Cardiopulmonary Resuscitation (CPR) Overview

Cardiopulmonary Resuscitation (CPR)

• CPR is an emergency procedure to manually preserve brain function until further measures restore circulation and breathing.

• It's a technique of Basic Life Support (BLS).

• Normal heart rate is 60-100 beats per minute and the Cardiac cycle time period is 0.8 second.

• Sudden Cardiac Death (SCD) attack is caused by abrupt heart function loss. This occurs from various heart conditions.

• Coronary heart disease is the primary cause of sudden cardiac arrest, alongside various other cardiac and non-cardiac conditions.

• Risk factors include smoking, obesity, family history, and lack of physical exercise.

• Immediate management of sudden cardiac arrest involves basic life support (BLS), advanced cardiac life support (ACLS) and CPR.

• BLS involves maintaining airway, respiration, and circulation without equipment.

• CPR consists of artificial ventilation and circulation for an adolescent or adult who isn't breathing and has no pulse.

• Age considerations for CPR include adult (adolescents and older), children (1 year to puberty), and infants (less than 1 year).

• Contraindications to CPR include DNR orders, pulse less ventricular activity, pulse less electrical activity, asystole, and pulse less bradycardia.

• The Adult chain of survival has 5 links for In-Hospital Cardiac Arrest:

  • Surveillance and prevention
  • Recognition and activation of the emergency response system
  • Immediate high-quality CPR
  • Rapid defibrillation
  • Advanced life support and post-arrest care

• The first step in CPR is assessment and scene safety - ensuring a safe environment for rescuer and victim.

  • Checking for physical injury
  • Determining if the victim is responsive

• The second step is activating the emergency response system (ERS)- calling for medical help.

• The third step is checking for a pulse (carotid artery pulse) and breathing (look for air coming from the victim's mouth or nose) within 10 seconds.

• The fourth step is starting CPR (CAB); Circulation, Airway, and Breathing.

• The fifth step is re-assessing the victim during every 5 cycles of CPR, to check for the presence of pulse and breathing.

  • If the victim has recovered, put him in recovery position; if not, continue CPR till medical help arrives.

• CPR involves three steps: Circulation, Airway, Breathing (CAB).

• Compression involves positioning the victim on their back with rescuer kneading next to their neck and shoulder; if a victim has spinal injury roll or move the victim as a single unit in flat and firm surface; Place heel of your hand on the midline lower 1/3 of the sternum; maintaining straight elbows and shoulders directly on hands; ensure hard and fast compressions with depth of at least 2.4 inches and chest recoil;

  • Begin compressions at 30 compressions in the rate of 100 to 120 compressions per minute. -Maintain 30:2 cycle (30 compressions to 2 breaths)
  • Complete 5 cycles in 2 minutes, and check for pulse and breath regularly during every 5 CPR cycles.
  • Minimize the interruption during compression.

• Airway opening involves head tilt-chin lift to open the victim's airway, where one hand is placed on forehead and pushed forward to tilt back; Chin is pushed up with two fingers and thumb, without closing the victim's mouth as it can obstruct airway. Also, jaw thrust is used as a spinal injury precaution.

• Breathing involves administering rescue breaths after every 30 compressions in a 30:2 cycle. Pinch the victim's nose with thumb and index finger.

  • Take a regular breath and form a seal over the victim's mouth. Blow air for 1 second, checking for chest rise.
    • Use a handkerchief to avoid infection
    • Blow air forcefully for at least 500 ml at once.
    • Use mask over the victim's mouth during rescue breathing to ensure a tight seal. One hand forms a 'C' shape to press against the mask's edges, enabling a tight fit on the victim's face. The remaining fingers lift the jaw angles in an 'E' shape and squeeze the bag to deliver breath, checking for chest rise.

• Steps for two rescuer CPR: One rescuer checks for response and starts CPR with 30 compressions. The second rescuer calls for help and provides 2 breaths to complete first cycle after every 30 compressions by the first rescuer.

• Position will be changed from the head side of the victim and in a “C” shape by each rescuer after every 5 cycles or whenever required.

• Re-assessment is done after every 5 cycles of CPR.

• Recovery position is used for unresponsive victims with signs of breathing and circulation.

• After the recovery phase, ensure the victim's head lies flat on the back of the palm while the other hand lies on the victim's side with palm upwards.

• The leg should be bent at the knee to approximately 90 degrees.

• Continue monitoring breathing, pulse, and signs of circulation with rechecking every few minutes till medical help arrives as these signs can stop suddenly at any point.

Anatomy of Heart

• The circulatory system is powered by the heart.
• The heart is a muscular organ roughly the size of a closed fist.
• The heart is located in the thoracic cavity.
• The heart is posterior to the sternum and medial to the lungs.
• The heart is tilted slightly to the left side of the sternum.
• Approximately 2/3 of the heart's mass is on the left side of the body and 1/3 on the right side.
• The heart wall comprises three layers: pericardium, myocardium, and endocardium.
• The heart has four chambers: right atrium, left atrium, right ventricle, and left ventricle.
• Heart valves are classified into atrioventricular valves (tricuspid and bicuspid valves) and semilunar valves (pulmonary and aortic valves).

Conduction System of the Heart

• The sinoatrial (SA) node, the heart's natural pacemaker, starts the conduction system.
• The SA node is found on the right atrium's wall, below the superior vena cava.

This quiz covers the essential aspects of Cardiopulmonary Resuscitation (CPR) and Basic Life Support (BLS). It includes information about the procedure, risk factors for cardiac issues, and the importance of immediate management during sudden cardiac arrest. Test your knowledge on how to effectively respond in emergencies.