1. Chest compressions

3. Indication If after 30 seconds of effective bag and mask ventilation with 100% oxygen, heart rate is below 60 per minute

4. When to stop chest compressions When heart rate is 60 per minute or more

5. Principle Pump out blood from the heart during compression and fill up blood in the heart during release Must always be accompanied by ventilation with 100% oxygen

6. Mechanism of Chest Compressions CompressRelease heart sternum

7. Components Position Neck slightly extended with firm support for the back Lower 1/3 rd of sternum between nipple line & sternum Pressure required – depth 1/3 rd of the AP diameter of chest Rate 90/min

8. Chest Compressions Position Lower third of sternum Between nipple line and xiphisternum

9. Techniques of Chest Compressions Thumb method Two-finger method

10. Techniques Thumb technique Two-finger technique # Do not remove thumbs/finger from chest

11. Thumb technique Thumbs on sternum, hands on torso & finger supporting the back Thumbs flexed at the first joint Pressure applied vertical

12. Chest Compressions

13. 2-finger technique Easier with right hand for right handed Index and middle or ring fingers Other hand used to support the back Pressure applied vertically

14. Chest Compressions

15. Preferred method - thumb Advantages Better control of depth Less tiring Superior generation of peak systolic & coronary perfusion pressure Nails do not hinder performance Disadvantages Difficult when baby is big Umbilicus difficult to cannulate.

16. Compression One compression consists downward compression plus the release Actual distance is not a number but depends on size of baby Duration of the downward stroke should be shorter than release to produce max COP

17. Rate & adequacy Rate 3 CC then 1 ventilation (1:3) 90 CC to 30 ventilation in one minute Adequacy Palpate femoral/carotid pulse

18. Cycle of events One – and – two –and – three – and – breathe – and Consists of 3 compression & one ventilation 120 events in 60 seconds 1 cycles in 2 seconds

19. Chest Compressions Dangers Broken ribs Lacerated liver Pneumothorax Precautions No pressure on the ribs, xiphisternum, abdomen Do not lift thumbs/fingers

20. Evaluation after 30 sec of CC & BMV HR 60 per minute or more Stop CC, continue BMV at 40-60/min If no improvement, check : Effectiveness of BMV Oxygen is 100% Technique of CC is correct

21. Key points When to do? Why to do ? How to do? Which is best ? When to stop ? What if fails ?