CPCR

Fazulu Rahaman .A
Secretary
 CARDIO PULMONARY CEREBRAL RESUSCITATION

“HERE IT IS THE MINUTE THAT COUNTS”

DEFINITION
STEPS TAKEN TO REVIVE
• A HEART THAT HAS STOPPED BEATING
• THE LUNGS THAT HAS STOPPED OXYGENATING THE
BLOOD
• THE BRAIN WHICH IS BECOMING MORE AND MORE
DYSFUNCTIONAL DUE TO LACK OF OXYGEN
• THE HEART RECEIVES DEOXYGENATED BLOOD
FROM THE ENTIRE BODY

• PUMPS IT TO THE LUNGS WHERE IT IS

OXYGENATED

• IT RECEIVES OXYGENATED BLOOD BACK FROM

THE LUNGS

• PUMPS IT BACK TO THE VITAL ORGANS AND

OTHER TISSUES
 WHAT IS A CARDIO-RESPIRATORY ARREST

IT IS THE CESSATION OF THE FUNCTIONING OF THE

HEART AND LUNGS

IRRESPECTIVE OF WHICH STOPS FIRST, THE SECOND

ONE WILL SOON FOLLOW THE SUIT
 WHAT IS THE RESULT OF CARDIO
RESPIRATORY ARREST

WITH THE FAILURE OF THE PUMP AND THE

OXYGENATION PLANT

THERE IS NO SUPPLY OF OXYGENATED BLOOD TO

THE ORGANS AND TISSUES

- LEADS TO DAMAGE - FIRST REVERSIBLE AND

LATER IRREVERSIBLE DAMAGE OF THE ORGANS
BRAIN IS THE MOST SENSITIVE ORGAN IT CANNOT
WITHSTAND THE LACK OF OXYGEN FOR MORE THAN 4-
6 MINUTES

AFTER THIS TIME BRAIN SUFFERS IRREVERSIBLE

DAMAGE

ONCE THIS HAPPENS EVEN IF THE HEART AND LUNGS

ARE REVIVED, WE WILL HAVE IN HAND A BRAIN DEAD
PATIENT WHO IS LIKE A VEGETABLE

THIS BRINGS US TO THE MOST IMPORTANT POINT

 “TIME IS VERY
PRECIOUS”

THE RESUSCITATIVE STEPS SHOULD BE TAKEN UP AS

EARLY AS POSSIBLE
 WHY SHOULD WE ATTEMPT TO REVIVE A
PATIENT WHO SUSTAINED AN ARREST

1. NOT ALL PATIENTS DIE OF OLD AGE

2. NOT ALL PATIENTS DIE OF TERMINAL OR INCURABLE

DISEASES

3. NOT ALL PATIENTS WHO SUSTAIN A CARDIO-

RESPIRATORY ARREST CANNOT LEAD A NORMAL
LIFE AFTER THEY ARE SUCCESSFULLY
RESUSCITATED
 SOME STATISTICS

IN DEVELOPED COUNTRIES
40-50% OF THE DEATHS ARE DUE TO CARDIOVASCULAR
DISEASES
60-65% OF THESE DEATHS OCCUR BEFORE THEY REACH
THE HOSPITAL
A HIGH SURVIVAL RATE HAS BEEN NOTED IF
CARDIOPULMONARY RESUSCITATIVE MEASURES ARE
TAKEN WITHIN THE FIRST FOUR MINUTES OF ARREST.
SIMILARLY TRAUMA CASES ALSO SHOW A BETTER
OUTCOME IF THE RESUSCITATIVE MEASURES ARE
TAKEN IN TIME.
 WHY SHOULD YOU/EVERYONE LEARN CPR

“UNEXPECTED THINGS HAPPEN AT THE MOST

UNEXPECTED TIME AND PLACE”

IF YOU ARE THE PERSON STANDING NEXT TO HE WHO

HAD THE ARREST AT THE BUS STOP OR THE PERSON
TRAVELLING IN THE SAME COMPARTMENT OF THE TRAIN
YOU SHOULD NOT BE SAYING
 “I DON’T KNOW
WHAT TO DO”

ESPECIALLY WHEN YOU ARE IN THE MEDICAL FRATERNITY

THE CARDIO PULMONARY RESUSCITATION IS
INSTITUTED IN THREE STAGES

STAGE I BASIC LIFE SUPPORT

STAGE II ADVANCED LIFE SUPPORT

STAGE III PROLONGED LIFE SUPPORT

 BASIC LIFE SUPPORT

THIS STAGE CONSISTS OF ELEMENTS OF RESUSCITATION

WHICH CAN BE PERFORMED WITHOUT ANY ADDITIONAL
EQUIPMENTS OR WITH VERY SIMPLE AND EASY TO
CARRY DEVICES.

