1. CardioPulmonary Resucitation
DEFINITION OF CPR
CardioPulmonary Resucitation

2. Heart disease
Heart disease is the number one killer in the United States today, and over 60% of all victims will die before they reach the hospital!
The heart lies between the sternum and the spine.

3. What are the functions of CPR?
A. As basic life support – to maintain a viable (living) victim for advanced life support. (EMS)
EMS stands for Emergency Medical Service
B. To minimize the occurrence of panic during times of emergency.
C. For early diagnosis and detection of the symptoms of heart attack.
Be able to recognize the signs of a heart attack.
The greatest risk of death from heart attack is in the initial two hours after the onset of the symptoms
60% of all victims die before they reach the hospital. (paramedics now stabilize the victim at the site before transporting.)

4. R = Resuscitation (recover)
What does CPR stand for?
C = Cardio (heart)
P = Pulmonary (lungs)
R = Resuscitation (recover)
Oxygen is the basic requirement for breathing and every
Living cell in the body
The function of the epiglottis is to guard the entrance to
trachea

5. What types of situations might cause a victim to need CPR?
Heart attack
Electrocution
Drug overdose
Accidents
Stroke
Diabetes
Choking
Poisoning
Smoke Inhalation
Epilepsy
Suffocation
Drowning

6. Emergency Situations Requiring CPR and Emergency First Aid
Alcohol Overdose - Alcohol Poisoning
Drug or Medicine Overdose
Choking – Airway Obstruction
Auto Accident
Electrical Shock
Gun Shot
Stabbing/Knife Wound
Smoke Inhalation
Drowning
Poisoning
Heat Exhaustion
Over Exposure to
Cold Temperatures

7. What are the real symptoms of a heart attack?
Uncomfortable pressure and squeezing, usually located in the center of the chest
Pain may spread to shoulders, arms, neck, and back (usually on the left side)
The pain is not always severe and may come and go (sharp, stabbing twinges of pain usually are not signals of heart attack)
Sweating, nausea, shortness of breath, feeling of weakness
May occur in either sex, even young adults, and not necessarily during physical or emotional stress.

8. How does the heart work?
The right side of the heart receives deoxygenated blood from the body which it then pump to the lungs (through the pulmonary artery) where carbon dioxide is exchanged for oxygen.
The left side of the heart receives the oxygenated blood from the lungs (through the pulmonary vein) which it then pumps through the atrium to the ventricle; from the ventricle the blood is pumped through the aorta to the rest of the body.

9. How to help a heart attack victim that is conscious
Help the victim into a comfortable position
Sitting if he or she is short of breath
Lying down if he or she is light headed
Loosen clothing around neck and waist.
Call an ambulance. Call 911!

10. Definitions
Coronary Heart Disease – the blood supply to a part of the heart is blocked; that part of the heart not receiving oxygen begins to die.
Respiratory Arrest – breathing stops
Cardiac Arrest – the heart has stopped
Stroke – the blood supply to a part of the brain is blocked; those brain cells not receiving oxygen begin to die.
Clinical Death – means the heart and breathing have stopped.
Heart attack – A sudden severe instance of abnormal heart function.

11. Definitions Continued…
Brain Death – Occurs 4-6 minutes after clinical death when the cells of the brain begin to die.
Biological death- all systems cease to function. Organ systems have shut down and are no longer working

12. General CPR; In Three Simple Steps: ABC
1. Airway – head tilt, chin lift
2. Breathing – look, listen, feel
3. Circulation – give chest compressions

13. Adult; over 8 years old; CPR check for unresponsiveness and call for help
A. Check the Victim for unresponsiveness. Gently shake them and ask “Are you all right, are you okay?”
B. If the victim doesn’t respond SEND SOMEONE TO GET HELP. Call 911 and return to the victim.

14. Adult CPR Airway and breathing
C. Use the head tilt, chin lift method to open airway. Look, listen and feel for breathing. 
D. If the victim is not breathing normally, pinch the nose and cover their mouth with yours. Give 2 full breaths until you see the chest rise. Each breath should last about 1 second.  
E. With each breath the chest should lower and rise so you know that air is getting in.

15. Adult CPR
F. After giving two breaths, immediately begin chest compressions.
G. Use the nipple line (“armpit over”) to determine the proper place to do chest compressions.
H. Push down on the chest 1 1/2 to 2 inches, 30 times right between the nipples where the heart lies. (ratio 30:2)
J. Pump at the rate of 100 compressions / 1 minute
K. If you see chest movement, put the victim in the side position in case they vomit.

16. Chest compressions should be performed on the lower
½ of the sternum

17. For each compression it is important to push down
far enough and to be sure the chest is completely
released after each compression. This will allow
the heart to fill with blood after each compression.

18. Recovery Position What is the Recovery Position?
First Aid procedure to use if the person is unconscious,
breathing and have a pulse.
It is a safe position to put them in while you are waiting for the EMS to arrive
Allows them to breathe easily and prevents them from choking on their tongue or any vomit.

