Cardiopulmonary resuscitation (CPR)

Cardiac arrest is cessation of effective circulation.

Signs of cardiac aresst.

Unconsciousness. Absence of Pulse & heart sounds. Absence of spontaneous breathing.

Manifestation of cardiac arrest on the monitor.

Ventricular fibrillation. Pulse less ventricular tachycardia. Pulse less electrical activity ( PEA) describes a situation in which there is an electrical rhythm other than VTAC. It is due to EMD in which the heart is not contracting despite the presence of electrical activity. Asystole.

CPR.
is an artificial method to keep oxygenated blood flowing to the vital organs such as brain.

CPR consists of to major steps.

Basic life support ( BLS) consists of those elements of resuscitation that can be performed without additional equipments. these are 1. basic airway management. 2. rescue breathing. 3. manual chest compression. Advanced cardiac life support.

Protocol for BLS.

Step 1 first check the patient's responsiveness ( feel the carotid pulse & check the breathing & establish the need for intervention. Step 2 quickly prepare the patient for CPR. A hard surface beneath the patient is must for effective cardiac massage. the patient should be on supine. Step 3 start CPR.

ABC of CPR .
A for air way check the air way for obstruction. If there is no evidence of cervical spine instability , a head tilt chinlift should be tried. In case of trauma to the head & neck avoid head tilt/ chin-lift maneuver. A jaw thrust is used instead. the second rescuer should stabilize the head & neck manually until spinal imobilization done.

B for breathing.
Mouth- to-moth or mouth- to-musk (mouth-to-barrier-device) rescue breathing should be instituted in the breathless patient. Successful breathing ( 7001000ml TV 1012times/minute in adult ) is confirmed by observing the chest rising & falling with each breath. A rescuer's exhaled air has an oxygen concentration of only 1617% & contains significant co2 . Low inspired oxygen concentration & hypercarbia combined with low cardiac output & intrapulmonary shunting during resuscitation, invariably results in hypoxia. Supplemental oxygen preferably 100% should always be used if available. If supplemental oxygen is used, a smaller TV of 400700ml is recommended.

C for circulation.
If the patient is pulseless or severely hypotensive the circulatory system must be supported by a combination of 1. external chest compression. 2.IV drug administration. 3. defibrillation.

External chest compression.

Technique of ECC. The heel of the rescuer's hand is placed over the lower half of the sternum or mid sternum at nipple line. The other hand is placed over the the hand on the sternum with the fingers interlaced or extended.

Summary of the recommended BLS techniques.

Infant ( 112) Breathing rate Pulse check Compression rate Compression method Compression / ventilation ratio Foreign body obstruction 20/min. brachial >100/min. 2 or 3 fingers 5:1 Back blows & chest thrust. Child > 12mo 20/min. carotid 100/min. Heel of one hand 5:1 Heimlich maneuver Adult 1012/min Carotid 100/min. Hands interlaced. 15:2 Heimlich maneuver.