THERE ARE FOUR COMPONENTS TO BASIC LIFE SUPPORT.

THESE ARE KNOWN AS THE “A B C D” OF BASIC LIFE
SUPPORT

A - AIRWAY

B - BREATHING

C - CIRCULATION

D - DEFIBRILLATION
 “A” - AIRWAY

AIM :

TO MAINTAIN THE PATENCY OF THE AIRWAY

EXTENDING FROM THE MOUTH OPENING THROUGH
THE ORAL CAVITY AND PHARYNX UPTO THE
TRACHEA
CAUSES OF AIRWAY OBSTRUCTION IN AN
UNCONSCIOUS PATIENT

1 TONGUE & EPIGLOTTIS

2 FOREIGN BODIES
1. TONGUE AND EPIGLOTTIS

EPIGLOTTIS IS A LEAF LIKE STRUCTURE

OVERHANGING THE LARYNX (ENTRANCE INTO THE
TRACHEA) WHICH PREVENTS FOOD AND OTHER
PARTICLES FROM ENTERING THE TRACHEA.

TONGUE AND EPIGLOTTIS ARE HELD IN ITS NORMAL

POSITION BY A NUMBER OF MUSCLES WHICH ARE
ATTACHED TO THE MANDIBLE
IN AN UNCONSCIOUS VICTIM, THESE MUSCLES
BECOME FLACCID

CAUSES THE TONGUE AND EPIGLOTTIS TO FALL BACK

PRESSING AGAINST THE BACK OF THE MOUTH

- CAUSES THE OBSTRUCTION OF THE AIRWAY

 HOW TO PREVENT THIS OBSTRUCTION

“HEAD TILT CHIN UP TECHNIQUE”

• HEAD TILTED BACKWARDS BY APPLYING PRESSURE

OVER THE FOREHEAD

• CHIN IS LIFTED UP BY HOOING THE FINGERS UNDER

THE SUB MENTAL PART OF THE MANDIBLE.

• THIS WILL STRETCH THE MUSCLES OF THE NECK

WHICH INTURN LIFTS UP THE TONGUE AND
EPIGLOTTIS
 JAW THRUST

FOR SUSPECTED CASES OF TRAUMA WITH

FRACTURE OF CERVICAL SPINE JAW THRUST IS
APPLIED BY USING BOTH HANDS ON EITHER SITE OF
THE FACE LIFTING THE ANGLE OF THE MANDIBLE
WITH OUT HEADTILT
• THERE ARE MANY SIMPLE EQUIPMENT'S AVAILABLE
TO KEEP THE AIRWAY PATENT.

• THE SIMPLEST ONE IS OROPHARYNGEAL AIRWAY

• WHEN INSERTED INTO THE MOUTH KEEPS THE

TONGUE FROM FALLING BACK.
• NASO PHARYNGEAL AIRWAY IS INSERTED
THROUGH THE NOSE WHICH WILL KEEP THE
TONGUE FROM FALLING BACK
 ENDOTRACHEAL INTUBATION

• BEST METHOD OF ENSURING A PATENT AIRWAY

• ENDOTRACHEAL TUBES ARE PASSED THROUGH THE

MOUTH INTO THE TRACHEA WITH THE HELP OF A
LARYNGOSCOPE.

• IT NEEDS EXPERTISE AND EXPERIENCE TO PERFORM

INTUBATION
SIMPLER METHODS LIKE LARYNGEAL MASK AIRWAY

AND COMBITUBE HAVE ALSO BEEN INTRODUCED FOR

EMERGENCIES
 FOREIGN BODIES

• A VARIETY OF OBJECTS CAN CAUSE OBSTRUCTION OF

THE AIRWAY
• PARTIALLY CHEWED FOOD ESPECIALLY MEAT PIECES
• DENTURES
• COINS
• SMALL PARTS OF TOYS
• VONLITUS-ESPECIALLY IN AN UNCONSCIOUS
PATIENT.
IF YOU SEE A PERSON,
- STRUGGLING FOR BREATH
- NOT ABLE TO TALK OR COUGH
- TRYING TO TELL THROUGH SIGNS THAT HE CAN’T
BREATH

YOU CAN BE SURE THAT HE IS CHOKING.

