CPR

CARDIOPULMONARY RESUSCITATION

1. Presented to: Mrs. Sameeksha Patial (Assistant Professor, ACN) Presented by: Ms. Yoshita Sood BS22MHNS022 Presented on: May 20, 2023 CARDIOPULMONARY RESUSCITATION 4/19/2023 1

2. HISTORY 1732 - First medical BLS by William Tossach 1780 - First attempt of newborn resuscitation by blowing 1858 - method of restoring natural breathing by Dr. H.R. Silvester 1992 - First attempt of external chest compression 1949 - First report of mouth to mouth ventilation to cardiac arrest victim by James 1991 - Chain of survival by AHA 2000 - First International CPR Guidelines by ILCOR 4/19/2023 2

3. DEFINITION It is an emergency life saving procedure performed when the heart stops breathing. CPR can be initiated anytime an individual cannot adequately oxygenate or perfuse vital organs- not only following cardiac or respiratory arrest. CPR is an emergency procedure that combines chest compressions with artificial ventilation in an effort to manually intact brain function until further measures to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest . 4/19/2023 3

4. PURPOSES To maintain a clear and open airway. To maintain breathing by external ventilation. To maintain blood circulation by external cardiac massage. To save life of the patient. To provide basic life support till advanced and medical life support arrives. To reverse the initiating patho -physiological event. 4/19/2023 4

5. WHEN TO GIVE? WHEN NOT TO GIVE? Unconscious Person not breathing Has an abnormal pulse rate Heart abruptly stopped beating Neither scene nor victim and rescuer is safe Patient has developed rigor mortis Normal pulse and breathing 4/19/2023 5

6. INDICATIONS Acute Myocardial Infarction Cardiomyopathy Congestive heart failure Cardiac temponade Acute coronary syndrome Hypoxia Tension pneumothorax 4/19/2023 6

7. GOLDEN RULES TO BE KEPT IN MIND Optimise chest compressions rate : 100-125 compression per minute. Optimise compression depth : 50mm Minimise interruptions Promote full chest recoil Control breathing and ventilation 4/19/2023 7

8. TYPES 4/19/2023 8

9. BLS ( BASIC LIFE SUPPORT) BLS is the foundation of saving lives after cardiac arrest. A level of medical care which is used for victims of life threatening illnesses or injuries until they can be given full medical care at the hospital. Provided by a trained health professional . Includes psychomotor skills to perform high quality CPR , using an AED and relieve an obstructed airway. 4/19/2023 9

10. OBJECTIVES OF BLS It is primary medical aid provided in an emergency medical situation. Objective here is not to “treat” the person but to buy some valuable time until the emergency team arrives. BLS is performed by anyone who knows how to do it, anywhere, immediately without any other equipment. To reverse the initiating patho -physiological condition. To “save hearts too good to die” while preventing irreversible cerebral damage from anoxia. 4/19/2023 10

11. SEQUENCE C- compression A- airway B- breathing A- airway B- breathing C- compression 4/19/2023 11

12. WHY C-A-B?? To emphasize the simplest but the most important step. To increase survival rate in sudden cardiac arrest. Patient’s blood stays oxygenated for 4-6 minutes after last breath but circulation should be restarted at the earliest. Rescue breathing almost always delays chest compressions. 4/19/2023 12

13. 4/19/2023 13 AHA CHAIN OF SURVIVAL

14. COMPONENTS 4/19/2023 14

15. INITIAL STEPS Level of consciousness: Tap person gently on the shoulder Shout “ Are you okay?” Circulation and breathing: Check for carotid pulsation for not more than 10 seconds but 5 seconds Check for respiration, if there is at all any sign of it Agonal breaths 4/19/2023 15

16. CONTD. Call for help: Seek help from bystanders, other providers or from any trained individual. Activate EMS: Dial up 102/108 for EMS. Activate CODE BLUE for in-patients. Kolkata Accident Response and Medical Assistance(KARMA) 4/19/2023 16

17. CONTD. 4/19/2023 17

18. CHEST COMPRESSIONS It is foundation of CPR. Continued emphasis on providing high quality CPR. Push hard, push fast. Hands-only CPR. Rescuer should be at victim’s side. Patient should be supine on flat, firm surface. Chest is exposed adequately. 4/19/2023 18

19. CONTD. Heel of the hand is placed in the centre of the chest on the lower half of sternum. Other hand is placed on top. Fingers are interlaced. Arms are kept as straight as possible. Shoulder directly over the hands. Elbows are locked. Movement of the rescuer should be from the hip joint. 4/19/2023 19

20. CHEST COMPRESSIONS 4/19/2023 20

21. HIGH QUALITY CPR(ADULT) Push hard (at least 2 inches) and fast (100-120/min) Allow complete chest recoil. Minimize interruptions in compressions. Avoid excessive ventilation. Change compressor every 2 minutes, or sooner if fatigued. If no advanced airway, 30:2 compression-ventilation ratio. 4/19/2023 21

