1. CARDIOPULMONARY RESUSCITATION
& MANAGEMENT
Advisor: dr.Nicolaas P.S, Sp. An
1

2. Time is critical
• > 300,000 people experience sudden cardiac
death in prehospital settings each year.
• If resuscitation begins within a few
minutes, many of these individuals have a
chance for survival.
epidemiologi
2

3. Time is Critical!
• To begin resuscitation within a few minutes:
• Patient’s collapse witnessed
• EMS immediately activated
• CPR started immediately
• Defibrillation within minutes
3

4. Review of the Circulatory System
What is the function of the
circulatory system?
4

5. The Circulatory System
Delivers
O2 and
nutrients
Removes
CO2 and
wastes
5

6. Why is the function of the circulatory
system critical to our survival?
6

7. Lack of
O2
accumulatio
n of wastes
quickly lead
• to death 7

8. 8

9. Major
Arteries
9

10. Heart Physiology
• LV contracts – sends wave of blood
• Pressure wave felt as pulse
• No contraction = No blood flow = cardiac
arrest
10

11. Time is Critical!
• Brain damage begins
in 4–6 min
• Brain damage
irreversible in 8–10
min
Circulation must be
restored within 4–
6 minutes.
11

12. CPR
• Provides minimal amount of
circulation/oxygenation until cause of cardiac
arrest corrected
• External chest compressions circulate blood
• Artificial ventilations provide O2 to lungs
12

13. HISTORY
2010 : New Guidelines on CPR (AHA)
13

14. Causes of Cardiac Arrest
• Heart disease
• Respiratory arrest
• Medical emergencies
• Drowning and suffocation
• Congenital heart defects
• Trauma
14

15. AMERICAN HEART
ASSOCIATION
CHANGES IN THE 2010
GUIDELINES AFFECTING
ALL RESCUERS
AMERICAN HEART
ASSOCIATION
15

16. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
Health Care Provider*
 “PUSH HARD AND PUSH FAST”
 At least 100 COMPRESSIONS / MINUTE*
 Allow the chest to recoil -- equal compression and relaxation times
 <10 seconds for pulse checks or rescue breaths
 Compression Depth*
 Adults 2”
 Child/Infant 1/3 depth of chest 1.5" infant 2" child
 Avoid excessive ventilations
16

17.  A-B-C changed to C-A-B*
 Critical element is chest compressions
 Delay in A-B
 Avoidance of A & B
 Early defib
 If alone--call and retrieve AED
 Exception asphyxial arrest
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
17

18. New Sequence
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19. • Cricoid pressure not recommended
• Advanced airway = 1 every 6-8 seconds
• Adult: 1 every 5-6 Peds: 1 every 3
• With advanced airway- no pause
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
19

20. AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
AHA ECC Adult Chain of Survival - New
20

21. Simplified Universal
BLS algorithm
AMERICAN HEART ASSOCIATION:
2010 GUIDELINES
21

22. Causes of Cardiac Arrest
• Heart disease
• Respiratory arrest
• Medical emergencies
• Drowning and suffocation
• Congenital heart defects
• Trauma
22

23. CPR
Compression : ventilation remains 30 : 2
Duration of 2 breaths = 5 seconds
23

24. CPR – 1 Rescuer
• If there is no
pulse, find your
landmarks, lower
half of the
sternum, between
the nipples

25. CPR – 1 Rescuer
• Begin chest
compressions

26. CPR – 1 Rescuer
• Perform 30 chest
compressions
• Push hard
• Push fast
• Allow the chest to
recoil after each
compression

27. CPR – 1 Rescuer
• Administer two
ventilations then
return to
compressions

28. CPR – 2 Rescuer
1 2
3 4

29. CPR - Children
• Use heel of one
hand
• Keep airway open
with other hand
• 30 compressions:2
ventilations if alone
(2 rescuers use 15:2)

30. CPR - Infant
• Give chest thrusts and
puffs of air
• 30 compressions:2
ventilations if alone
• 15 compressions: 2
ventilations with 2
rescuers

31. Copyright © 2004 Elsevier (USA). All Rights Reserved
Defibrillation
•Ventricular fibrillation
a common cause of
arrest
•Can only correct with
defibrillation

32. Copyright © 2004 Elsevier (USA). All Rights Reserved
• Chance of success
decreases with time
• AEDs save lives!
Defibrillation

33. AEDs
• Safe, accurate &
lightweight
• Easy to operate
33

34. PAD
• AEDs in public
places
• Training the public
in CPR/AED
34

35. AED

36. Assess • Check your
patient

37. Power
• Turn the power
on

38. Patient
• Apply pads to
patient

39. Analyze
• Stay clear while
patient’s heart
rhythm analyzed

40. Clear
• Head to toe and
toe to head:
everyone is clear!

41. Shock
• Defibrillate

42. Patient
• Standard is set of 1
shock
• Immediately restart
CPR for 2 minutes
then check pulse

43. ADULT CARDIAC ARREST ALGORITHM
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51. 51

52. Summary
• Continual beating, or contracting, of the heart
is necessary to keep blood circulating
throughout the body.
• Brain damage begins in 4 to 6 minutes of
cardiac arrest.
• There are many causes of sudden cardiac
death, but the most common is ventricular
fibrillation.
52

53. Summary
• Survival from cardiac arrest depends on the
sequence (chain) of survival.
• Rescuers are critically important in
maintaining the sequence (chain) of survival.
53

54. Thank you
54