Cardiopulmonary resuscitation
Dr Vaibhav Shahi
MD Anaesthesia
INTRODUCTION
• Cardiopulmonary resuscitation (CPR) consists of
the use of chest compressions and artificial
ventilation to maintain circulatory flow and
oxygenation during cardiac arrest.
• Although survival rates and neurologic
outcomes are poor for patients with cardiac
arrest, early appropriate resuscitation-involving
early defibrillation and appropriate
implementation of post-cardiac arrest care lead
to improved survival and neurologic outcomes.
DEFINITION
• Cardio Pulmonary Resuscitation is a
technique of basic life support for
oxygenating the brain and heart until
appropriate, definitive medical
treatment can restore normal heart
and ventilatory action.
PURPOSES
• To maintain an open and clear airway
(A).
• To maintain breathing by external
ventilation (B).
• To maintain Blood circulation by external
cardiac massages (C).
• To save life of the Patient.
• To provide basic life support till medical
and advanced life support arrives.
INDICATION
CPR should be performed immediately on any
person who has become unconscious and is
found to be pulseless.
The most common arrhythmias are…
• Ventricular fibrillation (VF)
• Pulseless ventricular tachycardia (VT)
• Pulseless electrical activity (PEA)
• Asystole
• Pulseless bradycardia
Respiratory Arresst
This may be result of following:
• Drowning
• Stroke
• Foreign body in throat
• Smoke inhalation
• Drug overdose
• Suffocation
• Accident, injury
• Coma
Contraindications
• The only absolute contraindication to CPR is a
do-not-resuscitate (DNR) order or other advanced
directive indicating a person’s desire not to be
resuscitated in the event of cardiac arrest.
• A relative contraindication to performing CPR is if a
clinician justifiably feels that the intervention would be
medically futile(useless).
Principles of CPR
• To restore effective circulation and
ventilation.
• To prevent irreversible cerebral
damage due to anoxia. When the
heart fails to maintain the cerebral
circulation for approximately four
minutes the brain may suffer
irreversible damage.
CPR procedure
Sequences of procedures performed to
restore the circulation of oxygenated blood after a
sudden pulmonary and/or cardiac arrest
Chest compressions and pulmonary
ventilation performed by ANYONE who knows
how to do it, ANYWHERE, IMMEDIATELY,
WITHOUT any other EQUIPMENT
• Universal precautions (ie, gloves, mask, gown) should
be taken.
• However, CPR is delivered without such protections in
the vast majority of patients who are resuscitated in the
out-of-hospital setting, and no cases of disease
transmission via CPR delivery have been reported.
• Some hospitals and EMS systems employ devices to
provide mechanical chest compressions.
• A cardiac defibrillator or AED provides an electrical
shock to the heart via 2 electrodes placed on the
patient’s torso and may restore the heart into a normal
perfusing rhythm.
Technique
• Cardiopulmonary resuscitation (CPR) comprises 3 steps
(CAB) :
Chest compressions (C),
Airway (A), and
Breathing (B)
• Lay rescuers should perform compression-only CPR
(COCPR).
• Healthcare providers, however, should perform all 3
components of CPR (chest compressions, airway, and
breathing).
Positioning for CPR :
• CPR is most easily and effectively performed by laying
the patient supine on a relatively hard surface, which
allows effective compression of the sternum .
• Delivery of CPR on a mattress or other soft material is
generally less effective.
• The person giving compressions should be positioned
high enough above the patient to achieve sufficient
leverage, so that he or she can use body weight to
adequately compress the chest .
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
APPROACH SAFELY!
WATCH
OBSERVE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE
SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
OPEN AIRWAY
Head tilt and chin lift
- lay rescuers
- non-healthcare rescuers
No need for finger sweep
unless solid material can be
seen in the airway
OPEN AIRWAY
Head tilt, chin lift + jaw thrust
cardio pulmonary resuscitation presentation for doctors
• Open the airway using a
head tilt lifting of chin. Do
not tilt the head too far
back
Check the pulse on carotid
artery using fingers of the
other hand
CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
CHECK BREATHING
• Look, listen and feel
for NORMAL
breathing
• Do not confuse
agonal breathing with
NORMAL breathing
AGONAL BREATHING
• Occurs shortly after the heart stops
in up to 40% of cardiac arrests
• Described as barely, heavy, noisy or
gasping breathing
• Recognise as a sign of cardiac arrest
• B (Breathing)
•
• Tilt the head back
and listen for. If
not breathing
normally, pinch
nose and cover
the mouth with
yours and blow
until you see the
chest rise.
