1.SEMINAR ON CPR SUBMITTED TO: GEETA SHIROOR ASSO. PROFESSOR,BVCON. SUMITTED BY: MR.STAWAN UTTAM CHOUGULE F.Y.M.Sc.,BVCON,PUNE.

2. CARDIOPULMONARYRESUSCITATION 3. INTRODUCTIONAccording to recent statistics sudden cardiac arrestis rapidly becoming the leading cause of death inAmerica. Once the heart ceases to function, ahealthy human brain may survive without oxygen forup to 4 minutes without suffering any permanentdamage. Unfortunately, a typical EMS response maytake 6, 8 or even 10 minutes.It is during those critical minutes that CPR (CardioPulmonary Resuscitation) can provide oxygenatedblood to the victims brain and the heart, dramaticallyincreasing his chance of survival. And if properlyinstructed, almost anyone can learn and performCPR. 4. CPRDEFINITION :It is an emergency medical procedure for a victim of cardiac arrest or , in some circumstances, respiratory arrest. 5. REVIEW OF ANATOMY AND PHYSIOLOGY 6. HEART 7. HEARTHODS - November 2006 7 8. HEARTHollow, muscular organ300 grams (size of a fist)4 chambersFound in chest between lungsSurrounded by membrane called pericardiumPericardial space is fluid-filled to nourish and protect the heart.HODS - November 20068 9. HEART ANATOMY The heart is a complex muscular pump that maintains blood pressure and flow through the lungs and the rest of the body. The heart pumps about 100,000 times and moves 7200 liters (1900 gallons) of blood every day.HODS - November 20069 10. HEART ANATOMY The heart has fourchambers. Two atria act ascollecting reservoirs. Two ventricles act aspumps. The heart has four valvesfor: Pumping action of theheart. Maintainingunidirectional blood flow. HODS - November 200610 11. Functions of the Heart Generates blood pressure Routes blood Heart separates pulmonary and systemiccirculation Ensures one-way blood flow Heart valves ensure one-way flowHODS - November 2006 11 12. Functions of the Heart Regulates blood supply Changes in contraction rate and force match blood delivery to changing metabolic needsHODS - November 2006 12 13. The Heart: Conduction System The heart pumps blood through the body This is accomplished by contraction andrelaxation of the cardiac muscle tissue inthe myocardium layer. Intercalated discs allow impulses to travelrapidly between adjacent cells so theyfunction as one rather than individual cells 14. Cardiac Muscle Tissueintercalated disc intercalated disc 15. Conduction System Continued. Cardiac conduction system: Theelectrical conduction system controlsthe heart rate This system creates the electricalimpulses and sends them throughoutthe heart. These impulses make theheart contract and pump blood. 16. Components of the ConductionSystem Sinoatrial node (part I): Located in back wall of the right atrium near theentrance of vena cava Initiates impulses 70-80 times per minute withoutany nerve stimulation from brain Establishes basic rhythm of the heartbeat Called the pacemaker of the heart Impulses move through atria causing the two atriato contract. At the same time, impulses reach the second part ofthe conduction system 17. Components of the ConductionSyStem Continued . Atrioventricular node (part II): Located in the bottom of the right atriumnear the septum Cells in the AV node conduct impulses moreslowly, so there is a delay as impulses travelthrough the node This allows time for atria to finish contractionbefore ventricles begin contracting 18. Septum 19. Atrioventricular Bundle Bundle of His From the AV node,impulses travelthrough to the rightand left bundlebranches These branchesextend to the right andleft sides of theseptum and bottom ofthe heart. 20. Atrioventricular Bundle Continued. These branch a lot to formthe Purkinje fibers thattransmit the impulses tothe myocardium (muscletissue) The bundle of His, bundlebranches and Purkinjefibers transmit quickly andcause both ventricles tocontract at the same time Like a phone tree 21. Atrioventricular BundleContinued. As the ventricles contract, blood isforced out through the semilunar valvesinto the pulmonary trunk and the aorta. After the ventricles complete theircontraction phase, they relax and the SAnode initiates another impulse to startanother cardiac cycle. 22. 