CPR Cardiopulmonary Resuscitation is an emergency lifesaving procedure performed when the heart stops beating.

1. Mr Suresh Chander
Nursing Tutor
Module First Aid
Topic: Basic Life
Support

2. CPR(Cardiopulmonary resuscitation)
 Cardiopulmonary resuscitation (CPR) is a lifesaving
technique that's useful in many emergencies, such as a heart
attack or near drowning, in which someone's breathing or
heartbeat has stopped. The American Heart Association
recommends starting CPR with hard and fast chest
compressions. This hands-only CPR recommendation
applies to both untrained bystanders and first responders.
 If you're afraid to do CPR or unsure how to
perform CPR correctly, know that it's always better to try
than to do nothing at all. The difference between doing
something and doing nothing could be someone's life.

3. Here's advice from the American Heart Association:
 Untrained. If you're not trained in CPR or worried about giving
rescue breaths, then provide hands-only CPR. That means
uninterrupted chest compressions of 100 to 120 a minute until
paramedics arrive You don't need to try rescue breathing.
 Trained and ready to go. If you're well-trained and confident
in your ability, check to see if there is a pulse and breathing. If
there is no pulse or breathing within 10 seconds, begin chest
compressions. Start CPR with 30 chest compressions before
giving two rescue breaths.
 Trained but rusty. If you've previously received CPR training
but you're not confident in your abilities, then just do chest
compressions at a rate of 100 to 120 a minute.

4. Delivery of chest compressions. Note the overlapping hands
placed on the center of the sternum, with the rescuer's arms
extended. Chest compressions are to be delivered at a rate of at
least 100 compressions per minute.
Technique
In its full, standard form, CPR comprises the following 3 steps,
performed in order:
 Chest compressions (Restore blood flow)
 Airway (Open the air way)
 Breathing ( Breathe for the person)

5. Indications :-
 CPR should be performed immediately on any person who has
become unconscious and is found to be pulse less.
 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

6. Equipment required for CPR:-
Two types of equipments for CPR should be there in all hospitals;
small concept kit of Basic Life support (BLS) and
comprehensive mobile kits for Advanced Life Support.

7. Positioning for CPR is as follows:
 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.

8. CPR steps: Quick reference
 Use CPR when an adult is not breathing or when they are
only gasping occasionally, and when they are not responding
to questions or taps on the shoulder.
 In children and infants, use CPR when they are not breathing
normally and not responding.

9. Components of High-Quality CPR
The 5 components of high-quality CPR are
 Ensuring chest compressions of adequate rate
 Ensuring chest compressions of adequate depth
 Allowing full chest recoil between compressions
 Minimizing interruptions in chest compressions
 Avoiding excessive ventilation

10. CPR step-by-step:-
There are two main stages to CPR:
1.The preparation stage
2. CPR stage.

11. Step 1 Check to see if the victim is conscious
 Make sure you and the victim are in safe surroundings.
(scene safety)
 Tap the victim gently.
 Shout, “Are you OK?“
 If they are not responding, call for help before performing
CPR.
 Look quickly to see if the victim has any injuries, bleeding,
or medical problems.
 If possible, ask a bystander to go and search for an AED
machine. If available in Indian scenario.

12. Step 2.
 Place the person on their back and open airway
 Place the person carefully on their back and kneel beside
their chest. Tilt their head back slightly by lifting their chin.
 Open mouth and check for any obstruction, such as food or
vomit. Remove any obstruction if it is loose. If it is not
loose, trying to grasp it may push it farther into the airway.

13. Step 3. Check for breathing
 Look ,Listen and feel
 Place your ear next the person’s mouth and listen for no
more than 10 seconds. If you do not hear breathing, or you
only hear occasional gasps, begin CPR.
 If someone is unconscious but still breathing, do not perform
CPR. Instead, if they do not seem to have a spinal injury,
place them in the recovery position. Keep monitoring their
breathing and perform CPR if they stop breathing.

