CPR
When to Start CPR
CPR should be started on all :
Unresponsive
Non-breathing
Pulseless patients
AUTOMATED
EXTERNAL
DEFIBRILLATOR
( AED )
Chain of Survival
Each Chain of Survival includes elements of the following:
Prevention and preparedness, including responder training, early recognition of cardiac
arrest, and rapid response
Activation of the emergency response system, either outside of or within the hospital
High-quality CPR, including early defibrillation of ventricular fibrillation and pulseless
ventricular tachycardia
Advanced resuscitation interventions, including medications, advanced airway
interventions, and extracorporeal CPR
Post–cardiac arrest care, including critical care interventions and targeted temperature
management
Recovery, including effective support for physical, cognitive, emotional, and family needs
New Sequence
A Change From A-B-C to C-A-B
Open the airway
• Turn victim
onto her / his back
• Open the airway :
Head tilt
Chin lift
Head tilt, chin lift
Open the airway
Head tilt, chin lift + jaw thrust
- healthcare professionals
PULSE CHECK IN CPR
Check pulse for not more than 10 seconds.
Carotid for adults, bracheal and femoral for infants
I. ventricular fibrillation (VF)
II. pulseless ventricular tachycardia (pVT)
III. pulseless electric activity (PEA)
IV. asystole.
11
12
13
Attempt to improve CPR quality if…
Etco2 <10 mm Hg
Diastolic pressure <20 mm Hg
SvO2 is < 30%
Back blows and chest thrusts
15
Cardioversion should be synchronized with the QRS complex and is recommended for
hemodynamically stable and unsynchronized shocks.
Synchronized
1. PSVT
2. Atrial fibrillation
3. Atrial flutter.
4. Wide-complex tachycardia requiring cardioversion (Monomorphic VT )
Unsynchronized shocks.
1. VF
2. Polymorphic VT
3. Pulseless VT
Interventions Not Recommended for
Routine Use During Cardiac Arrest
I. Available evidence suggests that routine use of atropine
during PEA or asystole is unlikely to have a therapeutic
benefit.
II. Routine use of sodium bicarbonate is not
recommended for patients in cardiac arrest.(In some
special resuscitation situations, such as preexisting
metabolic acidosis, hyperkalemia, or tricyclic
antidepressant overdose, bicarbonate can be beneficial.)
III. Routine administration of calcium for treatment of in-
hospital and out-of-hospital cardiac arrest is not
recommended.
Interventions Not Recommended for
Routine Use During Cardiac Arrest
IV. Fibrinolytic therapy should not be routinely
used in cardiac arrest.
V. Electric pacing is not recommended for routine
use in cardiac arrest.
VI. The precordial thump(striking at the middle of a
person’s sternum with the ulnar aspect of the fist)
may be considered for termination of witnessed
monitored unstable ventricular tachyarrhythmias
when a defibrillator is not immediately ready for
use but should not delay CPR and shock delivery.