CARDIOPULMONARY

RESUSCITATION

Yohanes Rudijanto, dr., SpAn.

KSM Anestesiologi
RS Immanuel - Bandung
 Updates in CPR Guidelines
2005 2010
A-B-C C-A-B
Look, Listen, Feel *removed
Compression ± Compression ≥
100x/mnt 100x/mnt
Compression 4-5 cm Compression ≥ 5 cm
“Push hard-push fast “
Hands only CPR
 INTRODUCTION
 Mr. K, 57 yo, was queuing for lunch in KFC
in front of you
 Suddenly he clutched his chest, gasping
for breath and fell down to the floor,
unconscious
 You, as a medical student, were the only
person to help
WHAT WILL YOU DO ?
 CPR
 Combines rescue breathing and chest
compressions
 Revives heart (cardio) and lung
(pulmonary) function
 Used if no breathing and no pulse
 Provides O2 to the brain until
Advanced Care arrives (ACLS)
Chain of Survival
Chain of Survival
 Why CPR Works

 Effective CPR provides 1/4 to 1/3

normal blood flow
 Rescue breaths contain 16% oxygen
(21%)
 Start CPR Immediately

 Better chance of survival

 Brain damage starts in 4-6 minutes

 Brain damage is certain after 10

minutes without CPR
 Even With Successful CPR, Most
Won’t Survive Without ACLS

 ACLS (Advanced
Cardiac Life
Support)
 ACLS includes
defibrillation,
oxygen, drug
therapy
 Age Criteria

 Adults : over 8 years of age

 Children : 1 to 8
 Infants : 0 to 1
Survey The Scene, then: RAP

R - Responsiveness
 Tap shoulder and
shout “Are you ok?”
 RAP
 A - Activate EMS ( if unresponsive)
 YOU - call 911 – come back and let
me know what they said (another can
stay by the phone)
 You may have to make the call
 Kenyataan lapangan

 Kemungkinan harus mempersiapkan

pasien untuk transfer ke RS
 RAP
P - Position on back
 All body parts rolled over at the
same time
 Always be aware of head and spinal
cord injuries
 Support neck and spinal column
 ABC of Resuscitation
 Airway
 Breathing

 Circulation

 Disability (keep this in mind from

the beginning) + Defibrillation
 Updates in CPR Guidelines
2005 2010
A-B-C C-A-B
Look, Listen, Feel *removed
Compression ± Compression ≥
100x/mnt 100x/mnt
Compression 4-5 cm Compression ≥ 5 cm
“Push hard-push fast “
Hands only CPR
 Cause of the need for CPR

 SCA : Sudden Cardiac Arrest : CAB

 Stroke : ABC

 Drowning : ABC

 FBAO : Foreign Body Airway

Obstruction : ABC
 A – Open the airway

A – Airway
 Open the airway
 Head tilt chin lift

 Jaw thrust
 B – Check For Breathing

 Look, listen and

feel for breathing
 No longer than
10 seconds
 Breathing
 If the victim is not
breathing, give two
breaths (1½ - 2 sec.)
 Pinch the nose
 Seal the mouth with yours

 If the first two don’t go in,

re-tilt and give two more
breaths (if breaths still do
not go in, suspect choking)
 Rescue Breathing
If victim shows signs of
circulation but is not
breathing:
 1 rescue breath every 5 sec.
 Reassess after 1 minute and
every few minutes thereafter
 No chest compressions when
there are signs of circulation
 C - Circulation
 Check for circulation
(< 10 sec.)
 Maintain head tilt
 Observe:
 Breathing, coughing, movement,
normal skin temp. and color,
improved level of responsiveness,
pulse
 Check pulse at carotid artery
NEAREST YOU
 Chest Compression
 If there is no breathing and no
signs of circulation:
 Do chest compressions
 Place heel of one hand on center of
chest between the nipples OR
 Feel up the rib cage

 Place middle finger at the xiphoid

process, index finger next to it
Hand Placement for CPR
External Chest Compression
 Place heel of the hand
next to the index finger
(on the sternum)
 Using both hands, give
30 chest compressions
 Count 1 and 2 and 3
and....
 Depth of compressions:
1 .5 to 2 inches
 External Chest
Compression
 After 30 chest compressions give:
 2 slow breaths
 Complete 5 cycles (30:2) in 2
minutes
 Re-check for circulation (after 2
minute)
 Continue CPR reassessing every few
minutes
 Continue CPR
Until :
 Victim revives
 Trained help arrives
 Too exhausted to continue
 Unsafe scene
 Physician directed (do not resuscitate
orders)
 Cardiac arrest > 30 minutes
 controversial
 Two Persons CPR

