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CARDIOPULMONARY RESUSCITATION (CPR)

 CPR stands for Cardiopulmonary Resuscitation and is a lifesaving technique.

 It is an emergency procedure performed to manually assist a person who is
experiencing cardiac arrest or has stopped breathing.
 It aims to keep blood and oxygen flowing through the body when a person’s
heart and breathing have stopped.
 CPR involves a combination of chest compressions to maintain blood
circulation and rescue breaths to provide oxygen to the lungs.
 The aim of CPR is to buy time and sustain the vital functions of the body until
professional medical help arrives.
 It is a critical intervention that can help improve the chances of survival
during a cardiac emergency.
 The primary goal of CPR is to keep blood flow active until medical
professionals arrive.

IMPORTANCE:
 According to the American Heart Association (AHA), CPR can double or
triple the chances of survival after cardiac arrest.
 CPR performed within the first few minutes of the heart stopping can keep
someone alive until medical help arrives.
 Rescue breathing techniques were used to revive drowning victims as early as
the 18th century.
 But it wasn’t until 1960 that external cardiac massage was proven to be an
effective revival technique, which is when AHA developed a formal CPR
program.
 Proper training in CPR is essential to ensure effective administration and
maximize the potential for a positive outcome.
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T Y P E S:
STANDARD CPR WITH RESCUE BREATHS:
 Involves chest compressions with rescue breaths at a ratio of 30:2
compressions to ventilation.
 Standard CPR can provide more oxygen to the body before the paramedics
arrive.
 Healthcare providers and individuals with CPR training can only do it.
 Studies have shown that a combination of chest compressions and rescue
breaths is most effective, especially for children and infants who experience
cardiac arrest due to hypoxia or severe lack of oxygen.
 In addition, other underlying causes of cardiac arrests, such as drowning,
trauma, drug overdose, and other non-cardiac causes, will benefit from
breaths and compressions.
HANDS-ONLY CPR:
 Also known as compressions-only CPR, hands-only CPR
 Involves calling for help and doing continuous and uninterrupted chest
compressions in a rapid motion.
 Hands-only CPR can be performed by the general public or bystanders who
witness an out-of-hospital cardiac arrest.
 It can prevent a delay in getting the blood moving through the body.

WHEN TO DO CPR:
 Cardiopulmonary resuscitation (CPR) is used on someone with cardiac arrest.
 This is when the heart stops beating, causing the person to collapse, lose
consciousness, and stop breathing.
 By applying external pressure on the chest, one can manually pump the heart
and keeps blood flowing.
 CPR is needed when a person has the four signs of cardiac arrest:
 CPR can be performed on people of any age and following are the indications.
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 Out of hospital cardiac emergency

 Choking
 Road traffic accident
 Near-drowning
 Suffocation
 Poisoning
 Drug overdose
 Alcohol overdose
 Smoke inhalation
 Electrocution
 Suspected sudden infant death syndrome
 The person has collapsed.
 The person is non-responsive.
 Breathing has stopped.
 There is no Pulse.

BEFORE STARTING CPR:

1. Make sure that you and the victim are well away from traffic, fire, or any
other hazard.
2. Ask the person loudly if they are OK to see if they are responsive.
3. If not, call 102 /104 /108 for help or ask a bystander to do so.
4. If available, ask someone to get or find an AED (often available in public
facilities).
5. Turn the person on their back and check if they are breathing by listening
for breathing sounds or seeing if their chest rises and falls.
6. Check for a pulse on the person's neck.
7. If there is no pulse, start CPR.
8. All of these tasks can be performed in less than a minute.

STEPS OF C.P.R.:
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 The steps of CPR are a bit different according to whether the person is an
adult, child, or infant.
 The primary difference is whether chest compressions are performed with
two hands (adults), one hand (children), or thumbs/fingers (infants).

