Cardiopulmonary

Resuscitation
Techniques
Emergency Respiratory
Care
ODAYAN, Yollymar Rose P.
PORTILLO, Kathleen
Qas, Sarrah
TAHIR, Amna Osman

BACHELOR OF SCIENCE IN RESPIRATORY

THERAPY
LA UNION MEDICAL CENTER
 Table of contents
TREATING FOREIGN
01 INTRODUCTION 05 BODY AIRWAY
Causes and Prevention of Sudden death
Determining unresponsiveness OBSTRUCTION
Abdominal Thrust
Restoring circulation Vomiting
Back blows and chest thrust
02 STEPS OF CPR Evaluating the effectiveness of Foreign Body
Providing chest compression removal
Chest compression under special circumstance
Restoring ventilation
One-rescuer vs. Two-rescuer Adult CPR
06 EVALUATING THE
PHARMALOGICAL EFFECTIVENESS OF CPR
03
INTERVENTION
Routes for administration TRANSPORTATION OF
Drugs administered 07 CRITICALLY ILL PATIENT
04 RESTORING Respiratory Care Equipment needed during
transport
CARDIAC FUNCTION
Cardioversion
Defibrillation
Electrocardiogram electrical activity
 INTRODUCTION
CAUSES AND PREVENTION OF SUDDEN
DEATH

500, 000 cases

Experience SCA and
receive an attempted
resuscitation every year in
USA.

- Leading cause of death among adults over the age of 40 in the 209, 000 cases
United States Patients are being treated
- In the Philippines, heart diseases being the most common cause for in-hospital cardiac
of death (accounting for close to 20 percent of all deaths arrest.
according to the recent Department of Health statistics) among
adults.
 BASIC LIFE SUPPORT
(BLS)
- First-responders, healthcare providers and
public safety professionals provide to anyone
who is experiencing CARDIAC ARREST,
RESPIRATORY DISTRESS OR AN
OBSTRUCTED AIRWAY.
- The goal of BLS is to restore ventilation and
circulation to victims of airway obstruction and
respiratory or cardiac arrest.

S- Scene Safety A- Airway

I- Introduce, get consent B- Breathing
R- Responsiveness C- Circulation
A- Activate Medical Help
 01
Determining
Unresponsiveness
A patient’s response level can be
summarized in the AVPU mnemonic
as follows:

A- Alert
V- Responsive to voice
P- Responsive to Pain
U- Unresponsive/ Unconscious
ACTIVATING MEDICAL HELP

OUTSIDE HOSPITAL IN HOSPITAL

SETTINGS SETTINGS
● The victim’s level of
● Specific protocols exist for
consciousness must be
“calling a code”
checked whatever the ● All RTs must be familiar
location
with the protocols of their
● The rescuer must call for
institution for handling
help and activate the
these emergency situations.
emergency medical services
(EMS) system if the patient
is not moving or breathing.
 02RESTORING CIRCULATION
A
Pulse B
• CAROTID PULSE- Bleeding C
Adult and children Skin color,
• • Check for Blood-
BRACHIAL PULSE-
Neonates / infants soaked clothing or temperature
blood spurting out of ● Assessment of these
the wound.
can tell you more
about the patient’s
circulatory system.

NOTE: If no pulse is found within 10 seconds, health care providers can immediately proceed with chest
compressions.
 STEPS FOR EMERGENCY ACTION
PRINCIPLES
1 2 3

Learn how Step 01 Step 02 Step 03

to help
6 5 4

Step 06 Step 05 Step 04

 CARDIOPULMONARY RESUSCITATION
COMPONENT ADULT (age of CHILD (1- age of INFANT (under
puberty and puberty) age of 1)
above)
Recognition of Unresponsive (for all ages)
cardiac arrest No breathing or no normal breathing (i.e. only gasping)
No definite pulse within 10 seconds
Activation of EMS If you are alone with no phone, leave the victim to activate EMS
before beginning CPR. Otherwise, if someone is there to help
get AED and start CPR
Checking of Carotid artery Carotid or femoral Brachial artery
breathing and artery
circulation Breathing could be checked by the rise and fall of the chest.
For Lay rescuer: if no breathing, start CPR.
 CARDIOPULMONARY RESUSCITATION
COMPONENT ADULT (age of CHILD (1- age of INFANT (under
puberty and puberty) age of 1)
above)
Compression rate At least 100- 120/ minute
Compression depth 2 inches (5 cm) not At least 1/3 AP At least 1/3 of AP
more than 2.4 in diameter; About 2 diameter; about 1 ½
inches (5 cm) inches
Chest wall recoil Allow complete recoil between compressions
HCPs and PRs rotate compressions every 2 minutes
Compressions Minimize interruptions in chest compressions.
interruptions Attempt to limit interruptions to <10 seconds.

