BY

ASHOK BISHNOI
Lcturer,JINR
INTRODUCTION:-
 Sudden death occur when heartbeat &
breathing stop suddenly or unexpectedly.
the major role of CPR is to provide oxygen to
heart ,brain,& the other vital organ until
medical treatment (advance cardiac life
support-ACLS) can restore normal heart
action.
DEFINITION:-
 Angela Morrow RN
Cardiopulmonary resuscitation
(CPR) is a procedure used when a patient's heart stops
beating and breathing stops. It can involve
compressions of the chest or electrical shocks along
with rescue breathing.

 Mosby medical dictionary

CPR is a basic emergency
procedure for life support consisting of artificial and
manual external cardiac massage

.
CHAIN OF SURVIVAL:-
INDICATIONS:-
 Cardio vascular disorders

CAD, congenital heart diseases , coronary

embolism, cardiac rupture & dissection
 Pulmonary causes

pulmonary embolism, pulmonary edema, asphyxia

 Metabolic causes

hypoglycemia, electrolyte imbalances

 Fluid imbalance

extensive hemorrhage, hypotension, shock

 Neurological causes

brain injuries, massive cva

 Poisons substance and drug overdose

co poisoning, propanolol over dose

 Other causes

electrical shock, hypothermia, narcotic overdose

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

 Hypothermia
CPR PROCEDURE
EQUIPMENTS
i. Ambu bag and masks with different size.

ii. Oropharyngeal airways.

E
T

iii. Endotracheal tubes of appropriate T

U
sizes and stillet. B
E
iv. Paediatric laryngoscope
with straight (Miller) and
curved (McIntosh)
blade – Appropriate sizes.

v. Suction apparatus.

vi. NG tube.
i. IV equipments & fluids
ii. Pulse-oxymetry
iii. Oxygen sources
iv. Automated external defibrillator

v. Emergency drugs
vi. Cardiac monitor
STEPS FOR CPR:-
 Airway:-Maintaining an open airway.

 Breathing:-Providing artificial ventilation by rescue

breathing.

 Circulation:-Promoting artificial circulation by

external cardiac compression.

 Defibrillation:-Restoring the heart beat.

CHECK RESPONSE

Shake shoulders gently

Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
(A) AIRWAY :-
 Head tilt chin lift manoeuvre

 Jaw thrust manoeuvre

 HEAD TILT CHIN LIFT MANOEUVRE
 JAW THRUST MANOEUVRE
(B) Breathing:-
Look Listen Feel
Method:
 Mouth to mouth ventilation

 Mouth to mask ventilation

 Bag mask ventilation

 MOUTH TO MOUTH VENTILATION
MOUTH TO MASK VENTILATION
BAG MASK VENTILATION
NEONATAL PEDIATRIC ADULT
(C) Circulation:-

Assess pulse
{Adult}
Assess pulse (infant)
CHEST COMPRESSIONS
CHEST COMPRESSIONS

• Place the heel of one hand in

the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 3-5 cm(1.5 to 2 inches)
– Equal compression : relaxation
• When possible change CPR
operator every 2 min
 IN ADULT
 IN CHILD
 IN INFANT
(D) DEFIBRILLATION:-
 Device that delivers direct electrical current
across the myocardium. The aim is to produce
synchronous depolarization of cardiac muscle

STRATEGIES:
Test defibrillate for
 full battery charge
 switch on power button
 change paddle mode
 Key issues:
Paddle site: Rt intraclavicular region
lt lower axillary region
Paddle size: 8cm -12 cm
wave form patterns :
monophasic
biphasic truncated exponential
biphastic rectilinear
Energy level:

Pediatric : 2-4 J/kg

Adult: Monophasic=> 360J

Biphasic truncated=> 150-200J
Biphasic rectilinear=> 120 J
 STEPS:-
 switch on

 select paddle mode

 assess rhythm

 press paddles firmly over the chest

 deliver the shock

 resume cpr
 Intensive care:-(shifting in ICU)

 transfer to ICU
 monitor closely and continuously
 monitor vital signs every hour
 watch for convulsions
 intubate if necessary
 catheterize the patient and monitor output
 record the procedure
POST CARDIAC ARREST MANAGEMENT:-
Continued care
 To ensure hemodynamic monitoring
 To minimize the effect of loss of spontaneous
circulation of various organs
 To recognize and treat recurrent cardiac arrests
Objectives:
 Optimize cardio pulmonary function& systemic
perfusion
 Transport victim out of hospital
 Identify and treat thre precipating factor
 Intitute measure to prevent recurrence and improve
neurological function
 Respiratory system;
 Intubate & mechanically ventilate until they are stable
 Administer supplemental oxygen
 Obtain chest x ray
 Administer drugs
 Avoid hyperventilation

 Cardio vascular system:

 Obtain expert consultation
 Monitor ecg , x-ray, lab analysis,
 Monitor intra arterial blood pressure
 Administer drugs
COMPLICATIONS OF CPR:-:-

 Rib fractures
 Laceration related to the tip of the
sternum
 Liver, lung, spleen
 Aspiration
 Vmiting