CPR
SUBMITTED BY: ANJILA CHAPAGAIN
SUBMITTED TO: DR. SAFAL DHUNGEL
DR. MANISH YADAV
BDS FINAL YEAR
DEPARTMENT OF ORAL AND
ROLL NO:16006 MAXILLOFACIAL SURGERY
COMS-TH COMS-TH
CONTENTS
• Introduction
• Causes Of Cardiac Arrest
• Treatment Of Cardiac Arrest
• Basic Life Support
• Procedure Of BLS
• Triple Maneuver
• Assessment Of Restoration Of Breathing And Circulation
• Defibrillation
• Advanced Techniques For Airway Patency
• Drugs Used In CPR
• Post Cardiac Complications
What does CPR stand for?
C = Cardio (heart)
P = Pulmonary (lungs)
R = Resuscitation (recover)
DEFINITION
Cardio pulmonary resuscitation (CPR) is a technique
of basic life support for the purpose of oxygenation to
the heart, lungs and brain until and unless the
appropriate medical treatment can come and restore
the normal cardiopulmonary function
INDICATION
• Cardiac arrest
• Respiratory arrest
• Combination of both
What is Cardiac Arrest?
It can be broadly defined as “inability of heart to sustain an effective
output”
Causes of cardiac arrest (6 H &
4 T)
• 1) Hypoxia • 1) Cardiac Tamponade.
• 2) Hypotension. • 2) Tension pneumothorax.
• 3) Hypothermia • 3) Thromboembolism
• . 4) Hypoglycemia. (pulmonary, coronary).
• 5) Acidosis (H+). • 4) Toxicity (eg.digoxin, local
anesthetics,insecticides)
• 6) Hypokalemia (electrolyte
disturbance).
Diagnosis of cardiac arrest
(TRIAD)
1) Loss of consciousness.
2) Loss of apical & central pulsations (carotid, femoral).
3) Apnea.
WARNING SIGNS OF CARDIO
PULMONARY ARREST
Early signs:
loss of consciousness & convulsions
Late signs:
Apnoea
Dilated pupils
Absence of heart sounds
Other signs
Changes in respiratory rate
A weak or irregular pulse
Bradycardia
Cyanosis
TREATMENT OF CARDIAC ARREST
-Most effective when started immediately
-Should be initiated by any person present at the time of arrest
-Outside the hospital- Basic Life Support[BLS]
-Inside the hospital- BLS + Advanced Care Life Support and Post
Resuscitation Life Support
BASIC LIFE SUPPORT
• It is life support without the use of special equipment
Objective
To maintain oxygenation in lungs, brain and heart with rescue breathing
and cardiac compression before the ACLS
Early recognition
Assessment is of crucial importance. It includes :
1) Unresponsiveness - Check the victim for a response.
• Shake shoulders gently -Ask “Are you all right?’’
2) No breathing or no normal breathing (i.e, only gasping)
3) No pulse felt within 10 seconds.
PROCEDURE OF BLS
• Airway
• Breathing
• Circulation
• [A-B-C is now C-A-B] according to American Heart association 2010
Each part of CAB begins with an assessment phase to determine
patients response, presence of pulse and state of respiration
AIRWAY
• Position of the victim
Made to lie supine on a firm flat surface
• Position of the rescuer
Should be at victims side at a distance equal to the width of the victims
body and level of shoulder
TRIPLE MANEUVER
• Open the mouth-clear the airway
• Head tilt and chin lift
• Jaw thrust
Open the mouth and clear the airway
• Incase of aspirated objects tongue could be posteriorly displaced
causing partial or total airway block at the level of larynx
• Hypoxia should be prevented
• If required,ensuring airway followed by oxygenation
- With rescuer{mouth-to-mouth respiration}
- Ambu bag{atmospheric air}
- 100% oxygen if available
Head tilt and chin lift
• Place the patient in supine position
• Lift the chin forward to move the mandible anteriorly while tilting the
head backward
• Next is hyperextended
Jaw thrust/chin lift maneuver(for neck injury
patient)
• Jaw thrust maneuver: lift the mandible forward with index finger
while pushing aginst the zygomatic arch with thumb
• Chin lift maneuver: place one hand on the forehead to stabilize the
head and neck
• Grab the mandible between the thumb and index finger of the other
hand
• Lift the mandible forward
• Hold the head to keep the head and neck still and in alignment with
rest of the body
BREATHING
Determine the presence or absence of breathing by:
-placing the ear near the victims mouth or nose
-Looking for chest wall movement
-Auscultation of chest for breath sounds
EXPIRED AIR RESUSCITATION
• Mouth-to-mouth breathing
• Mouth-to-mask breathing
• Bag mask ventilation
Give 2 Breaths
• Pinch the nose closed with your thumb and index finger
• Take a regular breath and seal your lips around the victim’s mouth, creating
an airtight seal
• Slowly breath air into victim’s mouth until victim’s chest rises
• Remove your mouth to let the air come out
• Repeat one more breath
CIRCULATION
Assess pulse {Adult}
Assess pulse (infant)
CHEST COMPRESSIONS
• Patient must be placed on a hard surface (wooden board).
