CPR perspective

Cardiac arrest
Sudden and complete
loss of cardiac output
 Due to
 VF/VT
 NON VF/VT asystole/PEA
 Return from the loss is possible.
1.Electrical activity
2. Mechanical activity
1. Electrical activity
Mechanical activity
 Cardiac arrest

It is a clinical diagnosis
– Unconsciousness

– Pulselessness

– Breathing may take some

time to stop completely
• Agonal breathing
 Oxygen content
 Hb. gm/dl x 1.34 ml/gm
 16x1.34 ml
 20 ml./dl x COP
 20x 5000/100
 20x50 ml
 1000 ml
 Metabolic need 250ml
 1000 ml/250 ml/min
 4 min
 Lung
 Expired air oxygen 16-17%
 Tv 500ml
 heart
 Muscular bag
 Compressible
 In between two hard objects
 SV= 90 ml
 1/3 rd expressed with adequate compr.
 Brain and heart delays injury.
 cpr
 AIM
 GOAL
 BLS buys time
 ALS achieves aim and goal
 CPR: INTRODUCTION

1. Objectives:
 Idea of CPR is to familiarize with the modern
methods of life saving procedure in hospital.
 Course will help participant’s to achieve a better
understanding of person in cardiac arrest and to
learn the roles & intervention used by resuscitation
team.
 Resuscitation efforts can restore the stopping heart
to spontaneous activity before the brain has been
permanently injured.
 CPR: INTRODUCTION

2. Objectives (cont.):
 On successful completion of CPR training
participants will be able to recognize
 Respiratory arrest or insufficiency
 Obstructed airway
 Cardiac arrest
 Able to perform CPR correctly to prevent needless
death results from
 Failure to recognize the symptoms
 Failure to accept the truth of the symptoms
 Frightening of the family & over crowding around the
patient.
 Incorrect way of resuscitation.
 CPR

3. Content of the CPR Module:

A. Introduction - Life support in perspective
B. Video Presentation on BLS
C. Practical Demonstration on BLS
D. Demonstration on 6 Stations-
i. Defibrillation
ii. ECG
iii. Drugs
iv. Intubation
v. O2 Adjunct
vi. I.V Cannulation
E. Lecture on Trauma Resuscitation
F. ACLS Team: Case Scenario
G. Post Resuscitation Management
 Lecture on
INTRODUCTION - LIFE SUPPORT IN PERSPECTIVE

4. Background:
 CPR: Broad range of maneuvers and techniques to
restore spontaneous circulation and respiration.
 CPR vs CPCR (Cardiopulmonary cerebral
resuscitation)
 Initially CPR started from OT to resuscitate cardiac
arrest during operation
 Then spread from OT to the rest of the hospital
 Then to the community at large.
5. Background (cont.)
 Over the post 30 years, CPR is widely practiced then

popularized by AHA and others organization

 AHA also develop courses at different levels to teach CPR

 FOR the Medical personal in 1966.

 For, the paramedical personal
 For, then lay people in 1973.
 AHA adapted ACLS course in 1975.
 This course will also be conducted in accordance with the
curriculum of AHA.
6. CPR
 Leading cause of death
Cardiovascular disease, Malignancy, Trauma,
Resp. Disease, Infection,Other systemic disease
 Cause of death from cardiovascular disease
1. Heart Attack
2. Stoke
3. Heart Disease
4. Hypotension
 Cardio Pulmonary arrest: - Sudden loss of Cardiac Function
 Terminal events signifying death.
 No respiration
 No Pulse

 Loss of consciousness
7. CPR include

 BLS or Basic life support

 ABC
 DIFFERENCES BETWEEN BLS/CPR

 ACLS or Advanced CPR

8. BLS- Attempt to restore spontaneous circulation and
respiration by using chest wall compression &
pulmonary ventilation without? addition of equipment.
 It covers recognition of early warming signs of
 Resp Arrest
 Obstructed airway
 Cardiac arrest
 EMS?.
 Tools of BLS
 Sincere desire to save life
 Hands & Mouth of resquer
 Pitfalls of BLS
 Expired air contain 16% O2.
 Adequate Chest compression gives 1/4 to 1/3rd of
normal carotid artery flow.
9. ACLS
 Attempt to restore spontaneous circulation
and respiration by using-
 Basic CPR
 Use of specialized equipment to monitor
 Advanced airway management -ET intubation
 Defibrillation
 I.V medication to stabilize the patient.
 ACLS also refers to the education programe
that provides guidelines for these
techniques.
ACLS

10. Primary Survey:

A. Airway - Open airway
B. Breathing - Provide the pressure
ventilation.
C. Circulation - Give chest compression
D. Defibrillation- Shock VF & pulse less VT.

