Cardiopulmonary Resuscitation

(CPR)

Session 5

Foundation Year Department

 Objectives
Student is able to:
• Assess the victim’s consciousness 
• Be well prepared for Cardiopulmonary Resuscitation
• Perform Cardiopulmonary Resuscitation for adult,
infant, and child
• Understand the process to use Bag-valve mask and
Automated External defibrillator
Cardiopulmonary Resuscitation (CPR)

CPR: Is performed to provide

circulation & oxygen to the body tissue.
 What Will Happen if the Heart Stops
Beating?

• If a person has cardiac arrest, blood does not circulate

through the body. As a result, the vital organs, most
importantly the brain cells becomes oxygen deprived
and cannot survive for more than 3 - 4 minutes
without oxygen supply.
 Key Elements for Survival

Call for help

Start CPR

Specialized treatment and

advanced care
 Cardiac Arrest in Adult
Before providing CPR

Check if responsive: Shake the Step 1

victim’s shoulder gently and ask
“what has happened”, unresponsive.
 Cardiac Arrest in Adult (Cont.)
Before providing CPR
Check carotid pulse: Put 2 fingers between
the larynx and the anterior border of the Step 2
sternocleidomastoid muscle at the level of the
cricoid cartilage not more than 10 seconds,
“cannot palpate the  pulse”.

Step 3 Ask a helper to call 119

Check and remove foreign body from the

Step 4
mouth by using 2 fingers. 
 How to Perform Chest Compression
Step 1

• Kneel beside the victim level with his/her chest.

• Find extreme sternum (xiphoid process) and place 2 fingers then
place the heel of one hand next to 2 fingers.
• Place the heel of another hand on top of the first hand and
 
interlock the fingers, making sure the fingers are kept off the
ribs.
 How to Perform Chest Compression (Cont.)
Step 2 Chest Compression 30 times and give 2 rescue breaths (1
cycle 30:2)
• Compress the chest 30 times (rate of 100-
120/min) by press down vertically on the
sternum (depth 5-6 cm or 2-2½ inch).
• Count 1 & 2 & 3 & 4 & 5, & 1 & 2 & 3 &
 
4 & 10, & 1 & 2 & 3 & 4 & 15, 1 & 2 & 3
& 4 & 20, 1 & 2 & 3 & 4 & 25, 1 & 2 & 3
& 4 & 30.
• Release the pressure without removing
your hands from his/her chest. Allow the
chest to come back up fully (recoil) before
giving  the next compression.
 How to Perform Chest Compression (Cont.)
Step 3 Give 2 rescue breaths (mouth-to-mouth)

• Put one hand on the victim’s forehead

& 2 fingers of another hand under the
tip of victim’s chin. 
• Move the hand that was on the
 
forehead down to pinch the soft part of
the nose with the finger and thumb.
Allow the victim’s mouth to open.
• Make sure that the nostrils are closed to
prevent air from escaping.
 How to Perform Chest Compression (Cont.)
Step 3 Give 2 rescue breaths (mouth-to-mouth)

• Take a deep breath & place your lips

around the victim’s mouth.
• Rescue 1st breath by blowing into the
victim’s mouth
  until the chest rises (A
complete rescue breath takes 1 second).
• Keep head tilted and chin lifted, take your
mouth off & look to see the chest fall then
give 2nd breath.
• The chest rises visibly and falls fully in
each blow.
 How to Perform Chest Compression (Cont.)

•If there is another rescuer, change to

another rescuer when you are exhausted
with minimal interruption < 10 seconds.
•Complete 5 cycles (complete 2 minutes)
of 30:2 then check carotid pulse.  
•Or continue CPR until the emergency
help arrives & takes over.
•Or continue CPR until the victim
responds (breathe, cough, speak, open
eyes, move…etc,.)
Specialized Treatment and Advanced Care
How to place the victim in recovery position

• Kneel beside the victim and remove his/her

spectacles and any bulky objects such as
mobile phones or large bunches of keys.
• Put the victim’s both legs straight then
 
place the arm that is nearest to you at right
angles to the victim’s body, with the elbow
bent and the palm facing upwards.
• Bring the arm that is farthest from you
across the victim’s chest then hold the back
of his hand against the cheek nearest to
you.
 Specialized Treatment and Advanced Care
(Cont.)
• With another hand, grasp the far leg just above the knee
then pull it up & roll towards to you, keeping the foot
flat on the ground.
• Adjust the upper leg so that the hip & the knee are bent
at right angles.  
 Specialized Treatment and Advanced Care
(Cont.)

