By

Dr. M. Imroze Habib

A combination of expired air ventilation

(rescue breathing) and chest compression is
known as cardiopulmonary resuscitation
(CPR), which forms the basis of modern
basic life support.

Basic life support (BLS) is the maintenance

of an airway and the support of breathing
and the circulation without using equipment
other than a simple airway device or
protective shield.

75% of all cardiac arrests happen in people's homes.

CPR doubles a person's chance of survival from
sudden cardiac arrest.
There has never been a case of HIV transmitted by
mouth-to-mouth CPR.
CPR provides a trickle of oxygenated blood to the
brain & heart & keeps these organs alive until
defibrillation can shock the heart into a normal
rhythm.
If CPR is started within 4 minutes of collapse &
defibrillation provided within 10 minutes, a person
has a 40% chance of survival.

Institute CPR within 3 minutes.

Cardiopulmonary resuscitation is usually not
effective in preventing brain damage unless
it is not initiated within 4 minutes of an
cardiac arrest.
Brain damage is certain after 10 minutes
without CPR!

 Effective

CPR provides 1/4 to 1/3

normal blood flow.
Rescue breaths contain 16% oxygen.
(21% present in air)

CPR should be performed immediately on

any person who has become unconscious
and is found to be pulseless.
Assessment of cardiac electrical activity via
rapid "rhythm strip" recording can provide a
more detailed analysis of the type of cardiac
arrest as well as indicate additional
treatment options.

Loss of effective cardiac activity is generally

due to the spontaneous initiation of a
nonperfusing arrhythmia, sometimes
referred to as a "malignant arrhythmia."
The most common nonperfusing
arrhythmias include the following:

Ventricular fibrillation (VF)

Pulseless ventricular tachycardia (VT)
Pulseless electrical activity (PEA)
Asystole
Pulseless bradycardia

Check response
Gentle shake by the
shoulder and ask
simple questions.
Are you OK?
Can you hear me?
Open your eyes.

Call for help

Phone for available
EMS system and
second rescuer.

 Airway
Breathing
Circulation
Defibrillation

If victim is unconscious but does

display vital signs, place on left side

 Positioning

and
establishment of
airway
Open airway
Head tilt chin lift
Jaw thrust (when
applicable)
Do not tilt head in
infants (0-1 yr)
because trachea can
collapse if neck is
hyper extended.

Any foreign body or

fluid
Turn on to that side
and clear

 Check

breathing
Look (At the chest
movement)
Listen (For air
escaping)
Feel (For expired
air)
No

longer than 10
seconds

 Rescue

breath

If not breathing
Give 2 breaths
Make chest rise
If the first two
dont go in, re-tilt
the head and give
two more breaths
(if breaths still do
not go in, suspect
choking)

 If

no response,
check pulse for
10 seconds
Peripheral
Femoral
Carotid

Definite

pulse

Give 1 breath every

5 - 6 seconds
Recheck pulse every
2 minutes

If no pulse or any
sign of life
Give cycles of 30
compressions and 2
breaths
Chest depressions
for Adult: 1.5-2
Children (1-8 yrs):
1-1.5
Infant (0-1 yr): 0.51

 Do this at
least 5 times
in 2 minutes
until
AED or
Defibrillator
arrives
ALS providers
take over
Victim starts to
move

 If the person
shows signs of
life, then place
the person on
their side
(Recovery
Position)

If the person shows No signs of life, continue

CPR till help arrives
AED (Automated External Defibrillator)
Defibrillator
EMS team

Step by step approach:

When AED arrives, place it at the victims side,

next to the responder using it.
First - POWER on the AED.
Second - ATTACH the pads to the victim, then
attach to AED.
Third - Clear the victim and ANALYZE the rhythm,
by pressing the analyze button.
Fourth - SHOCK If the AED advises a shock,
Clear the victim and press the SHOCK button.

CPR After AED gives the shock, begin CPR

beginning with chest compressions.
RE-ANALYZE After 2 minutes of CPR, press
ANALYZE on AED.
Four Special situations:
Take heed of the four special situations (hairy
chest, wet/water, pacemaker, and medicine
patch) and know what to do and take precautions

Use adult pads on victims aged 8 and Older.

Use specialized pediatric pads on victims aged 1 to
8.
Currently no evidence to recommend for AED use
on infants aged 1 or less.

Injuries Related to CPR

Rib fractures
Bruising and Lacerations
Injuries to internal organs like liver, lung, spleen
Ensure correct technique

Vomiting
Aspiration
Place victim on left side
Wipe vomit from mouth with fingers wrapped in a
cloth
Reposition and resume CPR

Air in the stomach

Creates pressure against the lungs
Prevention of Stomach Distension

Dont blow too hard

Slow rescue breathing
Re-tilt the head to make sure the airway is open
Use mouth to nose method

The only absolute contraindication for CPR

is a Do Not Resuscitate (DNR) order or other
advanced directive indicating a person's
desire to not be resuscitated in the event of
cardiac arrest.
A relative contraindication for performing
CPR is if a clinician justifiably feels that the
intervention would be medically futile,
although this is clearly a complex issue that
is an active area of research.

(Ref: http://emedicine.medscape.com/article/1344081-overview)

Delay in starting
Improper procedures (e.g. Forget to pinch
nose)
Improper techniques
No ACLS follow-up and delay in
defibrillation

Only 15% who receive CPR live to go home

Terminal disease or unmanageable disease

(e.g. massive heart attack)

 The resuscitation is successful

Spontaneous return of vital functions
Assisted life supports measures are
initiated
Patient is transferred to Emergency
Vehicle or Code Team arrives
Unsafe scene
Patient is pronounced dead by physician
Rescuer is too exhausted to continue