Brief explanation of Cardio Pulmonary Resucitation

Cardiopulmonary resuscitation (CPR) is a life-saving emergency procedure that combines chest compressions with artificial ventilation to maintain circulatory flow and oxygenation in a person whose heart has stopped beating (cardiac arrest) or who has stopped breathing (respiratory arrest). It is a vital technique used in emergencies, including heart attacks, near drownings, and accidents where someone's breathing or heartbeat has stopped. Below is a comprehensive description of CPR, broken into several sections to ensure a thorough understanding of its purpose, steps, effectiveness, and variations.

### 1. **Introduction to CPR**

CPR is a critical intervention that keeps oxygenated blood circulating through the body, particularly to the brain and vital organs, when the heart is not functioning effectively. In a cardiac arrest, every second counts. Brain cells begin to die within minutes if they are deprived of oxygen, leading to irreversible damage. CPR delays this process and provides the necessary blood flow to the brain until advanced medical help arrives or the heart is restarted using defibrillation.

The primary goals of CPR are:
- To restore partial flow of oxygenated blood to the brain and heart.
- To delay tissue death.
- To extend the window of opportunity for successful resuscitation without permanent brain damage.

### 2. **History of CPR**

The concept of artificial resuscitation has been around for centuries, but modern CPR as we know it was developed in the mid-20th century. Dr. Peter Safar and James Elam pioneered mouth-to-mouth resuscitation in the 1950s, and Dr. Kouwenhoven, Knickerbocker, and Jude described chest compressions in 1960. Together, these techniques formed the basis of modern CPR.

Since then, CPR has evolved, with organizations like the American Heart Association (AHA) and the European Resuscitation Council (ERC) playing significant roles in refining and disseminating updated guidelines to improve its effectiveness.

### 3. **When to Perform CPR**

CPR is needed in any situation where a person is unresponsive and not breathing or breathing abnormally. This can be due to a variety of causes:
- **Cardiac arrest**: Often caused by a heart attack, but it can also occur due to arrhythmias, heart failure, or other heart conditions.
- **Drowning**: CPR is used when a person is pulled from water and is not breathing.
- **Choking**: Obstruction of the airway can lead to respiratory arrest, requiring immediate intervention.
- **Drug overdose**: Certain substances, like opioids, can suppress respiration, leading to cardiac arrest.
- **Severe trauma**: Accidents or injuries can cause someone to stop breathing or for their heart to stop.
- **Electrocution**: Can disrupt the heart’s electrical activity and cause it to stop.

Early recognition of cardiac arrest and initiation of CPR can significantly increase the chances of survival.

### 4. **Steps of CPR**

The steps to perform CPR are commonly taught using the acronym C-A-B

1. Presented by: Dr. Poonam Soni & Dr. Yogita Jhandai CPR

2. INTRODUCTION Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped.

3. DEFINITION Cardio Pulmonary Resuscitation is a technique of basic life support for oxygenating the brain and heart until appropriate definitive medical treatment can restore normal heart and ventilatory action.

4. MANAGEMENT OF CPR Management guidelines are based on the recent recommendation 2015, by American Heart Association (AHA) & Emergency Cardiovascular Care (ECC) with International Liaison Committee on resuscitation(ILCOR). AHA & ECC have giving four link chain of survival: Early recognition and activation of emergency medical services. Immediate CPR(every minute delay decreases prognosis by 7-10 %). Early shock (CPR + shock within 5 minute has survival rate of 49-75%) Early advance life support.

5. PURPOSES   • To maintain an open and clear airway (A). • To maintain breathing by external ventilation (B). • To maintain Blood circulation by external cardiac massages (C). • To save life of the Patient. • To provide basic life support till medical and advanced life support arrives .

6. INDICATIONS Cardiac Arrest • Ventricular fibrillation (VF) • Ventricular tachycardia (VT) • Asystole • Pulse less electrical activity

7. Respiratory Arrest This may be result of following: • Drowning • Stroke • Foreign body in throat • Smoke inhalation • Drug overdose • Suffocation • Accident, injury • Coma • Epiglottis paralysis.

8. PRINCIPLES OF CPR • To restore effective circulation and ventilation. •To prevent irreversible cerebral damage due to anoxia. When the heart fails to maintain the cerebral circulation for approximately four minutes the brain may suffer irreversible damage .

9. CPR PROCEDURE SEQUENCES OF PROCEDURES PERFORMED TO RESTORE THE CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY AND/OR CARDIAC ARREST. CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER EQUIPMENT

10. ALGORITHM SHOWING BASIC LIFE SUPPORT

11. APPROACH SAFETY Watch & Observe

12. CHECK RESPONSE Shake shoulders gently Ask “Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly.

13. WARNING SIGNS OF CARDIO PULMONARY ARREST:- Early signs: loss of consciousness & convulsions Late signs: Apnoea Dilated pupils Absence of heart sounds Other signs :- Changes in respiratory rate A weak or irregular pulse Bradycardia Cyanosis Hypothermia

14. SHOUT FOR HELP Remember! Before you begin: Confirm that the area is secure Notify (or have someone notify) medical personnel about the situation CPR is best done with 2 people One person doing the breathing One person doing the compressions Tuesday, March 5, 2024 14

15. OPEN AIRWAY Head tilt and chin lift lay rescuers non-healthcare rescuers No need for finger sweep unless solid material can be seen in the airway Head tilt, chin lift + jaw thrust

16. CHECK BREATHING  Look, listen and feel for NORMAL breathing B is for Breathing Put your ear to the mouth and nose Listen to see if they are breathing Observe if the chest is rising Feel for breaths on your cheek • Do not confuse agonal breathing with NORMAL breathing. AGONAL BREATHING- Occurs shortly after the heart stops in up to 40% of cardiac arrests . • Described as barely, heavy, noisy or gasping breathing . • Recognize as a sign of cardiac arrest.

17. CALL 108 30 CHEST COMPRESSION • Place the heel of one hand in the centre of the chest • Place other hand on top • Interlock fingers • Compress the chest – Rate 100 min-1 – Depth 4-5 cm (1.5 to 2 inch) – Equal compression : relaxation • When possible change CPR operator every 2 min

18. RESCUE BREATHS  • Pinch the nose • Take a normal breath • Place lips over mouth • Blow until the chest rises • Take about 1 second • Allow chest to fall • Repeat

19. RESCUE BREATHS RECOMMENDATIONS: - Tidal volume  500 – 600 ml Respiratory rate Give each breaths over about 1s with enough volume to make the victim’s chest rise Chest-compression - only continuously at a rate of 100 min

20. POSSIBLE COMPLICATIONS •  Coronary vessel injury • Diaphragm injury • Hemopericardium • Hemothorax • Interference with ventilation  Liver injury • Myocardial injury • Pneumothorax • Rib fractures • Spleen injury • Sternal fracture

21. MEDICAL MANAGEMENT ADRENALINE Adrenaline (epinephrine) s the main drug used during resuscitation from cardiac arrest. ATROPINE Atropine as a single dose of 3mg is sufficient to block vagal tone completely and should be used once in cases of asystole . It is also indicated for symptomatic bradycardia in a dose of 0.5mg - 1mg. AMIODARONE It is an antiarrhythmic drug. XYLOCARD X ylocard is prservative free lignocane used for treatment of ventricular ptacyarhythmia . The dose is 1.5-2.0 mg/kg.

22. THANK YOU