CPR IN ADULTS AND OLDER CHILDREN:

 The following steps apply to adults and children over 8 years old
 Place one hand on the middle of the person’s chest just below the nipples.
Place the other hand on top, locking fingers.
 Using your body weight, push hard with the heel of your hand. You need
to push hard enough to compress the chest to a depth of around 2 inches.
Keep your arms straight.
 Keep compressing at a rate of 100 to 120 beats per minute.
 If qualified to give rescue breaths, do chest compressions for 30 seconds,
followed by two rescue breaths, followed by another set of chest
compressions, and so on.
 If you are not, keep doing chest compressions without rescue breaths.
 If another person is available to help, they can take over if you get tired.
 Continue until emergency medical help arrives or the person revives.

CPR FOR CHILDREN 1 TO 8 YEARS:

 The procedure for giving CPR to a child is essentially the same as that for
an adult.
 Place one hand in the middle of the child’s chest on the breastbone.
 Push hard with your hand, compressing the chest to a depth of around 2
inches.
 Keep compressing at a rate of 100 to 120 beats per minute.
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 If you are qualified to give rescue breaths, do chest compressions for 30

seconds, followed by two rescue breaths, followed by another set of chest
compressions, and so on.
 If not, keep doing chest compressions without rescue breaths.
 Continue until emergency medical help arrives or the child revives.

CPR FOR INFANTS:

 With infants, check for responsiveness by flicking the bottom of their foot.
 If the infant is non-responsive and there are no signs of breathing or a
heartbeat, proceed as follows
 Place two fingers in the center of the infant's chest.
 Firmly compress the chest about 1-1/2 inches deep at a rate of around 120
beats per minute.
 If you are qualified to give rescue breaths, do chest compressions for 30
seconds, followed by two rescue breaths, followed by another set of chest
compressions, and so on.
 If not, do chest compressions without rescue breaths.
 Continue until emergency medical help arrives or the infant revives.

RESCUE BREATHS FOR ADULTS AND CHILDREN:

 Rescue breathing is performed as follows
 Check that the person's mouth is clear. If there is a visible obstruction, try
to fish it out with your fingers.
 Tilt the person's head back slightly and lift their chin.
 Pinch their nose shut.
 Place your mouth fully over theirs.
 Blow forcefully to make their chest rise.
 If their chest does not rise, tilt their head back a little further and try again.
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RESCUE BREATHS FOR INFANTS:

 Rescue breathing is slightly different for infants
 Check that the infant's mouth is clear. If there is a visible obstruction, try to
fish it out with a finger.
 Tilt the infant's head back slightly and lift their chin.
 Place your mouth fully over their nose and mouth.
 Blow forcefully to make their chest rise.
 If their chest does not rise, tilt their head back a little further and try again.

Hands Only C.P.R. C.P.R. with Breaths

Survey the scene Check the scene for safety
Check the responsiveness Check for responsiveness
Seek immediate help if non- Place the child on a firm, flat surface
responsive
Place the person on a firm, flat Give 30 compressions
surface
Check the heart with an automated
Open the airway
external defibrillator (AED)
Locate hand Position Give two breaths
Begin compressions Continue alternating breathing with chest
compressions
Continue compressions -----
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CORRECT ORDER FOR CPR:

 The original order for CPR till recent past is A – B – C (Airway – Breathing
- Compressions)
 However, based on the latest guidelines of the American Heart
Association, the correct order for CPR is now the C-A-B Steps
or Compression, Airway, and Breathing.
 This is because cardiac arrest victims can go a minute or two without
taking a breath.
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HOW LONG IS THE CPR CYCLE?

 The cycle of CPR is for 2 minutes.
 For CPR to be effective, rescuers should perform five cycles in two
minutes.
 Additionally, it's recommended that rescuers swap after two minutes and
five cycles to prevent exhaustion and maintain effective compressions.

WHEN SHOULD CPR BE STOPPED?