1 - Sinoatrial node (SA node)2 - Atrioventricular node (AV node)3 Bundle of His4 - Right & Left Bundle Brancheswhich lead to Purkinje Fibers 23. CIRCULATION OF BLOODHODS - November 2006 23 24. LUNGSHODS - November 2006 24 25. ANATOMYHODS - November 2006 25 26. LOWER RESPIRATORY SYSTEMTracheaBronchial tree Left and rightmain bronchus Carina Lobar bronchus Segmentalbronchus Bronchiole AlveoliHODS - November 200626 27. PURPOSES OF CPR Restore cardiopulmonary functioning. Prevent irreversible brain damage from anoxia.HODS - November 200627 28. INDICATIONS OF CPR1 .CARDIAC ARRESTa) Ventricular fibrillation.b) Ventricular tachycardiac) Asystoled) Pulseless electrical activity2.RESPIRATORY ARREST :-a) Drowningb) Strokec) Foreign body airway obstructiond) Smoke inhalatione) Drug overdosef)Electroculation/injury by lightningg) Suffocationh) Accident/injuryi)ComaHODS - November 200628 29. ADULTBASIC LIFE SUPPORT (BLS) 30. OBJECTIVESStudents should be able to demonstrate: How to assess the collapsed victim How to perform chest compression and rescue breathing How to place an unconscious breathing victim in the recovery position. 31. BACKGROUND Approximately 700,000 cardiac arrests per yearin Europe Survival to hospital discharge presentlyapproximately 5-10% Bystander CPR vital intervention before arrivalof emergency services double or triplesurvival from SCA (sudden cardiac arrest) Early resuscitation and prompt defibrillation(within 1-2 minutes) can result in >60% survival 32. CHAIN OFSURVIVAL 33. CHAIN OF SURVIVALAHA ECC Adult Chain of SurvivalThe links in the new AHA ECC Adult Chain of Survival are as follows:1. Immediate recognition of cardiac arrest and activation of the emergency response system2. Early CPR with an emphasis on chest compressions3. Rapid defibrillation4. Effective advanced life support5. Integrated postcardiac arrest care 34. BASIC LIFE SUPPORTSEQUENCES OF PROCEDURES PERFORMED TORESTORE THE CIRCULATION OF OXYGENATED BLOODAFTER A SUDDEN PULMONARY AND/OR CARDIACARRESTCHEST COMPRESSIONS AND PULMONARYVENTILATION PERFORMED BY ANYONE WHO KNOWSHOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUTANY OTHER EQUIPMENTProtective devices 35. APPROACHSAFELY 36. CHECK RESPONSE 37. CHECKRESPONSE Shake shoulders gently Ask Are you all right? If he responds Leave as you find him. Find out what is wrong. Reassess regularly. 38. SHOUT FOR HELP 39. CHECK FOR CAROTIDPULSE RESCUE BREATH FOR THEM:- 1 breath every 5 to 6 seconds for about 10- 12 per minute (each breath should be delivered over 1 second making the chest rise) - Recheck pulse every 2 minutesIF THE VICTIM DOES NOT HAVE CIRCULATION (NO PULSE)Start chest compressions, at the center of the chest atthe nipple line with the heal of one hand on top of theother, at a ratio of:- 30 compressions to 2 ventilation at a rate of100 per minute and a depth of 1 to 2- Reassess after 5 cycles of 30 compressions to 2breaths, after 2 minutes 40. CHEST COMPRESSIONS Place the heel of one handin the centre of the chest Place other hand on top Interlock fingers Compress the chest Rate at least 100 / min Depth at least 2 inches Equal compression : relaxation When possible change CPRoperator every 2 min 41. HEAD TILT & CHIN LIFT OPENAIRWAY JAWTHRUST 42. HEAD-TILT CHIN-LIFTThe head-tilt chin-lift is the primary maneuver used in any patient in whom cervical spine injury is not a concern. The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most first aid courses as the standard way of clearing an airway. 43. JAW THRUSTThe jaw-thrust maneuver is an effective airway technique,particularly in the patient in whom cervical spine injury is a concern.The jaw thrust is a technique used on patients with asuspected spinal injury and is used on a supine patient. Thepractitioner uses their thumbs to physically push the posterior (back)aspects of the mandible upwards - only possible on a patient witha GCS < 8 (although patients with a GCS higher than this should alsobe maintaining their own patent airway). When the mandible isdisplaced forward, it pulls the tongue forward and prevents it fromoccluding (blocking) the entrance to the trachea, helping to ensure apatent (secure) airway. 44. FOREIGN-BODY AIRWAYOBSTRUCTION (FBAO)Approximately 16 000 adults and children receive treatment forFBAO in the UK yearlySIGNSMILD obstructionSEVERE obstructionAre you choking? YES Unable to speak, may nodOther signsCan speak, cough, Can not breathe breathe/wheezy breathing/silent attempts to cough/ unconsciousness 45. ADULT FOREIGN BODY AIRWAYOBSTRUCTION TREATMENT 46. BACK BLOWS 47. ABDOMINAL THRUSTS 48. RESCUE BREATHS Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat 49. RESCUE BREATHSRECOMMENDATIONS:- Tidal volume500 600 ml- Respiratory rategive each breaths over about 1s with enoughvolume to make the victims chest rise- Chest-compression-only continuously at a rate of 100 min 50. CONTINUE CPR30 2 51. DEFIBRILLATION 52. AUTOMATEDEXTERNALDEFIBRILLATOR(AED) Some AEDs will automatically switch themselves on when the lid is opened 53. Automatic ExternalDefibrillator 54. Objectives for this subject- Why we use the AED?