27
mouth to mouth or mouth to nose
respiration
ventilation by a face mask and a self-
inflating bag with oxygen
2 initial subsequent breaths
wait for the end of expiration
10-12 breaths per minute with a volume of app. 800 ml, each
breath should take 1,5-2 seconds
Control over the ventilation
check chest movements during ventilation
check the air return
Algorithm
for artificial ventilation
• C. Circulation
• Restore the circulation, that is start
external cardiac massage
29
2 mechanisms explaining the
restoration of circulation by
external cardiac massage
Cardiac
pump
Thoracic
pump
30
Cardiac pump during the cardiac
massage
Blood pumping is assured by the
compression of heart between
sternum and spine
Between
compressions
thoracic cage is
expanding and heart
is filled with blood
31
Thoracic pump at the cardiac massage
Blood circulation is
restored due to the
change in intra thoracic
pressure and jugular and
subclavian vein valves
During the chest
compression blood is
directed from the
pulmonary circulation to
the systemic circulation.
Cardiac valves function
as in normal cardiac
cycle.
32
ALGORITHM of Cardiopulmonary resuscitation
4 cycles: 15 compression
and 2 breaths
10 cycles: 5 compression
and 1 breath
check the pulse on carotid arteries (5 sec)
in case of absence of pulse continue resuscitation
2 breaths (duration 1 – 1.5 sec.)
palpation of pulse on carotid arteries (5 – 10 sec.)
in case of absence of pulse initiate
external cardiac massage
1
person
compression rate 80 – 100/min.
compression/breath = 15 : 2
compression rate 80 – 100/min
compression/breath = 5 : 1
2 breaths in 4 – 7 sec. breath during 1 – 1.5 sec. after
each 5th
compression
2
persons
a
a
a
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
• Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm (1.5 to 2 inch)
– Equal compression :
relaxation
• When possible change CPR
operator every 2 min
CHEST COMPRESSIONS
Chest compression
The provider should do the following:
• Place the heel of one hand on the patient’s sternum and the other
hand on top of the first, fingers interlaced.
• Extend the elbows and the provider leans directly over the patient .
• Press down, compressing the chest at least 2 inches.
• Release the chest and allow it to recoil completely
• The compression depth for adults should be at least 2 inches
• The compression rate should be at least 100/min
• The key phrase for chest compression is, “Push hard and fast”.
NB: Untrained bystanders should perform chest compression–only CPR (COCPR)
• After 30 compressions, 2 breaths are given;
however, an intubated patient should receive continuous
compressions while ventilations are given 8-10 times per
minute.
• This entire process is repeated until a pulse returns or
the patient is transferred to definitive care
• To prevent provider fatigue or injury, new providers
should intervene every 2-3 minutes (ie, providers should
swap out, giving the chest compressor a rest while
another rescuer continues CPR .
RESCUE BREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
RESCUE BREATHS
• Pinch the nose
• Take a normal breath
• Place lips over
mouth
• Blow until the chest
rises
• Take about 1 second
• Allow chest to fall
• Repeat
RESCUE BREATHS
RECOMMENDATIONS:
- Tidal volume
500 – 600 ml
- Respiratory rate
give each breaths over about 1s with enough
volume to make the victim’s chest rise
- Chest-compression-only
continuously at a rate of 100 min
CONTINUE CPR
30 2
POSSIBLE COMPLICATIONS
• Coronary vessel injury
• Diaphragm injury
• Hemopericardium
• Hemothorax
• Interference with ventilation
• Liver injury
• Myocardial injury
• Pneumothorax
• Rib fractures
• Spleen injury
• Sternal fracture
MEDICAL MANAGEMENT
Adrenaline
• Adrenaline (epinephrine) is the main drug used
during resuscitation from cardiac arrest.
Atropine
• Atropine as a single dose of 3mg is sufficient to
block vagal tone completely and should be used
once in cases of asystole. It is also indicated for
symptomatic bradycardia in a dose of 0.5mg -
1mg.
Amiodarone
• It is an antiarrhythmic drug.