 Once the CPR has begun, It should not be stopped except in one of these
situations:
 The victim shows apparent signs of life, such as movement or breathing.
 An AED is available and ready to use.
 Another trained responder or EMS personnel takes over to provide
advanced life support.
 You are too exhausted to continue.
 The scene becomes unsafe

SIGNS OF EFFECTIVE CPR:

Several signs indicate the effectiveness of CPR:

 Return of Spontaneous Circulation (ROSC): This is the restoration of a
stable and consistent heart rhythm.
 Normal Breathing: If the person starts breathing normally on their own, it
is a positive sign.
 Increased Responsiveness: Regaining consciousness or responsiveness is
an indication that oxygen is reaching vital organs.
 Pulse Detection: Feeling a pulse or detecting a pulse on a monitor
indicates circulation has been restored.
 Colour Improvement: If the person's skin colour improves from a bluish
tint to a more normal hue, it suggests improved oxygenation.
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 It's important to note that even if these signs are observed, the person
should still receive professional medical attention to assess and address
any underlying issues.

WHAT SHOULD BE DONE AFTER CPR IS ADMINISTERED?

 After administering CPR, it is crucial to continue monitoring the
individual until professional help arrives.
 If the person starts breathing normally and shows signs of life, such as
movement or responsiveness, he should be placed in the recovery position.
 This position helps maintain an open airway and prevents potential
complications.
 Continue to stay vigilant and provide any necessary information to
emergency services when they arrive.
 Remember that the effectiveness of CPR doesn't guarantee full recovery,
and professional medical assessment and care are essential.

POTENTIAL RISKS / COMPLICATIONS ASSOCIATED WITH CPR:

 The potential risks or complications associated with performing CPR are
numerous.
 The most common risks include broken ribs, a punctured lung, infection,
and nerve damage.
 In extreme cases, a person administering CPR may suffer from
overexertion due to the physical strain involved in performing
compressions.
 To minimize these risks, it is important to ensure that rescuers are properly
trained in CPR and take frequent breaks to avoid overexertion.
 Additionally, rescuers should wear protective gloves to reduce the risk of
infection.
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DEFEBRILLATION

 Defibrillation is a treatment for life-threatening cardiac arrhythmias,

specifically ventricular fibrillation and non-perfusing ventricular
tachycardia.
 Defibrillation is often an important step in cardiopulmonary
resuscitation (CPR) which is an algorithm-based intervention aimed to
restore cardiac and pulmonary function.
 It involves delivering a high intensity electrical charge in order to polarize
the entire myocardium at onetime so that the fastest normal pacemaker
can regain control over the pacing function of the Heart

 Defibrillation is indicated only in certain types of cardiac dysrhythmias,

specially ventricular fibrillation (VF) & pulse-less ventricular tachycardia.

 If the heart has completely stopped, as in a-systole or pulse-less electrical

activity (PEA), defibrillation is not indicated.
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 Defibrillation is also not indicated if the patient is conscious nor has a

pulse.

 Improperly given electrical shocks can cause dangerous dysrhythmias,

such as ventricular fibrillation.
 A defibrillator delivers a dose of electric current to the heart.

COMPLICATIONS:
 Damage to myocardium due to repeated high energy electrical shocks.
 Chest – Burns due to repeated high-energy discharges and poor contact
between the Paddles and the skin

 Electrocution of the by-standers

 Formation of short-circuits between the paddles due to excessive amount

of conduction jelly applied on the Paddles causing loss of electrical energy.

DEFIBRILLATORS:
 A defibrillator delivers a dose of electric current (often called a counter-
shock) to the heart.
 Defibrillators are medical devices that help to re-start the heart when it
stops pumping due to a sudden cardiac arrest.

 Although not fully understood, this process depolarizes a large amount of

the heart muscle, ending the arrhythmia.

 Subsequently, the body's natural pacemaker in the sino-atrial node of the

heart is able to re-establish normal sinus rhythm.

 A heart which is in a-systole (flat-line) cannot be restarted by a

defibrillator.
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 It would be treated only by cardiopulmonary resuscitation (CPR) and

medication, and then by cardio version or defibrillation if it converts into a
shockable rhythm.

