CARDIOPULMON

ARY
RESUSCITATION
(CPR)
 Definition:
• Cardiopulmonary resuscitation
(CPR) consists of the use of chest
compressions and artificial
ventilation to maintain
circulatory flow and oxygenation
during cardiac arrest.
 Indication:
• CPR should be performed
immediately on any person who has
become unconscious and is found to
be pulse less. Assessment of cardiac
electrical activity via rapid “rhythm
strip” recording can provide a more
detailed analysis of the type of
cardiac arrest, as well as indicate
additional treatment options.
 Equipment

• CPR, in its most basic form, can be

performed anywhere without the
need for specialized equipment.
Universal precautions (ie, gloves,
mask, and gown) should be taken.
However, CPR is delivered without
such protections in the vast majority
of patients who are resuscitated in
the out-of-hospital setting.
• A cardiac defibrillator provides an electrical
shock to the heart via 2 electrodes placed on
the patient’s torso and may restore the heart
into a normal perfusing rhythm.
 Technique
In its full, standard form, CPR comprises the
following 3 steps, performed in order:
• Chest compressions
• Airway
• Breathing
For lay rescuers, compression-only CPR
(COCPR) is recommended.
Positioning for CPR is as follows:
• CPR is most easily and effectively
performed by laying the patient supine on a
relatively hard surface, which allows
effective compression of the sternum
• Delivery of CPR on a mattress or other soft material
is generally less effective
• The person giving compressions should be
positioned high enough above the patient to achieve
sufficient leverage, so that he or she can use body
weight to adequately compress the chest.
For an unconscious adult, CPR is initiated as follows:
• Give 30 chest compressions
• Perform the head-tilt chin-lift maneuver to open the
airway and determine if the patient is breathing
• Before beginning ventilations, look in the patient’s
mouth for a foreign body blocking the airway
 Chest compression
The provider should do the following:
• Place the heel of one hand on the patient’s
sternum and the other hand on top of the first,
fingers interlaced
• Extend the elbows and the provider leans directly
over the patient
• Press down, compressing the chest at least 2 in
• Release the chest and allow it to recoil completely
• The compression depth for adults should be at
least 2 -3 inches (instead of up to 2 inches, as in
the past)
• The compression rate should be at least 100/min
The key phrase for chest compression is, “Push hard
and fast”
• Untrained bystanders should perform
chest compression–only CPR (COCPR)
• After 30 compressions, 2 breaths are
given. 30:2
• This entire process is repeated until a
pulse returns or the patient is
transferred to definitive care
• To prevent provider fatigue or injury,
new providers should intervene every
2-3 minutes (ie, providers should swap
out, giving the chest compressor a rest
while another rescuer continues CPR
 Ventilation- BREATHING

If the patient is not breathing, 2 ventilations

are given via the provider’s mouth or
a bag-valve-mask (BVM). If available, a
barrier device (pocket mask or face shield)
should be used.
• To perform the BVM or invasive airway
technique, the provider does the following:
• Ensure a tight seal between the mask and
the patient’s face
• Squeeze the bag with one hand for
approximately 1 second, forcing at least
500 mL of air into the patient’s lungs
BAG VALVE MASK / AMBU BAG
 MOUTH 2 MOUTH
the provider does the following:
• Pinch the patient’s nostrils closed to assist
with an airtight seal
• Put the mouth completely over the patient’s
mouth
• After 30 chest compression, give 2 breaths
(the 30:2 cycle of CPR)
• Give each breath for approximately 1 second
with enough force to make the patient’s
chest rise
• Failure to observe chest rise indicates an
inadequate mouth seal or airway occlusion
• After giving the 2 breaths, resume the CPR
cycle
 Complications

Complications of CPR include the following:

• Fractures of ribs or the sternum from
chest compression (widely considered
uncommon)
• Gastric insufflations from artificial
respiration using noninvasive ventilation
methods (eg, mouth-to-mouth, BVM); this
can lead to vomiting, with further airway
compromise or aspiration; insertion of an
invasive airway (eg, endotracheal tube)
prevents this problem
 INDICATIONS FOR BASIC LIFE
SUPPORT (BLS)
Cardiac arrest
Cardiac arrest occurs when the heart
stops pumping in a regular rhythm. In
this situation, early defibrillation is the
key to returning the victim's heart back
to a normal rhythm. When a
defibrillator is not readily available, a
rescuer or bystander should keep the
blood flowing by performing chest
compressions and rescue breaths at an
age-appropriate rate until it is restored.
 Respiratory Arrest
Respiratory arrest is when there is no
measurable breathing in a victim. It
tends to occur in conjunction with
cardiac arrest, but this is not
always the case. Respiratory arrest
is the most common indication of
BLS in infants and toddlers. The
most critical factor in restoring
breathing in the victim is to provide
high quality rescue breaths.
 DROWNING
• In cases of drowning, rescuers should provide
CPR as soon as an unresponsive victim is
removed from the water. In particular, rescue
breathing is important in this situation. A lone
rescuer is typically advised to give CPR for a
short time before leaving the victim to call
emergency medical services. Since the primary
cause of cardiac arrest and death in drowning
and choking victims is hypoxaemia, it is
recommended to start with rescue breaths
before proceeding to chest compressions (if
pulseless). If the victim presents in a shockable
rhythm, early defibrillation is still
recommended.
 Choking