Airway ,dkinweifvwghvfHead-tilt-chin lift (HCP & PR: suspected trauma: jaw thrust)
 CARDIOPULMONARY RESUSCITATION
COMPONENT ADULT (age of CHILD (1- age of INFANT (under
puberty and puberty) age of 1)
above)
Compressions- to- 30:2 30:2
ventilation ratio 1 or 2 rescuers Single rescuer
(until advanced 15:2
airway placed) 2 HCP rescuers
Ventilations with 1breath every 5-6 seconds (10-12 breaths/min)
advanced airway Asynchronous with chest compressions
placed (HCP and Visible chest rise
PR)
Defibrillation Attach and use AED as soon as available. Minimize interruptions
in chest compressions before and after shock; resume CPR
beginning with chest compressions immediately after each
shock.
 PROVIDING CHEST COMPRESSION

POINTS TO REMEMBER:

• Minimum rate of 100

compressions per minute
• Do not exceed with 120
compressions per minute
• 1:1 downstroke-to-
upstroke ration
PHYSIOLOGIC PARAMETERS TI CHEST
COMPRESSION

 Quantitative waveform capnography

 Arterial relaxation diastolic pressure
 Arterial pressure monitoring
 Central pressure oxygen monitoring
PROVIDING CHEST COMPRESSION
A. ADULTS
PROVIDING CHEST COMPRESSION
B. CHILDREN AND INFANTS
PROVIDING CHEST COMPRESSION
C. NEONATE

Neonates – depth of approximately

1/3
 3:1 ratio of 90 compressions
 30 breaths for 120 events per
minute

• 2 methods
 Wraparound Technique
 Two – finger Technique
PROVIDING CHEST COMPRESSION UNDER
SPECIAL CIRCUMSTANCES

NEAR DROWNING
- Use of ABC method
- Help first before call, unless two-
rescuers and bystanders are
available.
PROVIDING CHEST COMPRESSION UNDER
SPECIAL CIRCUMSTANCES
Suspected opioid-related life-threatening emergency.

- Use of ABC method

- Administration of Naloxone
 03 RESTORING VENTILATION

The rescuer should To determine breathlessness, HCPs should use a ratio

assess for the the rescuer places their ear of 30 compressions to 2
patient’s breathing over the patient’s nose and breaths.
before attempting to
mouth while observing for
provide artificial
spontaneous rise and fall of
ventilation.
the chest not taking no longer
than 3 to 5 seconds.
 Providing Artificial Ventilation
Point #01
Victim should be provided with 100%
Oxygen for at least 4 to 6 minutes.

Point #02
HCPs should provide ventilation with
Bag Valve mask that delivers 100%
oxygen.
Point #3
O2 administration without positive
pressure during conventional CPR is
NOT recommended.
 MANUAL RESUSCITATOR
Uses of manual Resuscitator

2 3
Manual ventilation During transport of
patient who requires
artificial
1 ventilation

Hyperinflation of 4
lungs before Delivers
suctioning positive-pressure
ventilation to a
patient’s airway
 MODES OF VENTILATION

Mouth- to- mouth
Trained rescuers can restore
adequate oxygenation
through mouth-to-mouth
ventilation.
Mouth-to-mouth
Mouth-to-nose
and nose
Airway opening maneuvers Good for patients who
for children experiences lock jaw or if
and infants are similar to rescuer has a difficulty of
maneuvers for adults tightening the seal of
patient’s mouth.
ONE-RESCUER VS. TWO-
RESCUER

ONE-RESCUER TWO-RESCUER
 PHARMACOLOGIC INTERVENTION
Central Venous Line

Peripheral IV line

Intraosseous (IO) infusion

ROUTES OF
ADMINISTRATION ET tube
● Drug administration is of secondary
importance.
● Insertion of an advanced airway whether Intracardiac
for drug administration or
● ventilation, unless bag-mask ventilation
is ineffective, is of secondary
importance.
 PHARMACOLOGIC INTERVENTION
DRUG INDICATIONS ROUTE OF DOSAGE
ADMINISTRATION
Naloxone
Hydrochloride
Atropine 1. Sinus Bradycardia 1. IV bolus a. 10 mg IV every 5
Sulfate 2. Symptomatic 2. ET tube if other minutes for
bradycardia routes are not asystole
available b. 0.5 mg IV every
5 minutes
Lidocaine 1. lidocaine may be 1. IV bolus a. 1–1.5 mg/kg
considered 2. IV infusion bolus every
immediately after 3. IO b. 5–10 min up to 3
ROSC from cardiac 4. Endotracheal mg/kg
arrest due to VF/pVT
 PHARMACOLOGIC INTERVENTION
DRUGS INDICATIONS ROUTE OF DOSAGE
ADMINISTRATION
Vasopressin 1. Cardiac arrest 1. IV 40 units IV push
(one-time dose), may
be used in place of
first or second dose
of epinephrine in
cardiac arrest.