• Keep the airway open by

tilting the victim’s head back
 
and tilting his/her chin then
adjust the hand under the
cheek.
 Cardiac Arrest in Child

Check if responsive: Shake the

Step 1 child’s shoulder gently and ask “what
has happened”, unresponsive.

 
Check carotid pulse: Put 2 fingers
between the larynx and the anterior
Step 2 border of the sternocleidomastoid
muscle at the level of the cricoid
cartilage not more than 10 seconds,
“cannot palpate the pulse”.
Cardiac Arrest in Child (Cont.)

Ask a helper to call 119 Step 3

Check and remove foreign

Step 4
body from the mouth.
 Cardiac Arrest in Child (Cont.)

Kneel beside the child level with

Step 5
his/her chest.

Find extreme sternum then

Step 6
place the heel of one hand on
the sternum.
 Cardiac Arrest in Child (Cont.)
Chest compression 30 times & give 2 rescue breaths (1
Step 7
cycle 30:2) 

• Compress the chest 30 times (rate of 100-

120 /min) by press down vertically on the
sternum at least one-third of its dept.
 
• Count 1 & 2 & 3 & 4 & 5, & 1 & 2 & 3 & 4 &
10, & 1 & 2 & 3 & 4 & 15, 1 & 2 & 3 & 4 &
20, 1 & 2 & 3 & 4 & 25, 1 & 2 & 3 & 4 & 30.
• Release the pressure without removing your
hands from the child’s chest. Allow the chest to
come back up fully (recoil) before giving  the
next compression.
 Cardiac Arrest in Child (Cont.)
Step 8 Give 2 rescue breaths (mouth-to-mouth)

• Put one hand on the child’s forehead and 2

fingers of the other hand under the tip of
child’s chin. 
 
• Move the hand that was on the forehead
down to pinch the soft part of the nose with
the finger and thumb. Allow the child’s
mouth to open.
• Make sure that the nostrils are closed to
prevent air from escaping.
 Cardiac Arrest in Child (Cont.)
Step 9 Give 2 rescue breaths (mouth-to-mouth)

• Take a deep breath and place your lips

around the child’s mouth.
• Rescue 1st breath by blowing into the child’s
 
mouth until the chest rises (A complete
rescue breath takes 1 second).
• Keep head tilted and chin lifted, take your
mouth off & look to see the chest fall then
give 2nd breath.
• The chest rises visibly and falls fully in each
blow.
 Cardiac Arrest in Child (Cont.)
Step 9 Give 2 rescue breaths (mouth-to-mouth)
• If there is another rescuer, change to another rescuer
when you are exhausted with minimal interruption <
10 seconds.
• Complete 5 cycles then check carotid pulse.
 
• Or continue CPR until the emergency help arrives &
takes over.
• Or continue CPR until the victim responds (breathe,
cough, speak, open eyes, move…etc,.) then place the
child in recovery position (see adult recovery
position).
• In case there is one rescuer, perform 30:2
• There are 2 rescuers, perform 15:2
 Cardiac Arrest in Infant
Before providing CPR

Step 1 Check if responsive: Gently tap the sole

of the infant’s foot & call his/her name to
see responds, unresponsive.
 
Step 2 Check brachial artery: “cannot palpate
the pulse”.

Step 3 Ask a helper to call 119.

