https://userupload.net/38urdql2w91i Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.[1]

1. CARDIOPULMONARY
RESUSCITATION (CPR)
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2. OUTLINE OF PRESENTATION
 Introduction
 History of CPR
 Causes of cardiac arrest
 Diagnosis of cardiac arrest
 Definition of CPR
 Aim of CPR
 Sequence of operations in CPR

3.  Stages of CPR
 CPR in adult victim
 CPR in child
 CPR in infants
 Conclusions
 Public health significance
 References
OUTLINE OF PRESENTATION

4. HISTORY
 Friedrich Maass : Father of CPR.
 He first started using chest compressions in the year 1892.
 Later he defines CPR (1960) as integrated cardiac
compressions and rescue breaths.
 American Heart Association – ‘CPR can double or triple the
survival chances after a sudden cardiac arrest’

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6. CAUSES OF CARDIAC ARREST
Ischemic heart disease
Valvular disorders
Cardiac tamponade
Ruptured aorta
Airway obstruction
Acute respiratory
failure
Shock
Embolisms of different
origin
Poisoning
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7. DIAGNOSIS OF CARDIAC ARREST
In the beginning
Blood pressure measurement
Take the pulse on peripheral arteries
Auscultation of cardiac tones
LOSS OF TIME

8. SYMPTOMS OF CARDIAC ARREST
 Absence of pulse on carotid arteries – a pathognomic
symptom
 Respiration arrest – may be in 30 seconds after cardiac
arrest
 Enlargement of pupils – may be in 90 seconds after
cardiac arrest

9. INTRODUCTION
 CPR is one of the technique aimed at maintaining blood
flow following cardiac arrest.
 The goal of CPR is to continue to provide a small amount of
blood and oxygen to the tissues to prevent permanent
damage till standard care arrives.

10. 1. Check responsiveness
2. Call for help
3. Correctly place the victim and ensure the open airway
4. Check the presence of spontaneous respiration
5. Check pulse
6. Start external cardiac massage and artificial ventilation
SEQUENCE OF OPERATIONS (six c’s)

11. MAIN STAGES OF CPR
ABCD format
A = airway
B = Breathing
C = Circulation
D = Defibrillator

12. PRIOR TO CPR….
Basic life support (BLS)
Position of the patient
Ensure airway
Breathing
Circulation

13. BASIC LIFE SUPPORT
CONSISTS OF:
Airway management
Artificial ventilation
External chest compression
Advantages:
1. Helps to provide continuous supply of oxygenated blood
to the brain and heart.
2. Avoids irreversible damage to the victim.

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16. CPR- IN ADULT VICTI M
Recognition of
unconsciousness
Summon
assistance and
position the
patient
Assessment of
airway
Breathing Circulation
1 2 3
4 5

17. RECOGNITION OF UNCONSCIOUSNESS
 Stimulate the victim by shaking the shoulders or by
shouting the victim's name.
 Lack of response _ diagnosed as unconscious.
 Follow the ABCD format.

18. SUMMON ASSISTANCE AND POSITIONING THE
VICTIM
 Summon should call EMS (emergency medical service)
 Place the victim in supine position.
 The head and chin of the victim are placed parallel to the floor
and feet elevated slightly 100.
---- To facilitate return of blood from the periphery

19. ASSESSMENT AND MAINTAINCE OF AIRWAY
1. Head tilt and chin lift can be employed to obtain the
patient airway.
2. The rescuer places one hand on the victim’s forehead and
the other bony prominence of the chin.

20. BREATHING
Look, listen and feel the breathing
not more than 10 seconds .

21. BREATHING
 If the victim is not breathing, give two breaths (1
second or longer)
– Pinch the nose
– Seal the mouth with yours
 If the first two don’t go in, re-tilt and give two more
breaths

22. ARTIFICIAL BREATHING
Mouth to mouth or mouth to
nose respiration
Ventilation by a face mask and a self-
inflating bag with oxygen
2 initial subsequent breaths
wait for the end of expiration
10-12 breaths per minute with a volume of app. 800 ml, each breath
should take 1,5-2 seconds
Control over the ventilation
check chest movements during ventilation
check the air return

23. COMPRESSIONS
After giving breaths…
Locate proper hand position for chest compressions
– Place heel of one hand on center of chest at the
nipple line

24. COMPRESSIONS
– Using both hands, give 30 chest
compressions
• Count 1, 2, 3 …
– Depth of compressions: 1 .5 to 2
inches
– For children: ½ to 1/3 of chest
depth and use 1 or 2 hands (keep
one hand on forehead if possible)

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26. CPR
After 30 chest compressions:
• 2 slow breaths
• Continue until help arrives or victim
recovers
• If the victim starts moving: check breathing

27. ADVANTAGES OF COMPRESSIONS
It creates blood flow by increasing the intrathoracic pressure
and direct compression on heart.
When sternum is compressed, intrathoracic pressure
increases.
It produces cardiac output by compressing the vessels with in
the chest cavity
Forces blood back to and through, the heart.

