1. CARDIOPULMONARY RESUSCITATION

2. CARDIAC ARREST
Abrupt loss of consciousness caused by lack of adequate cerebral blood flow due to failure of cardiac pump function.

3. Survival depends on
The setting in which arrest occurs
Electrical mechanisms
Underlying clinical status

4. Electrical mechanisms
Ventricular fibrillation
Pulseless VT
Asystole
Pulseless electrical activity

5. PHASES OF VF ELECTRICAL (0-4 min) adequate myocardial ATP store
defibrillation alone restore perfusing
rhythm(without chest compressions)
duration of this phase can be prolonged
by bystander CPR.

6. Circulatory phase(4-10 min)
depletion of ATP store, lactic acidosis
defibrillation without chest compression
rarely successful, may result in PEA
ECG fine fibrillatory wave.

7. Metabolic phase(>10 min)
terminal phase
irreversible damage
less chance of successful defibrillation
mild therapeutic hypothermia delay the
onset.

8. Pulseless electrical activity
H “S
T”S
Hypoxia
Hypovolemia
Hydrogen ion(acidosis)
Hypo/hyperkalemia
Hypothermia.
Toxins
Tamponade
Tension pneumothorax
Thrombosis(pulmonary)
Thrombosis(coronary)

9. Asystole No cardiac electrical and mechanical activity of heart.
Terminal rhythm in non intervened PEA or VF
Same causes of PEA can also sometimes present initially as asystole

10. AHA 2010 GUIDELINE
Recognition of SCA based on unresponsiveness and absence of normal breathing( ie the victim is not breathing or gasping)
Look ,listen, and feel removed
ABC Sequence CAB
Encourage hands only CPR

11. Continue effective chest compressions/CPR until return of spontaneous circulation (ROSC) or termination of resuscitative efforts
Continued de-emphasis on pulse check

12. Ensure high-quality CPR
compressions of adequate rate and depth
Allowing full chest recoil between compressions
Minimizing interruptions in chest compressions
Avoiding excessive ventilation

13. Chain of Survival Chain of Survival
Immediate recognition and activation, early CPR, rapid defibrillation, effective advanced life support and integrated post-cardiac arrest care.

14. ADULT BLS SEQUENCE Recognition of SCA unresponsive
no breathing or only gasping
Pulse check-
not recommended for lay rescuer
Healthcare provider –not more than 10 sec
Early CPR

15. Early CPR Chest Compressions
Chest compressions consist of forceful rhythmic applications of pressure over the lower half of the sternum.
These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart.
This generates blood flow and oxygen delivery to the myocardium and brain.

16. Effective chest compressions “push hard and push fast”
rate of at least
100 compressions per minute
compression depth of at least 2 inches/5 cm.
Allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression
Minimizing interruptions in compressions
A compression-ventilation ratio of 30:2 is recommended

17. HANDS ONLY CPR
Initially during SCA with VF rescue breath are not important
Oxygen level remains adequate.
Gasping and passive chest recoil allow gas exchange.
Improves survival in OHCA

18. Airway Control and Ventilation
During low blood flow states such as CPR, oxygen delivery to the heart and brain is limited by blood flow rather than by arterial oxygen content.
Advanced airway placement in cardiac arrest should not delay initial CPR and defibrillation
Empirical use of 100% inspired oxygen during CPR optimizes arterial oxyhemoglobin content and in turn oxygen delivery.

19. Airway and Ventilations
Opening the airway (with a head tilt–chin lift or jaw thrust) followed by rescue breaths
Untrained rescuer will provide Hands-Only (compression-only) CPR and the lone rescuer who is able, should open the airway and give rescue breaths with chest compressions.
Ventilations should be provided if the victim has a high likelihood of an asphyxial cause of the arrest.

20. Rescue Breaths by mouth-to-mouth or bag-mask
Deliver each rescue breath over 1 second
Give a sufficient tidal volume to produce visible chest rise.
Use a compression to ventilation ratio of 30:2

21. Mouth-to-Mouth Rescue Breathing
Open the victim’s airway, pinch the victim’s nose
Create an airtight mouth-to-mouth seal.
Give 1 breath over 1 second, take a “regular” (not a deep) breath
A second rescue breath over next 1 second

22. Ventilation With Bag and Mask
With room air or oxygen.
Positive-pressure ventilation without an advanced airway
Produce gastric inflation and its complications
To deliver approximately 600mL tidal volume.
Squeezing a 1-L adult bag about two thirds of its volume or a 2-L adult bag about one third.

23. Cycles of 30compressions and 2 breaths.
Delivers ventilations during pauses in compressions and each breath over 1 second.
Can use supplementary oxygen (O2concentration 40%, at a minimum flow rate of 10 to 12 L/min) when available.

