1. SEMINAR ON CPR
SUBMITTED TO:
GEETA SHIROOR
ASSO. PROFESSOR,BVCON.
SUMITTED BY:
MR.STAWAN UTTAM CHOUGULE
F.Y.M.Sc.,BVCON,PUNE.

2. CARDIOPULMONARY
RESUSCITATION

3. INTRODUCTION
According to recent statistics sudden cardiac arrest
is rapidly becoming the leading cause of death in
America. Once the heart ceases to function, a
healthy human brain may survive without oxygen for
up to 4 minutes without suffering any permanent
damage. Unfortunately, a typical EMS response may
take 6, 8 or even 10 minutes.
It is during those critical minutes that CPR (Cardio
Pulmonary Resuscitation) can provide oxygenated
blood to the victim's brain and the heart, dramatically
increasing his chance of survival. And if properly
instructed, almost anyone can learn and perform
CPR.

4. CPR
DEFINITION :
“It is an emergency medical
procedure for a victim of cardiac
arrest or , in some circumstances,
respiratory arrest.”

5. REVIEW OF ANATOMY
AND PHYSIOLOGY

6. HEART

7. HEART
HODS - November 2006 7

8. HEART
 Hollow, muscular organ
 300 grams (size of a fist)
 4 chambers
 Found in chest between lungs
 Surrounded by membrane called
pericardium
 Pericardial space is fluid-filled to
nourish and protect the heart.
HODS - November 2006 8

9. HEART ANATOMY
 The heart is a complex
muscular pump that
maintains blood
pressure and flow
through the lungs and
the rest of the body.
 The heart pumps about
100,000 times and
moves 7200 liters (1900
gallons) of blood every
day.
HODS - November 2006 9

10. HEART ANATOMY
 The heart has four
chambers.
 Two atria act as
collecting reservoirs.
 Two ventricles act as
pumps.
 The heart has four valves
for:
 Pumping action of the
heart.
 Maintaining
unidirectional blood flow.
HODS - November 2006 10

11. Functions of the Heart
 Generates blood pressure
 Routes blood
 Heart separates pulmonary and systemic
circulation
 Ensures one-way blood flow
 Heart valves ensure one-way flow
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12. Functions of the Heart
 Regulates blood supply
 Changes in contraction rate and force
match blood delivery to changing
metabolic needs
HODS - November 2006 12

13. The Heart: Conduction
System
 The heart pumps blood through the body
 This is accomplished by contraction and
relaxation of the cardiac muscle tissue in
the myocardium layer.
 Intercalated discs allow impulses to travel
rapidly between adjacent cells so they
function as one rather than individual cells

14. Cardiac Muscle Tissue
intercalated disc
intercalated disc

15. Conduction System
Continued….
 Cardiac conduction system: The
electrical conduction system controls
the heart rate
 This system creates the electrical
impulses and sends them throughout
the heart. These impulses make the
heart contract and pump blood.

16. Components of the Conduction
System
 Sinoatrial node (part I):
 Located in back wall of the right atrium near the
entrance of vena cava
 Initiates impulses 70-80 times per minute without
any nerve stimulation from brain
 Establishes basic rhythm of the heartbeat
 Called the pacemaker of the heart
 Impulses move through atria causing the two atria
to contract.
 At the same time, impulses reach the second part of
the conduction system

17. Components of the Conduction
SyStem Continued ….
 Atrioventricular node (part II):
 Located in the bottom of the right atrium
near the septum
 Cells in the AV node conduct impulses more
slowly, so there is a delay as impulses travel
through the node
 This allows time for atria to finish contraction
before ventricles begin contracting

18. Septum

19. Atrioventricular Bundle
 “Bundle of His”
 From the AV node,
impulses travel
through to the right
and left bundle
branches
 These branches
extend to the right and
left sides of the
septum and bottom of
the heart.

20. Atrioventricular Bundle
Continued….
 These branch a lot to form
the Purkinje fibers that
transmit the impulses to
the myocardium (muscle
tissue)
 The bundle of His, bundle
branches and Purkinje
fibers transmit quickly and
cause both ventricles to
contract at the same time
 Like a “phone tree”

21. Atrioventricular Bundle
Continued….
 As the ventricles contract, blood is
forced out through the semilunar valves
into the pulmonary trunk and the aorta.
 After the ventricles complete their
contraction phase, they relax and the SA
node initiates another impulse to start
another cardiac cycle.

