Cardiopulmonary Resuscitation

(CPR)

Dr. Ahmad Aqel, 2016

The University of Jordan/School of Nursing

AHA guidelines
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Assess responsiveness
1. Tap the victims shoulder &
shout Are you all right?
- If a victim is not breathing or
not breathing normally (ie,
gasping), you must activate
the emergency response
system.
2. Phone 911 or emergency
number, Get AED, or send
Rescuer (if available) to do this.
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C-A-B
Initiate chest compressions
before ventilations. Why?
To reduce delay to CPR
Emphasize primary
importance of chest
compressions
CPR Starts with Compressions:
Many adults with witnessed arrest
have ventricular fibrillation (VF)
and require chest compressions and
early defibrillation

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Check pulse:
Locate trachea and slide fingers into the groove
Palpate carotid artery 5-6 seconds

If a victim is not breathing or not breathing normally (ie, gasping), you

must activate the emergency response system. IF IN THE HOSPITAL,
CALL THE CODE!!

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Start Chest compression:
Ensure victim is lying supine on a firm surface
Expose the victim's chest
Put your hands on (middle of the sternum)
Straighten your arms and position your shoulders
directly over your hands
Push hard and fast
Depth of compression: at least 2 inches (100 times
per minute).
Ensure full recoil of chest wall
Do not interrupt chest compressions
Begin 30 chest compression and 2 breaths
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Compression ventilation ratio

Adult Child Infant

1 rescuer 30: 2 30:2 30:2
2 rescuer 30:2 15:2 15:2

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A = Airway
Open Airway
Note: Tongue is the Main Cause of Airway Block In the Unresponsive Pt.

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Open the airway by:
1. Head-Tilt-Chin Lift 2. Jaw thrust

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B = Breathing
Air oxygen = 21% (4% consumed
;17% out with exhalation,

Steps:
Hold airway opened..
Pinch nose closed..
Take a regular breath & seal Mouth-to-Mouth Breathing
your lips around the victims
mouth..
Give 1 breath over 1 sec..
Watch for chest to rise..
Give a 2nd breath over 1 sec..
Watch chest to rise. Mouth-to-Mask Breathing

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 Caution!
Avoid Hyperventilation

Giving Breaths too quickly or with too much force

lead to:
Gastric Inflation may lead to:
Vomiting, Aspiration, or Pneumonia

Taking 1 sec to deliver each breath. Just

enough to make the chest rise

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D for Defibrillator
Automated External Defibrillator (AED)
Steps
1 POWER ON the AED

2 ATTACH AED PADS to the victims bare chest.

- Attach the pads on the victims upper-right chest AND to the side
of the left nipple.
3 Clear the victim and ANALYZE the rhythm

4 If the AED advices to SHOCK, Clear the victim before delivering the
shock
After any shock delivery, immediately resume CPR (5 cycles)

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Modifications to CPR for Children

Amount of Air for Breaths: (enough to make chest rise)

Give 2 Effective Breaths: that make the victims chest rise.
Depth of Compressions (approximately 2 inches) 1/3 depth of
chest)
1-Handed Chest Compressions

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CHILD BLS Sequence
Recognize unresponsive child with no
breathing or only agonal gasps
activate emergency response & retrieve AED.
Check for pulse (no more than 10 seconds)
If no pulse, begin sets of 30 chest
compressions and 2 breaths.
Lone rescuer activates emergency response
after 2 minutes of CPR.
Use AED as soon as available.

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 CPR
For Infants

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Check for Responsiveness
Tap foot & shout Are you all right?

A =airway
Open airway by head tilt chin lift

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B = Breathing
Mouth-to-Mouth-&-Nose Breathing
Mouth-to-Mouth Breathing
Taking 1 sec to deliver each breath.
Just enough to make the chest rise
One breath every 6-8 sec (with advanced
airway)

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If no pulse, Or pulse is < 60 with
signs of poor perfusion Start
Compressions
Use 2 fingers just below the
nipple line
Press down 1/3 of chest depth
(4cm); At least 100/m

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 Infant Bag-Mask Technique
Appropriate Size
Mask Cover mouth & nose
Not cover eyes or overlap chin
E-C Clamp Technique

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Infant Rescue Breathing
Respiratory Arrest with Pulse
Rescue Breathing

Give 1 breath every 3- 5 sec

Each in 1 sec
Chest Rise
Check pulse about every 2 min

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2 Thumb-Encircling Hands Technique
Both thumbs on just below the nipple line
Support back with fingers of both hands
Depress breastbone 1/3 to chest depth
(& squeeze with fingers)
Full chest recoil
Smooth at least 100 compressions/ m

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2-Rescuer Infant CPR
Rescuer 1 Victims 2 thumb-encircling hands
Side technique
Counts out loud
Switches duties every 2
min (<5sec)
Rescuer 2 Victims Maintains an open airway
Head Provides effective breaths
Encourages effective
compressions
Switches duties every 5
cycles (<5 sec)

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Basic Airway Adjuncts
Oropharyngeal Airways Nasopharyngeal Airways

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 Bag-Mask Device

Bag + Face mask

+ ? Nonrebreathing valve

Instruction & Practice

- Effective bag-mask ventilation

Open airway & Tight seal

Supplementary O2
- Each breath also over 1 sec

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 Adult & Child Rescue Breathing
In case of Respiratory Arrest (Absent or Inadequate
Breathing) but pulse is available, Give breaths without
Compressions

1 breath every 5- 6 sec 1 breath every 3- 5 sec

10- 12 breaths per min 12- 20 breaths per min

Each breath over 1 sec

Visible chest rise
Check pulse about every 2 min

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 2-Rescuer
Compression-Ventilation Ratio
1-Rescuer Adult/ Child/ Infant CPR 30:2

2-Rescuer Adult CPR 30:2

2-Rescuer Child/ Infant CPR 15:2

More Frequent Ventilations are of greater benefit

For Children
Respiratory Difficulty

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 2-Rescuer CPR Sequence

Switching Rolls
every 5 cycles of CPR (about every
2 min)
taking less than 5 sec to switch

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2-Rescuer CPR Sequence

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Advanced Airway Considerations
(2-Rescuer CPR)

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 Head, Neck, or Spine Injury
Opening Airway-Jaw Thrust
? Cervical Spine Injury Jaw Thrust (Without Head
Extension)
Hands on each side of head +
Elbows on surface
Fingers under angles of lower jaw
Lift with both hands
If lips close retract lower lip with
thumb

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 Head, Neck, or Spine Injury
Moving Patient-Log Roll
? Head or Neck Trauma
Move Pt only for safety to provide CPR

Turn head, neck & torso as a unit (logroll the victim)

avoid flexion or twisting of neck or back

A 2-person procedure: one to hold head & neck, & one to

move the body

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 Recovery Position
To manage unresponsive victims with adequate
breathing and suspected trauma Move only if:
Cannot keep airway open, Unsafe scene, or Otherwise cannot
give CPR

Check Breathing often; If breathing stops AED, Roll

to back, CPR
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 The Adult Chain of Survival

1. Early Recognition of the Emergency & Activation of the EMS

Recognition of the warning signs + Activate EMS before collapse
2. Early CPR
Bystander CPR Positive effect on survival
3. Early Defibrillation
4. Early Advanced Care
Ventilation, IV access, Drugs, Arrhythmias, Transport

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