A LIFE SAVING TECHNIQUE

3. TERMINOLOGIES
•BLS
•ACLS
•DEFEBRILLATION
•AED
•VENTILATION
•VENTRICULAR FIBRILLATION.
•VENTRICULAR TACHYCARDIA
•ASYSTOLE AND PEA

5. 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
VENTILATOR ACTION.

6. HISTORICAL REVIEW
•5OOO
•3OOOBC
•874
•1901
•1946
•1960
•1980

7. PURPOSE OF CPR
•TO MAINTAIN BLOOD CIRCULATION (C)
•TO MAINTAIN AN OPEN AND CLEAR AIRWAY (A)
•TO MAINTAIN BY ARTIFICIAL BREATHING (B)
•TO SAVE THE LIFE OF THE PATIENT
•TO PROVIDE BASIC LIFE SUPPORT TILL MEDICAL
AND ADVANCED LIFE SUPPORT ARRIVES

8. INDICATION OF CPR
A) CARDIAC ARREST:
•VENTRICULAR FIBRILLATION
•VENTRICULAR TACHYCARDIA
(PULSELESS)
•ASYSTOLE
•PULSELESS ELECTRICAL ACTIVITY
B) RESPIRATORY ARREST
•DROWNING
•STROKE
•FOREIGN BODY IN THROAT
•SMOKE INHALATION
•DRUG OVERDOSE
•SUFFOCATION

9. HIGH QUALITY CPR (AHA 2015)
•START COMPRESSION WITHIN 10 SECOND
•PUSH HARD PUSH FAST: COMPRESS AT A RATE OF 100-120/MIN WITH A
DEPTH OF AT LEAST 5CM (2INCH) WHILE AVOIDING EXCESSIVE CHEST
COMPRESSION DEPTHS GREATER THAN 2.4INCH FOR AN ADULT, APPROX
5CM (2INCH) FOR CHILDREN AND 4CM (1 AND HALF INCH) FOR
INFANTS.
•ALLOW COMPLETE CHEST RECOIL, DO NOT LEAN ON AFTER EACH
COMPRESSION.

10. CONTD….
•MINIMIZE INTERRUPTION
•GIVE EFFECTIVE BREATH
•AVOID EXCESSIVE VENTILATION

11. BLS (BASIC LIFE SUPPORT)
•BASIC FIRST AID TO TREAT CARDIOPULMONARY ARREST
•C---A---B (CHEST COMPRESSION,AIRWAY AND BREATHING)
•CHAIN OF SURVIVAL (AMERICAN HEART ASSOCIATION)
ADULT
PEDIATRIC

12. ADULT CHAIN OF SURVIVAL

13. PEDIATRIC CHAIN OF SURVIVAL

14. BLS STEP FOR ADULT (AHA)
Step 1. Assessment and scene safety
•Make sure the scene is safe for the rescuer and the victim
•Tap the victim’s shoulder and shout, “are you all right”?
•Check to see if the victim is breathing.

15. STEP 2. ACTIVATE THE EMERGENCY
RESPONSE SYSTEM AND GET AN AED
•If The Rescuer Is Alone And Find An Unresponsive Victim Not
Breathing, Shout For Help.
•If No One Responds, Activate The Emergency Response System,
Get An AED If Available And The Return To The Victim

16. STEP 3. PULSE CHECK.
•Palpate The Carotid Pulse
•If You Do Not Definitely Feel A Pulse
Within 10 Second ( For At Least 5 But
Not More Than 10sec), Start Chest
Compression

17. STEP 4: CHEST COMPRESSION AND BREATH
•Compression Ventilation Ratio 30:2
•Put The Heel Of One Hand On The Centre Of The Victim’s Chest On The Lower
Half Of The Breastbone And The Heel Of The Other Hand On Top Of The First
Hand.
•Straighten Your Arms Ans Position, Your Shoulders Directly Over Your Hand.
•Push Hard And Fast (1oo-120/Min At A Depth Of Atleast 5cm (2inch) While
Avoiding Excessive Chest Compression Depths Greater Than 2.4inch For An
Adult.

19. 5. Opening The
Airway For Breath:
•Head Tilt Chin Lift:

20. •JAW THRUST:

21. 6.WAY OF DELIVERING BREATH:
•MOUTH TO MOUTH BREATHING
•MOUTH TO BARRIER DEVICE BREATHING:
MOUTH TO MASK ( 1 RESCUER)
BAG MASK DEVICE ( 2 RESCUER)

22. STEP 5. AED/ DEFEBRILLATOR.
•POWER ON THE AED
•ATTACH AED PADS TO THE VICTIMS BARE CHEST
 PLACE ONE AED PAD ON THE VICTIMS UPPER RIGHT CHEST
(DIRECTLY BELOW THE COLLAR BONE)
 OTHER PAD TO THE SIDE OF THE LEFTT NIPPLE, A FEW
CENTIMITRES BELOW THE ARMPIT

24. CONTD…•“CLEAR” THE VICTIM AND ANALYSE THE RHYTHM.
•IF THE AED ADVISE A SHOCK, IT WILL TELL YOU TO CLEAR THE VICTIM AND PRESS
THE “SHOCK” BUTTON.
•IF NO SHOCK IS NEEDED OR AFTER ANY SHOCK DELIVERY, IMMEDIATELY RESUME
CPR , STARTING WITH CHEST COMPRESSION.
•AFTER 5 CYCLES OR ABOUT 2MIN OF CPR, THE AED WILL PROMPT YOU TO REPEAT
STEPS 3 AND 4
•IF NO ADVISED SHOCK IMMEDIATELY RESTART CPR BEGINNING WITH CHEST
COMPRESSION.