IN A CONSCIOUS PATIENT WHO IS CHOKING THE
FOLLOWING MANOEUVRES MAY BE ATTEMPTED.

• HEIMLICH’S MANOEUVRE – ABDOMINAL

THRUST
• STERNAL THRUST
• BACK BLOWS
 HEIMLICH”S MANOEUVRE - ABDOMINAL THRUST
•VICTIM STANDING OR SITTING
•RESCURE FROM BEHIND, REACHES AROUND THE
VICTIM
•PLACES FIST OF ONE HAND IN THE EPIGASTRIUM-
MIDWAY BETWEEN THE LOWER END OF STERNUM OR
THE BREAST BONE & UMBILICUS (BELLY BUTTON)
•FIST IS GRASPED WITH THE OTHER HAND AND PRESSED
INTO THE EPIGASTRIUM WITH A QUICK UPWARD
THRUST.
•THIS PUSHES THE DIAPHRAGM UP FORCING AIR OUT OF
THE LUNGS WHICH WILL DISLODGE THE FORGIEN
BODY.
 STERNAL THRUST

•IN VERY OBESE VICTIMS OR WOMEN IN ADVANCED

PREGNANCY INSTEAD OF ABDOMINAL THRUST,
STERNAL THRUST CAN BE ATTEMPTED.

•THE FIST IS PLACED AT THE MIDDLE OF THE

STERNUM AND THRUSTS ARE APPLIED.
 BACK BLOWS

THE VICTIM SHOULD BE IN A HEAD DOWN POSITION.

BLOWS ARE APPLIED DIRECTLY OVER THE SPINE

BETWEEN THE SCAPULAE
 IN AN UNCONSCIOUS VICTIM

ABDOMINAL AND STERNAL THRUST SHOULD BE

ATTEMPTED WITH
• THE VICTIM LYING DOWN SUPINE
• THE RESCUER BY THE SIDE
• HAND POSITIONS SAME AS IN A CONSCIOUS
PATIENT

BACK BLOWS MAY BE TRIED WITH THE

PATIENT IN A LATERAL OR SIDE POSTION.
ATTEMPTS SHOULD BE REPEATED SINCE WHEN THE

MUSCLES BECOME LAX DUE TO LACK OF OXYGEN,

THESE FOREIGN BODIES MAY BE EASILY DISLODGED.

IF ALL THESE MANOEUVRES FAIL

• THE RESCUER SHOULD OPEN THE MOUTH OF THE

VICTIM

• TONGUE AND JAW PULLED FORWARD

• WITH THE FINGER OF THE OTHER HAND HE SHOULD

TRY TO DISLODGE IT MANUALLY
 “B” - BREATHING

AS THE VICTIM IS NOT BREATHING, AIR HAS TO BE

PUSHED INTO THE LUNGS- TO VENTILATE THE VICTIM

THE MOST EASILY ACCESSIBLE METHODS ARE

1. MOUTH TO MOUTH RESPIRATION
2.MOUTH TO NOSE RESPIRATION
 MOUTH TO MOUTH RESPIRATION
VICTIM LYING SUPINE
RESCUER STANDING OR KNEELING BY THE SIDE
RESCUER OPENS THE AIRWAY BY TILTING THE HEAD
AND LIFTING THE CHIN
PINCHES AND CLOSES THE NOSE OF THE VICTIM
TAKES A DEEP BREATH

KEEPS HIS MOUTH ON THE MOUTH OF THE VICTIM

MAKING A TIGHT SEAL

BLOWS THE AIR INTO THE MOUTH OF THE VICTIM. AT

THE SAME TIME WATCHING THE MOVEMENT OF THE
CHEST.
 MOUTH TO NOSE METHOD

RESCUER POSITIONS HIMSELF AS IN MOUTH TO

MOUTH VENTILATION
MAINTAINS HEAD TILT- CHIN UP POSITION OF THE
VICTIM
CLOSES THE MOUTH OF THE VICTIM.
TAKES A DEEP BREATH
PLACES THE MOUTH AROUND THE NOSE AND
BLOWS INTO IT.
THE EFFICACY OF EXPIRED AIR VENTILATION