28. COMPRESSION – VENTILATION RATIO
For single rescuer:
A compression-ventilation
ratio of 30:2 is recommended.

29. Currently,
Compression-ventilation ratio is15:2
Advantages:
1. Minimizes the interruptions
in chest compression.
2. Reduce the likelihood of
hyperventilation
COMPRESSION – VENTILATION RATIO

30. AUMATED EXTERNAL DEFIBRILLATOR

31. AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
Defibrillation is the
application of electrical
shock to help and restore
the heart’s regular rhythm

32. AUTOMATED EXTERNAL DEFIBRILLATOR
Early defibrillation is the single
most important factor in
determining survival from
cardiac arrest.

33. WHEN TO ACHIEVE AED?
Defibrillation should be
performed with in the
first eight minutes after
cardiac arrest. Ideally,
the sooner, the better.

34. TYPES OF AED
Automatic
Semi-automatic

35. TYPES OF AED
Automatic: where machine does all of
the work.
Semi Automatic: where machine tells
you when to push button to deliver
shock.

36. MUST TO REMEMBER
Always making sure that CPR is
still in progress while you are
setting up the AED.

37. Now attach the adhesive pads to
the cables remembering-
White is negative, anterior chest
wall.
Red is positive , left anterior
axillary line.
“Red on Ribs! White on right!”

38. INDICATIONS FOR AED
Unresponsive
Apneic
Pulseless patients
> 8 years old

40. HOW TO PERFORM CPR ON CHILD?
Use the same compression-breath rate as is used for adults: 30
compressions followed by two breaths. This is one cycle.
Following the two breaths, immediately begin the next
cycle of compressions and breaths.

41. Child age: 1-8 years
Use only one hand to perform heart compressions.
Breathe more gently.
If you’re alone, perform five cycles of compressions and
breaths on the child — this should take about two
minutes — before calling 911 or your local
emergencies.
HOW TO PERFORM CPR ON CHILD?

42. CPR FOR INFANTS
Give CPR
– Press sternum 1/2 to 1/3
depth of the chest
– Use middle and ring finger
30 compressions to 2
If alone, resuscitate for 2
minutes then call 911

43. CHOKING: CONSCIOUS INFANTS
• Position with head downward.
• 5 back blows (check for expelled
object)
• 5 chest thrusts (check for expelled
object)
• Repeat

44. CPR FOR INFANTS

45. CONCLUSIONS
 CPR is one of the technique aimed at maintaining blood
flow following cardiac arrest.
 The goal of CPR is to prevent permanent damage by
constant supply of small amount of oxygen and blood to the
tissues.
 Two causes for cardiac arrest
 Cardiac
 Extra cardiac

46.  Main stages of CPR includes airway, breathing, circulation
and defibrillator.
 Compression- ventilation ratio is 30:2 for two rescuers
15:2 for one rescuers
CONCLUSIONS

47. PUBLIC HEALTH SIGNIFICANCE
• Members in the health care team should be trained
thoroughly in performing the CPR Which includes medical
and dental doctors, nurses, anganwadi workers, local dais
and auxiliaries.
• Regular continuing medical education programs should be
conducted.
• All the health institutions should be well equipped in
providing CPR by trained professionals.

48. • Incorporation of medical emergencies, which includes
technique of CPR in out reach programs.
• Health professionals should educate and train the
population regarding medical emergencies.
PUBLIC HEALTH SIGNIFICANCE

49. REFERENCES
1. Stanley F. Malamed - Medical emergencies in the dental
office-5th & 6th edition.
2. KD Tripathi, Essentials of medical pharmacology;5th
edition, jaypee publishers.
3. Medical emergencies in the dental office, The dental
clinics of North America, Jan 1982:W.B Sounders
company.

50. 4. Sujit K. Chaudhri. Concise medical physiology, 2nd edition,
New central book agency, calcutta,1995 .
5. WWW. Google. Com as accessed on 22-12-11and 26-
12-11
REFERENCES

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