26. BLS FOR CHILDREN FROM 1YR OF AGE TO
PUBERTY:
•PULSE– CAROTID OR FEMORAL PULSE.
•COMPRESSION VENTILATION RATIO
1 RESCUER – 30: 2; AND 2 RESCUER– 15:2
•COMPRSSION DEPTH: APPROXIMATELY 5CM
•COMPRESSION TECHNIQUE MAY USE 1 OR 2 HANDED CHEST
COMPRESSION.

27. CONTD…
•WHEN TO ACTIVATE EMERGENCY RESPONSE SYSTEM:
 IF YOU DID NOT WITNESS THE ARREST AND ARE ALONE, PROVIDE
2MIN OF CPR BEFORE LEAVING THE CHILD TO ACTIVATE ERS AND GET
THE AED.
 IF THE ARREST IS SUDDEN AND WITNESSED LEAVE THE CHILD TO
ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET THE AED.

28. FOR INFANT:
•PULSE: BRACHIAL ARTERY
•TECHNIQUE OF DELIVERING COMPRESSION
SINGLE RESCUER: TWO FINGER
TWO RESCUER : THUMB ENCIRCLING HAND TECHNIQUE.
•COMPRESSION VENTILATION RATIO
1 RESCUER – 30: 2; AND 2 RESCUER– 15:2
•COMPRSSION DEPTH: APPROXIMATELY 4CM

33. ACLS ( ADVANCED CARDIAC LIFE
SUPPORT)
•ACLS IS DONE AFTER THE COMPLETION OF BLS SURVEY.
•ASSESSMENT, INTERVENTION WTH CARDIAC ARREST,
DYSRHYTYMIA.
•SIX MEMBER ARE COMPULSORY TO PERFORM THE INTERVENTION
TEAM MEMBER, AIRWAY ( AT HEAD END), COMPRESSOR, IV/ IO
MEDICINE, OBSERVER/ RECORDER, MONITOR/ DEFEBRILLATOR.

34. ASSESSMENT:
•HISTORY TAKING
•PHYSICAL ASESSMENT
•12 LEAD ELECTROGARDIOGRAM.
•CARDIAC ENZYM ANALYSIS: LDH, CREATININEKINASE,
TRANSAMINASE, TROP I

35. AIRWAY MANAGEMENT
•MAINTAIN AIRWAY PATENCY IN UNCONCIOUS PATIENT BY USE OF HEAD
TILT CHIN LIFT.
•USE ADVANCED AIRWAY MANAGEMENT IF NEEDED
•IF USING ADVANCED AIRAWAY DEVICES:
 CONFIRM PROPER INTEGRITY OF CPR AND VENTILATION.
 PHYSICAL EXAMINATION
 QUANTITATIVE WAVEFORM CAPNOGRAPHY.
•SECURE THE DEVICE TO PREVENT DISLODGEMENT.

36. BREATHING
•GIVE SUPPLEMENTARY OXYGEN WHEN INDICATED.
•MONITOR THE ADEQUACY OF VENTILATION AND
OXYGENATION
•AVOID EXCESSIVE VENTILATION

37. CIRCULATION
•MONITOR CPR QUALITY
QUANTITATIVE WAVEFORM CAPNOGRAPHY ( IF PETCO2 < 10MM OF HG TO IMPROVE
THE QUALITY OF CPR)
INTRA ARTERIAL PRESSURE (IF DIASTOLIC PRESSURE IS < 20MM OF HG, ATTEMPT
TO IMPROVE CPR)
• ATTACH MONITOR/ DEFEBRILATTOR FOR ARRYTHMIAS
•DEFEBRILLATOR
•OBTAIN IV/ IO ACCESS
•GIVE IV/ IO FLUIDS

38. DIFFERENTIAL DIAGNOSIS:
5TS AND 5HS
•HYPOVOLEMIA
•HYPOXIA
•HYDROGEN ION
•HYPO/ HYPERKALEMIA
•HYPOTHERMIA
•TENSION PNEUMOYHORAX
•TEMPONADE CARDIAC
•TOXIN
•THROMBOSIS ,PULMONARY
•THROMBOSIS, CORONARY

39. COMPLICATION OF CPR
•STERNAL AND RIB FRACTURE
•PNEUMOTHORAX
•HAEMOTHORAX
•INJURY TO HEART AND GREAT
VESSEL
•ORGAN LACERATION
•ASPIRATION OF STOMACH
•NECK HYPER EXTENSION
•VERTEBRAL FRAGMENT
•RUPTURED STOMACH
•GASTRIC DISTENTION

40. NURSING MANAGEMENT

41. THANK YOU