Epinephrine 1. Asystole 1. IV bolus 1. 1 mg IV every 3

2. Sinus Arrest 2. IO route minutes
3. Ventricular Fibrillation 3. ET tube 2. 2 to 2.5 times the
4. Pulseless ventricular 4. Intracardiac IV dose down ET
tachycardia tubes
5. Pulseless electrical activity
Evaluating the effectiveness of CPR
CARDIAC ARREST
Possible causes:
• Decreased or absent cardiac output
, • Decreased or absent pulmonary blood flow
• Sudden decrease in CO2 values

RETURN OF SPONTANEOUS CIRCULATION

Possible causes:
• Increase in cardiac output
• Increase in pulmonary blood flow
• Gradual increase in CO2 production
HAZARDS AND COMPLICATIONS

Neck and spine

Internal trauma
injuries
can be minimize by using
Use of Jaw-thrust maneuver the correct techniques

Gastric Foreign Body Airway

inflammation Obstruction
prolonged mouth-to-mouth
ventilation may cause the
air to enter the esophagus
and stomach
Contraindications of CPR
When to NOT/STOP to perform CPR?

 If the patient is biologically dead

 Spontaneous signs of breathing
and circulation are restored
 Turned over to a professional
provider
 Operator is exhausted and
cannot continue CPR
 Physician assumes responsibility
 Scene becomes unsafe
 Patient signed DNR
 Health Concerns and CPR
40 10%
% Reluctance to
Disease
initiate CPR
Transmission May impose other
Mouth-to-mouth complications and life-
ventilation threatening emergencies.
30
% 20%
Contamination
of Fomites Mechanical
barrier aids to
Proper use of PPEs. ventilation
Graph is only for illustration purposes only.
also been suggested to
allay fear and protect
the rescuer
TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
Universal distress signal for foreign
body obstruction
With a completely obstructed airway, the patient
commonly clutches at his or her throat.

A person with a complete obstruction cannot:

 Talk
 Cough
 Breathe

Is in dire need of emergency intervention using

abdominal thrusts, chest thrusts, back blows, or
a combination of two or more such maneuvers.
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
Abdominal Thrusts (Heimlich Maneuver)
Quick thrusts to the abdomen rapidly displace
the diaphragm upward, increasing intrathoracic
pressure and creating expulsive expiratory airflow

If an adult victim with FBAO becomes

unresponsive, the rescuer should move the
patient to the ground, activate the EMS system,
and begin CPR.
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
HAZARDS OF THRUST MANEUVER

Vomiting
Vomiting is another complication associated with
abdominal thrusts and gastric inflation; it is
impossible to avoid in some victims.

• Vomiting and aspiration can be lessened by

limiting gastric inflation.
• Using a 1-second inspiratory time and tidal
volumes limited to 500 mL may reduce the
incidence of gastric inflation and the aspiration of
vomitus.
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
HAZARDS OF THRUST MANEUVER

Internal Organ Damage

Possible damage to internal organs, such as
laceration or rupture of abdominal or thoracic
viscera.
• Can be minimized by the rescuer placing his
or her arms and fist below the victim’s xiphoid
process and the lower margin of the ribs.
• Abdominal thrusts are not recommended for infants
younger than 1 year of age because of their relatively
unprotected abdomens and large livers.
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
Back Blows and Chest Thrust
• Since abdominal maneuver can easily cause
abdominal injury when applied to infants, a
combination of back blows and chest
thrusts should be used to clear foreign bodies
from the upper airway.

• Back blows alone may create sufficient force

to dislodge trapped objects, but if this is
ineffective, the back blows should be followed
with five chest thrusts.
 TREATING FOREIGN BODY AIRWAY
OBSTRUCTION
Evaluating the Effectiveness of Foreign
Body Removal

• Successful removal of an obstructing body is

indicated by the following:

 Confirmed expulsion of foreign body

 Clear breathing and ability to speak
 Return of consciousness
 Return of normal color
 ADVANCED CARDIOVASCULAR LIFE
SUPORT
ACLS extends BLS capabilities by providing
additional measures beyond immediate
ventilatory and circulatory assistance. These
measures include using accessory equipment to
support ventilation.

- This is when the paramedics and medical

technicians when arrived at the scene.
- This is to treat, stabilize and transport patient
to the hospital.