19. CPR: Children 1 to 8 years of age
A. Check for unresponsiveness
B. If you are alone with the child give 4-5 cycles of 30 compressions before calling 911.
C. Open the airway
D. Check for breathing: look, listen, feel
E. Not breathing: give 2 breaths
F. Perform chest compressions on the nipple line in the center of the chest.
G. If the child is small, use one hand for compressions. If the child is larger, use 2 hands.
H. Press the sternum down 1” to 1 ½”.
I. Give 30 compressions to 2 breaths (ratio of 30:2).
J. Pump at the rate of 100 compressions per 1 minute
K. You should perform 5 cycles of 30 compressions in 2 minutes.

20. CPR: Infant; 0 to 1 year check for unresponsiveness; call for help
A. Check for unresponsiveness: tickle, touch, pinch the infant gently.
B. If there is no response, perform 5 cycles of 30 compressions before calling 911.

21. CPR: Infant; open airway
C. A = Open The Airway.
D. Tilt the head back gently, only far enough so that the infant’s mouth is facing the ceiling. Do not tilt the head too far back! This may injure the neck, and collapse the airway.

22. CPR: INFANT; check breathing
E. B = breathing: Look, listen, and feel for air.
F. If the infant is NOT breathing give 2 small gentle “puffs” of air.
G. Cover both the baby's mouth AND nose with your mouth.
H. You should see the baby's chest rise with each breath.

23. CPR: Infants; check circulation
I. The proper placement for chest compressions is just below the nipple line.
J. Position your 3rd and 4th fingers in the center of the chest ½ inch below the nipples.
K. Press down ½” to 1”.
L. Perform 30 chest compressions at a ratio of 30:2 (30 compressions for every 2 breaths)
M. At least 100 compressions should be given within 1 minute.

24. CPR: Infants
If the infant recovers, put them in the recovery position by gently supporting the neck and picking them up.

25. Under what special circumstances can a non-physician discontinue CPR?
The victim responds.
The rescuer collapses.
A doctor pronounces the victim dead.
Someone with equal or more training takes over.
With a child/infant – stop after 1 minute to call 911 if you alone, and no one will be coming.

26. Obstructed airway (choking)
Partially obstructed airway with good air exchange: victim can make some sounds; may be able to speak and cough
Partially obstructed airway with poor exchange: victim cannot speak, may be wheezing or coughing weakly
Fully obstructed airway: victim cannot make any sounds
The most common cause of an airway obstruction in a conscious person is food or a foreign object.
The most common cause of an airway obstruction in an unconscious person is the tongue.

27. Adult choking; conscious The Heimlich maneuver
A. Ask the victim: : “Are you choking?”
B. If the victim nods yes, ask them “Would you like my help?”
If they say “NO”, do not help them. If they say yes, you may help them.
C. Position yourself by placing one of your legs between the legs of your victim. Give 5 abdominal thrusts and continue as needed.
For a pregnant or obese person, perform chest thrusts.
D. Repeat thrusts until the object is expelled and the obstruction is relieved OR the victim becomes unresponsive/unconscious.

28. CONSCIOUS ADULT CHOKING

29. Adult choking; unconscious
A. Call 911.
B. Open the airway.
C. Perform a finger sweep to remove possible foreign object in mouth.
D. Open the airway and try to get air in. Give 2 breaths. If air does not go in, reposition the head and give 2 more breaths. If air still does not go in, the airway is obstructed.
F. With the victim lying on the floor, give 5 abdominal thrusts while straddling your victim.
G. Repeat the steps until victim is no longer choking or continue the steps of CPR as needed.

30. ADULT UNCONSCIOUS CHOKING
You would straddle the victim while
performing any needed CPR and abdominal chest thrusts.
Do not push down on the Xiphoid process!

31. Infant choking; conscious
A. Check for breathing difficulty, ineffective cough, weak cry.
B. Confirm signs of severe or complete airway obstruction.
C. Give 5 back blows with your open hand and 5 chest thrusts, using your 3rd and 4th fingers.
D. Repeat back blows and chest thrusts until object is expelled OR the victim becomes unresponsive.

32. BACK SLAPS
FINGER SWEEP
CHEST THRUSTS

33. Infant choking; unconscious
A. Call 911
B. Open the airway and if you see the object, remove it
C. Try to give 2 breaths. If the chest does not rise, re-open the airway and try to give 2 more breaths.
D. If the air still does not go in they are choking. Give 5 back blows, 5 chest thrusts and 2 breaths. Re-open airway and give 2 more breaths.
E. Repeat above steps until breathing is effective. Perform CPR if needed.
F. If the rescuer is alone and the airway obstruction is not relieved after 1 minute, call 911.

34. Treat a conscious or unconscious child (1-8 years old) with an airway obstruction like a conscious or unconscious adult with an airway obstruction.
Example of a conscious choking child

35. When performing CPR, the victim must be placed on a firm, flat surface, in the “head-tilt, chin-lift” position
The universal sign for choking is two hands placed at the throat
If you give a victim 2 full breaths and they don’t seem to go in, you should re-tilt the head (head tilt, chin lift) and try again. If the air still does not go in your victim may be choking..

36. In a two person rescue situation, rescuers should rotate between compressions and breathing every 2 minutes to avoid fatigue.
Ideally, the rescuers should switch positions within 5 seconds so the victim is not left unattended for too long.

37. Good Samaritan Law
Law that protects rescuers from prosecution or civil law suits, unless their actions constitute willful misconduct and negligence.
The Rescuer MUST comply with proper emergency first aid and CPR guidelines; acting in good faith by being prudent and responsible in their rescue efforts.