 Rescuer 1:
 RAPABC
 Rescuer 2:
 While circulation is
being checked, place
hands for compressions
 Compression rate: 30:2
 Switch off when tired
 Why CPR May Fail

 Delay in starting
 Improper procedures (ex. forget to pinch
nose)
 No ACLS follow-up and delay in defibrillation
 Only 15% who receive CPR live to go home
 Improper techniques
 Terminal disease or unmanageable disease
(massive heart attack)
 Injuries Related to CPR

 Rib fractures
 Laceration related to the tip of the
sternum
 Liver, lung, spleen
 Complications of CPR

 Vomiting
 Aspiration
 Place victim on left side

 Wipe vomit from mouth with fingers

wrapped in a cloth
 Reposition and resume CPR
 Stomach Distension
 Air in the stomach
 Creates pressure against the lungs
 Prevention
 Don’t blow too hard
 Slow rescue breathing

 Re-tilt the head to make sure the

airway is open
 Use mouth to nose method
Mouth to Mouth Barrier Devices

 Masks, Shields
 Rescue Breathing: Child

 Respiration and breathing are

rates increased
 Give 1 breath every 3 seconds

 If alone, activate EMS after one

minute of resuscitation
 Recheck circulation every minute
 CPR : Child
 Compress sternum with one hand (1 to
1.5 inches deep)
 Keep other hand on the tilted head
 Choking
 The tongue is the most common
obstruction in the unconscious victim
(head tilt- chin lift)
 Vomit
 Foreign body
 Balloons
 Foods
 Swelling (allergic reactions/ irritants)
 Spasm (water is inhaled suddenly)
 How To Recognize Choking
 Can you hear breathing or coughing
sounds?
 High pitched breathing sounds?
 Is the cough strong or weak?
 Can’t speak, breathe or cough
 Universal distress signal (clutches neck)
 Turning blue
 Recognizing Choking #2

A partial airway obstruction

with poor air exchange
should be treated as if it were
a complete airway blockage.
 If victim is coughing strongly,
do not intervene
Foreign Body Airway Obstruction

 Give 5 abdominal thrusts (Heimlich

maneuver)
 Place fist just above the
umbilicus (normal size)
 Give 5 upward and inward thrusts
 Pregnant or obese? 5 chest thrusts
 Fists on sternum
 Continue until successful or victim
becomes unconscious
 Choking: Conscious Infants

 Position with head

downward
 5 back blows

 5 chest thrusts

 Repeat
 Update
Guidelines
for CPR
(2005)
 BREATHING CHECK

OLD

Present or absence
of breathing check
NEW

Check 5-10 second

No “Normal” breath

2 rescue breaths CPR

X
“GASPING” is “NO
BREATHING” !
 AIRWAY MANOUVRES
OLD NEW

Jaw thrust Head tilt or Chin lift

X 
 Jaw thrust is difficult and can
produce movement of an injured
spine like other techniques
OLD

Breath were
to be
NEW

Breath given over 1
second see
delivered chest rise
over 1 to 2 Avoid too large and
second forcefull

X
 During CPR, blood flow to the lung
decrease need for ventilation decrease
 Rescue breath increase pressure in the
chest decrease refill the heart
decrease blood flow in the next
compressions
 CPR is interupted more often
 Chest Compression
OLD NEW
Emphasized on “Push hard and push fast”
(except newborn)
quality and rate Recoil chest
Limited interruption
(100x/min)

X 
 Rate, depth, recoil adequate more
blood flow

 CPR interrupted  blood flow stop 

first few compression are not as
effective as the later compressions
Compression-to-Ventilation Ratio
OLD

15 : 2 X
NEW

30 : 2
excluding
newborn

 The higher the C-to-V ratio the
more chest compressions are
given in a series during CPR
increase blood flow
 Defibrillation
OLD NEW
 “Shockable rhytm” 1 shock following by
3 shocks without any immediate CPR 5
CPR between the cycles and than


shocks check rhytm
 Check the rhytm
before and after
shocks
X
 The rhytm analysis result in delays of 37
second even longer after each shock
 In cases first shock fails, resumption of CPR
is likely to confer a greater value than
another shock
 Shock eliminates VFseveral minutes for a
normal heart rhytm to return and to create
blood flow
 There is no evidence that CPR immediately
after defib will provoke recurrent VF
AHA CPR GUIDELINES 2005
 Updates in CPR Guidelines
2005 2010
A-B-C C-A-B
Look, Listen, Feel *removed
Compression ± Compression ≥
100x/mnt 100x/mnt
Compression 4-5 cm Compression ≥ 5 cm
“Push hard-push fast “
Hands only CPR
2005
2010
2010
THANK
YOU