TYPES OF DEFEBRILLATORS:
Defibrillators can be:
 External (manual & Automated)
 Internal (Trans venous, Implanted, Wearable)

EXTERNAL DEFEBRILLATORS

MANUAL:

 These are the Professional Use defibrillators

 Manual external defibrillators require the expertise of a healthcare
professional.
 They are used in conjunction with an electrocardiogram, which can be
separate or built-in.
 Manual defibrillators have capabilities that AEDs do not have.
 They are designed for medical professionals like EMTs, paramedics,
doctors, and more to use.
 A manual defibrillator gives the user the capability to determine the
problem with the heart and treat it appropriately.
 A healthcare provider first diagnoses the cardiac rhythm and then
manually determines the voltage and timing for the electrical shock.
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 These units are primarily found in hospitals and on some ambulances for
use by the attending paramedics and technicians

AUTOMATED EXTERNAL DEFIBRILLATORS (A.E.D):

 These are the Public Access defibrillators

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 Automated external defibrillators (AEDs) are designed for use by

untrained or briefly trained laypersons.
 AEDs contain technology for analysis of heart rhythms.
 As a result, it does not require a trained health provider to determine
whether or not a rhythm is shockable.
 By making these units publicly available, AEDs have improved outcomes
for sudden out-of-hospital cardiac arrests.
 Recent studies show that AEDs does not improve outcome in patients with
in-hospital cardiac arrests.
 AEDs have set voltages and do not allow the operator to vary voltage
according to need and may also delay delivery of effective CPR.
 AEDs can be fully automatic or semi-automatic.
 A semi-automatic AED automatically diagnoses heart rhythms and
determines if a shock is necessary.
 If a shock is advised, the user must then push a button to administer the
shock.
 A fully automated AED automatically diagnoses the heart rhythm and
advises the user to stand back while the shock is automatically given.
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INTERNAL DEFIBRILLATORS:

 An internal defibrillator is often used to defibrillate the heart during or

after cardiac surgery such as a heart bypass.
 The electrodes consist of round metal plates that come in direct contact
with the myocardium.
 Manual internal defibrillators deliver the shock through paddles placed
directly on the heart.
 They are mostly used in the operating room and, in rare circumstances, in
the emergency room during an open heart procedure

IMPLANTED CARDIOVERTER DEFIBRILLATORS (ICDS):

 Implanted cardio-verter defibrillators (ICDs) are small devices surgically

placed in the chest.
 Implantable cardio-verter-defibrillators, also known as automatic internal
cardiac defibrillator (AICD), are implants similar to pacemakers (and
many can also perform the pacemaking function).
 They constantly monitor the patient's heart rhythm, and automatically
administer shocks for various life-threatening arrhythmias, according to
the device's programming.
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 Many modern devices can distinguish between ventricular

fibrillation, ventricular tachycardia, and more benign arrhythmias
like supraventricular tachycardia and atrial fibrillation.
 Some devices may attempt overdrive pacing prior to synchronise cardio-
version. When the life-threatening arrhythmia is ventricular fibrillation,
the device is programmed to proceed immediately to an unsynchronized
shock.

COMPLICATIONS:

 There are cases where the patient's ICD may fire constantly or
inappropriately.
 This is considered a medical emergency, as it depletes the device's battery
life, causes significant discomfort and anxiety to the patient
 In some cases may actually trigger life-threatening arrhythmias.
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WEARABLE CARDIOVERTER DEFIBRILLATORS (WCDS):

 Wearable cardio-verter defibrillators (WCDs) are vests with a rechargeable
battery.
 A wearable cardio-verter defibrillator is a portable external defibrillator that can
be worn by at-risk patients.
 The unit monitors the patient 24 hours a day and can automatically deliver a
biphasic shock if VF or VT is detected.
 This device is mainly indicated in patients who are not immediate candidates for
ICDs.
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