Cardiopulmonary

Resuscitation
Pre-Lab Lecture
Ralph Rebello, M.D.
 TABLE OF CONTENTS
Cardiopulmonary Arrest
01
& CPR

02 How to save a life

Important
03
considerations in BLS
 01
Cardiopulmonary
Arrest & CPR
 Introduction
Cardiopulmonary resuscitation (CPR) is a
collection of interventions performed to provide
oxygenation and circulation to the body during
cardiac arrest (Goyal et. al 2023).
Cardiopulmonary Arrest
● Cardiopulmonary arrest is the cessation
of adequate heart function and
respiration and results in death without
reversal (Sharabi & Singh, 2023).
● Failure of heart to pump blood → ↓ O2
delivery
➔ Brain: 4 min
➔ Heart: 7 min
➔ Body: 1-2 hr
 Most common cardiac arrhythmia
that causes sudden cardiac arrest:

Ans: Ventricular Fibrillation

Ventricular Fibrillation (VFib)
Survival rate from minutes of beginning CPR
30% 0-2%
<4min >10 min

20% 2-8%
7 min 8-10 min
 02
“How to save a
life” - The Fray
I. Initial Assessment
 I. Initial Assessment

1. Unconscious victim on visual assessment

*While tapping both
shoulders*
“HEY HEY! ARE YOU “The scene is
OKAY?! HEY HEY! ARE 2. Ensure scene safety safe. I am safe.”
YOU OKAY?!”

3. Check for responsiveness

“1. Help!
2. Call 911!
4. Call for help 3. Activate EMS!
4. Get the AED!"

5. Check for pulse and breathing

 After the initial assessment

I. Check for pulse and

No pulse With pulse
breathing (<10 seconds)
No breathing No breathing

II. Perform CPR III. Give Rescue Breaths

C-A-B 1. Open the airway

1. Chest 2. Apply a barrier
compressions (C) device
2. Airway (A) 3. Provide artificial
3. Breathing (B) respiration
*Get the Defibrillator
Checking for pulse and breathing
● Done within 10 seconds
● For pulse: Check the carotid pulse
❖ Child: Carotid or Femoral Pulse
❖ Infant: Brachial Pulse
● For breathing: Observe for chest rise

“Checking for pulse and breathing. No pulse,

no breathing. I’m going to start CPR”
 Overview on the CPR algorithm
After the initial assessment

I. Check for pulse and

No pulse With pulse
breathing (<10 seconds)
No breathing No breathing

II. Perform CPR III. Give Rescue Breaths

C-A-B 1. Open the airway

1. Chest 2. Apply a barrier
compressions (C) device
2. Airway (A) 3. Provide artificial
3. Breathing (B) respiration
*Get the Defibrillator
 First Scenario
After the initial assessment

I. Check for pulse and

No pulse With pulse
breathing (<10 seconds)
No breathing No breathing

II. Perform CPR III. Give Rescue Breaths

C-A-B 1. Open the airway

1. Chest 2. Apply a barrier
compressions (C) device
2. Airway (A) 3. Provide artificial
3. Breathing (B) respiration
*Get the Defibrillator
I. Cardiopulmonary
Resuscitation
Chest Compressions
Chest Compressions
Put your other hand on top of the
Put the heel of your
first with fingers interlaced
hand at the lower
half of the sternum
 Chest Compressions

Shoulders over hands

Elbows locked
Arms straight Keep contact
with chest
 Chest Compressions

Push hard and fast.

100-120 2.0-2.4 in
compressions/min 5-6 cm
 Chest Compressions

1 -2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 1
0 - 11 - 12 - 13 - 14 - 15 - 16 -
17 - 18 - 19 - 20 - 21 - 22 - 23
- 24 - 25 - 26 - 27 - 28 - 29 -
and - ONE

Allow complete
chest recoil
Chest Compressions
1. Appropriate ratio of chest compressions to rescue breaths = 30:2
❖ 30 compressions followed by 2 rescue breaths
2. Connect Automated External Defibrillator (AED) as soon as possible and follow the prompt
3. Check pulse and breathing after 5 cycles (approx. 2 minutes or 200-240 compressions). Continue
CPR if necessary
4. If pulse and breathing have resumed, put the victim in the recovery position
5. Continue CPR until S-T-O-P:
● Spontaneous breathing and pulse is present
● The healthcare team (EMS) arrives
● Over-exhaustion of the rescuer
● Physician declared that the patient is dead
 Chest Compressions - Using the AED
I. Check for pulse and
No pulse With pulse
breathing (<10 seconds)
No breathing No breathing

II. Perform CPR Attach the AED III. Give Rescue Breaths

C-A-B 1. Open the airway

Rhythm shockable? 2. Apply a barrier
1. Chest
compressions (C) Yes No device
2. Airway (A) 3. Provide artificial
3. Breathing (B) respiration
Give 1 shock. Resume CPR Resume CPR
*Get the Defibrillator for 5 cycles. Assess after