THANK YOU

More Related Content

PPTX
ADULT Cardio pulmonary resuscitation.pptx
PPTX
ADULT CARDIO PULMONARY RESUSCITATION.pptx
PPTX
Cardio pulmonary resuscitationppt
PDF
Procedure of CPR
PPTX
PPTX
cardiopulmonaryresuscitationpresentation.pptx
PDF
Cardio pulmonary resuscitation
PPTX
Cardiopulmonaryresuscitation
ADULT Cardio pulmonary resuscitation.pptx
ADULT CARDIO PULMONARY RESUSCITATION.pptx
Cardio pulmonary resuscitationppt
Procedure of CPR
cardiopulmonaryresuscitationpresentation.pptx
Cardio pulmonary resuscitation
Cardiopulmonaryresuscitation

Similar to cardio pulmonary resuscitation presentation for doctors (20)

PPTX
Cardiopulmonary Resuscitation- CPR.pptx
PPTX
Cardiopulmonary resuscitation (cpr)
PPTX
Cardiopulmonary Resuscitation (CPR)
PPTX
ACLS & BLS
PPTX
Brief explanation of Cardio Pulmonary Resucitation
PPTX
Advance cardiac life support lecture.pptx
PPTX
advance cardiac life support skills.pptx
PPTX
CPR.pptx
PPTX
cpr-211003133129 ugiglilugoiguiiyudt1).pptx
PPTX
Cardiopulmonaryresuscitation (1)
PDF
CPR 202123456UYTFDE345UHGFR5UYTR6UYT6YHG.pdf
PPTX
PPTX
CPR Principles and Techniques, Proper patient handing
PDF
details of BLS and CPR By Dr. Keerti Gupta Assistant Professor Anesthesiology
PPTX
PPTX
PPT
Cardiopulmonary resuscitation for children and adults
PPTX
CPR.pptx
PPTX
CPR. to present 1
PPTX
CPR. to present 1
Cardiopulmonary Resuscitation- CPR.pptx
Cardiopulmonary resuscitation (cpr)
Cardiopulmonary Resuscitation (CPR)
ACLS & BLS
Brief explanation of Cardio Pulmonary Resucitation
Advance cardiac life support lecture.pptx
advance cardiac life support skills.pptx
CPR.pptx
cpr-211003133129 ugiglilugoiguiiyudt1).pptx
Cardiopulmonaryresuscitation (1)
CPR 202123456UYTFDE345UHGFR5UYTR6UYT6YHG.pdf
CPR Principles and Techniques, Proper patient handing
details of BLS and CPR By Dr. Keerti Gupta Assistant Professor Anesthesiology
Cardiopulmonary resuscitation for children and adults
CPR.pptx
CPR. to present 1
CPR. to present 1
Ad

Recently uploaded (20)

PDF
B C German Homoeopathy Medicineby Dr Brij Mohan Prasad
PDF
The_EHRA_Book_of_Interventional Electrophysiology.pdf
PDF
Glaucoma Definition, Introduction, Etiology, Epidemiology, Clinical Presentat...
PPTX
Hypertensive disorders in pregnancy.pptx
PPTX
HOP RELATED TO NURSING EDUCATION FOR BSC
PDF
Forensic Psychology and Its Impact on the Legal System.pdf
PDF
Adverse drug reaction and classification
PDF
AGE(Acute Gastroenteritis)pdf. Specific.
PPTX
The Human Reproductive System Presentation
PPT
Rheumatology Member of Royal College of Physicians.ppt
PPTX
NUCLEAR-MEDICINE-Copy.pptxbabaabahahahaahha
PDF
OSCE Series Set 1 ( Questions & Answers ).pdf
PPTX
Mitral Stenosis in Pregnancy anaesthesia considerations.pptx
PPT
nephrology MRCP - Member of Royal College of Physicians ppt
PPTX
Vesico ureteric reflux.. Introduction and clinical management
PPTX
ARTHRITIS and Types,causes,pathophysiology,clinicalanifestations,diagnostic e...
PDF
OSCE Series ( Questions & Answers ) - Set 6.pdf
PPT
Blood and blood products and their uses .ppt
PPTX
Approach to chest pain, SOB, palpitation and prolonged fever
PPTX
@K. CLINICAL TRIAL(NEW DRUG DISCOVERY)- KIRTI BHALALA.pptx
B C German Homoeopathy Medicineby Dr Brij Mohan Prasad
The_EHRA_Book_of_Interventional Electrophysiology.pdf
Glaucoma Definition, Introduction, Etiology, Epidemiology, Clinical Presentat...
Hypertensive disorders in pregnancy.pptx
HOP RELATED TO NURSING EDUCATION FOR BSC
Forensic Psychology and Its Impact on the Legal System.pdf
Adverse drug reaction and classification
AGE(Acute Gastroenteritis)pdf. Specific.