This includes:
 Emergency intubation
 Emergency IV insertion
 Others
ADVANCED CARDIOVASCULAR LIFE
SUPORT

During ACLS in the hospital,

the RT assumes primary
responsibility for supporting
oxygenation, establishing and
maintaining the airway, and
providing ventilation
 RESTORING CARDIAC FUNCTION

ACLS must go beyond simple

perfusion support to identify,
remove, or relieve the underlying
cause of cardiac failure.
Done by combining ECG
monitoring with pharmacologic
and electrical therapies.
CARDIOVERSION
• Cardioversion is a synchronized current
of electricity delivered to the heart during
ventricular depolarization (QRS complex).

• Cardioversion is used to terminate the

following arrhythmias:

1. Atrial flutter
2. Atrial fibrillation
3. Ventricular tachycardia
4. Paroxysmal supraventricular tachycardia
5. Ventricular fibrillation (defibrillation is
usually indicated)
DEFIBRILLATION
• Defibrillation is an unsynchronized shock
used to depolarize all the myocardial
fibers simultaneously. It is the definitive
treatment for both VF and pulseless VT.
• When an electrical shock of appropriate
strength is applied to the myocardium, all
myocardial fibers depolarize
simultaneously.
ELECTROCARDIOGRAM
MONITORING

01
SUPRAVENTRICULAR
TACHYCARDIA
ELECTROCARDIOGRAM
MONITORING

02
VENTRICULAR TACHYCARDIA
ELECTROCARDIOGRAM
MONITORING

03
VENTRICULAR
FIBRILLATION
ELECTROCARDIOGRAM
MONITORING

04
PULSELESS ELECTRICAL
ACTIVITY
PATIENT CARE AFTER RESUSCITATION

The key principles of post-arrest care are:

 To identify and treat the core etiology of the

cardiac arrest
 To lessen ischemia reperfusion injury and
avert secondary organ injury
 Make accurate appraisals of prognosis to
guide the clinical team
 To advise the family when they are selecting
goals for continued care
PATIENT CARE AFTER RESUSCITATION

RESPIRATORY MANAGEMENT

● If the patient remains apneic or exhibits irregular

breathing after resuscitation, mechanical
ventilation is instituted through a properly
positioned endotracheal tube with an initial O2
concentration of 100%.
● ABG analysis also helps differentiate between
pulmonary and nonpulmonary (or cardiac)
causes of hypoxemia and tissue hypoxia.
● Mechanical ventilation is adjusted to maintain a
normal PaCO2 level.
 ADVANCE DIRECTIVES

Do-not-resuscitate
(DNR) protocols Allowed:
1. Do not initiate CPR. 1. O2 administration
2. Do not insert an oropharyngeal 2. Airway suctioning
airway or ET. 3. Use of a cardiac monitor
3. Do not provide any kind of 4. Emotional support
ventilatory assistance. 5. Control of bleeding
4. Do not initiate chest 6. Initiation of an IV line
compressions.
5. Do not administer cardiac
resuscitation drugs.
6. Do not defibrillate.
Transportation of critically ill
patients
• Unstable patients must be
transported with great care to
avoid worsening of their condition.
• Special attention must be given to
monitoring lines that could
become dislodged during
transport.
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• Patients should be adequately
images by Freepik
sedated to help prevent anxiety
and allow safer transport.
Transportation of critically ill
patients
Respiratory Care Equipment Needed During Transport

1. O2 system (tanks or liquid)

2. Portable suction machine and
catheters
3. Portable ventilator
4. Portable
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6. Intubation equipment
7. Manual resuscitator
Cardiopulmonary Resuscitation
TechniquesRespiratory Care
Emergency

RECAP!!
!
Cardiopulmonary Resuscitation
TechniquesRespiratory Care
Emergency

Reference:
Kacmarek, R., Stoller, J., Heuer, A. (2020).
Emergency Cardiovascular Life
Support. Barnes, T. Egan’s
Fundamentals of Respiratory Care.
Twelfth edition. Pp. 788-814.
 Thanks!
Does anyone have any
questions?
ODAYAN, Yollymar Rose
PORTILLO, Kathleen
QAS, Sarrah
CREDITS: This presentation template was created by
TAHIR,
Slidesgo,Amna Osman
including icons by Flaticon, and infographics &
images by Freepik
BSResPT- IV INTERNS
LA UNION MEDICAL CENTER
Cardiopulmonary
Resuscitation
Techniques
Emergency Respiratory
Care
ODAYAN, Yollymar Rose P.
PORTILLO, Kathleen
Qas, Sarrah
TAHIR, Amna Osman

BACHELOR OF SCIENCE IN RESPIRATORY

THERAPY
LA UNION MEDICAL CENTER