22. 1 - Sinoatrial node (SA node)
2 - Atrioventricular node (AV node)
3 – Bundle of His
4 - Right & Left Bundle Branches
which lead to Purkinje Fibers

23. CIRCULATION OF BLOOD
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24. LUNGS
HODS - November 2006 24

25. ANATOMY
HODS - November 2006 25

26. LOWER RESPIRATORY SYSTEM
 Trachea
 Bronchial tree
 Left and right
main bronchus
 Carina
 Lobar bronchus
 Segmental
bronchus
 Bronchiole
 Alveoli
HODS - November 2006 26

27. PURPOSES OF CPR
 Restore cardiopulmonary functioning.
 Prevent irreversible brain damage from
anoxia.
HODS - November 2006 27

28. INDICATIONS OF CPR
1 .CARDIAC ARREST
a) Ventricular fibrillation.
b) Ventricular tachycardia
c) Asystole
d) Pulseless electrical activity
2.RESPIRATORY ARREST :-
a) Drowning
b) Stroke
c) Foreign –body airway obstruction
d) Smoke inhalation
e) Drug overdose
f) Electroculation/injury by lightning
g) Suffocation
h) Accident/injury
i) Coma
HODS - November 2006 28

29. ADULT
BASIC LIFE SUPPORT
(BLS)

30. OBJECTIVES
Students should be able to demonstrate:
 How to assess the collapsed victim
 How to perform chest compression and rescue
breathing
 How to place an unconscious breathing victim in
the recovery position.

31. BACKGROUND
 Approximately 700,000 cardiac arrests per year
in Europe
 Survival to hospital discharge presently
approximately 5-10%
 Bystander CPR vital intervention before arrival
of emergency services – double or triple
survival from SCA (sudden cardiac arrest)
 Early resuscitation and prompt defibrillation
(within 1-2 minutes) can result in >60% survival

32. CHAIN OF
SURVIVAL

33. CHAIN OF SURVIVAL
AHA ECC Adult Chain of Survival
The links in the new AHA ECC Adult Chain of
Survival are as follows:
1. Immediate recognition of cardiac arrest
and activation of the emergency response
system
2. Early CPR with an emphasis on chest
compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post–cardiac arrest care

34. BASIC LIFE SUPPORT
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
Protective devices

36. APPROACH
SAFELY

37. CHECK RESPONSE

38. CHECK
RESPONSE
Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.

39. SHOUT FOR HELP

40. CHECK FOR CAROTID
PULSE
RESCUE BREATH FOR THEM:
- 1 breath every 5 to 6 seconds
for about 10-
12 per minute (each breath should
be
delivered over 1 second making
the chest
rise)
- Recheck pulse every 2 minutes
IF THE VICTIM DOES NOT HAVE CIRCULATION (NO PULSE)
Start chest compressions, at the center of the chest at
the nipple line with the heal of one hand on top of the
other, at a ratio of:
- 30 compressions to 2 ventilation at a rate of
100 per minute and a depth of 1 ½” to 2”
- Reassess after 5 cycles of 30 compressions to 2
breaths, after 2 minutes

41. CHEST COMPRESSIONS
• Place the heel of one hand
in the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate at least 100 / min
– Depth at least 2 inches
– Equal compression :
relaxation
• When possible change CPR
operator every 2 min

42. HEAD TILT
& CHIN LIFT
OPEN
AIRWAY
JAW
THRUST

43. HEAD-TILT CHIN-LIFT
The head-tilt chin-lift is the
primary maneuver used in
any patient in whom cervical
spine injury is not a
concern. The simplest way
of ensuring an open airway
in an unconscious patient is
to use a head tilt chin lift
technique, thereby lifting the
tongue from the back of the
throat. This is taught on
most first aid courses as the
standard way of clearing an
airway.

44. JAW THRUST
The jaw-thrust maneuver is an effective airway technique,
particularly in the patient in whom cervical spine injury is a concern.
The jaw thrust is a technique used on patients with a
suspected spinal injury and is used on a supine patient. The
practitioner uses their thumbs to physically push the posterior (back)
aspects of the mandible upwards - only possible on a patient with
a GCS < 8 (although patients with a GCS higher than this should also
be maintaining their own patent airway). When the mandible is
displaced forward, it pulls the tongue forward and prevents it from
occluding (blocking) the entrance to the trachea, helping to ensure a
patent (secure) airway.

45. FOREIGN-BODY AIRWAY
OBSTRUCTION (FBAO)
Approximately 16 000 adults and children receive treatment for
FBAO in the UK yearly
SIGNS MILD obstruction SEVERE obstruction
“Are you choking?” “YES” Unable to speak,
may nod
Other signs Can speak, cough, Can not
breathe breathe/wheezy
breathing/silent
attempts to cough/
unconsciousness

46. ADULT FOREIGN BODY AIRWAY
OBSTRUCTION TREATMENT

47. BACK BLOWS

48. ABDOMINAL THRUSTS

49. 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

50. 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

51. CONTINUE CPR
30 2

52. DEFIBRILLATION

53. AUTOMATED
EXTERNAL
DEFIBRILLATOR
(AED)
 Some AEDs will
automatically switch
themselves on when
the lid is opened

54. Automatic External
Defibrillator

55. Objectives for this
subject
- Why we use the AED?
- How to use the AED?
- Indications for the AED?
- Contraindications to AED?