The Human Reproductive System Presentation
Rheumatology Member of Royal College of Physicians.ppt
NUCLEAR-MEDICINE-Copy.pptxbabaabahahahaahha
OSCE Series Set 1 ( Questions & Answers ).pdf
Mitral Stenosis in Pregnancy anaesthesia considerations.pptx
nephrology MRCP - Member of Royal College of Physicians ppt
Vesico ureteric reflux.. Introduction and clinical management
ARTHRITIS and Types,causes,pathophysiology,clinicalanifestations,diagnostic e...
OSCE Series ( Questions & Answers ) - Set 6.pdf
Blood and blood products and their uses .ppt
Approach to chest pain, SOB, palpitation and prolonged fever
@K. CLINICAL TRIAL(NEW DRUG DISCOVERY)- KIRTI BHALALA.pptx
Ad

cardio pulmonary resuscitation presentation for doctors

  • 2. INTRODUCTION • Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest. • Although survival rates and neurologic outcomes are poor for patients with cardiac arrest, early appropriate resuscitation-involving early defibrillation and appropriate implementation of post-cardiac arrest care lead to improved survival and neurologic outcomes.
  • 3. DEFINITION • Cardio Pulmonary Resuscitation is a technique of basic life support for oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilatory action.
  • 4. PURPOSES • To maintain an open and clear airway (A). • To maintain breathing by external ventilation (B). • To maintain Blood circulation by external cardiac massages (C). • To save life of the Patient. • To provide basic life support till medical and advanced life support arrives.
  • 5. INDICATION CPR should be performed immediately on any person who has become unconscious and is found to be pulseless. The most common arrhythmias are… • Ventricular fibrillation (VF) • Pulseless ventricular tachycardia (VT) • Pulseless electrical activity (PEA) • Asystole • Pulseless bradycardia
  • 6. Respiratory Arresst This may be result of following: • Drowning • Stroke • Foreign body in throat • Smoke inhalation • Drug overdose • Suffocation • Accident, injury • Coma
  • 7. Contraindications • The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order or other advanced directive indicating a person’s desire not to be resuscitated in the event of cardiac arrest. • A relative contraindication to performing CPR is if a clinician justifiably feels that the intervention would be medically futile(useless).
  • 8. Principles of CPR • To restore effective circulation and ventilation. • To prevent irreversible cerebral damage due to anoxia. When the heart fails to maintain the cerebral circulation for approximately four minutes the brain may suffer irreversible damage.
  • 9. CPR procedure Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest Chest compressions and pulmonary ventilation performed by ANYONE who knows how to do it, ANYWHERE, IMMEDIATELY, WITHOUT any other EQUIPMENT
  • 10. • Universal precautions (ie, gloves, mask, gown) should be taken. • However, CPR is delivered without such protections in the vast majority of patients who are resuscitated in the out-of-hospital setting, and no cases of disease transmission via CPR delivery have been reported. • Some hospitals and EMS systems employ devices to provide mechanical chest compressions. • A cardiac defibrillator or AED provides an electrical shock to the heart via 2 electrodes placed on the patient’s torso and may restore the heart into a normal perfusing rhythm.
  • 11. Technique • Cardiopulmonary resuscitation (CPR) comprises 3 steps (CAB) : Chest compressions (C), Airway (A), and Breathing (B) • Lay rescuers should perform compression-only CPR (COCPR). • Healthcare providers, however, should perform all 3 components of CPR (chest compressions, airway, and breathing).
  • 12. Positioning for CPR : • CPR is most easily and effectively performed by laying the patient supine on a relatively hard surface, which allows effective compression of the sternum . • Delivery of CPR on a mattress or other soft material is generally less effective. • The person giving compressions should be positioned high enough above the patient to achieve sufficient leverage, so that he or she can use body weight to adequately compress the chest .
  • 13. Approach safely Check response Shout for help Open airway Check breathing Call 108 30 chest compressions 2 rescue breaths
  • 14. APPROACH SAFELY! WATCH OBSERVE Approach safely Check response Shout for help Open airway Check breathing Call 108 30 chest compressions 2 rescue breaths
  • 15. CHECK RESPONSE Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths
  • 16. Shake shoulders gently Ask “Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly. CHECK RESPONSE
  • 17. SHOUT FOR HELP Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths
  • 18. OPEN AIRWAY Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths
  • 19. OPEN AIRWAY Head tilt and chin lift - lay rescuers - non-healthcare rescuers No need for finger sweep unless solid material can be seen in the airway
  • 20. OPEN AIRWAY Head tilt, chin lift + jaw thrust
  • 22. • Open the airway using a head tilt lifting of chin. Do not tilt the head too far back Check the pulse on carotid artery using fingers of the other hand
  • 23. CHECK BREATHING Approach safely Check response Shout for help Open airway Check breathing Call 108 30 chest compressions 2 rescue breaths
  • 24. CHECK BREATHING • Look, listen and feel for NORMAL breathing • Do not confuse agonal breathing with NORMAL breathing
  • 25. AGONAL BREATHING • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing • Recognise as a sign of cardiac arrest
  • 26. • B (Breathing) • • Tilt the head back and listen for. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise.
