CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support CPR with both compression & rescue breath is critical for victim in emergency situation BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS Performed by a medical professional or an ordinary citizen who trained on it ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person

1. 04/12/08 1
Dr. Abhijit Diwate
Associate Professor
Cardio-Vascular & Respiratory PT
DVVPF College of Physiotherapy
Ahemednagar 414111

2.  Indications
 Warning sign
 ABC’s for CPR
 BLS Algorithm
 Advanced life support
 Shockable & non- shockable rhythm
04/12/08 1

3. Introduction
• CPR is a life saving emergency measure which
includes BLS, ALS, prolonged life support
• CPR with both compression & rescue breath is critical
for victim in emergency situation
• BLS includes recognition of signs of cardiac arrest,
heart attack, strock, foreign body air way
obstruction(FBAO) with activation of EMS
• Performed by a medical professional or an ordinary
citizen who trained on it
• ALS includes BLS & use of defibrillation, drugs to
stabilize the victim & done by specially trained medical
person
3

4. Indication
cardiac arrest
Auto mobile accident
Drug over dose
Drowning
Electrocution
suffocation
4

5. Warning signs
 Heart attack
 Chest Pain
 Confused with indigestion
 Uncomfortable pressure &
burning sensation in lower
chest & upper abdomen
 Antacids with relief
 Squeezing sensation in the
centre of chest
 Pain radiate into arms, jaw,
uppe abdomen
 Other- sweating, nausea or
vomiting, palpitation, shortness
of breath, weak, pale, feel faint
or dizzy
 stroke
 Extreme headache
 Confusion
 Weakness or numbness of
face, leg on one side of body
 Temporary dimness or loss of
sight
 Speech difficulty
 Unexplained dizziness
 Loss of balance
5

6. Warning signs
Signs of mild airway
obstruction
• Response to question ‘ ARE U
CHOCKING?’
 Victim speaks & saying YES
• Other signs
 Victim is able to speak, cough
& breath
Signs of severe airway
obstruction
 Response to question ‘ ARE U
CHOCKING?’
 Victim unable to speak
 Victim may respond by
nodding
 Other signs
 Victim is unable to breath
 Breathing will wheezy
 Attempts at coughing are
silent
 Exaggerated movement of
chest & abdomen
 Cyanosis
 Victims may unconscious
6

7. ABC’S of CPR
• First assess unresponsiveness
• Tap or shake the person’s shoulder gently
• Shout loudly near his ear to arouse him
“ARE YOU OK”
• Activate EMS( if two people are available,
one can access EMS, & the other initiate
CPR ‘or’ if one perform one minute CPR
before calling 911
7

8. Airway
‘Opening the airway’ is the first skill
Place on his back as a unit
In unconscious person, tongue is the
common obstruction
Head-tilt/chin-lift :the head rotates back with
head-tilt & jaw is raised with chin-lift
If neck injury is suspected(drowning ,
RTA)”jaw thrust” without head lift
The lips must remain open to allow free air
passage, then check breathing
8

9. Head-tilt/chin-lift jaw thrust
04/12/08 1

10. Breathing
Keep the airway open by maintaining the
head-tilt with hands while checking breathing
To assess breathing, lean over the victim’s
head facing towards the chest; place your ear
within an inch of victim’s mouth &nose
Look for chest raise or belly movement,
listen for air movement, & fell for air
movement (not more than 10sec)
If breathing normally, turn him to recovery
position
10

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12. Breathing
If not breathing, start rescue breathing
‘Rescue breathing’ is the second skill:
MOUTH-TO-MOUTH METHOD
An airtight seal is made by fully covering the
victim’s open mouth with your mouth & pinch
nose to seal the nostrils & give 2 rescue
breath with Head-tilt/chin-lift manure
Omit the 2 rescue breath & give 30
compression immediately when cardiac
arrest is established(change in BLS guide
lines)
12

13. Breathing
 Take a breath & make blow slowly(1 sec) into the
victim’s lungs
 As you remove your mouth, tipping your head
slightly to get a new breath of fresh air, you should
feel air passively flowing out of the mouth & see
the chest fall
 If good chest raise is not seen, you have failed
to provide open airway or there is a foreign body
obstruction?
 HELMLICH maneuver, foreign body check, back
blow (for airway obstruction)
 If good chest raise seen, then check pulse
13

14. Circulation
‘Circulation’(check Pulse) is the third skill
Do not rush! Take at least 5- 10 sec to check
pulse(carotid –adult or child )
Pulse present: rescue breath
Continue rescue breath at a rate of once
every 5-6 sec (10-12 breath/min)
Check breathing by tipping your head
Check pulse once a min to ensure heart
function
If breathing begins on his own rescuer can
also continue to monitor victim in side lying
14