• Place the heel of one hand in the junction of lower and middle third
of sternum
• Place other hand on top
• Interlock fingers
Compress the chest
Rate 100-120 /min
Depth 3-5 cm(1.5 to 2 inches) in adults and 2-4 cm in children, 1-2 cm
in infants .
30 chest compression followed by two attempted rescue breaths.
Equal compression : relaxation
When possible change CPR operator every 2 min Chest compressions
ASSESSMENT OF RESTORATION
OF BREATHING AND
CIRCULATION
Contraction of pupil
Improved color of the skin
Free movement of the chest wall
Swallowing attempts
Struggling movements
WHEN TO TERMINATE BLS?
Pulse and respiration returns
Emergency medical help arrives
Physician declared patient is deceased
In a non health setting ,another indication to stop BLS would be that
the rescuer was exhausted and physically unable to continue to
perform BLS.
ADVANCED CARDIAC LIFE
SUPPORT
• Helps to evaluate and restore spontaneous circulatory function
• Includes the use of adjunctive equipments and techniques available in
hospital set up assisting ventilation and circulation
ACLS primary survey
First ABCD of ACLS
• A-airway
• B –breathing
• C –circulation
• D –defibrillation
Second ABCD of ACLS
• A-perform endotracheal intubation
• B –assist ventilation
• C –circulatory support, gain iv access, attach monitor, identify rhythm,
measure bp and provide appropriate medication
• D –differential diagnosis, find and treat the case
DEFIBRILLATION
• Defibrillation consists of delivering a therapeutic dose of electrical
energy to the affected heart with a device called a defibrillator
• In cardiac arrest,the associated heart rhythms can be categorised into
two groups : 1) Shockable rhythm: VT/VF
2) Non shockable rhythm: asystole and PEA
• The basic difference in the treatment of these two groups of
arrythmia is the need for defibrillation in patients with VT/VF
ADVANCED TECHNIQUES FOR
AIRWAY PATENCY
1) Face Mask 47
2) Oropharyngeal airway
3) Nasopharyngeal airway
4) Laryngeal mask (LMA)
5) Endotracheal tube
6) Combitube
7) Cricothyrotomy (Surgical Airway)
8) Tracheostomy (Surgical Airway)
DRUGS USED IN CPR
Adrenaline:
vasopressor drug
Has alpha-adrenergic properties
Dose :0.01mg/kg body weight repeated every 5 minutes
Atropine sulfate:
indicated when bradycardia coexists with hypotension
Dose:Adults:0.5mg IV every 3-5minutes
Children:0.2mg per kg to maximum 0.5mg per kg body weight
lignocaine or xylocaine:
indicated in ventricular tachycardia
Dose:1mg/kg body weight followed by 0.5mg/kg body weight followed
by infusion[maximum 3mg/kg body weight]
Calcium
Indicated in hypocalcemia,hypercalcemia,ca-channel blocker overdose
Dose:10mg/kg body weight IV
Sodium bicarbonate
Indicated in metabolic acidosis, prolonged duration of arrest
Dose : 1mg/kg body weight ,half dose repeated every 10 minutes
POST CARDIAC COMPLICATIONS
Complications of CPR
Rib fractures
Gastric laceration or rupture
Splenic rupture
pneumothorax
