CPR

Cardiopulmonary
resuscitation

Guidelines 2010
Eduard Kasal

ARK FN Plze
2010
Chain of survival
 CardioPulmonary
Resuscitation
Definition:
CPR is an emergency first-aid procedure
that is used to maintain respiration and
blood circulation in a person, whose
breathing and heartbeats have suddenly
stopped,
(one or more vital functions failed ).
 CardioPulmonary
Resuscitation
Three basic vital functions:

Breathing
Circulation
Consciousness
CardioPulmonary Resuscitation
History
1. Peter Safar - Professor of Pittsburgh
University presented in 1968 small book
Cardiopulmonary Resuscitation .
2. Guidelines 2000

3. Guidelines 2005
Many changes of almost all algorithms used
for several tens of years
4. Guidelines 2010 - cosmetics
Publication of new guidelines does not mean, that CPR provided in
accordance with previous guidelines is not effective and not correct,
but we should follow them as possible
www.erc.edu
www.resuscitace.cz
 Theoretical background
Oxygene content
In atmospheric air - 21%
In alveoli - 14,5%
Expired air diluted by air from the
airways (dead space)
- 16 18 % O2

Provided that there is an adequate amount of

expired air reaching the victim's lungs, oxygen
delivery will be sufficient to ensure that the
victim's haemoglobin will be over 80%
saturated with oxygen.
Theoretical background

Cardiac arrest
1. Asystole
2. Ventricular fibrillation
Most cardiac arrest victims have an
electrical malfunction of the heart
hearts pumping function abruptly
ceases
3. Pulseless ventricular tachycardia
4. Pulseless electrical activity (PEA)

Signs = identical!!!
Differential dg: only ECG
 Pulseless electrical activity (PEA)

ECG curve present + unpalpable pulse on large

arteries
ECG - spectrum from normal curve to bradycardic
and tachycardic arrhythmias
Cause: several severe reversible etiologic causes:
severe hypovolemia, sudden bleeding out
haemorhage,
cardiac tamponade,
tension pneumothorax
massive pulmonary embolism
 Different approach
Beside CPR paralelly fast diagnostic procedures to find
out dg + adequate fast therapy

Always prefer clinical assessment to ECG technical

problems?

Treat the patient, not the monitor !!

 PEA (Asystole)
Potentially reversible causes
4H
Hypoxemia
Hypovolemia
Hyper a hypokalmia, hypokalcmia, acidosis
Hypothermia

4T
Tension PNO
Cardiac tamponade
Toxic substantions
TEN (tromboembolic disease)
Theoretical background
At best
chest compressions provide only 30% of
normal perfusion brain + heart

Time! Time! Time! Time! Time! Time! Time!

Time!
Failure of the circulation 3 - 5 minutes
irreversible cerebral damage.

Chances of successful CPR - restoration of

spontaneous circulation (ROSC) decreases
by 10% with each minute following sudden
cardiac arrest
 Distribution of blood during
cardiac arrest

50 90% of perfusion distributed

into the brain (normally 15%)
20 - 50% of perfusion distributed
into the coronary bed (normally 5%)
5% distributed into the the
splanchnic area
 Cause of cardiac arrest and
emergency system activation
Adults
1. Primary cardiac arrest -CAD -
ventricular fibrillation (> 80%)
Children
2. Secondary cardiac arrest due to
suffocation or choking with hypoxemia
or asphyxia.
Ventricular fibrillation is rare in children
(only 5-8%)
Trauma
Cause of cardiac arrest and emergency
system activation
different approach to the emergency system activation.

Adults
electric defibrillator is necessary as soon as possible;
therefore, if telephone is available:
1. call for help ( 155, 112 in the Czech Republic) and then
2. start with CPR

Children
1. start CPR immediately for 1 minute to provide some
tissue oxygenation
2. then call for help
Emergency telephone number

155, 112
in the Czech Republic
 Indication of CPR

to victims with unexpected cardiac

arrest in otherwise healthy
individuals
= to those, who can be described as
having heart too good to die
 CPR is not indicated
signs of biological death
witnessed information, that cardiac arrest had happened 15
or more minutes before the rescuer arrived (time
assessment in the stressing situation is not precise)
terminal stage of incurable disease (generalised malignant
disease)
an evident trauma without chance to survive (catastrophic
head injury)
living will - only in countries when constitution accepts it
DNR - Do not attempt resuscitation has been written in the
file (incurable disease after all available therapy failed)
execution

