DR J.O OLATOSI D.A,FWACS
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PRIMARY FMCP UPDATE - CPR LECTURE
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CARDIAC ARREST
 Sudden cessation of spontaneous and effective heart
function
 Diagnosis’unresponsive
 Sudden deep unconsciousness
 Absent major peripheral pulses
 Absent spontaneous ventilation/agonal breathing
Fixed dilated pupils not index for diagnosis or prognosis
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PRIMARY FMCP UPDATE - CPR LECTURE
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CAUSES OF CARDIAC ARREST
Airway obstruction
 Blood, vomit, foreign body
 Trauma
 Infection, inflammation
 Laryngospasm
 Bronchospasm
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 Decreased respiratory drive
-CNS depression
 Decreased respiratory effort
-neurological lesion
-muscle weakness
-restrictive chest defect
 Pulmonary disorders
-pneumothorax, lung pathology
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Cardiac abnormalities
Primary
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Ischaemia
Myocardial infarction
Hypertensive heart disease
Valve disease
Drugs
Electrolyte abnormalities
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Secondary
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Asphyxia
Hypoxaemia
Blood loss
Septic shock
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Cardiopulmonary Resuscitation
A technique combining artificial ventilation and chest
compressions designed to perfuse vital organs or
restore circulation in cardiac standstill.
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 Early access to get help
 Early BLS to buy time-
CPR slows down
deterioration of the brain
 Early defibrillation to
restart heart-restores a
perfusing rhythm
 Early ALS to stabilise
circulation
failure of circulation for 34mins can lead to
irreversible brain damage.
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Adult BLS sequence
Basic life support consists of the following sequence of
actions:
1 Make sure the victim, any bystanders, and you are
safe.
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2 Check the victim for a response.
• Gently shake his shoulders and ask loudly, ‘Are you all
right?’
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Shake and Shout
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3 A If he responds:
• Leave him in the position in which you find him
provided there is no
further danger.
• Try to find out what is wrong with him and get help if
needed.
• Reassess him regularly.
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3 B If he does not respond
 Shout for help.
 Turn the victim onto his back and then open the
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airway using head tilt
and chin lift:
Place your hand on his forehead and gently tilt his
head back.
With your fingertips under the point of the victim's
chin, lift the
chin to open the airway.
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Opening the airway
 Head tilt
 Chin lift
 If cervical spine injury
suspected:
 jaw thrust
C14
Assess Breathing
 Look for chest movement
 Listen for breath sounds
 Feel for expired air
 Assess for 10 seconds before
deciding breathing is absent
C15
5 A If he is breathing normally:
 Turn him into the recovery position .
 Send or go for help, or call for an ambulance.
 Check for continued breathing.
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5 B If he is not breathing normally:
 Ask someone to call for an ambulance or, if you are
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on your own, do
this yourself; you may need to leave the victim. Start
chest
compression as follows:
Kneel by the side of the victim.
Place the heel of one hand in the centre of the
victim’s chest.
Place the heel of your other hand on top of the first
hand.
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 Interlock the fingers of your hands and ensure that
pressure is
 not applied over the victim's ribs. Do not apply any
pressure over the upper abdomen or the bottom end
of the bony sternum (breastbone).
 Position yourself vertically above the victim's chest
and, with
 your arms straight, press down on the sternum 4 - 5
cm.
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 After each compression, release all the pressure on
the chest
 without losing contact between your hands and the
sternum.
 Repeat at a rate of about 100 times a minute (a little
less than
 2 compressions a second).
 Compression and release should take an equal
amount of time.
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Chest compressions
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6 A Combine chest compression with rescue
breaths.
 After 30 compressions open the airway again using
head tilt and chin lift.
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Rescue breathing
(Expired air ventilation)
 Occlude victim’s nose
 Maintain chin lift
 Take a deep breath
 Ensure a good mouth-tomouth seal
Rescue breathing
(Expired air ventilation)
 Blow steadily (2 sec) into
victim’s mouth
 Watch for chest rise
 Maintain chin lift, remove
mouth
 Watch chest fall
C23
6 B Chest-compression-only CPR.
 If you are not able, or are unwilling, to give rescue
breaths, give chest compressions only.
• If chest compressions only are given, these should be
continuous at a rate of 100 a minute.
• Stop to recheck the victim only if he starts breathing
normally; otherwise do not interrupt resuscitation.
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7 Continue resuscitation until:
 qualified help arrives and takes over,
 the victim starts breathing normally, or
 you become exhausted.
 A valid DNAR order is presented
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ALS
Basic Airway Adjuncts Oropharyngeal Airway
 Nasopharyngeal Airway
Advanced Airway Devices
 Laryngeal Mask Airway
 Combitube
 Endotracheal Tube
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DEFIBRILLATION
 Definition
“The termination of fibrillation or absence of VF/VT at 5
seconds after shock delivery”
 Critical mass of myocardium depolarised
 Natural pacemaker tissue resumes control
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Design
 Power source
 Capacitor
 Electrodes
Types
 Manual
 Automated
 Monophasic or Biphasic waveform
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Defibrillator waveforms
Damped Monophasic
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Truncated Biphasic
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Biphasic Defibrillators
 Require less energy for defibrillation
 smaller capacitors and batteries
 lighter and more transportable
 Repeated < 200 J biphasic shocks have higher success
rate for terminating VF/VT than escalating
monophasic shocks
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Automated external
defibrillators
 Analyse cardiac rhythm
 Prepare for shock delivery
 Specificity for recognition of shockable rhythm close
to 100%
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Advantages:
 Less training required
 no need for ECG interpretation
 Suitable for “first-responder” defibrillation
 Public access defibrillation (PAD) programs
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 Attach adhesive electrodes
 Follow audible and visual instructions
 Automated ECG analysis - stand clear
 Charges automatically if shockable rhythm
 +/- manual override
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Relies upon:
 Operator recognition of ECG rhythm
 Operator charging machine and delivering shock
 Can be used for synchronised cardioversion
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Defibrillator Safety
 Never hold both paddles in one hand
 Charge only with paddles on casualty’s chest
 Avoid direct or indirect contact
 Wipe any water from the patient’s chest
 Remove high-flow oxygen from zone of defibrillation
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Manual Defribillation
 Diagnose VF/VT from ECG and signs of cardiac
arrest
 Select correct energy level
 Charge paddles on patient
 Shout “stand clear”
 Visual check of area
 Check monitor
 Deliver shock
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