22. AIRWAY ASSESSMENT AND BREATHING Head tilt-Chin lift maneuver 4/19/2023 22

23. JAW THRUST MANEUVER 4/19/2023 23

24. RESCUE BREATH Mouth to mouth: Open airway- Pinch the nose seal mouth to mouth contact- Blow 4/19/2023 24

25. CONTD. Mouth to barrier device breathing: 4/19/2023 25

26. THE KISS OF LIFE Award winning 1967 photo was taken by Rocco Morabito . Champion Randall (hanging down after a cardiac arrest following electrocuted) and JD Thompson (giving mouth to mouth ventilation). CPR was given when Champion was brought down and survived and died of heart failure in 2002 at the age of 64. This photograph won Pulitzer Prize in 1968. 26 4/19/2023

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28. AUTOMATED EXTERNAL DEFIBRILLATOR 4/19/2023 28 AED is a portable electronic device that automatically analyses the patient’s rhythm and can provide defibrillation, an electric shock that may help the heart re-establish a perfusing rhythm. AED is an integral part of BLS protocol. Early defibrillation has been re-emphasized in all updates. AED’s deliver defibrillations to specific two shockable dysrhythmias: Ventricular fibrillation Ventricular tachycardia

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30. 4/19/2023 30 DIFFERENCES IN ADULT, CHILD AND INFANT

31. 4/19/2023 31 Adult: 1 ventilation every 5 to 6 seconds Child: 1 ventilation every 3 seconds Infant: 1 ventilation every 3 seconds

32. 4/19/2023 32 Adult : One pad on upper right chest and other on apex of heart Child: one pad on upper right chest below clavicle to sternum, other on left side of chest below nipple Infant: use anterior/ posterior placement- one pad in middle of chest and other on back between scapulae

33. RECOVERY POSITION 4/19/2023 33 MODIFIED H.A.I.N.E.S. POSITION “ High Arm In Endangered Spine” position ( for patients with suspected spine injury)

34. 4/19/2023 34 For patient who is unconscious and breathing with no head, neck and spinal injury

35. ACLS 4/19/2023 35 Advanced cardiac life support , advanced cardiovascular life support refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques .

36. 4/19/2023 36 DRUGS USED IN ACLS

37. ADENOSINE 4/19/2023 37 Uses : Supra ventricular Tachycardia (SVT) Dosage : 1 st dose- 6mg rapid IV push followed by saline bolus, 2 nd dose- 12mg rapid IV push in 1-2 minutes Side effects : Headache, dizziness, metallic taste, dyspnea, hypotension , bradycardia, nausea, flushing, sweating

38. EPINEPHRINE 4/19/2023 38 Uses : cardiac arrest, anaphylaxis, symptomatic bradycardia after atropine Dosage : Cardiac arrest- 1mg IV Side effects : tremors, dizziness, SVT, VT, Palpitations, chest pain , nausea, vomiting, hyperglycemia, vasoconstriction

39. AMIODARONE 4/19/2023 39 Class III antiarrhythmic agent Dosage : 300mg rapid bolus with 2 nd dose of 150mg if necessary to a maximum of 2.2 grams over 24 hrs. Side effects : significant hypotension, dizziness, bradycardia, torsades de pointes, tremors

40. LIDOCAINE HCL 2% 4/19/2023 40 Uses : cardiac arrest from VF , wide complex tachycardia Dosage : cardiac arrest: 1-1.5mg/kg IV bolus; may repeat twice at half dose in 5-10 minutes to total of 3mg/kg Side effects : seizures, bradycardia, dyspnea, tachycardia, vomiting , headache, dizziness, tremor, drowsiness, tinnitus

41. MAGNESIUM SULFATE 4/19/2023 41 Uses : Torsades de pointes; hypo- magnesemia ; digitalis toxicity Dosage : cardiac arrest due to hypomagnesemia : 1-2 gm IV bolus Torsades with pulse : 1-2 gm IV over 5-60 minutes followed by infusion at 0.5-1 gm per hr IV Side effects : confusion, sedation, weakness, respiratory depression, hypotension

42. RESEARCH ARTICLE 4/19/2023 42 The impact of cardiopulmonary resuscitation (CPR) training on schoolchildren and their CPR knowledge, attitudes toward CPR, and willingness to help others and to perform CPR: mixed methods research design. RESULT: Significant progress in cardiopulmonary resuscitation knowledge was noted after training implementation, with the greatest progress seen in the youngest age group (mean age 12.5). The greatest increase after training was seen for the variables Attitude toward helping others ( p  = 0.001) and Self-confidence ( p  = 0.001).

43. CONTD. 4/19/2023 43 The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Study objective:  To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. Result: Overall, seven of 35 patients (20%) were resuscitated successfully in the post-ACLS period, with two patients surviving to hospital discharge. This was not significantly different than the two of 29 patients (7%) resuscitated in the pre-ACLS period, with one patient surviving to discharge.

44. 4/19/2023 44 CONCLUSION

45. ANY QUERIES? 4/19/2023 45

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