Age of the patient is not restriction of CPR

 Outcome after CPR
Ventricullar fibrilation better than asystole
- in case of immediate CPR

Special emphasis

Soon defibrilation
1 minute - survival - 90%,
5 minutes - survival - 50%,
7 minutes - survival - 30%
10 - 12 minutes - survival - 2 5%.
 CPR outcome

In first 4 minutes brain damage is unlikely, if

CPR started
4 6 minutes brain damage possible
6 10 minutes brain damage probable
> 10 minutes severe brain damage certain

Cells of the brain cortex

without perfusion and oxygenation
irreversibly damaged after 3-5 minutes
 Signs of cardiac arrest
(Guidelines 2005)
1. No reactivity
2. Unconsciousness
3. Absence of normal breathing
Apnea
gasps
 Signs of cardiac arrest
1. Special situations general anaesthesia
 Basic conditions for CPR
1. Rescuers safety = the first priority
2. To assess the risk of trauma,
intoxication, infection
3. a victim position: supine on to his/her
back
4. on the firm flat surface to make
effective chest compressions
5. victims position in relation to
rescuers position
6. CPR during transfer
 Rescuers safety
The rescuer should never place him/herself or others at more
risk than the victim

before starting resuscitation assess the risks of ongoing

traffic, falling masonry, electrocution, toxic fumes and poisons
risk of infections transmission
bloodborne infections (hepatitis B and C, HIV)

airborne infections (TBC and several infectious

diseases - herpetic, meningococcal etc.
- can be transmitted by mouth-to-mouth breathing
Always: protect yourself !!!
personal protective equipment (gloves)
barrier protective devices
Moth to - barrier protective devices breathing
 Personal Protective

Equipment
Can control the risk of exposure to
bloodborne pathogens prevents an
organism from entering the body (medical
exam gloves, eye protection, mask)
All human blood and body fluids should be
considered infectious
Mouth-to-mouth barrier devices
Can prevent air-borne pathogens
transmission
Not documented case of disease transmission
Butshould be used whenever
possible
Risks of CPR (Guidelines 2010)
Risk of electric injury during defibrilation low
(gloves)
Risk of infection transmission is low
Personal protective equipment (gloves) and
barrier protective devices can protect
Due to the low risk of infection transmission
start without protection
Where you know about disease use adequate
measures
CardioPulmonary Resuscitation
Barrier devices

S tube
Face shields (resuscitation veil )
Pocket face mask + one-way valve
Handkerchief
Towel
 Stop CPR if

Victim starts to breathe normally

Patient has signs of weaking up

Medical assistance arrives and
instructs you to stop CPR

Physically exhausted
 Stop CPR if:
CPR has been performed for 20 minutes
without restoration of the spontaneous
circulation

It can be stopped earlier,

when:
rescuer is physically exhausted

when signs of biological death develop

(gravity-dependent livid stains)
 CPR should not usually be
abandoned after 20 minutes:

in case of the victims hypothermia

in case of persistent ventricular
fibrillation AED indicates
defibrilation shock
Small children ??? Ethiccal aspects???

Responsibility during CPR

 Safars algorithm of CPR
stressing conditions an inadequate situation
assessment

Airways
Breathing BLS
Circulation ALS
Drugs
ECG
 New resuscitation
alphabet in adults
Algorithm of CPR

EKG
Circulation BLS
Airways ALS
Breathing
Drugs
 Algorithm of CPR

A+B+C (+E)- even lay people without equipment

= basic life support

Advanced life support healthcare

providers
complete equipment including drugs
pre-hospital emergency system,
in-hospital, operation theatre
Unresponsive

Shake shoulders
Ask Are you all right
Unresponsive
Kneel by the side of the
victim
Shake shoulders
Ask Are you all right
If he responds
Leave as you find him
Find out what is wrong
Reassess regularly
Unresponsive

Shout for help

Unresponsive

Shout for help

Open airways
 Unresponsive

Shout for help

Open airway

Check breathing
Check breathing

Look, listen and

feel for NORMAL
breathing

Do not confuse
agonal breathing
with NORMAL
breathing
 Agonal breathing
Occurs shortly after heart stops in up
to 40% of cardiac arrests
Described as barely, heavy, noisy or
gasping breathing
Recognise as a sign of cardiac arrest
Start with chest compressions
Gasping has relation to the outcome
 Unresponsive