No
Yes
Victim resuscitated? Recovery position
Chest Compressions - Using the AED
A→E→D→S
1. Activate the AED and Attach electede
pads
2. Evaluate the rhythm
● Make sure no one is in physical contact
with the victim
3. Deliver shock
● Make sure no one is in physical contact
with the victim
4. Start/resume CPR
 Chest Compressions - Using the AED
A→E→D→S
1. Activate the AED and Attach electede
pads
2. Evaluate “1.
theAttaching
rhythm pads!
● Make2. sure
Clearnotoone
analyze!
is in physical contact
3. Clear to shock!
with the victim
4. 3. Deliver
Shocking shock
on 3! 1-2-3, shocking! Shock delivered!”
● Make sure no one is in physical contact
with the victim
4. Start/resume CPR
Airway & Breathing
Airway & Breathing
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide two rescue breaths
● Give second breath 5 seconds after the first
(Blow, then count 1-2-3-and-2 blow)
Airway & Breathing
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide two rescue breaths
● Give second breath 5 seconds after the first
(Blow, then count 1-2-3-and-2 blow)
Airway & Breathing
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide two rescue breaths
● Give second breath 5 seconds after the first
(Blow, then count 1-2-3-and-2 blow)
Summary Of Steps
Summary of Steps
1. “The scene is safe. I am safe.”
2. “Hey, hey are you okay?” (x2)
3. “No response! Help! Call 911, Activate EMS! Get the AED!”
4. “Checking for pulse and breathing!”
5. “No pulse, no breathing. Starting CPR!”
*Continue CPR while your partner attaches the pads* “Attaching Pads”
6. *After one cycle of CPR* “Stop-Switch-Analyze”
7. “Clear to Analyze” *Allow the AED to analyze the rhythm* *If shock is advised…* “Clear to shock!
Shocking on 3! 1-2-3! Shocking! Shock delivered! Resuming CPR!”
8. Continue until S-T-O-P
 Second Scenario
I. Check for pulse and
No pulse With pulse
breathing (<10 seconds)
No breathing No breathing

II. Perform CPR III. Give Rescue Breaths

C-A-B 1. Open the airway

1. Chest 2. Apply a barrier
compressions (C) device
2. Airway (A) 3. Provide artificial
3. Breathing (B) respiration
*Get the Defibrillator
II. Only Rescue Breaths
Rescue Breaths
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide rescue breaths for two minutes
Rescue Breaths
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide rescue breaths for 2 minutes
Rescue Breaths
1. Open the airway
● Head-tilt chin-lift maneuver
● Jaw-thrust w/o head extension
2. Apply a barrier device
● If no barrier device is available, hands only
cpr is recommended
3. Provide rescue breaths for 2 minutes
When providing only rescue breaths…
1. Give one breath every 5-6 seconds for 2 minutes
● ~12 breaths if you take into consideration the time utilized for blowing
● Blow, then count 1-2-3-and 2 *blow*
1-2-3-and 3 *blow*
● Until… 1-2-3-and 12 *blow*
2. Check for pulse and breathing again after 2 minutes
● No pulse → Begin CPR
● With pulse but no breathing → Repeat Rescue Breaths/Artificial Respiration
 03
Important
considerations
in BLS
Important considerations
● If there is suspected cervical spine trauma (Ex: the patient fell or was hit by a moving object):
❖ DO NOT move them EXCEPT if they are vomiting → Recovery Position
❖ When opening the airway, use the jaw-thrust method ONLY
❖ DO NOT place him/her in the recovery position
● In times such as the pandemic where airborne diseases are rampant, YOUR SAFETY COMES
FIRST
❖ Be SURE to apply a barrier device
❖ If no barrier device is available, hands-only CPR with AED use is highly recommended
Complications of CPR
● F-L-A-G
❖ Fractured Ribs
❖ Lacerated Liver
❖ Atelectasis (due to punctured lungs)
❖ Gastric Distension
 REFERENCES
● Bickley, Lynn S. (2003). Bates' guide to physical examination and history taking.
Philadelphia :Lippincott Williams & Wilkins
● Goyal A, Sciammarella JC, Cusick AS, et al. Cardiopulmonary Resuscitation. [Updated
2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470402/
● Loscalzo J, & Fauci A, & Kasper D, & Hauser S, & Longo D, & Jameson J(Eds.), (2022).
Harrison's Principles of Internal Medicine, 21e. McGraw Hill.
● Philippine Heart Association (2021). Basic Life Support
● Russell I. S. (2001). Accuracy of ATLS guidelines for predicting systolic blood pressure.
Authors' core assertion was wrong. BMJ (Clinical research ed.), 322(7285),
552–553.