- How to use the AED?- Indications for the AED?- Contraindications to AED? 55. Defibrillation isthe applicationof electricalshock to helprestore thehearts regularrhythm 56. Defibrillator is the deviceused to deliver that shockand it can be manual orautomatic. 57. Early defibrillation is the singlemost important factor indetermining survival from cardiacarrest. 58. AED Most common initial rhythms patients go into as they enter into cardiac arrest are: 59. 2 Shockable RhythmsV-Tach and V-Fib 60. Ventricular Tachycardia:Fast heart rhythm which does notallow the heart to fill properly andcardiac output is compromised andreduced. 61. Ventricular Fibrillation:disorganized series of electricaldischarges in the ventricles. Wherethe ventricles quiver.Stops Cardiacoutput and hearts pumping ability. 62. AEDs that are available areautomatic and semi-automatic. 63. Automatic: where machinedoes all of the work.Semi Automatic: wheremachine tells you when topush button to deliver shock. 64. Apply AEDas soon asyoudeterminethat yourpatient is notbreathingand does nothave a pulse. 65. Always making sure thatCPR is still in progress whileyou are setting up the AED. If by yourself, apply the AED. 66. Ensurebefore putting pads on chest, it is clear of all patches, paste or pacemakers. Dont cover something up with pad. 67. ATTACH PADS TO CASUALTYS BARE CHEST 68. Now attach theadhesive pads tothe cablesremembering-White is negative,anterior chest wall.Red is positive ,left anterior axillaryline. Red on Ribs! White on right! 69. Now turn onmachine andwait for AED toanalyze thepatientsrhythm. Makingsure that CPRhas beenstopped formachine todetect rhythm. 70. When machine advises ashock is indicated,CLEAR your patient.Ensuring that no one istouching patient or stretcher. 71. When the AED delivers a shockit will go back and reanalyze therhythm.If another shock is appropriateClear Patientanddeliver the shock. 72. Sets of 3 shocks are calledstacked shocks and they aredone without any pauses tocheck patients pulse oradminister CPR 73. IF VICTIM STARTS TO BREATHENORMALLY PLACE IN RECOVERYPOSITION 74. If No shock is indicated:-Check breathinggive appropriate oxygen therapy.-Check pulse, if no pulse! Start CPR for1 minute and then have the AEDreassess. 75. Safety should always bemaintained by the provider:-Not using near or around water-Ensuring all med patches and pastes areoff the patient.-Making sure that everyone is clear of thepatient when the shock is delivered. 76. Indications for AED* Unresponsive* Apneic* Pulseless patients. 77. Adult Patients> 8 years old> 55 lbs. Unresponsive,pulseless and apneic. 78. Contraindications:Infants and children< 8 years old< 55 lbs. 79. Contraindications:!! Hypothermia !!(Contact medical control) 80. Contraindications:Rigor / Livor MortisNo Code /DNR 81. The AED cant properlyanalyze patient inmoving ambulance.It is recommended that youstop the medic and let AEDdo its job. 82. CONTINUE RESUSCITATIONUNTIL Qualified help arrives and takes over The victim starts breathing normally Rescuer becomes exhausted 83. TERMINATION OF BLSSigns of restored ventilation and circulation include:1. Struggling movement2. Improved color3. Return of stronger pulse4. Return of systemic B.P. 84. COMPLICATIONS OF CPR 1.Broken bones 2.Internal injuries 3.Vomiting and aspiration 4.Body fluid expose 5.Gastric distension.HODS - November 2006 86 85. NURSESRESPONSIBILITY 86. research OUTCOMES OF CHEST COMPRESSION ONLY CPRVERSUS CONVENTIONAL CPR CONDUCTED BY LAYPEOPLE IN PATIENTS WITH OUT OF HOSPITALCARDIOPULMONARY ARREST WITNESSED BYBYSTANDERS: NATIONWIDE POPULATION BASEDOBSERVATIONAL STUDY. 87. BIBLIOGRAPHY1. Tortora Grabowski,principles Of Anatomy And Physiology,wiley,9th Edition.2. Anatomy And Physiology Gary A. Thibodeau And Kevin T. Patton.Mosby,5th Edition3. Medical And Surgical Nursing Phipps,cassmeyer ,Sands ,Lehman,5th Edition.4. Advanced Nursing Practise,emmess Medical Publisher,shabeer P.Basheer And S.Yaseen Khan,1st Edition.5. BLS For Health Care Provider,michael R Saure,md.6. Cardiopulmonary Resuscitation (Cpr)(encyclopedia Of Nursing And Allied Health)-enote.Com 88. THANK YOU