CPR

• Cardiopulmonary resuscitation (CPR)


  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

  
• Cardiopulmonary resuscitation


  A series of steps used to establish artificial ventilation and circulation in the patient who is not breathing and has no pulse
• Indications for CPR


  • Cardiac arrest
  • Respiratory arrest
  • Combination of both

  
• Cardiac arrest


  Loss of cardiac function, breathing and loss of consciousness
• Causes of cardiac arrest (6H & 4T)

  • Hypoxia
  • Hypotension
  • Hypothermia
  • Hypoglycemia
  • Acidosis
  • Hypokalemia
  • Cardiac tamponade
  • Tension pneumothorax
  • Thromboembolism
  • Toxicity

  
• Diagnosis of cardiac arrest (TRIAD)


  • Loss of consciousness
  • Loss of apical & central pulsations (carotid, femoral)
  • Apnea

  
• How CPR works


  • Air we breathe in travels to our lungs where oxygen is picked up by our blood and then pumped by the heart to our tissue and organs
  • When a person experiences cardiac arrest, the heart goes from a normal arrhythmic pattern called ventricular fibrillation, and eventually ceases to beat altogether, preventing oxygen from circulating throughout the body
  • CPR serves as an artificial heartbeat and an artificial respirator
• CPR may not save the victim even when performed properly, but if started within 4 minutes of cardiac arrest and defibrillation is provided within 10 minutes, a person has a 40% chance of survival
• Equipment for CPR

  • A hard flat surface
  • No additional equipment is necessary but in hospital setting, an emergency crash cart with defibrillator and cardiac monitor should be brought to the bedside

  
• Contents of a crash cart

  • Airway equipment
  • Suction equipment
  • Intravenous equipment
  • Laboratory tubes and syringes
  • Pre packed medication for advanced tide support
• Basic Life Support (BLS)


  Life support without the use of special equipment
• Advanced Life Support (ACLS)

  Life support with the use of special equipment (e.g., Airway, endotracheal tube, defibrillator)
• Chain of Survival


  • Early recognition
  • CPR sequence
  • Defibrillation
  • Advanced life support
• Early recognition


  Assessment including unresponsiveness, no breathing or no normal breathing, no pulse felt within 10 seconds
• CPR Sequence


  1. Compressions

  2. Airway

  3. Breathing
• Chest compressions (cardiac massage)

  The human brain cannot survive more than 3 minutes with lack of circulation, so chest compressions must be started immediately for any patient with absent central pulsations
• Technique of chest compression

  1. Patient must be placed on a hard surface

  2. The palm of one hand is placed in the concavity of the lower half of the sternum 2 fingers above the xiphoid process

  3. The other hand is placed over the hand on the sternum

  4. Shoulders should be positioned directly over the hands with the elbows locked straight and arms extended

  5. Sternum must be depressed at least 5 cm in adults, and 2-4 cm in children, 1-2 cm in infants

  6. Must be performed at a rate of 100-120/min

  7. During CPR the ratio of chest compressions to ventilation should be 30:2 for single rescuer, and chest compressions must not be interrupted for ventilation with 2 rescuers
• Chest compressions in infant (0-12 Months)

  Chest compressions must be continued for 2 minutes before reassessment of cardiac rhythm
• Golden rules for CPR

  • Ensure high quality chest compressions: rate, depth, recoil
  • Plan actions before interrupting CPR
  • Minimize interruption of chest compressions
  • Early defibrillation of shockable rhythm
• Assessment of the adequacy of chest compressions

  • Systolic BP: 60-80 mmHg
  • Diastolic BP: > 40 mmHg
  • COP 30% of normal
• Problems and complications of chest compressions

  • Rib fractures
  • Fracture sternum
  • Rib separation
  • Pneumothorax
  • Hemothorax
  • Lung contusions
  • Liver lacerations
  • Fat emboli
• Airway


  Loss of consciousness often results in airway obstruction due to loss of tone in the muscles of the airway and falling back of the tongue
• Basic techniques for airway patency

  1. Head tilt, chin lift

  2. Jaw thrust

  3. Finger sweep

  4. Heimlich maneuvers

  
• Breathing


  1. Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing

  2. With the airway open, pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal

  3. Mouth to mouth breathing

  4. Mouth to nose breathing

  5. Mouth to mouth and nose (for infants and small children)
• Signs of restored ventilation and circulation

  • Contraction of pupil
  • Improved color of the skin
  • Free movement of the chest wall
  • Swallowing attempts
  • Struggling movements
  • Return of or strong pulse
  • Return of systemic blood pressure
  • Pulse and respiration returns
• When to terminate BLS

  • 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 Life Support (ALS)

  Includes circulation by cardiac massage, airway management by equipment, breathing by advanced techniques, defibrillation by manual defibrillator, and drugs

  
• Advanced techniques for airway patency

  • Face mask
  • Oropharyngeal airway
  • Nasopharyngeal airway
  • Laryngeal mask (LMA)
  • Endotracheal tube
  • Cricothyrotomy (Surgical Airway)
  • Tracheostomy (Surgical Airway)
• Expired air


  Contains 16% O2
• Ambu Bag (room air)

  Contains 21% O2
• Ambu bag + O2 (10-15L)

  Contains 45% O2
• Successful breathing is achieved by delivery of a tidal volume of 800-1200 ml in adults at a rate of 10-12 Breaths/min in adults
• Advanced breathing techniques


  • Self-inflating resuscitation bag (Ambu Bag)
  • Mechanical ventilator in OR or in ICU
• When to terminate BLS
• Advanced Life Support (ALS)

  Includes:

  Circulation by cardiac massage

  Airway management by equipment's

  Breathing by advanced techniques

  Defibrillation by manual defibrillator

  Drugs

  
• Advanced techniques for airway patency

  • Face Mask
  • Oropharyngeal airway
  • Nasopharyngeal airway
  • Laryngeal mask (LMA)
  • Endotracheal tube
  • Cricothyrotomy (Surgical Airway)
  • Tracheostomy (Surgical Airway)
• Expired air


  16% O2
• Ambu Bag (room air)

  21% O2
• Ambu bag + O2 (10-15L)

  45% O2
• Ambu Bag + O2 + Reservoir bag

  85% O2