1. C ARDIOPULMONARY R ESUSCITATION (CPR)

2. OBJECTIVES At the end of this session, each student should be able to: List the sequence of CPR. Explain the procedures for performing CPR. Demonstrate CPR. Know when to terminate CPR.

3. I NTRODUCTION CPR is a life-saving technique. Time is critical in starting CPR. CPR is indicated whenever the heart stops (called: cardiac arrest), and/or the breathing stops (called: respiratory arrest). CPR can keep a person alive until more advanced procedures (such as defibrillation - an electric shock to the chest) can treat the cardiac arrest.

4. CPR steps are called CAB (Chest Compression, Airway, and then Breathing). Providing artificial circulation via chest compressions. Opening and maintaining the airway. Providing artificial ventilation through artificial breathing.

5. CPR provides circulation of blood to the brain and air to the lungs in order to prevent damage to the brain. If breathing stops → brain damage occurs within few minutes usually 4 minutes, and brain death could occur within 8-10 minutes.

6. I N CPR, VICTIMS ARE DIVIDED INTO 3 CATEGORIES : Adults Involve all adults and children who reached the puberty (i.e., adolescents). Puberty is defined as chest or underarm hair on males, or any breast development on females. Children Involve victims from the age of 1 to puberty. Infants Involve victims with less than 1 year of age.

7. S UMMARY OF H IGH -Q UALITY CPR C OMPONENTS FOR BLS P ROVIDERS

8. C HECKING R ESPONSIVENESS Check responsiveness by gently tapping on shoulders and asking loudly “Are you OK?” or “Do you hear me?” Note: In infants (i.e., less than 1 year of age) victims, you should tap on the heel of the foot.

9. C HEST C OMPRESSION STEP (A LSO CALLED C IRCULATION STEP ) o Check for the presence of pulse: o For adults, carotid artery pulse may be used. o For children, carotid artery pulse OR femoral artery pulse may be used. o For infants, brachial artery pulse may be used.

10. o If there is no definite pulse and/or breathing (or gasping), then this victim needs cardiopulmonary resuscitation (CPR). o In infants, if the pulse is 60 beats or less per minute, this victim also needs cardiopulmonary resuscitation (CPR). o Careful! If you are not trained to perform CPR, then find someone who is trained.

11. C AROTID A RTERY C HECKING

12. F EMORAL A RTERY C HECKING

13. B RACHIAL A RTERY C HECKING

14. A UTOMATED E XTERNAL D EFIBRILLATOR (AED)

16. S UMMARY OF H IGH -Q UALITY CPR C OMPONENTS FOR BLS P ROVIDERS

20. Hands Placements for Compressions: For Adults (See the Image on Next Slide) Ensure that the victim on his/her back on a firm surface. Put the heal of one hand on the center of bared chest over the lower half of the breastbone (sternum), then put the heal of the other hand over the top of the first. Your shoulder should be right over your hands and your elbows should be straight/extended.

21. H ANDS P LACEMENT IN A DULTS

22. Hands Placements for Compressions: For Adults Key Messages: You should deliver compressions in a smooth fashion at a rate of 100-120 compressions per minute. At the end of each compression, allow the chest to recoil completely.

23. Hands Placements for Compressions: For Children Similar to the Adults; but you have the option to use 1 or 2 hands. Remember: You should deliver compressions in a smooth fashion at a rate of 100-120 compressions per minute. At the end of each compression, allow the chest to recoil completely.

24. Hands Placements for Compressions: For Infants 1-rescure CPR Use 2 fingers of one hand. Place the middle and index fingers on the breastbone just below the nipple line. 2-rescuer CPR The compressor will place both thumbs side- by-side in the center of the chest on the lower half of the breastbone [ just below the nipple line]. This technique is also called: 2-thumb encircling hands technique.

25. Key Considerations Each set of 30 compressions should be done in approximately 18 seconds. A ventilator (the rescuer who provides ventilations): 1. CAN check for a pulse during compressions to make sure they are effective by feeling a pulse every compression. 2. SHOULD observe for correct delivery of compressions by the compressor.