Check and remove foreign body

Step 4
from the mouth.
 Perform Chest Compression- Infant
● Place the infant’s back on the firm surface or on the
floor at about waist height in front of you.
● Place 2 fingertips of your hand on the centre of the
infant’s chest.
● Press down vertically 30 times on the infant’s sternum
& depress his chest by at least 1/3 of its depth, 100-
120/min.
● Count 1 & 2 & 3 & 4 & 5, & 1 & 2 & 3 & 4 & 10, &
1 & 2 & 3 & 4 & 15, 1 & 2 & 3 & 4 & 20, 1 & 2 & 3
& 4 & 25, 1 & 2 & 3 & 4, & 30.
● Release the pressure without moving your fingers
from the sternum. Allow the chest to come back up
fully (recoil) before giving the next compression.
 Perform Chest Compression- Infant (Cont.)
Give 2 rescue breaths (mouth-to-mouth)
• Place one hand on the infant’s forehead and one
fingertip of the other hand under the tip of his
chin then lift the chin.
• Take a breath. Place your lips around the
infant’s mouth and nose to form an airtight seal.
• Rescue 1st breath by blowing gently into the
infant’s mouth & nose until the chest rises (A
complete rescue breath takes 1 second).
• Keep head tilt and chin lift, take your mouth off
& look to see the chest fall then give 2nd breath.
Perform Chest Compression- Infant (Cont.)

• If there is another rescuer, change to

another rescuer when you are exhausted
with minimal interruption < 10 seconds.
• Complete 5 cycles then check brachial
pulse.
 
• Or continue CPR until the emergency help
arrives & takes over.
• Or continue CPR until the victim responds
(breathe, cough, speak, open eyes, move…
etc,.)
• In case there is one rescuer, perform 30:2
• There are 2 rescuers, perform 15:2
Place the Infant in Recovery Position

Cradle the infant in your arms with

her/his head tilted downwards. This
position
 
prevents the infant from
choking on his/her tongue or from
inhaling vomit.
 CPR in Late Stage of Pregnancy
• Keep the woman's upper body as flat
on the floor.
• Raise her right hip and ask a helper
to kneel beside the woman so that his
knees are underneath the raised hip. 
• If you are on your own, place tightly
 
rolled up clothing or towels under
the woman’s.

• Manual left uterine displacement

by the 1 or 2-handed technique
from the left of the patient
 Perform CPR with Bag-valve Mask

• Bag-valve mask resuscitators (BVM resuscitator): a handheld

device used to administer a high concentration of oxygen than a
pocket mask.

• To perform CPR using BVM it’s required to be operated by two

 
rescuers.

• BVM comes in various sizes to fit adult, children, and infants

Perform CPR with Bag-valve Mask
(Cont.)

 
 Perform CPR with Bag-valve Mask
(Cont.)
• Rescuer needs to use appropriately sized BVM for the patient
to prevent harm.

• To use BVM, proper patient positioning is critical by head tilt,

 
chin lift maneuver or jaw thrust to keep airway open.

• Mask over the face, the pointed end of the mask over the nose,
and curved end below the lower lip.
 Perform CPR with Bag-valve Mask
(Cont.)
E-C seal technique:

C: first digit cover the mask

with thumb pressing down by the
nasal bridge. Second digit over  the
bottom of the mask by the mouth.

E: third through fifth digits

forming “E” and applying pressure
to to mandible to hold mask tight.
 Perform CPR with AED
An automated external defibrillator (AED)

The portable electronic devices that

analyzes the heart’s rhythm and
provides an electrical shock.
 
 Perform CPR with AED (Cont.)
Don’ts for AED use:
• Do not use alcohol to swipe
• Do not touch the victim while the AED is analyzing
• Do not touch the victim while the device is defibrillating
 
• Do not defibrillate the victim when around flammable
material.
• Do not use an AED on a victim wearing a medical patch on
chest
 Sources

• American Heart Association. (2015). Highlights of the 2015

American Heart Association Guideline Update for CPR and
ECC. (pp. 1-33)
• Austin, M., Crawford, R., & Klaassen, B. (2016). First Aid
 
Manual. (pp. 1-288). 10th ed. New York, United States.
• American Red Cross (2016). CPR/AED for professional
rescuers. (pp. 1-133). United States.
Thank You!