Shout for help

Open airway

Check breathing

Call 155 (112)

 Unresponsive

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions
Chest compression
Place the heel of one hand
in the centre of the chest
Place other hand on top
Interlock the fingers
Compress the chest
Rate at lest 100 min-1
Depth at least 5 cm
Equal compression :
relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression
Place the heel of one hand
in the centre of the chest
Place other hand on top
Interlock fingers
Compress the chest
Rate at least 100 min-1
no more than 120/min.
Depth at least 5 cm
Equal compression :
relaxation
When possible (2 or more
rescuers) change CPR
operator every 2 min. to
prevent fatigue
Chest compression
Place the heel of one hand
in the centre of the chest
Place other hand on top
Interlock fingers
Compress the chest
Rate at least 100 min-1
Depth at least 5 cm
Equal compression :
relaxation
When possible (2 or
more rescuers) change
CPR operator every 2
min. to prevent fatigue
 Unresponsive

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths
2 rescue breaths
Pinch nose
Place and seal your
lips over the victim
s mouth
Blow until the chest
rises
Take about 1 second
Allow chest to fall
Repeat (10 12
times per minute)
A)

Head tilted backward

Chin lift
Keep open mouths urin chin lift

Triple manouvre ???

 A) Airway management
clean the mouth cavity
foreign body airway obstruction
abdominal thrusts (Heimlich manouevre)
Principle of Heimlich
chest compressions
Heimlich manoevre ?
Sendwich manoevre?
 BLS in children
FBAO
back blows
chest thrusts
abdominal compression

All manouevres intrathoracic pressure

expulsion of FB out from the airways

50% of cases more than 1 manouevre is necessary

A. Airway management
1. Choking, partial airway blockade
(conscious) - encourage the victim to
cough and add several hits to his/her
back
Cough is much more effective than
any other manoeuvre.
2. Unconscious patient tongue
tilt the head backward + lift the
chin
 A. Airway management
1. Foreign body airways obstruction - rare but
revesrible cause
2. Potentially treatable
3. Mostly during eating
4. Commonly witnessed event
5. Oportunity for early intervention
6. Can cause (partial) mild or severe (comlete)
airway obstruction

Heimlich manoeuvre (several thrusts (5))

pregnant ladies, children
 A. Airway management
Signs of mild (partial) large airways
obstruction

Suffocation
Difficult intensive inspiration
Neck and thorax soft tissues retraction
Hoarse (croupy) sounds accompanying
inspiration (noisy breathing)
Barking cough
 A. Airway management
Signs of severe or complete large
airways obstruction

Difficult intensive inspiratiratory effort

Powerful breathing movements
Neck and thorax soft tissues retraction
No breathing phenomena hearable
Patients noncooperation, restlessness,
convulsions, coma, blue skin color
A airway management

Equipment
airways - oropharyngeal
- nasopharyngeal
tracheal intubation
Combi tube
laryngeal mask airway (LMA)
laryngeal tube new
A airway management

Equipment

airways - oropharyngeal
- nasopharyngeal
A

Nasopharyngeal airway

Placement
Size
Indication
A

Nasopharyngeal airway

Placement
Size
Indication
A

Combi tube

>121 cm
Placement
Indication
A

Laryngeal mask airway (LMA)

Placement
Indication
Benefits and problems
Complications

?
New:
Laryngeal tube
 Tracheal intubation

most reliable
only experienced rescuers
Laryngoscopy during massage
Chest compressions interrupt only for laryngeal intubation
Do not intubate more than 30 sec.
In case of intubation failure postpone another trial after
restoration of the spontaneous circulation
Surgical invasive methods
If tracheal intubation is not possible
(face or neck injury, severe tongue oedema or
laryngeal entrance )
Cricothyreopuncture or cricothyreotomy

Cricothyreopuncture
large i.v. canulla 14 nebo 12 G. 2x
special kits (Quicktrach)

Cricothyreotomy
ligamentum conicum membrana cricothyreoidea
Draw air
Invasive surgical methods
of airway management

Every physician must manage to do

cricothyreopuncture!!!

