CPR

Abdulfattah Alhazmi
ayhazmi@uqu.edu.sa
What is CPR?
Cardiopulmonary Resuscitation (CPR) is a first aid technique to help people who suffer a
“cardiac arrest” (their heart stops beating).

• > It involves doing chest compressions and rescue breaths to keep the casualty alive
until a defibrillator arrives.

• > A defibrillator is an electrical device which can be used to help restart someone’s heart.

• > CPR on its own is unlikely to restart someone’s heart, however it will increase the
chance of a defibrillator being successful.
New Guide Line AHA changes!
1.The change from A-B-C sequence to C-A-B
*Beside minimizing delay, the C-A-B sequence also has the advantage over A-B-C
because in A-B-C sequence, we are starting CPR with the steps which would be
considered most repulsive for the public to initiate CPR (steps A and B). Thus, by
using C-A-B sequence, we are encouraging public members to participate in CPR,
enabling community empowerment and participation in this vital partnership of
resuscitation

*Although no published human or animal evidence demonstrates that starting CPR

with 30 compressions rather than 2 ventilations leads to improved outcome, chest
compressions provide vital blood flow to the heart and brain, and studies of out-of-
hospital adult cardiac arrest showed that survival was higher when bystanders
made some attempt rather than no attempt to provide CPR.
*The change in the CPR sequence applies to adults, children and
infants, but excludes new-borns.

*Since 2008, the American Heart Association has recommended

that untrained bystanders use Hands-Only CPR ; CPR without
breaths for an adult victim who suddenly collapses.

*The steps to Hands-Only CPR are simple: call 997 and push hard
and fast on the centre of the chest until professional help or an
AED arrives.
2. Look, listen, feel is no longer recommended.
“Look, listen, and feel for breathing” has been removed from the
sequence for assessment of breathing after opening the airway. The
healthcare provider briefly checks for breathing when checking
responsiveness to detect signs of cardiac arrest. After delivery of 30
compressions, the lone rescuer opens the victim’s airway and delivers 2
breaths.
 BASICS of CPR
*Assess that it is safe to approach the fallen person.
*Use protective equipment and follow universal precautions.
*Attempt to wake the person by rubbing your knuckles firmly against the
sternum (breastbone) and shouting, “Are you okay?”
*If the person fails to rouse, immediately call 997 or shout for help,
depending on your situation. If there is an automated external defibrillator
(AED) available, also shout for someone to bring it.
*If the person becomes conscious, is moaning, or moves, do not start CPR.
*Call 997 if the person is not able to speak or appears confused. If the person
does not wake, begin CPR and use an AED if available.
 Steps for performing CPR
*Begin chest compressions by placing the heel of
your hand in the middle of the chest, over the
lower half of the breastbone at the nipple line.
Place your other hand on top and place your
fingers together (heel of one hand on chest, heel of
the other hand on top of that hand) and compress
the chest (2 inches for adult & children, 1.5 inches
for infants less than 1 year). Allow the chest to
recoil completely, and then perform thirty
compressions, at a rate of 100-120 compressions
per minute.
*After thirty chest compressions, immediately,
open the airway using the head-tilt, chin-lift
method. Avoid lifting the neck in the case of spinal
injury (Use Jaw thrust manoeuvre), them give the
two rescue breaths.
*Perform the cycle of thirty compressions
followed by two breaths for about two minutes.
Continue chest compressions and rescue breaths
until AED arrives or rescue team.

https://healthjade.net/head-tilt-chin-lift/
Automated External Defibrillators (AED)
*An AED is a small, portable electronic device that is used to deliver an electric shock
in an attempt to disrupt or stop abnormal electrical activity in the heart.
*Abnormal electrical activity correlates with an abnormal heart rhythm, and a continual
abnormal rhythm is not sufficient to pump blood and deliver oxygen through the body.
*An AED shock cannot restart a dead heart; the heart must have a rhythm (even though
the rhythm is abnormal).
*The AED will automatically diagnose any cardiac arrhythmia when attached by leads
to an unconscious person.
*When there is lethal rhythms, then treat the person with the AED electrical therapy or a
shock (defibrillation) that may interrupt the arrhythmia and allow the heart to re-
establish a normal and effective rhythm.
 Children Infants
Component Adults and Adolescents
(Age 1 Year to Puberty) (Age Less Than 1 Year, Excluding Newborns)
Scene safety Make sure the environment is safe for rescuers and victim
Check for responsiveness
Recognition of cardiac arrest No breathing or only gasping (ie, no normal breathing)
No definite pulse felt within 10 seconds (Breathing and pulse check can be performed simultaneously in less than 10 seconds)
If you are alone with no mobile Witnessed collapse
phone, leave the victim to activate the Follow steps for adults and adolescents on the left
emergency response system and get Unwitnessed collapse
Activation of emergency the AED before beginning CPR Give 2 minutes of CPR
response system Otherwise, send someone and Leave the victim to activate the emergency response system and get the AED
begin CPR immediately; Return to the child or infant and resume CPR;
use the AED as soon as it is available use the AED as soon as it is available

Compression-ventilation 1 or 2 rescuers 1 rescuer (30:2)

ratio without advanced airway 30:2 2 or more rescuers (15:2)

Compression-ventilation ratio Continuous compressions at a rate of 100-120/min

with advanced airway Give 1 breath every 6 seconds (10 breaths/min)

Compression rate 100-120/min

At least 2 inches (5 cm)*
At least one third AP diameter of chest At least one third AP diameter of chest
Compression Depth
About 2 inches (5 cm) About 1½ inches (4 cm)

1 rescuer
2 hands or 1 hand (optional for very 2 fingers in the center of the chest, just below the nipple line
2 hands on the lower half of the
Hand placement small child) on the lower half of the 2 or more rescuers
breastbone (sternum)
breastbone (sternum) 2 thumb–encircling hands in the center of the chest, just below the
nipple line

Chest recoil Allow full recoil of chest after each compression; do not lean on the chest after each compression
Minimizing interruptions Limit interruptions in chest compressions to less than 10 seconds

*Compression depth should be no more than 2.4 inches (6 cm)

 Problems Associated with CPR
*Excessive ventilation given during CPR and compressions that are interrupted
too frequently and that are often too slow and too shallow.
*A bystanders may be reluctant to perform CPR because it seems too complicated
and difficult to remember. That’s why the AHA has simplified the steps by
making the compression-ventilation ratio used the same for infants, children, and
adults.
*The public is afraid of contracting diseases and is therefore reluctant to perform
mouth-to-mouth resuscitation.
Many studies illustrates that transmission of infection is very low.
Barrier device (CPR mask) use while giving ventilations is encouraged.
If someone is still reluctant to give mouth-to-mouth ventilations, at least call for help and
start chest compressions immediately.
Video
https://youtu.be/O9T25SMyz3A •
Remember !
Chest Compressions