بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Cardiopulmonary resuscitation By Sahar Ahmed El karadawy Assistant Professor of Anaesthesia MRI Alex. Univesity

3. Objectives • Causes of cardiac arrest. • Recognition of cardiac arrest. • Principle of Basic life support. • Guide lines of adult and pediatric basic life support.

4. Causes of cardiac arrest • Acute Coronary Syndromes • Stroke • Drugs toxicity • Hypothermia • Drowning • Choking • Trauma • Electrolytes disturbance

5. Basic Life Support • Basic life support (BLS) is the foundation for saving livesfollowing cardiac arrest. • It includes immediate recognition of sudden cardiac arrest (SCA) and activationof the emergency response system, early cardiopulmonary resuscitation(CPR), and rapid defibrillation with an automated external defibrillator(AED).

6. Immediate recognition of cardiac arrest • Immediate recognitionof SCA ( Sudden cardiac arrest) based on assessing unresponsivenessand abnormal breathing or absence of normalbreathing.

8. Check for Response (Box 1,2)) • Are you all right? انت بخير? • If the “victim responds but is injured or needs medical assistant leave the victim to phone 123. Then return as quickly as possible and recheck the victim’s condition frequently.

9. If no response to stimulation or absence of normalbreathing • A lone rescuer (phone 123), get an AED (if available), and return to the victim to provide CPR. • When 2 or more rescuers are present, one rescuer should begin the steps of CPR while a second rescuer activates the EMS system and gets the AED.

10. Immediate Recognition and Activation of the Emergency Response System

12. Pediatric Chain of Survival.

13. Early recognition of the emergency and activation of the emergency medical services (EMS) or local emergency response system: “phone 123” • Early bystander CPR: immediate CPR can double or triple the victim’s chance of survival from VF SCA. • Early delivery of a shock with a defibrillator: CPR plus defibrillation within 3 to 5 minutes of collapse can produce survival rates as high as 49% to 75%. • Early advanced life support followed by postresuscitation care delivered by healthcare providers.

14. Start CPR

15. C. Circulation • A. Air way • B. Breathing

18. Pulse Check less than 10 sec

19. Chest compressions consist of rhythmic applications of pressure over the center of the chest. These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart Chest compressions

20. COMPRESSION METHOD • Push hard and fast at least 100 compressions /min allow complete recoil . • Hell of one hand , the other hand on the top( adult and children ) • 2 fingers or 2 thumb -encircle hands(infants)

21. COMRESSION DEPTH • * At least 5cm in adult. • * 1/2 the depth of chest in children and infants Compression ventilation ratio • 30/2 ( 1or 2 rescuers in adult) • 15/2 ( 2 rescuers in children and infants)

22. Minimize interruptions in chest compressions. • When multiple rescuers are present, they should rotate the compressor role about every 2 minutes. • Once an advanced airway is in place, 2 rescuers no longer deliver cycles of CPR (ie, compressions interrupted by pauses for ventilation). • Instead, the compressing rescuer should give continuous chest compressions at a rate of 100 per minute and 8-10 breathes /min

24. Jaw thrust

25. Boxes Check Breathing While maintaining an open airway, give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise

26. Mouth-to-Mouth Rescue Breathing • Open the victim’s airway • Pinch the victim’s nose • Create an air-tight mouth-to-mouth seal. • Give 1 breath over 1 second, take a “regular” (not a deep) breath • Give a second rescue breath over 1 second

27. Mouth to mouth

28. Mouth to mouth and nose

29. Mouth-to–Barrier Device Breathing Barrier devices are available in 2 types: face shields and face masks. Face shields are clear plastic or silicone sheets that reduce direct contact between the victim and rescuer but do not prevent contamination

30. Mouth to face mask

31. Mouth-to-Nose Mouth-to-nose ventilation is recommended if it is impossible to ventilate through the victim’s mouth (eg, the mouth is seriously injured), the mouth cannot be opened

32. Ventilation With Bag and Mask Bag-mask ventilation is a challenging skill that requires considerable practice for competency. The lone rescuer using a bag-mask device should be able to simultaneously open the airway with a jaw lift, hold the mask tightly against the patient’s face, and squeeze the bag. The rescuer must also watch to be sure the chest rises with each breath

33. Bag-mask ventilation is most effective when provided by 2 trained and experienced rescuers. One rescuer opens the airway and seals the mask to the face while the other squeezes the bag. Both rescuers watch for visible chest rise.

34. The rescuer should use an adult (1 to 2L) bag to deliver a tidal volume sufficient to achieve visible chest rise this volume can be delivered by squeezing a 1-L adult bag about one half to two thirds of its volume or a 2-L adult bag about one-third its volume. Automatic transport ventilators (ATVs) are useful for ventilation of adult patients who have an advanced airway in place, both in and out of the hospital

36. Prone CPR When the patient cannot be placed in the supine position; during lamenectomy, rescuers may provide CPR with the patient in the prone position if advanced airway in place without pauses for ventilation. The rescuer delivering ventilation provides 8 to 10 breaths per minute

38. Defibrillation (Boxes 8, 9, 10) Automated external defibrillator, manual defibrillation Automated External Defibrillators AEDs are sophisticated, reliable computerized devices that use voice and visual prompts to guide lay rescuers and health-care providers to safely defibrillate VF SCA. In recent clinical trials, modified prototype AEDs recorded information about frequency and depth of chest compressions during CPR.

39. Electrode placment :12 - 14 cm Electrode size

40. Shock first Versus CPR first Immediate defibrillation is the treatment of choice for VF of short duration 1- shock protocol versus 3- shock sequnce

41. Special Resuscitation Situations Drowning When rescuing a drowning victim of any age, Rescuersshould provide CPR, particularly rescue breathing, as soon asan unresponsive submersion victim is removed from the water. The lone healthcare provider should give 5 cycles (about 2 minutes) of CPR before leaving the victim to activate the EMS system

42. Foreign-Body Airway Obstruction (Choking) Conscious victim • Encouraged to cough • Up to 5 back blows • Abdominal thrusts

43. Unconscious victim • Able to breath • Encouraged to cough • Recovery position • Unable to breath • Call for help • 5 back blows • Supine position • Finger sweep • 2 - 5 ventilation • Up to 5 abdominal or chest thrust • Direct laryngoscopy • Surgical air way

44. Infant Back Blows for Airway Obstruction

45. Choking

46. Chest Thrusts for Air-Way Obstruction on Pregnant-or Obese Pt's

47. THANK YOU