ATMOSPHERIC AIR HAS AN OXYGEN CONCENTRATION

OF 21%

EXPIRED AIR WILL HAVE ONLY 16% OXYGEN

PROPPER ARTIFICIAL VENTILATION USING MOUTH TO

MOUTH OR NOSE TECHNIQUE WILL BE ABLE TO
SATURATE THE HEMOGLOBIN OF THE VICTIM UPTO 80%

IN AN EMERGENCY SITUATION THIS IS ACCEPTABLE

 THE DISADVANTAGE
- UNKNOWN PERSON WITH UNKNOWN MEDICAL
HISTORY
- POSSIBILITY OF A HIGHLY INFECTIOUS DISEASE LIKE
TUBERCULOSIS, HERPES HEPATITIS, RABIES
- HIV INFECTION POSSIBLE ALTHOUGH SPREAD
THROUGH SALIVA HAS NOT BEEN PROVED

ONE SIMPLE TECHNIQUE IS TO SPREAD A

HANDKERCHIEF ON VICTIM’S FACE AND THEN
PROCEED WITH MOUTH TO MOUTH OR MOUTH TO
NOSE VENTILATION
SIMPLE AIDES TO RESUSCITATORY VENTILATION

1. MASK –
A POCKET SIZE MASK WHICH FITS OVER THE
PATIENT AND WITH A PORT FOR THE RESCUER TO
BLOW
2. FACE SHIELD
 SAFAR AIRWAY

- HAS TWO LIMBS - ONE IS INTRODUCED THROUGH THE

MOUTH INTO PHARYNX OF THE VICTIM

- THE OTHER LIMB IS USED BY THE RESCUER TO BLOW

AIR INTO THE VICTIM’S LUNGS
 BROOKS AIRWAY

-SIMILAR TO SAFAR AIRWAY

- HAS A VALVE AND A SIDE OPENING THROUGH WHICH

THE EXPIRED AIR IS VENTED OUT
 BAG – VALVE – MASK

- THIS IS THE MOST COMMONLY USED

RESUSCITATORY EQUIPMENT AT PRESENT
- CONSISTS OF
- A SELF INFLATING BAG
- A MASK
- NON RETURN VALVE WHICH PREVENTS
EXPIRED AIR FROM REENTERING THE BAG
- EASY TO USE, EFFICIENT HYGIENIC BUT AVAILABLE
ONLY IN HOSPITAL SETUPS AND AMBULANCES
 “C” - CIRCULATION
EXTERNAL CARDIAC COMPRESSION –
THE EASIEST AND MOST EFFECTIVE METHOD TO
MAINTAIN CIRCULATION.

• INTERMITTENT COMPRESSION OF THE HEART

BETWEEN THE STERNUM OR BREASTBONE IN
FRONT AND VERTEBRAL COLUMN AT THE BACK

• PUMPS THE BLOOD OUT OF THE HEART INTO

THE BLOOD VESSELS WHICH IS CARRIED TO
VARIOUS ORGANS AND TISSUES.
IT IS ASSUMED THAT EXTERNAL CARDIAC

COMPRESSION ACTS BY EITHER COMPRESSING THE

HEART DIRECTLY OR BY COMPRESSING THE OTHER

ORGANS IN THE CHEST AND PUSHING OUT THE

BLOOD
 EXTERNAL CARDIAC COMPRESSION

CORRECT TECHNIQUE IS OF UTMOST IMPORTANCE

• VICTIM LIES ON HIS BACK ON A HARD SURFACE

WITH THE HEAD AT THE SAME LEVEL AS HEART
• RESCUER STAND OR KNEEL BY THE SIDE OF THE
PATIENT`S
• (R) HANDED RESCUER ON THE (L) SIDE OF VICTIM
AND VICEVERSA
• IDENTIFY THE LOWER END OF STERNUM OR
BREAST BONE
• IDENTIFY A POINT TWO FINGER BREADTH ABOVE THIS IN
THE MIDLINE ON THE STERNUM
• PLACE THE HEEL OF THE HAND NEAREST TO THE HEAD OF
VICTIM AT THIS POINT
• THE SECOND HAND IS PLACED ON THE TOP OF THE FIRST
• APPLY ENOUGH PRESSURE DOWN WARDS TO PUSH THE
STERNUM DOWN BY ABOUT 1 1/2 INCHES - 2 INCHES
• PRESSURE IS APPLIED ONLY THROUGH THE HEEL OF THE
HAND
• THE ELBOWS SHOULD BE STRIGHT AND PRESSURE APPLIED
BY THE WEIGHT OF THE BODY OF RESCUER AND NOT BY
USING THE MUSCLE POWER OF ARM
 PROTOCOL FOR C P R