Tracheotomy is not indicated in the urgent

medicine !!!
B breathing
Diagnosis of spontaneous breathing

Look, Listen and Feel

No > 10 sec.
assess whether breathing is
normal
Powerful breathing movements of the chest + neck and
chest soft tissues retraction + inaudiable breathing
= complete airways obstruction
(oedema during allergy, children suffocating
laryngotracheobronchitis, trauma, laryngospasm,
epiglotitis, foreign body)

Incomplete obstruction of large airways

typical signs: inspiratory stridor with retraction, noisy
breathing
B
expired air resuscitation
 B) Breathing
expired air resuscitation - several
techniques:
- Mouth-to-mouth breathing
- Mouth-to-nose breathing
- Mouth-to-mouth + nose breathing ( small
children)
- Mouth-to the barrier device ( to protect the
rescuer)
- Mouth to tracheostomy

Self-inflating bag
B
volume = normal breathing volume
Hyperventilation is harmful !!!

intrathoracic pressure
venous return
coronary pefusion pressure

V
VTT == 6-7
6-7 ml
ml // kg
kg t.t. hm.
hm.
CardioPulmonary Resuscitation
Artificial breath during expired air
resuscitation

Volum = normal breathing volum

Volum = 6-7 ml/ kg bw = 400-500 ml
Breath duration in adults = 1 second
Expiration passive
Check the chest rise during rescue
breath
3 consecutive rescue breath must not
last more than 5 seconds
 C: Circulation
Diagnosis:
Signs of life (=functional
circulation
(reactivity, breathing, coughing,
movement, skin condition, responsiveness,
pulse)
Pulse-less on large ( major)
arteries not reliable (65% of
healthcare providers do not know,
where is carotid artery) only
experienced rescuers
 Compression-only CPR
Top-less
Reluctance of rescuers to perform
mouth-to-mouth breathing on
strangers
Unwilling person to breathe
Unability to perform (vomiting,
bleeding, trauma, unskilled rescuer
Chest compressions only
Better some resuscitation than no
resuscitation
Wittnessed cardiac arrest (ICU)
A

a
Ratio od chest compressions and breathing

30 : 2
always in adults
1 rescuer
out-of-hospital CPR in children
not in infants (0-1 year)
 Improved quality of CPR
minimize chest compression interruption
chest compression interruption

Sudden decrease of coronary perfusion pressure

Only when you give several compressions previous perfusion

pressure is resumed

Point it out during trainig of CPR !!!

ratio 30 : 2 decreases risk of hyperventilation

 E
E precedes D

defibrilation by AED has become integral part of BLS,

where drugs are not available
ABCE is prefered to D !!!
Electric defibrilation

Indications

ventricullar fibrilation
pulseless ventricullar tachycardia
 Electric defibrilation
AED
automated(-tic) external defibrilator
biphazic
integrated part of BLS

Clasical defibrilator
monophazic
bifazic
integrated part of ALS
Automated(ic) External
Defibrilators (AEDs)
A new generation of smart defibrilators
Advanced computer technologies
Ability to interprete heart (ECG)
rhythm
Ability to determine whether
defibrilation is required
Delivery of electric shock
Guides the operator through every
action
Provides voice and message prompts
 AEDs
Easier than CPR
Readily available on places with haevy people
concentration, where can be probably used
once during 2 years
Extendes beyon healthcare prefessional
personnel to trained citizens
Possible to use in children above 1 year
Not suitable for infants
Switch on AED

All AEDs will

automatically switch
themselves on when
the lid is opened
 Attach pads to casualtys bare
chest as indicated on electrodes
Analyse rhythm do not touch
victim
Shock indicated stand
clear
Rescuer giving defibrilation shock

is responsible for his safety

is responsible for the safety of other
people around the victim
Immediately resume CPR

30 : 2
 Give CPR every moment, when
AED is not available, always if AED
is not available within 5 minutes

30 : 2
 Clasical defibrilation
= integrated part of ALS
1 shock only
Shock monophasic =360 J,
biphasic = 150 200 J
Prefer sticky electrodes
3 shocks:
during PCI invasive cordiology
wittnessed cardiac arrest (ICU)
postoperative cardiac arrest
Strategy of defibrilation
1 shock only
do not check the pulse
immediatelly after schock continue with 2 minutes
CPR 30:2