24. When an advanced airway (ie, endotracheal tube, combitube,or laryngeal mask airway [LMA]) is in place during 2-person CPR,
give 1 breath every 6 to 8 seconds without attempting to synchronize breaths between compressions
This will result in delivery of 8 to 10 breaths/minute
There should be no pause in chest compressions for delivery of ventilations

25. Cricoid Pressure
Applying pressure to the victim’s cricoid cartilage to push the trachea posteriorly and compress the esophagus against the cervical vertebrae
Used in a few special circumstances (eg, to aid in viewing the vocal cords during tracheal intubation,
The routine use of cricoid pressure in adult cardiac arrest is not recommended

26. During CPR cardiac output is 25% to 33% of normal
Oxygen uptake from the lungs and CO2 delivery to the lungs are also reduced
low minute ventilation (lower than normal tidal volume and respiratory rate) can maintain effective oxygenation and ventilation

27. Excessive ventilation is unnecessary and can cause gastric inflation and its resultant, regurgitation and aspiration
Excessive ventilation can be harmful because it increases
Intrathoracic pressure
decreases venous return to the heart
diminishes cardiac output
Rescuers should avoid excessive ventilation (too many breaths or too large a volume) during CPR

28. Universal Adult Basic Life Support (BLS) Algorithm

29. Adult Advanced Cardiovascular Life Support
Advanced cardiovascular life support (ACLS) includes interventions to treat cardiac arrest, and improve outcomes of patients who achieve return of spontaneous circulation (ROSC).
Includes:
-airway management,
-ventilation support, and
-Rhythm based management of cardiac arrest

30. Advanced airways Advantages Improved ventillation and oxygenation
Eliminate pauses in chest compressions
1 breath every 6-8 sec(8-10 breath/min)
Reduce risk of aspiration

31. Supraglotic airways Laryngeal mask airways regurgitation less
when ET is difficult
neck injury
positioning of patient is difficult for ET
Provides equivalent ventillation comp. ET.
Esophageal tracheal tube
Laryngeal tube

33. DEFIBRILLATION Initial shock
360j for monophasic , same dose for subsequent shocks
j for biphasic defibrillator, subsequent dose same or higher.
If VF recurs use previously successful energy level

36. Medication for arrest rhythms
Vasopressors
Epinephrine 1 mg IV/IO every 3-5 min
Alpha-adrenergic receptor stimulation produces vasoconstriction.
Increases coronary perfusion pressure,
Cerebral perfusion pressure.

37. Vasopressin
Non adrenergic
Coronary vasoconstrictor
Dose:40 units IV/IO

38. ANTI ARRYTHMICS AMIODARONE For VF/Pulseless VT unresponsive to CPR,
defibrillation ,vasopressor
Initial 300mg IV/IO can be followed by 150mg

39. Lidocaine
if amiodarone not available
initial dose 1 to 1.5 mg/kg IV
addl. Dose 0.5 to 0.75 mg/kg if not responding

40. Magnesium sulphate
Used in torsades de pointes
Dose 1-2gm diluted in 5% D

41. Post - cardiac arrest care
Objective
Optimise cardio pulmonary function
Try to identify precipitating causes
Control body temperature to optimise
Neurological recovery
Identify and treat ACS

42. Induced hypothermia
In comatose (lack of meaningful response to verbal commands) adult patients
With ROSC after out of hospital VF arrest
(class 1)
In hospital arrest with any rhythm (class2 b)
Cooled to C for hrs

43. Inhibitory effect on adverse enzymatic and chemical reactions initiated by ischemia
Inhibits the release of glutamic and dopamine
Induces brain derived neurotropic factors

44. Cooling blanket
Ice packs
Direct immersion in ice water
IV ice-cold fluids (500 ml to 30 ml/kg NS or Ringer’s lactate)
Monitor with esophageal thermometer
or bladder catheters in nonanuric patients

46. THANK U
THANK U

47. 1.current recommendation for compression ventilation ratio
15:2
30:2
15:1
1:5

48. 2.initial dose of amiodarone in ACLS a)300 mg bolus b)150 mg bolus c)450 mg d)200 mg

49. 3) Therapeutic hypothermia a)32-34 b)30-32 c)27-30 d)35

50. 4)1st shock for VF with monophasic defibrillator is a)300 j b)360 j c)250 j d)200 j

51. 5)Breath/min with advanced airway in CPR is a)8-10 b)5 c)7 d)2

52. 6)Max .rate of defibrillation success is in which phase of VT a)Circulatory phase b)Electrical phase c)Metabolic phase d)Equal in all phase

53. 7) rate of chest compression /min at least A)60 b)80 c)100 d)120

54. 8)drug not used routinely in adult ACLS a)Epinephrine b)Amiodarone c)Vasopressin d)atropine

55. 9)depth of chest compression A)3 cm b)5 cm c)4 cm d)6 cm

56. 10)not a part of BLS A)Chest compression b)Bag and mask ventillation c)Manual defibrillation d)AED