26. A IRWAY STEP Kneel close to the victim neck or shoulders. To open the airway, tilt the forehead backward and the chin upward (called head-tilt/chin-lift maneuver) طريقة حني رأس المصاب إلى الخلف و رفع الفك إلى أعلى.

27. Careful! In victims with suspected head, neck or back injuries, use a method called: jaw-thrust maneuver طريقة رفع الفك السفلي.

28. B REATHING STEP Close the nostril and give 2 breaths (mouth to mouth) and observe the chest rises. Give each breath over one second to allow chest recoil.

29. A FTER TWO (2) MINUTES OF “ COMPRESSION : VENTILATION CPR CYCLES ”, If the victim has no definite pulse and absent (or not normal) breathing, Resume CPR (starting with chest compressions). Every approximately 2 minutes: Within 5 to 10 seconds, look for no breathing (or only gasping) and check for definite pulse (simultaneously).

30. A FTER AROUND TWO (2) MINUTES OF “ COMPRESSION : VENTILATION CPR CYCLES ”, If the definite pulse is present BUT breathing is absent, Continue artificial breathing only (called rescue breathing ). In Adults: Give 1 breath every 5 ‐ 6 seconds for about 10 ‐ 12 breaths/minute. Each breath should be delivered over 1 second, making the chest rise. Every approximately 2 minutes: Within 5 to 10 seconds, look for no breathing (or only gasping) and check for definite pulse (simultaneously).

31. A FTER AROUND TWO (2) MINUTES OF “ COMPRESSION : VENTILATION CPR CYCLES ”, If the definite pulse is present BUT breathing is absent, Continue artificial breathing only (called rescue breathing ). In Children and Infants : Give 1 breath every 3 ‐ 5 seconds for about 12 ‐ 20 breaths/minute. Each breath should be delivered over 1 second, making the chest rise. Every approximately 2 minutes: Within 5 to 10 seconds, look for no breathing (or only gasping) and check for definite pulse (simultaneously).

32. A FTER AROUND TWO (2) MINUTES OF “ COMPRESSION : VENTILATION CPR CYCLES ”, If the pulse and breathing returned to normal, Place the victim in recovery position وضعية الانعاش ( وضعية الأمان الجانبي ), and: Continue to monitor the victim. Every approximately 2 minutes: Within 5 to 10 seconds, look for no breathing (or only gasping) and check for definite pulse (simultaneously).

33. 1 2 4 3

34. U SING AN AED

35. Put an AED on the victim as soon as it arrives and turn it on. When an AED is analyzing the victim's data (or during shocking if needed), no one should touch the victim.

36. U SING AN AED If the rhythm is SHOCKABLE, give 1 chock, and resume CPR immediately for about 2 minutes (until prompted by AED to allow rhythm check). Continue until advanced life support providers taking over or victim stars to move. If the rhythm is NOT SHOCKABLE, resume CPR immediately for about 2 minutes (until prompted by AED to allow rhythm check). Continue until advanced life support providers taking over or victim stars to move.

37. U SING AN AED

38. W HEN CAN I STOP CPR? The victim revives. Trained help arrives. You are too exhausted to continue. The victim is pronounced dead. The cardiac arrest continues for 20 minutes (controversial).

39. W HY CPR MAY FAIL ? Delay in starting. Delay in defibrillation. Improper procedures/techniques Examples: No pinching of the nose during ventilation. Not allowing for chest recoil between the chest compression. Terminal disease or unmanageable disease Example: Massive heart attack – especially with a death of more than 40% of heart cells during the attack.

40. M ORE I NFORMATION The first rescuer reaches the victim should ensure safety at the scene quickly. Hands-only CPR should be encouraged where untrained caregivers are involved. Performing CPR compressions on the xiphoid process can cause internal organ damage. Always, switch roles (compressor to ventilator, and vice-versa) when an AED starts analyzing the rhythm.

41. In 2-rescure adult CPR, switch roles (compressor to ventilator, and vice-versa) every 5 cycles or 2 minutes, taking less than 5 seconds, to prevent fatigue. In 2-rescure child or infant CPR, switch roles (compressor to ventilator, and vice-versa) every 10 cycles or 2 minutes, taking less than 5 seconds, to prevent fatigue. Note: During this 2-rescuer CPR, you are doing the CPR cycles at 15:2 not 30:2.