56. Defibrillation is
the application
of electrical
shock to help
restore the
heart’s regular
rhythm

57. Defibrillator is the device
used to deliver that shock
and it can be manual or
automatic.

58. Early defibrillation is the single
most important factor in
determining survival from cardiac
arrest.

59. AED
 Most
common
initial rhythms
patients go
into as they
enter into
cardiac arrest
are:

60. “2 Shockable Rhythms”
V-Tach and V-Fib

61. Ventricular Tachycardia:
Fast heart rhythm which does not
allow the heart to fill properly and
cardiac output is compromised and
reduced.

62. Ventricular Fibrillation:
disorganized series of electrical
discharges in the ventricles. Where
the ventricles “quiver”.Stops Cardiac
output and hearts pumping ability.

63. AED’s that are available are
automatic and semi-
automatic.

64. Automatic: where machine
does all of the work.
Semi Automatic: where
machine tells you when to
push button to deliver shock.

65. Apply AED
as soon as
you
determine
that your
patient is not
breathing
and does not
have a pulse.

66. Always making sure that
CPR is still in progress while
you are setting up the AED.
If by yourself, apply the AED.

67.  Ensure before
putting pads
on chest, it is
clear of all
patches,
paste or
pacemakers.
Don’t cover
something up
with pad.

68. ATTACH PADS TO CASUALTY’S
BARE CHEST

69. Now attach the
adhesive pads to
the cables
remembering-
White is negative,
anterior chest wall.
Red is positive ,
left anterior axillary
line.
“Red on Ribs! White on right!”

70. Now turn on
machine and
wait for AED to
analyze the
patients
rhythm. Making
sure that CPR
has been
stopped for
machine to
detect rhythm.

71. When machine advises a
shock is indicated,
”CLEAR”
your patient.
Ensuring that no one is
touching patient or stretcher.

72. When the AED delivers a shock
it will go back and reanalyze the
rhythm.
If another shock is appropriate
“Clear Patient”
and
deliver the shock.

73. Sets of 3 shocks are called
stacked shocks and they are
done without any pauses to
check patients pulse or
administer CPR

74. IF VICTIM STARTS TO BREATHE
NORMALLY PLACE IN RECOVERY
POSITION

75. If “No shock” is indicated:
-Check breathing
give appropriate oxygen therapy.
-Check pulse, if no pulse!
Start CPR for
1 minute and then have the AED
reassess.

76. Safety should always be
maintained by the provider:
-Not using near or around water
-Ensuring all med patches and pastes are
off the patient.
-Making sure that everyone is clear of the
patient when the shock is delivered.

77. Indications for AED
* Unresponsive
* Apneic
* Pulseless patients.

78. Adult Patients
> 8 years old
> 55 lbs.
 Unresponsive,pulseless and
apneic.

79. Contraindications:
Infants and children
< 8 years old
< 55 lbs.

80. Contraindications:
!! Hypothermia !!
(Contact medical control)

81. Contraindications:
Rigor / Livor Mortis
No Code /DNR

82. The AED can’t properly
analyze patient in
moving ambulance.
It is recommended that you
stop the medic and let AED
do it’s job.

84. CONTINUE RESUSCITATION
UNTIL
 Qualified help arrives and takes over
 The victim starts breathing normally
 Rescuer becomes exhausted

85. TERMINATION OF BLS
Signs of restored ventilation and
circulation include:
1. Struggling movement
2. Improved color
3. Return of stronger pulse
4. Return of systemic B.P.

86. COMPLICATIONS OF CPR
1. Broken bones
2. Internal injuries
3. Vomiting and aspiration
4. Body fluid expose
5. Gastric distension.
HODS - November 2006 86

87. NURSES
RESPONSIBILITY

88. research
 OUTCOMES OF CHEST COMPRESSION ONLY CPR
VERSUS CONVENTIONAL CPR CONDUCTED BY LAY
PEOPLE IN PATIENTS WITH OUT OF HOSPITAL
CARDIOPULMONARY ARREST WITNESSED BY
BYSTANDERS: NATIONWIDE POPULATION BASED
OBSERVATIONAL STUDY.

89. BIBLIOGRAPHY
1. Tortora Grabowski,principles Of Anatomy And
Physiology,wiley,9th Edition.
2. Anatomy And Physiology Gary A. Thibodeau And Kevin T.
Patton.Mosby,5th Edition
3. Medical And Surgical Nursing Phipps,cassmeyer ,Sands
,Lehman,5th Edition.
4. Advanced Nursing Practise,emmess Medical
Publisher,shabeer P.Basheer And S.Yaseen Khan,1st
Edition.
5. BLS For Health Care Provider,michael R Saure,md.
6. Cardiopulmonary Resuscitation (Cpr)(encyclopedia Of
Nursing And Allied Health)-enote.Com

90. THANK YOU