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CARDIOPULMONA
RY RESUSCITATION
definition
Cardiopulmonary resuscitation
describe a combined technique of
mouth-to-mouth ventilation and
closed cardiac chest compressions in
a pulseless patient
History
 CPR is a term that was first used in the early
1960s
 Specific techniques have been revised every 5
to 6 years.
 The most recent guidelines were released in
October 2010
Chain of Survival3
Simplified Universal Adult BLS
Algorithm
 729
American Heart Association
CPR
 Bsic life support
Advanced cardiac life
support
Elements of BLS
 Noninvasive emergency lifesaving care
 For any patient having cardiac arrest, the most important
steps are
(1) immediate recognition of unresponsiveness,
(2) checking for lack of breathing or lack of normal
breathing
(3) activating an emergency response system and retrieving
an automated external defibrillator (AED),
(4) checking for a pulse (no more than 10 seconds), and
(5) starting cycles of 30 chest compressions followed by 2
breaths
Responsiveness
Prior to approaching a
victim, the rescuer should
make sure that the scene
is safe; then the victim is
assessed for responsiveness
by tapping or questioning
(“Are you OK?”).
A quick check for presence of breathing or lack
of normal breathing should
occur simultaneously
then the emergency
response system should
be activated,
and an AED should be
quickly retrieved.
Circulation
 The health care provider should take no more
than 10 seconds to check for a definitive pulse
either at the carotid or femoral artery
 IF the patient has
 No pulse,
 No signs of life,
 Or the rescuer is unsure,
 THEN compressions should be started
immediately
METHOD
 The heel of the hand should be placed
longitudinally on the lower half of the sternum,
between the nipples
 The sternum should be depressed at least 5 cm
(2 inches) at a rate of at least 100 compressions
per minute.
 Complete chest recoil is necessary to allow for
venous return and is important for effective CPR
 The pattern should be 30 compressions to 2
breaths (30:2 equals 1 cycle of CPR), regardless
of whether one or two rescuers are present.
How CPR Works
717
“C-A-B” rather than “A-B-C”
New for 2010
 Initiate chest compressions
before ventilations.
Why Change?
 Beginning CPR with 30
compressions rather than 2
ventilations leads to a
shorter delay to first
compression11-13 providing
vital blood flow to the
heart and brain.
How can CPR be effective without
rescue breathing?
 because the oxygen level in the blood remains
adequate for the first several minutes after cardiac
arrest.4
 Animal models suggest gasping do allow for some
oxygenation and carbon dioxide (CO2)elimination.9-10
AIR WAY opening
Opening of the airway can be achieved by
Simple head tilt–chin lift technique
Oral or nasal airway
Tracheal intubation
Laryngeal mask
Breathing
 chest compression-alone CPR is not inferior
to traditional compression-ventilation CPR,
health care providers are still expected to
provide assisted ventilation
 A lone rescuer, if not an expert in airway
management, should not use a bag-mask for
ventilation, but should use mouth-to-mouth
or mouth-to-mask
Assessing ABCs
(8 of 18)
NOTE
 Care should be taken to avoid rapid or forceful
breaths
 Delivered tidal volumes are given over 1 second
and should produce visible chest rise.
 Delivered tidal volumes are given over 1 second
and should produce visible chest rise
 A lower than normal minute ventilation (cardiac
output is much less than normal) should be the
goal (CO2 and brain vasoconstriction and delay
neurologic recovery.)
Mouth to Mouth Barrier
Devices
Assessing ABCs
(12 of 18)
Defibrillation
 A defibrillator should be attached to the patient
as soon as possible.
 Proper electrode pad placement on the chest
wall should be to the right of the upper sternal
border below the clavicle and to the left of the
nipple with the center in the midaxillary line
 Alternative locations include anteriorposterior,
anterior-left infrascapular, and anterior-right
infrascapular. Right anterior axillary to left
anterior axillary is not recommended(718)
ENERGY USED FOR
DEFIBRILLATION
 amount of energy (joules) delivered is dependent
on type of defibrillator used
 Two major defibrillator types
 monophasic : deliver a unidirectional energy charge
 Biphasic : deliver bidirectional energy charge more
successful in terminating ventricular tachycardia (VT)
and ventricular fibrillation(VF) In addition, biphasic
waveform shocks require less energy than traditional
monophasic waveform shocks (120 to 200 J versus 360
J, respectively) and may therefore cause less
myocardial damage.
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)
(Adult
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
 If unsuccessful, support chest with one hand
and give back blows with the other
If Victim Becomes
Unconscious After Giving
Thrusts
 Call 115
 Try to support victim with your
knees while lowering victim to
the floor
 Assess
 Begin CPR
 After chest compressions, check
for object before giving breaths
breaths
Choking: Conscious
Infants
 Position with head
downward
 5 back blows (check for
expelled object)
 5 chest thrusts (check for
expelled object)
 Repeat
Tracheal intubation
 226-230-239