CPR DONE IN A HAPHAZARD MANNER IS OF NO

BENEFIT TO THE VICTIM

HENCE A DEFINITE PROTOCOL HAS BEEN

DEVELOPED OVER THE YEARS
“PROTOCOL FOR ONE RESCUER C.P.R”
1. DETERMINE WHETHER THE SITE IS SAFE
( TO PREVENT SECONDARY INJURY )
2. ASSESS THE RESPONSIVENESS OF THE VICTIM
GENTLE SHAKING /TAPPING
CALLING
3. IF NO RESPONSE
A.CALL FOR HELP
B.ALERT EMS (EMERGENCY MEDICAL SERVICE)
4. POSITION THE PATIENT ON A FIRM FLAT SURFACE
MOVE THE PATIENT WITH ONE HAND
SUPPORTING THE HEAD AND NECK AND THE OTHER
HAND SUPPORTING THE BODY
5. OPEN THE AIRWAY WITH HEAD TILT CHIN LIFT
TECHIQUE
(USE HEAD TILT ONLY IF THERE IS NO HEAD OR NECK
INJURY. OTHERWISE USE JAW THRUST ONLY)
6. KEEP THE RESCUER’S FACE CLOSE TO THE VICTIM’S
MOUTH, AT THE SAME TIME LOOKING AT THE CHEST.
THE IDEA IS TO
LOOK FOR CHEST MOVEMENT
LISTEN TO ANY SOUND OF BREATHING
FEEL THE WARM EXPIRED AIR IF THE PATIENT IS
BREATHING.
IF THE PATIENT IS NOT BREATHING
7. GIVE TWO BREATHS/
MOUTH TO MOUTH
AMBU BAG MASK
8.CHECK FOR THE CAROTID PULSE
FEEL FOR THYROID CARTILAGE(ADAM’S APPLE)
WITH TWO FINGERS
SLIDE THE FINGERS DOWN TO THE SIDE WHERE A
GROOVE IS FELT.
CAROTID PULSATIONS IF PRESENT IS FELT THERE.

9.IF THERE IS PULSE, CONTINUE ASSISTING RESPIRATION

10.IF THERE IS NO PULSE

START CHEST COMPRESSION.
11. 30 CHEST COMPRESSIONS FOLLOWED BY TWO
BREATHS AND AGAIN CYCLE IS REPEATED

12. THE RATE RECOMMENDED FOR CHEST COMPRESSION :

100/MIN.

13. AT THE END OF EVERY 4 CYCLES OR 1 MINUTE CHECK

FOR CAROTID PULSE

14. IF THERE IS NO PULSE CONTINUE CPR

15. IF THERE IS A PALPABLE CAROTID PULSE

– STOP CHEST COMPRESSION
– ASSIST BREATHING

16. IF SPONTANEOUS BREATHING HAS STARTED STOP CPR

 PROTOCOL FOR 2 RESCUER CPR
RESCUER 1 RESCUER 2

CHECK FOR RESPONSIVENESS IDENTIFIES THE LOWER STRENUM AND

POINT FOR CHEST COMPRESSION
NO RESPONSE
STAND READY FOR CHEST COMPRESSION
MAINTAIN AIRWAY (HEAD TILT / CHIN LIFT)

TWO BREATHS

CHECK FOR CAROTID PULSE

NO PULSE

SAYS – START CPR

30 COMPRESSIONS

2 BREATH
30 COMPRESSIONS
when rescuer 2 becomes tired he suggests change of position and does so
as soon as one cycle of compression is over
This is for an unprotected airway. If the patient is intubated the ratio is
5:1
 CPR IN INFANTS
WITH ONE RESCUER:
STANDS BY THE SIDE
- USES 2 FINGERS TO COMPRESS
THE MIDDLE OF STERNUM
- THE CHEST IS COMPRESSED TO THE DEPTH OF
1/2 - 1 INCH
- USE A LOWER VOLUME BREATH
- RATIO USED 30:2
WITH TWO RESCUERS:
- USE TWO THUMB ENCIRCLING HANDS
TECHNIQUE
COMPRESSION VENTILATION RATIO INFANTS 15:2
 CPR IN OLDER CHILDREN

