given directly into the heart through
the chest wall, though this may damage the heart muscle or cause a pneumothorax.
E. ELECTROCARDIOGRAM
 Ventricular fibrillation should be treated by defibrillation
 Asystole should be treated with adrenaline and then defibrillation.
 Ventricular tachycardias may be treated by defibrillation or
verapamil.
 Bradycardias may be treated with atropine.

F. FIBRILLATION TREATMENT
 Ventricular fibrillation or ventricular tachycardia are seen then
clear the area and DC defibrillate the patient.
 External defibrillation using 100-400J. Repeat shock as necessary.
 Convert fine fibrillation to coarse fibrillation using adrenaline.
 Lignocaine 1-2mg/kg intravenously as necessary. If a defibrillator
is not available, then lignocaine intravenously or via the
endotracheal tube may convert to a sinus rhythm.
 WHERE A PATIENT IS ALREADY IN HOSPITAL HAVING
HIS ECG MONITORED WHEN HE HAS CARDIAC
ARREST, AND IT IS KNOWN THAT HE WENT INTO
VENTRICULAR FIBRILLATION DURING THE LAST 30
SECONDS.

 THEN THE TREATMENT OF CHOICE WOULD BE TO

FIRST ATTEMPT TO DEFIBRILLATE HIM USING 200
JOULES.

 IF THIS DID NOT SUCCEED, THEN ONE SHOULD

IMMEDIATELY PROCEED TO BASIC LIFE SUPPORT
WITH THE MAINTENANCE OF A PATENT AIRWAY AND
VENTILATION AS WELL AS KEEPING THE PATIENT’S
CIRCULATION GOING WITH EXTERNAL CARDIAC
MASSAGE
 PROLONGED LIFE SUPPORT

 G. GAUGING
1. Gauge the likely outcome of resuscitation.
2. Gauge the cause of the cardiorespiratory arrest and treat it.

 H. HUMAN MENTATION
1. Preserve cerebral function by maintaining normal cerebral blood
flow and oxygenation.
2. Reduce and control intracranial pressure.
3. Monitor cerebral function.

 I. INTENSIVE CARE
1. Provide intensive therapy.
2. Intensive nursing.
3. Intensive monitoring.
THANK U