Reason: minimize no flow interval

biphasic defibrilation
repeated shock identical or escalating energy
in repeated VF use the energy of the last effective shock
in children energy 4 J / kg bw
CPR in rhythms treatable by defibrilation
1. 1. defibrilation 360 /150 200 J
2. 2 minutes CPR 30:2
3. Check rhythm = continues?
4. 2. defibrilation 360 / 150 360J
5. 2 minutes CPR 30:2
6. Check rhythm = continues?
7. 3. defibrilation 360 / 150 360J
8. adrenalin 1 mg before 3. defibrilation
amiodaron 300 mg before 4. defibrilation
9. during 2 minutes CPR 30:2
10. Sequence drug shok CPR
11. Check thythm continues?
12. 4. defibrilation
CPR in rhythms treatable by defibrilation

13. 2 minutes CPR 30:2

14. Check rhythm = rhythm does not require
defibrilation - narrow, regular complexes QRS
15. Check the pulse on large arteries
16.
 Precordial chest thumps
Indication:
wittnessed cardiac arrest (patients
collapse)
adults only
within 20 sec.
Effective only for VT
Only experienced rescuers
Emergency and ICU
Contraindications:
children
D drugs for CPR
oxygene
adrenalin
anti-arrhytmic drugs
atropin
 Application of drugs during CPR
periferalvein on extremities
external jugular vein
central venous catheter ???

Important!!!
flush of drug by 20 40 ml NS
 I.v. acces and drugs application in children
intraoseal route not only children, but adults as
well
- onset comparable with CVC
- laboratory samples from bone marrow
- doses identical as iv

tracheal route only in infants ( no more in adults

and in children)
- adrenalin 3 10 x higher than iv
- dilution 1-3ml in children better absorption
risk of low doses of adrenalin- mimetic effect

coronary perfusion pressure
 D - drugs
Adrenalin (epinephrine)
reccommenden on the base of animal studies
coronary and brain perfusion pressure
in VF can improve effect of defibrilation shock
dose 1 mg i.v. 3 5 minut
Consensus: give adrenalin when VF/VT persists after 3
shocks

Do not interrupt CPR during drugs application !!!

Children
Adrenalin 0,01 0,03 mg / kg b.w. i.v.
0,03 0,1 /kg b.w. tracheally
 D

Adrenalin = main vasopresor used during

CPR
Adrenalin - prefered for the therapy of
anaphylactic reactione as well
Adrenalin = drug of 2. line in cardiogenic
shock
Atropin
indication: bradycardia
dose: 0,5 mg to the total dose 3 mg
asystolia
can be caused by excessive vagotonus
theoretically reversible by vagolytic agent
no evidence about effect of vagolytic therapy

No more reccommended full vagolytic dose

of atropin 3 mg i.v. in
asytolia
PEA with rate < 60/ min.
 D
Antiarrhythmic drugs
No evidence of effect improving outcome

amiodaron in VF rezistent on defibrilation shock

before 4. defibrilation together with adrenalin
1. dose 300 mg
another possible dose 150 mg
continue 900 mg/day continually
 D
Antiarrhythmic drugs
Lidokain
dose 1 mg / kg bw
used before now
alternativ of amiodaron
do not applicate after amiodaron application
max. dose 3 mg/kg bw

Magnesium
torsades de pointes
digoxin intoxication
 D
Sodium bikarbonate
during CPR not indicated !!!
reccommended only
in hyperkalemie
overdose by TCA
 D

Other drugs

Calcium
dtto Guidelines 2000
hyperkalemia
hypomagnezemia
intoxication of calcium channels blocking
drugs
Asystole

open A
CPR 30:2
if coorinated ECG check the pulse
in asystolia look for P waves on ECG possible
therapy by pacing
 Postresuscitation care
ROSC is 1. step to reccovery

Posteruscitation care probably improves outcome

Intensive care always at least 24 48 h.

Oxygen therapy at least 24 h.