• USES THE HEEL OF ONE HAND FOR CARDIAC

COMPRSSION
• THE RATIO IN CHILDREN ARE 30 COMPRESSION TO 2
BREATHS
D. DEFIBRILLATION
MAJORITY OF ADULTS WITH SUDDEN CARDIAC
ARREST HAVE ON THE INITIAL ECG - VENTRICULAR
FIBRILLATION . VF
VF RHYTHM TENDS TO CONVERT TO ASYSTOLE
WITHIN A FEW MINUTES
A SURVIVAL RATE OF 90% REPORTED IF PATIENT IS
DEFIBRILLATED WITHIN 1 MINUTE OF ARREST
DECREASES TO 50% AT 5 MTS, 30% AT 7 MTS 10% AT
9-11 MTS AND 2-5% BEOYND 12 MTS
THE EARLIER THE DEFIBRILLATION THE BETTER THE
PROGNOSIS
WHAT IS DEFIBRILLATION

PASSAGE OF AN ELECTRIC CURRENT OF DEFINITE

ENERGY ACROSS THE HEART
STUNS THE HEART - MYOCARDIAL FIBRES GO INTO
THE REFRACTORY PERIOD
GIVES A CHANCE FOR THE PACEMAKER - S.A. NODE
TO RE-ESTABLISH A RHYTHM
THE ENERGY USED IS MEASURED IN JOULES
DEFIBRILLATION - IS TO REVERT VENTRICULAR
FIBRILLATION/PULSELESS VENTRICULAR
TACHYCARDIA TO NORMAL RHYTHM

CARDIOVERSION - USES A LOWER ENERGY SHOCK

TO REVERT
VENTRICULAR TACHYCARDIA
ATRIAL FIBRILLATION
ATRIAL FLUTTER
BACK TO NORMAL RHYTHM
TRADITIONAL DEFIBRILLATORS USE A SINGLE
CURRENT PULSE (MONOPHASIC) IN ONE DIRECTION
ONLY.

THE RHYTHM WHICH APPEARS ON THE MONITOR HAS

TO BE ANALYSED BY THE OPERATOR AND HE HAS TO
DECIDE WHETHER THE PATIENT NEEDS A SHOCK AND
HOW MUCH ENERGY IS TO BE USED.
AUTOMATED EXTERNAL DEFIBRILLATORS USES
BIPHASIC WAVE FORMS ie. A SEQUENCE OF TWO
CURRENT PULSES WITH OPPOSITE POLARITY.

AED SENSES THE RHYTHM, ANALYSES IT & DECIDES

WHETHER IT NEEDS SHOCK TREATMENT, SELECTS
THE SUITABLE ENERGY AND READIES ITSELF FOR
USE

IT IS BEING INTRODUCED AS PUBLIC ACCESS

DEFIBRILLATION (PAD) WHERE EVEN A TRAINED LAY
PERSON CAN USE IT IN THE COMMUNITY AVOIDING
THE DELAY OF SHIFTING THE PATIENT TO HOSPITAL
ADVANCED CARDIAC LIFE SUPPORT
(SECONDARY ABCD SURVEY)
A- AIRWAY - ESTABLISHMENT OF PROPER AIRWAY
Eg. ENDOTRACHEAL TUBE
LARYNGEAL MASK AIRWAY
- CONFIRM PROPER PLACEMENT BY
AUSCULTATION
END TIDAL CO2 MONITORING
- SECURE THE AIRWAY.
FIX THE TUBE
USE TUBE HOLDERS
B - BREATHING

- ESTABLISHMENT OF PROPER VENTILATION

AMBU BAG, VENTILATOR
- CONFIRM ADEQUATE VENTILATION
AUSCULTATION
OBSERVING THE CHEST MOVEMENT
- SUPPLIMENTAL OXYGEN
- CONFIRM ADEQUATE OXYGENATION
PULSE OXIMETRY
C. CIRCULATION

