1. CARDIOPULMONARY RESUSCITATION
DR J.O OLATOSI D.A,FWACS
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PRIMARY FMCP UPDATE - CPR LECTURE

2. CARDIAC ARREST
Sudden cessation of spontaneous and effective heart function
Diagnosis’unresponsive
Sudden deep unconsciousness
Absent major peripheral pulses
Absent spontaneous ventilation/agonal breathing
Fixed dilated pupils not index for diagnosis or prognosis
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PRIMARY FMCP UPDATE - CPR LECTURE

3. CAUSES OF CARDIAC ARREST
Airway obstruction
Blood, vomit, foreign body
Trauma
Infection, inflammation
Laryngospasm
Bronchospasm
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4. -restrictive chest defect -pneumothorax, lung pathology
Decreased respiratory drive
-CNS depression
Decreased respiratory effort
-neurological lesion
-muscle weakness
-restrictive chest defect
Pulmonary disorders
-pneumothorax, lung pathology
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PRIMARY FMCP UPDATE - CPR LECTURE

5. Cardiac abnormalities
Primary
Ischaemia
Myocardial infarction
Hypertensive heart disease
Valve disease
Drugs
Electrolyte abnormalities
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6. Secondary Asphyxia Hypoxaemia Blood loss Septic shock
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7. Cardiopulmonary Resuscitation
A technique combining artificial ventilation and chest compressions designed to perfuse vital organs or restore circulation in cardiac standstill.
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PRIMARY FMCP UPDATE - CPR LECTURE

8. Early access to get help
Early BLS to buy time-CPR slows down deterioration of the brain
Early defibrillation to restart heart-restores a perfusing rhythm
Early ALS to stabilise circulation
failure of circulation for 3-4mins can lead to irreversible brain damage.
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9. Adult BLS sequence
Basic life support consists of the following sequence of actions: 1 Make sure the victim, any bystanders, and you are safe.
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PRIMARY FMCP UPDATE - CPR LECTURE

10. 2 Check the victim for a response
2 Check the victim for a response. • Gently shake his shoulders and ask loudly, ‘Are you all right?’
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11. Shake and Shout
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12. 3 A If he responds:
• Leave him in the position in which you find him provided there is no
further danger.
• Try to find out what is wrong with him and get help if needed.
• Reassess him regularly.
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PRIMARY FMCP UPDATE - CPR LECTURE

13. 3 B If he does not respond Shout for help.
Turn the victim onto his back and then open the airway using head tilt
and chin lift:
Place your hand on his forehead and gently tilt his head back.
With your fingertips under the point of the victim's chin, lift the
chin to open the airway.
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PRIMARY FMCP UPDATE - CPR LECTURE

14. Opening the airway Head tilt Chin lift
If cervical spine injury suspected:
jaw thrust

15. Assess Breathing Look for chest movement Listen for breath sounds
Feel for expired air
Assess for 10 seconds before deciding breathing is absent

16. 5 A If he is breathing normally:
Turn him into the recovery position .
Send or go for help, or call for an ambulance.
Check for continued breathing.
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PRIMARY FMCP UPDATE - CPR LECTURE

17. 5 B If he is not breathing normally:
Ask someone to call for an ambulance or, if you are on your own, do
this yourself; you may need to leave the victim. Start chest
compression as follows:
Kneel by the side of the victim.
Place the heel of one hand in the centre of the victim’s chest.
Place the heel of your other hand on top of the first hand.
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18. Interlock the fingers of your hands and ensure that pressure is
not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
Position yourself vertically above the victim's chest and, with
your arms straight, press down on the sternum cm.
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19. After each compression, release all the pressure on the chest
without losing contact between your hands and the sternum.
Repeat at a rate of about 100 times a minute (a little less than
2 compressions a second).
Compression and release should take an equal amount of time.
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PRIMARY FMCP UPDATE - CPR LECTURE

20. Chest compressions
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21. 6 A Combine chest compression with rescue breaths.
After 30 compressions open the airway again using head tilt and chin lift.
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22. Rescue breathing (Expired air ventilation)
Occlude victim’s nose
Maintain chin lift
Take a deep breath
Ensure a good mouth-to-mouth seal

23. Rescue breathing (Expired air ventilation)
Blow steadily (2 sec) into victim’s mouth
Watch for chest rise
Maintain chin lift, remove mouth
Watch chest fall

24. 6 B Chest-compression-only CPR.
If you are not able, or are unwilling, to give rescue breaths, give chest compressions only.
• If chest compressions only are given, these should be continuous at a rate of 100 a minute.
• Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.
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25. 7 Continue resuscitation until:
• qualified help arrives and takes over,
• the victim starts breathing normally, or
• you become exhausted.
A valid DNAR order is presented
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PRIMARY FMCP UPDATE - CPR LECTURE

26. ALS Basic Airway Adjuncts- Oropharyngeal Airway Nasopharyngeal Airway
Advanced Airway Devices
Laryngeal Mask Airway
Combitube
Endotracheal Tube
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PRIMARY FMCP UPDATE - CPR LECTURE

27. DEFIBRILLATION Definition Critical mass of myocardium depolarised
“The termination of fibrillation or absence of VF/VT at 5 seconds after shock delivery”
Critical mass of myocardium depolarised
Natural pacemaker tissue resumes control
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28. Design Types Power source Capacitor Electrodes Manual Automated
Monophasic or Biphasic waveform
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29. Defibrillator waveforms
Damped Monophasic
Truncated Biphasic
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30. Biphasic Defibrillators
Require less energy for defibrillation
smaller capacitors and batteries
lighter and more transportable
Repeated < 200 J biphasic shocks have higher success rate for terminating VF/VT than escalating monophasic shocks
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31. Automated external defibrillators
Analyse cardiac rhythm
Prepare for shock delivery
Specificity for recognition of shockable rhythm close to 100%
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32. Less training required Suitable for “first-responder” defibrillation
Advantages:
Less training required
no need for ECG interpretation
Suitable for “first-responder” defibrillation
Public access defibrillation (PAD) programs
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33. Attach adhesive electrodes Follow audible and visual instructions
Automated ECG analysis - stand clear
Charges automatically if shockable rhythm
+/- manual override
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34. Operator recognition of ECG rhythm
Relies upon:
Operator recognition of ECG rhythm
Operator charging machine and delivering shock
Can be used for synchronised cardioversion
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35. Defibrillator Safety Never hold both paddles in one hand
Charge only with paddles on casualty’s chest
Avoid direct or indirect contact
Wipe any water from the patient’s chest
Remove high-flow oxygen from zone of defibrillation
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PRIMARY FMCP UPDATE - CPR LECTURE

36. Manual Defribillation
Diagnose VF/VT from ECG and signs of cardiac arrest
Select correct energy level
Charge paddles on patient
Shout “stand clear”
Visual check of area
Check monitor
Deliver shock
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