14. Step 4. Perform 30 chest compressions
 Place one of your hands on top of the other and clasp them
together. With the heel of the hands and straight elbows,
push hard and fast in the center of the chest, slightly below
the nipples.
 Push at least 2 inches deep. Compress their chest at a rate of
least 100-120 times per minute. Let the chest recoil between
compressions.

16. Step 5. Perform two rescue breaths:-
 Rescue breathing can be mouth-to-mouth breathing or
mouth-to-nose breathing if the mouth is seriously injured or
can't be opened. Current recommendations suggest
performing rescue breathing using a bag-mask device with a
high-efficiency particulate air (HEPA) filter.
 Making sure their mouth is clear, tilt their head back slightly
and lift their chin. Pinch their nose shut, place your mouth
fully over theirs, and blow to make their chest rise.
 If their chest does not rise with the first breath, retile their
head. If their chest still does not rise with a second breath,
the person might be choking.

18. Step 6.
 Repeat the cycle of 30 chest compressions and 2 rescue breaths
until the person starts breathing or help arrives. If an AED
arrives, carry on performing CPR until the machine is set up
and ready to use. Carotid pulse assessed at frequently after
every cycle to determine whether CPR is still required.
 Ratio of chest compression and rescue breath are-30:2

19. Step 7:-
CPR is carried out until one of the following occur:-
 The patient regain satisfactory pulse rate and no longer need
CPR
 Patient is pronounced dead.
 The rescuer is exhausted and unable to continue and there is
no one else available to take over performing CPR.

20. Signs of effective CPR:-
For the Resuscitation efforts to be judged effective , at least one of
the following sings must be present.
 Movement and struggling.
 Distinct carotid pulsation with each cardiac compression.
 Decreased cyanosis
 Breathing that begins spontaneously
 Blinking upon stimulation of eyelids
 Constriction of pupils.

21. In effective CPR:-
When CPR efforts are not effective , it is usually because of one
or more of those problems:-
 The patient is not laying on a hard surface.
 The patients head is not placed in the proper head tilt position
for ventilation.
 The patients mouth is not opened wide enough for air
exchange.

22.  There is not an effective seal made against the patient mouth
or nose.
 The rescuer's hands are incorrectly placed
 There are prolonged interruptions of external chest
compressions.
 The chest is not sufficiently compressed.
 The compression ratio is too rapid or too slow.

23. Complication of CPR:-
 Pneumothorax ( Due to ribs fracture)
 Hemorrhage from ruptured liver or spleen due to faulty CPR
technique
 Brain damage as a result of cerebral hypoxia
 Seizures due to either brain damage or metabolic acidosis.

24. Post CPR care:-
 Providing cardio respiratory support to optimize tissue perfusion
, especially to brain.
 Transport the patient to hospital emergency department and to
an appropriately equipped critical care unit.
 Attempted to identify the precipitating cause to the arrest.
 Institute measures such as anti- arrhythmic therapy to prevent
recurrence.

27. Resuscitation Algorithms( Basic Life Support):-
Assess unconciousness,cynosiss & pallor
Clear Airway: head tilt and jaw support
Spontaneous breathing
Place in recovery position
No spontaneous breathing
Mouth to mouth ventilation
Observe and feel for carotid pulse
Pulse present
Continued artificial ventilation
No Pulse
External chest compression & mouth to mouth ventilation
Collapsed patient
Note:-
One
Rescuer-15:2
Two
Rescuer-30:2
Achieve
:
100
compression
/min

28. Summary
 CPR is a life-saving first aid procedure. It can significantly
improve someone’s changes of surviving if they suffer a heart
attack or stop breathing following an accident or trauma.
 The steps vary depending on whether the person is an infant,
child, or adult. However, the basic cycle of chest compressions
and rescue breaths will remain the same.
 Only use CPR when an adult has stopped breathing. Check the
person to see whether they respond to verbal or physical stimuli
before starting CPR.

29. References:-
 Lakhwinder kaur, Maninderkaur,A text of nursing foundation,
Edition 2017, Page no-498-503