- ESTABLISHMENT OF IV ACCESS

- IDENTIFY THE ECG RHYTM ON MONITOR

- ADMINISTER DRUGS AND FLUIDS APPROPRIATE

FOR THE RHYTHM AND CONDITION

- CHECK BLOOD PRESSURE, HEART RATE,

TEMPERATURE
D. DIFFERENTIAL DIAGNOSIS
- SEARCH FOR THE CAUSE OF ARREST
- TREAT IDENTIFIED CAUSES
MOST COMMON CAUSES OF SUDDEN CARDIAC ARREST
5Hs 5Ts
- HYPOVOLEMIA - TABLETS(DRUGS OVER DOSE)
- HYPOXIA - TAMPONADE (CARDIAC)
- HYDROGEN IONS - TENSION PNEUMOTHORAX
(ACIDOSIS)
- HYPER/HYPOKALEMIA -THROMBOSIS - CORONARY
- HYPOTHERMIA - THROMBOSIS - PULMONARY
EMBOLISM
 VENTRICULAR FIBRILLATION /
PULSELESS VENTRICULAR TACHYCARDIA
BCLS PRIMARY ABC

ATTACH MONITOR - DEFIBRILLATOR

RHYTHM - VF / PULSELESS VT

DEFIBRILLATE - 1ST SHOCK - 200J

2ND SHOCK - 200-300J
3RD SHOCK - 360J

PERSISTENT VF / PULSELESS VT

Contd.
 VENTRICULAR FIBRILLATION /
PULSELESS VENTRICULAR TACHYCARDIA

ACLS - SECONDARY ABCD SURVEY

INJ. EPINEPHRINE 1MG I/V REPEAT EVERY3-5MTS

OR
INJ. VASOPRESSIN 40 UNITS I/V ONLY ONE DOSE

CPR FOR 1MT

ATTEMPT DEFIBRILLATION 360 JOULES ONE ATTEMPT

VF / VT PULSELESS CHANGE IN RHYTHM

CONTINUE CPR TREAT IF NEEDED
 PERSISTENT VF/ PULSELESS VT

CONTINUE CPR

CONSIDER ANTIARRYTHMIC DRUGS

AMIODARONE 5MG /KG SLOW I.V
LIDOCAINE 1.5MG/KG IV
PROCAINAMIDE

CONSIDER SODIUM BICARBONATE

CPR FOR 1 MNT.

REPEAT DEFIBRILLATION 360 JOULES 1 ATTEMPT

REPEAT CPR IMT FOLLOWED BY DEFIBRILLATION

 ASYSTOLE
THIS DENOTES A RATHER LATE STAGE OF CARDIAC ARREST
VERY LOW SURVIVAL RATE 1-2%
BETTER CHANCES OF SURVIVAL IF A REVERSIBLE CAUSE IS
IDENTIFIED AND TREATED
BLS PRIMARY ABCD SURVEY

MONITOR - ASYSTOLE

SCENE SURVEY - ANY INDICATION OF DNAR

STATUS

- ANY CLINICAL INDICATIONS

OF DEATH

IF PRESENT DO NOT START

RESUSCITATION

IF NO INDICATIONS OF DNAR STATUS OR CLINICAL INDICATION OF DEATH

Contd.
 ASYSTOLE

ACLS - SECONDARY ABCD SURVEY.

TRANSCUTANEOUS PACING - IF CONSIDERED

PERFORM
IMMEDIATELY

INJ. EPINEPHRINE 1MG I/V - REPEAT EVERY 3-5 MT

CONTINUE CPR

INJ. ATROPINE 1MG I/V - REPEAT EVERY 3-5 MTS TO A

TOTAL OF 0.04MG /KG
 PERSISTENT ASYSTOLE

WITHHOLD RESUSCITATION ATTEMPTS

CONSIDER THE QUALITY OF ATYPICAL CLINICAL FEATURE
RESUCITATION
ADEQUATE BLS / ACLS RULE OUT
TRACHEAL INTUBATION DROWNING
EFFECTIVE VENTILATION HYPOTHERMIA
SHOCKED VF. DRUG OVERDOSE
I/V ACCESS - EPINEPHRINE
ATROPINE
RULED OUT REVERSIBLE CAUSES
CONTINUOUSLY DOCUMENTED ASYSTOLE FOR 5MT
IF THESE CRITERIA ARE FULLFILLED, RESUSCITATION CAN BE
WITHHELD
PULSELESS ELECTRICAL ACTIVITY OR
ELECTRO MECHANICAL DISSOCIATION
- ABSENCE OF DETECTABLE PULSE IN PRESENCE OF
ECG RHYTHM OTHER THAN VF/ OR VT
- ALTHOUGH THERE IS ELECTRICAL ACTIVITY THE
SYNCRONIZED SHORTENING OF MYOCARDIAL FIBRES
IS ABSENT / FEEBLE
- AS A RESULT THE PUMPING EFFECT OF THE HEART IS
ABSENT TO PRODUCE A PULSE
- TWO TYPES OF COMPLEXES ARE NOTICED
1. WIDE COMPLEXES WITH SLOW RATES
2. NARROW COMPLEXES WITH FAST RATES
COMMON CAUSES

