Cardiopulmonary

Resuscitation

Dr. Prashant S. Agarwal

Dr. Ashok Jadon
Dept. of Anaesthesiology
TATA Motors Hospital
Jamshedpur
India
To Prevent………
 Cardiac arrest survival is dependent upon
Early CPR performed properly
For each minute that CPR & defibrillation is
delayed
Survival is reduced by 7 to 10%

Valenzuela, et al. Circulation. 1997;96:3308-13.

Chain of Survival

Early Early Early

Early Early
Access CPR Defibrillation Advanced
Care
ABCD of CPR (Learning Objectives)
A–
Airway
B–
Breathing
C–
Circulation
D–
Defibrillation
Chest Compressions
• Position Victim
• Heel of hand over nipple line
• Other hand over first hand
• Arms straight
• Shoulders above hands
• Push hard and fast @ 100/min
• Allow full chest recoil
• Interruptions not for > 10 sec.
 Compress the lower half of the sternum in
the center of the chest between the nipples
The heel of one hand touches the sternum
with the heel of the second hand on top
Wrist, elbow and shoulder in a
straight line •Compression &
ventilation ratio:
(30:2)

•Depth of
Compression :
4-5 cm

•Rate : 100
per minute
Chest
Compression
Video –
Compressions.mpg
Compression-Decompression
Compression
• Heart is squeezed between
sternum & spine
• intrathoracic pressure Increased
to force blood out of the heart

Decompression
• Allow complete chest recoil
after each compression to
maximize the vacuum in the
thoracic cavity to force blood
flow back to the heart
! Important Points
Four key Hard & Deep

aspects Chest Recoil

to Good Rate 100/min
Compressions
Uninterrupted

Rescue & Amblance Trainning Section

 Opening of Airway
• Head tilt – chin lift

Chin Lift
Head tilt
Check for Breathing

Look, Listen & Feel

 Deliver Breaths
• Use bag & mask technique
• Give O2
• Hold the mask against nose and mouth
• Give breaths while watching the chest rise
• If chest doesn't rise, reposition the mask
• Give 1 breath for 1 sec.
• @ 8 – 10 breaths / min
• Don’t over inflate
• Bag & Mask ventilation video –
AdultRescueBrwBagMask.mpg
! Important Points
Good mask seal
Four key
aspects Chest rise
to Good 1 breath 1 sec.
Breaths
Rate 10/min

Rescue & Amblance Trainning Section

 Cycles of CPR
• 2 breaths
• 30 chest compressions
• Each cycle starts with 2 breaths
• Cycle ends after 30 compressions
• Complete at least 5 cycles over 2 minutes
• Stop for pulse and rhythm check only after
completing 5 cycles of CPR
• & defibrillate only after 5 cycles
Cycles of CPR

2 30
Breaths Compressions
 Defibrillation
• Attach ECG leads
• Turn on the machine
• Analyze the rhythm
– Shockable – VF and VT
– Nonshockable – Asystole
• Charge the defibrillator (120-200J)
• Apply jelly over the pads
• Put pads on chest (hard & firm)
• Speak loud – Clear all 1, 2 & 3
• Deliver the shock after 3rd count
! Important Points
CPR “protocols” scripted to

minimize hands-off time

Ventilation
Early
+
CPR
Compression
ANY Q?
 Scene Safety

BLS Algorithm

Video
–
Assessm
 Scene Safety
BLS Algorithm

Call for Help & Defibrillator

BLS Algorithm contd..
 BLS Algorithm contd..

Video – 1-Rescuer CPR Demo.mpg

ANY Q?
Scene Safety
 • Is person responsive?
What will you do? Are you
okay?

•Check the victim for a response

•Tap on Shoulders & shout
•No painful stimuli
Victim not responding…..

Call for Help

Return to the victim &…….

Open the airway

Head tilt and chin lift

Check for……

Check for breathing

Look, listen and feel for normal breathing

If breathing is absent….

Give 2 Rescue Breaths

open the airway and give two breaths

while watching..the chest rise

Now what…..?
 pulse check

•Check Carotid Pulse

•At least for 5 sec.
•Not for more than 10 sec.
 If no pulse present…..

press down on the

sternum 4—5 cm

Place the heel of one hand in Place the heel of your other
the centre of the victim’s chest. hand on top of the first hand.
Chest Compression

push hard and push fast

Now…………..?
attach the ECG monitor
 Next…………..?
• Complete 5 cycles of CPR

Than…….…………..?

Assess & Defibrillate

• Analyze the rhythm
• Check for pulse
• Defibrillate if rhythm is shockable
• Resume CPR
• Reassess after 5 cycles
Vicious circle
 Causes of cardiac arrest

6 H’s 5 T’s
2. Toxins
3. Hypovolemia
4. Hypoxia 3. Temponade (Cardiac)
5. Hydrogen ion 4. Tension Pnumothorax
6. Hyper/hypokalemia
5. Trombosis
7. Hypoglycemia
8. Hypothermia 6. Trauma