15. Circulation
Pulse absent: External chest compression
It is started immediately if pulse less
Kneel beside the victim, then place the heel
of your hand centering over midline & lower
half of sternum with fingers off the chest &
interlocking
With proper hand placement, straighten out
your arms, position your shoulder directly
over the sternum which enables maximum
effort
Bend at your hips allows your shoulder &
arms to move straight up & down as a unit
15

16. 04/12/08 1

17. Circulation
Depress the chest to 1.5-2 inch depth,
which is enough to circulate o2 rich blood
to maintain life
Release the pressure to allow blood into
the chest & is then available to be pumped
out on next compression with heel contact
on sternum
17

18. Circulation
Counting aloud, “one and two and three”
will help to maintain both speed & rhythm
(i.e) down stroke = upstroke
For combined compression & rescue
breath: Continue chest compression &
rescue breath in a ratio of 30:2 at the rate
of 100 per min for 2 min(about 5 cycle at
30:2)
Check pulse check at every 2 min, if pulse
less continue CPR until qualified help
arrived 18

19. BLS Algorithm
Activate EMS
If not breathing,2 rescue
breathing
Open airway, check
breathing
19

20. 20

21. Advanced life support
ALS includes chest compression,
defibrillation, airway management &
ventilation, venous access, administration
of drugs, and identification & correction of
reversible factors
Arrhythmias associated with cardiac arrest
divided into shockable rhythms(VT/VF) &
non-shockable rhythms(asystole/PEA)
21

22. 04/12/08 1

23. Shockable rhythms
• Check the rhythm with ECG
• If VF/VT, perform 1 shock(150-200 J in
biphasic or 360 J in monophasic)
• Immediately resume CPR (30:2) without
reassessing rhythm or feeling pulse for 2
min (i.e)5 cycles of CPR
• Then pause briefly to check the monitor
23

24. 04/12/08 1

25. Shockable rhythms
• If VF/VT persists:
Give a further (2nd) shock(150-200 J in
biphasic or 360 J in monophasic)
Resume CPR immediately & continue for 2
min
Pause briefly to check the monitor
25

26. Shockable rhythms
• If VF/VT persist (drug-shock-CPR-
rhythm check sequence)
Give adrenaline 1mg followed immediately by
a (3 rd) shock & repeat the same every 3-5
min thereafter if VF/VT persists
Resume CPR immediately & continue for 2
min
Check monitor
26

27. Shockable rhythms
• If VF/VT persists
Give amiodarone 300 mg by bolus injection or
lidocaine1-1.5 mg/kg (no lidocaine if amiodarone
is given already) followed immediately by a (4th
)
shock
Resume CPR & continue for 2 min
Continue adrenaline 1mg IV immediately before
alternate shock(i.e) approx every 3-5 min
• Give a further shock after each 2 min period
of CPR and after confirming that VF/VT
persists 27

28. Shockable rhythms
• If organized electrical activity is seen
during brief pause in compression, check
for pulse
If pulse present, start post-resuscitation care
If no pulse present, continue CPR & switch to
the non-shockable algorithm
• If asystole is seen, continue CPR & switch
to the non-shockable algorithm
28

29. Non-shockable rhythms
Sequence of action for PEASequence of action for PEA
Start CPR 30:2
Give adrenaline 1mg IV as soon as
intravascular access is achieved
Continue CPR 30:2 until the airway is
secured, then continue chest compression
without pausing during ventilation
29

30. Non-shockable rhythms
 Recheck the rhythm after 2 min
If there is no change in the ECG
Continue CPR
Recheck the rhythm after 2 min & proceed accordingly
Give further adrenaline 1mg IV every 3-5 min
If ECG changes & organised electrical activity is
seen, check for pulse
If a pulse is present, start post-resuscitation care
If no pulse is present:
o Continue CPR
o Recheck the rhythm after 2 min and proceed accordingly
o Give further adrenaline 1mg IV every 3-5 min
30

31. Non-shockable rhythms
Sequence of action for asystole and slowSequence of action for asystole and slow
PEA(<60)PEA(<60)
 Start CPR 30:2
 Without stopping CPR, check that the
leads are attached correctly
 Give adrenaline 1 mg IV as soon as
intravascular is achieved
 Give atropine 3mg IV (once only)
31

32. Non-shockable rhythms
• Continue CPR until airway is secured,
then continue chest compression without
pausing during ventilation
• Recheck the rhythm after 2 min & proceed
accordingly
• If VF/VT recurs, change to shockable
rhythm
• Give adrenaline 1 mg IV every 3-5 min
32

33. ALS Algorithm
33

34. 34

35.  Indications & Warning sign
 ABC’s for CPR
 BLS Algorithm
 Advanced life support
 Shockable & non- shockable rhythm
04/12/08 1

36. 1. What are shockable and non-shockable
rhythms? 7mrks
2. Write about indication and warning sings of
cardio-pulmonary resuscitation? 5mrks
04/12/08 1

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