WIDE & SLOW COMPLEXES NARROW & FAST COMPLEXES

HYPERKALEMIA HYPOVOLEMIA
HYPOTHERMIA INFECTION
HYPOXIA PULMONARY EMBOLISM
ACIDOSIS CARDIAC TAMPONADE

DRUG OVER DOSAGE

TRICYCLIC ANTEDEPRESSANTS
B BLOCKERS
CALCIUM CHANNEL BLOCKERS
DIGITALIS
MANAGEMENT OF PEA

BLS - PRIMARY ABCD

ACLS - SECONDARY ABCD
IDENTIFY THE CAUSE
- 5Hs & 5Ts
- TREAT THE CAUSE
EPINEPHRINE 1MG IV - REPEAT EVERY 3-5 MTS

CONTINUE CPR
ATROPINE 1MG IV - IF RATE IS SLOW.
REPEAT EVERY 3-5 MTS
TO A TOTAL OF 0.04MG/KG.
ONCE A SINUS RHYTHM IS ESTABLISHED
- DRUGS MAY BE NEEDED TO MAINTAIN HEART RATE
& BLOOD PRESSURE
-FLUIDS AND INOTROPES

- VENTILATORY SUPPORT MAY HAVE TO BE CONTINUED

TILL ADEQUATE SPONTANEOUS RESPIRATION IS
ESTABLISHED

-BLOOD GAS, ACID BASE AND ELECTROLYTE

ESTIMATION TO BE DONE AND CORRECTIVE STEPS TO
BE CARRIED OUT.
THE LAST STAGE IS
STAGE III - PROLONGED LIFE SUPPORT

DURING THIS STAGE THE VICTIM IS

ASSESSED IN DETAIL WITH RESPECT TO
- THE PROGNOSIS - THE OUTCOME
- THE CERBRAL FUNCTION
- THE NEED FOR CONTINUED INTENSIVE
CARE TREATMENT
 PROLONGED LIFE SUPPORT
(POST RESUSCITATIVE BRAIN ORIENTED THERAPY)
CONSISTS OF
G-GAUGING DETERMINE AND TREAT THE CAUSE
OF CARDIAC ARREST
H-HUMAN
MENTATION
DETERMINE SALVAGIBILITY
I- INTENSIVE CARE

AFTER RESTORATION OF
SPONTANEOUS CIRCULATION AND
THROUGHOUT THE COMATOSE STATE
- AFTER RESTORATION OF HEARTRATE AIM FOR A BRIEF
HYPERTENSIVE PERIOD FOLLOWED BY NORMOTENSION
- VENTILATE FOR AT LEAST 12 HOURS POST ARREST
- MAINTAIN NORMOCAPNIA / MILD HYPOCAPNIA(PaCO2 - 25-35mmHg)
- MODERATE HYPEROXIA (PaO2 > 100mmHg)
- NORMO/ MILD HYPOTHERMIA (34-360C)
- ARTERIAL pH 7.3 - 7.5 BASE DEFICIT < 7mmol/L
- IMMOBILISATION OR PARTIAL NEUROMUSCULAR BLOCKADE AS
NEEDED
- SEDATION AND ANTICONVULSANTS AS NEEDED
- NORMALISATION OF ELECTROLYTES, HAEMATOCRIT GLUCOSE AND
OSMOLALITY
- STANDARD INTENSIVE CARE FOR ALL ORGANS
- KEEP HEAD SLIGHTLY ELEVATED
- TURN THE TRUNK FROM SIDE TO SIDE PERIODICALLY.
 THE SATISFACTION ONE GETS WHEN
HE SEES A VICTIM HE HAS
REVIVED, WALKING AROUND CHEERFULLY
IS SOMETHING WHICH CANNOT BE EXPRESSED IN
WORDS