• Choking occurs when a foreign body

obstructs the trachea. Rescuers
should only intervene in victims who
show signs of severe airway
obstruction, such as a silent cough,
cyanosis, or inability to speak or
breathe. If a victim is coughing
forcefully, rescuers should not
interfere with this process and
encourage the victim to keep
coughing.
• If a victim shows signs of severe airway
obstruction, anti-choking manoeuvres
such as thrusts should be applied until
the obstruction is relieved. If a victim
becomes unresponsive he should be
lowered to the ground, and the rescuer
should call emergency medical services
and initiate CPR. When the airway is
opened during CPR, the rescuer should
look into the mouth for an object causing
obstruction, and remove it if it is evident
 Jaw-thrust manoeuvre
The jaw-thrust manoeuver is a first
aid and medical procedure used to
prevent
the tongue from obstructing the upper
airways. This manoeuver and the head-
tilt/chin-lift manoeuver are two of the
main tools of basic airway
management, and they are often used
in conjunction with other basic airway
techniques including bag-valve-mask
ventilation.
• The jaw-thrust maneuver is often used on
patients with cervical neck problems or
suspected cervical spine injury.
• The maneuver is used on a supine patient.
It is performed by placing the index and
middle fingers to physically push the
posterior aspects of the lower jaw upwards
while their thumbs push down on the chin
to open the mouth. When the mandible is
displaced forward, it pulls the tongue
forward and prevents it from obstructing
the entrance to the trachea.
 Jaw-thrust maneuver cont’d
• Traditionally, the jaw-thrust
maneuver has been considered the
better alternative (rather than the
head-tilt/chin-lift maneuver) when
a first aider suspects that the
patient may have a spinal
injury (especially one to the neck
portion of the spine).
 How to perform abdominal thrusts
(Heimlich manoeuvre) on yourself
Because choking cuts off oxygen to the
brain, give first aid as quickly as
possible.
The universal sign for choking is hands
clutched to the throat. If the person
doesn't give the signal, look for these
indications:
• Inability to talk
• Difficulty breathing or noisy breathing
• Squeaky sounds when trying to breathe
• Cough, which may either be weak or
forceful
• Skin, lips and nails turning blue or
dusky
• Skin that is flushed, then turns pale or
bluish in colour
• Loss of consciousness
• If the person is able to cough forcefully,
the person should keep coughing. If the
person is choking and can't talk, cry or
laugh forcefully, a "five-and-five"
approach to delivering first aid:
• Give 5 back blows. Stand to the
side and just behind a choking
adult.
• Give 5 abdominal thrusts. Perform
five abdominal thrusts (also known as
the Heimlich manoeuvre).
• Alternate between 5 blows and 5 thrusts until
the blockage is dislodged
 Heimlich manoeuvre) on someone else
• Stand behind the person. Place one foot slightly in
front of the other for balance. Wrap your arms
around the waist. Tip the person forward slightly. If
a child is choking, kneel down behind the child.
• Make a fist with one hand. Position it slightly above
the person's navel.
• Grasp the fist with the other hand. Press hard into
the abdomen with a quick, upward thrust — as if
trying to lift the person up.
• Perform between six and 10 abdominal
thrusts until the blockage are dislodged.
If the person becomes
unconscious, perform
standard cardiopulmonary
resuscitation (CPR) with chest
compressions and rescue
breaths.
• To clear the airway of a choking infant younger
than age 1:
• Assume a seated position and hold the infant
face down on your forearm, which is resting on
your thigh. Support the infant's head and neck
with your hand, and place the head lower than
the trunk.
• Thump the infant gently but firmly five times on
the middle of the back using the heel of your
hand. The combination of gravity and the back
blows should release the blocking object. Keep
your fingers pointed up to avoid hitting the infant
in the back of the head.
• Turn the infant face up on your
forearm, resting on your thigh with
the head lower than the trunk if the
infant still isn't breathing. Using two
fingers placed at the centre of the
infant's breastbone, give five quick
chest compressions. Press down about
1 1/2 inches, and let the chest rise
again in between each compression.
• Repeat the back blows and chest
thrusts if breathing doesn't resume.
Call for emergency medical help.
• Begin infant CPR if one of these
techniques opens the airway but the
infant doesn't resume breathing.
• If the child is older than age 1 and
conscious, give abdominal thrusts
only. Be careful not to use too much
force to avoid damaging ribs or
internal organs