 Postresuscitation care

Sedation
Convulsion therapy
Therapy of hyperpyrexia
Hyperthermia often during 48 hours after CPR
Risk of worse neurologic outcome inreases with every
degree above 37 C
Treat every hyperpyrexi during 72 hours after CPR
 Therapeutic hypothermia
Mild theraputic hypothermia 32 - 34 C suppresses
chemical reactions related to reperfusion
Indications:
uncousiossness after CPR
functional circulation
agreement with recommendation of ILCOR 10/2002

- optimal ratget temperature: 32-34C

- maximal rate of cooling
- lenght of hypothermia: 24 h.
- warming: very slow, max. 0,25-0,5C/h.
- cooling methods - internal
- external
- cold stress reaction!!!
- many severe side effects!!!
 Therapeutic hypothermia

Neglected therapeutic
hypothermia, when indicated
after CPR,
in our country -non-lege-artis
approach.
 Trombolysis during CPR

Indication:
Ineffective CPR with suspection of pulmonary
embolism
myocardial ischemia with coronary occlusion or
trombosis

Effects:
Improved brain perfusion during CPR
Improved anoxic encephalopathy
Not increased bleeding complications in non-trauma
cardiac arrest
 Trombolysis during CPR

Clinical use:

CPR in adults
initial failure of CPR
In case of trombolysis continual CPR 60 90 minutes.
 Post-resuscitation care

PCI prefered
Therapy of glycemia > 10, avoid hypoglycemia
Therapeutic hypothermia
Most predictors of poor outcome not reliable
 CPR in children
Who is an infant? 0 1 year

Landmark between child and adult:

puberta

Who is a child? 1 - puberta

 CPR in children

Differencies:
Cause of cardiac arrest choking, trauma
Activation of emergency system
Hypoxia developes faster high metabolic rate
Ventricular fibrillation rare
Primary cardiac arrest uncommon,
Precordial thump is contraindicated
Length of CPR - identical

Chain:
Choking- hypoxia hypercapnia apnoea
bradycardia cardiac arrest

Trauma
 CPR in children
A) The most often cause of vital
functions failure = choking

Foreign body obstruction

Infectious diseases afecting throat by
swelling ( epiglotitis, acute
suffocating LTB)
Trauma
 CPR in children
Sequence of action
Rescuers with no knowledge of
pediatric resuscitation may use the
adult sequence with the exception
of the start with 5 initial breaths
followed by
30 compressions
30 : 2 for 1 minute
than call 155 (112)
but
Generally prefered ratio in
children = 15:2
 CPR in children
A
Identical
Cuff-less tracheal tube
Cuffed tracheal tube can be safely
used in children and infants
Cuff inflation pressure should be < 25
cm H2O (= 18 mm Hg)

LMA more complications

 CPR in children
B
Look, listen and feel no more than
10 s
Volum 6-7 ml /kg bw
Blow steadily over 1 1.5 sec.
To make the chest visibly rise
Start with 5 breaths
 CPR in children
B)

Technique
Volumes 6-7 ml/kg bw
Paediatric size of self-inflating bag
 CPR in children
C
Look for signs of circulation
(reactivity, movement, coughing,
or normal breathing)
Check the pulse (if you are a
health provider) no more than 10 s
(brachial artery)
Lower third of the sternum
One third of the depth of the chest
100 compressions per min.
 CPR in children
C)

Algorithm of CPR: 2:15

1 rescuer: 2:30
Infants: 1:3
 CPR in children

Compressions for 1/3 of the chest depth

around 4 cm in infants
around 5 cm in children
rate of chest compressions = at least 100/min., no
more than 120/min.
time of inspiration 1 - 1,5 sec.
call for help after 1 minute of CPR
exception: wittnessed collaps of a child
probability of the defibrilator use
algorithm as in adults
 CPR in children
Chest compression

infants = dtto G2000:

2 fingers - 1 rescuer
2 thumbs - 2 rescuers
place for chest compressions
chest compressions in children 1 or both hands
infants: 3: 1
AED

above 1 year

Manual defibrilators

4 J/kg
 ALS u dt
D
Drugs application i.v. or i.o.
adrenalin 0,01 (- 0,03) mg/kg
atropin 0,02 mg /kg
amiodaron 5 mg/ kg

Infants also intratracheal application

adrenalin 100 mcg/ kg t.hm. (= 0,01 mg/kg)
atropin 30 mcg / kg t.hm.
lidocain 2 3 mg /kg t.hm.

Dilute in 1-3 ml of NS
5 rescue breaths
Bradycardia

chest compressions + adrenalin

most often cause hypoxemia
Therapy oxygene and ventilation
in case of vagal stimulation atropin indicated
before adrenalin
cardiostimulation indicated only in AV block
cardiostimulation anad atropin not effected in
asystole and arrhytmias caused by hypoxemia
Post-resuscitation care

identical with adults

aggresive therapy of hyperpyrexia
hypothermia

Parents during CPR of their child