1.BY ASHOK BISHNOI Lcturer,JINR

2. INTRODUCTION:- Sudden death occur when heartbeat & breathing stop suddenly or unexpectedly. the major role of CPR is to provide oxygen to heart ,brain,& the other vital organ until medical treatment (advance cardiac life support-ACLS) can restore normal heart action. 3. DEFINITION:- Angela Morrow RN Cardiopulmonary resuscitation (CPR) is a procedure used when a patient's heart stops beating and breathing stops. It can involve compressions of the chest or electrical shocks along with rescue breathing. Mosby medical dictionary CPR is a basic emergency procedure for life support consisting of artificial and manual external cardiac massage . 4. CHAIN OF SURVIVAL:- 5. INDICATIONS:- Cardio vascular disorders CAD, congenital heart diseases , coronary embolism, cardiac rupture & dissection Pulmonary causes pulmonary embolism, pulmonary edema, asphyxia Metabolic causes hypoglycemia, electrolyte imbalances 6. Fluid imbalance extensive hemorrhage, hypotension, shock Neurological causes brain injuries, massive cva Poisons substance and drug overdose co poisoning, propanolol over dose Other causes electrical shock, hypothermia, narcotic overdose 7. WARNING SIGNS OF CARDIO PULMONARY ARREST:- Early signs: . loss of consciousness & convulsions Late signs: . Apnoea .Dilated pupils .Absence of heart sounds 8. Other signs Changes in respiratory rate A weak or irregular pulse Bradycardia Cyanosis Hypothermia 9. CPR PROCEDURE 10. EQUIPMENTS i. Ambu bag and masks with different size. ii. Oropharyngeal airways. iii. Endotracheal tubes of appropriate sizes and stillet. E T T U B E 11. iv. Paediatric laryngoscope with straight (Miller) and curved (McIntosh) blade Appropriate sizes. v. Suction apparatus. vi. NG tube. 12. i. IV equipments & fluids ii. Pulse-oxymetry iii. Oxygen sources iv. Automated external defibrillator v. Emergency drugs vi. Cardiac monitor 13. STEPS FOR CPR:- Airway:-Maintaining an open airway. Breathing:-Providing artificial ventilation by rescue breathing. Circulation:-Promoting artificial circulation by external cardiac compression. Defibrillation:-Restoring the heart beat. 14. Shake shoulders gently Ask Are you all right? If he responds Leave as you find him. Find out what is wrong. Reassess regularly. CHECK RESPONSE 15. (A) AIRWAY :- Head tilt chin lift manoeuvre Jaw thrust manoeuvre 16. HEAD TILT CHIN LIFT MANOEUVRE 17. JAW THRUST MANOEUVRE 18. (B) Breathing:- Look Listen Feel 19. Method: Mouth to mouth ventilation Mouth to mask ventilation Bag mask ventilation 20. MOUTH TO MOUTH VENTILATION 21. MOUTH TO MASK VENTILATION 22. BAG MASK VENTILATION 23. NEONATAL PEDIATRIC ADULT 24. (C) Circulation:- Assess pulse {Adult} 25. Assess pulse (infant) 26. CHEST COMPRESSIONS 27. 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 3-5 cm(1.5 to 2 inches) Equal compression : relaxation When possible change CPR operator every 2 min CHEST COMPRESSIONS 28. IN ADULT 29. IN CHILD 30. IN INFANT 31. (D) DEFIBRILLATION:- Device that delivers direct electrical current across the myocardium. The aim is to produce synchronous depolarization of cardiac muscle STRATEGIES: Test defibrillate for full battery charge switch on power button change paddle mode 32. Key issues: Paddle site: Rt intraclavicular region lt lower axillary region Paddle size: 8cm -12 cm wave form patterns : monophasic biphasic truncated exponential biphastic rectilinear 33. Energy level: Pediatric : 2-4 J/kg Adult: Monophasic=> 360J Biphasic truncated=> 150-200J Biphasic rectilinear=> 120 J 34. STEPS:- switch on select paddle mode assess rhythm press paddles firmly over the chest deliver the shock resume cpr 35. Intensive care:-(shifting in ICU) transfer to ICU monitor closely and continuously monitor vital signs every hour watch for convulsions intubate if necessary catheterize the patient and monitor output record the procedure 36. POST CARDIAC ARREST MANAGEMENT:- Continued care To ensure hemodynamic monitoring To minimize the effect of loss of spontaneous circulation of various organs To recognize and treat recurrent cardiac arrests Objectives: Optimize cardio pulmonary function& systemic perfusion Transport victim out of hospital Identify and treat thre precipating factor Intitute measure to prevent recurrence and improve neurological function 37. Respiratory system; Intubate & mechanically ventilate until they are stable Administer supplemental oxygen Obtain chest x ray Administer drugs Avoid hyperventilation Cardio vascular system: Obtain expert consultation Monitor ecg , x-ray, lab analysis, Monitor intra arterial blood pressure Administer drugs 38. COMPLICATIONS OF CPR:-:- Rib fractures Laceration related to the tip of the sternum Liver, lung, spleen Aspiration Vmiting