  • 27. 27 mouth to mouth or mouth to nose respiration ventilation by a face mask and a self- inflating bag with oxygen 2 initial subsequent breaths wait for the end of expiration 10-12 breaths per minute with a volume of app. 800 ml, each breath should take 1,5-2 seconds Control over the ventilation check chest movements during ventilation check the air return Algorithm for artificial ventilation
  • 28. • C. Circulation • Restore the circulation, that is start external cardiac massage
  • 29. 29 2 mechanisms explaining the restoration of circulation by external cardiac massage Cardiac pump Thoracic pump
  • 30. 30 Cardiac pump during the cardiac massage Blood pumping is assured by the compression of heart between sternum and spine Between compressions thoracic cage is expanding and heart is filled with blood
  • 31. 31 Thoracic pump at the cardiac massage Blood circulation is restored due to the change in intra thoracic pressure and jugular and subclavian vein valves During the chest compression blood is directed from the pulmonary circulation to the systemic circulation. Cardiac valves function as in normal cardiac cycle.
  • 32. 32 ALGORITHM of Cardiopulmonary resuscitation 4 cycles: 15 compression and 2 breaths 10 cycles: 5 compression and 1 breath check the pulse on carotid arteries (5 sec) in case of absence of pulse continue resuscitation 2 breaths (duration 1 – 1.5 sec.) palpation of pulse on carotid arteries (5 – 10 sec.) in case of absence of pulse initiate external cardiac massage 1 person compression rate 80 – 100/min. compression/breath = 15 : 2 compression rate 80 – 100/min compression/breath = 5 : 1 2 breaths in 4 – 7 sec. breath during 1 – 1.5 sec. after each 5th compression 2 persons a a a
  • 33. Approach safely Check response Shout for help Open airway Check breathing Call 108 30 chest compressions 2 rescue breaths
  • 34. 30 CHEST COMPRESSIONS Approach safely Check response Shout for help Open airway Check breathing Call 108 30 chest compressions 2 rescue breaths
  • 35. • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest – Rate 100 min-1 – Depth 4-5 cm (1.5 to 2 inch) – Equal compression : relaxation • When possible change CPR operator every 2 min CHEST COMPRESSIONS
  • 36. Chest compression The provider should do the following: • Place the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers interlaced. • Extend the elbows and the provider leans directly over the patient . • Press down, compressing the chest at least 2 inches. • Release the chest and allow it to recoil completely • The compression depth for adults should be at least 2 inches • The compression rate should be at least 100/min • The key phrase for chest compression is, “Push hard and fast”. NB: Untrained bystanders should perform chest compression–only CPR (COCPR)
  • 37. • After 30 compressions, 2 breaths are given; however, an intubated patient should receive continuous compressions while ventilations are given 8-10 times per minute. • This entire process is repeated until a pulse returns or the patient is transferred to definitive care • To prevent provider fatigue or injury, new providers should intervene every 2-3 minutes (ie, providers should swap out, giving the chest compressor a rest while another rescuer continues CPR .
  • 38. RESCUE BREATHS Approach safely Check response Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths
  • 39. RESCUE BREATHS • Pinch the nose • Take a normal breath • Place lips over mouth • Blow until the chest rises • Take about 1 second • Allow chest to fall • Repeat
  • 40. RESCUE BREATHS RECOMMENDATIONS: - Tidal volume 500 – 600 ml - Respiratory rate give each breaths over about 1s with enough volume to make the victim’s chest rise - Chest-compression-only continuously at a rate of 100 min
  • 42. POSSIBLE COMPLICATIONS • Coronary vessel injury • Diaphragm injury • Hemopericardium • Hemothorax • Interference with ventilation
  • 43. • Liver injury • Myocardial injury • Pneumothorax • Rib fractures • Spleen injury • Sternal fracture
  • 44. MEDICAL MANAGEMENT Adrenaline • Adrenaline (epinephrine) is the main drug used during resuscitation from cardiac arrest. Atropine • Atropine as a single dose of 3mg is sufficient to block vagal tone completely and should be used once in cases of asystole. It is also indicated for symptomatic bradycardia in a dose of 0.5mg - 1mg. Amiodarone • It is an antiarrhythmic drug.