Exception – DABC
CAB
ACLS
11. Secondary Survey:
A. - Airway - Established advanced airway
control. Perform ET intubation.
B. Breathing - Assess adequacy of ventilation via
ET tube - provide +ve pressure venti.
C. Circulation - Obtain IV access
- Continue CPR
- Provide rhythm appropriate drugs.
D. D/D - Identify possible reason of arrest
- Identify reversible cause that have
specific therapy.
12. Time is Critical

 There is enough O2 in the lungs and

blood stream to sustain life up to 6
minutes.
 The first 4 to 6 minutes hold the key to
another chance for life.
13. Time is Critical

Time to BLS Time to ACLS

CPR (min) <8 min 8-16 min >16 min

0-4 43% 19% 10%

4-8 26% 19% 5%

8-14 - 6% 0%
14. LIKELIHOOD OF RECOVERY WITHOUT
BRAIN DAMAGE
15. Cardiac rhythm in Cardiac Arrest : ECG

1. VF Need defibrillation
2. VT (Pulse less)

3. Asystole Treat the reversible causes

4. PEA
 17. Drugs used in cardiac arrest
1. Epinephrine - Universally used
2. Lidocaine
3. Atropine
4. Sodium bicarbonate
5. Bretyllium : Not available in Bangladesh
6. O2
7. Steroid - still abused in Bangladesh
 18. I/V bolus epinephrine

 In VF & Pulse less VT - When DC shock fails.

 In Asystole & PEA - Treat the reversible cause.
19. ET tube as a route of drug administration

 Epinephrine
 Atropin
 Lidocaine
 Naloxone
 Sodi-bi-carb
* Dose of drug through ET tube: 2 -3 times of I.V
dose
 22. Chain of Survival : Successful

Survival depends on a series of critical

intervention:
 Early access - calling EMS support.
 Early basic CPR
 Early defibrillation
 Early ACLS
• Immediate recognition of cardiac arrest and activation of the emergency
response system

• Early compressions

• Rapid defibrillation

• Effective advanced life support

• Integrated post-cardiac arrest care

 C ard iop u lm on ary A rrest

In C om m u n ity Typ e n am e h ere In H osp ital

Typ e title h ere

B ystan d er C P R / B asic
A m b u lan ce C P R

E m erg en cy D ep t In H osp ital

A d van ced C P R A d van ced C P R

S u rvival

IC U / C C U
24. CPR
25. Heart, Lung, Airway
26. Airway
27. Assessing unresponsiveness
28. Position the victim as a unit
29. Head tilt & chin lift
30. Assessment of breathing
31. Mouth to mouth breathing
32. Head tilt & carotid pulse
33. Correct location & cardiac compression
34. Mouth to Mouth & Chest Compression
35. Airway Obstruction
36. Airway obstruction
37. Suspected neck injury - jaw thrust
38. Infant - Head tilt & palpation of brachial A
39. Infant mouth to mouth & Chest compression
40. Back blows
Chest thrust
 20. Na-bi-carbonate
 Usually used if other measures fail
 Preferably used in metabolic acidosis (not
due to lactic acidosis)
 Still an abused drugs in Bangladesh
 Paradoxical acidosis
 16. Causes of Asystole & EMD
PEA
ASYSTOLE
1. Hypovalemia
1. Hypoxia 2. Hypoxia
2. Hyperkalemia 3. Pericardial Tempnode
4. Tension Pneumothorox
3. Hypokalaemia 5. Hypothermia
4. Pre-existing acidosis 6. Massive Pul embolism
5. Drug overdose 7. Drug overdose
8. Hypokealimia
6. Hypothermia 9. Adidosis
10. Massive AMI
 Muscular bag
 In between two hard objects
 Stroke vol
 1/3 SV