1. CARDIO-PULMONARY RESUSCITATION (CPR)
4/14/2017
CARDIO-PULMONARY RESUSCITATION (CPR)
Module 10
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JO/CPR/04

2. CARDIAC PULMONARY RESUSCITATION
Introduction
Cardiac disease is the second main cause of death in Singapore.
Hence, public education and training are crucial in reducing “sudden death”

3. CARDIAC PULMONARY RESUSCITATION
CHAIN OF SURVIVAL
The concept of ‘Chain of Survival’ is the best approach to the treatment of victim with cardiac arrest

4. CARDIAC PULMONARY RESUSCITATION (Chain of Survival)
Early Access
prompt a person to call 995 before victim collapse
Early CPR
most effective when started immediately after victim collapse, chances of successful resuscitation depend on prompt bystander CPR and competent rapid response team
Early Defibrillation
is most likely to improve survival rates of cardiac arrest patients
Early Advance cardiac life support
to bring equipment to support ventilation, eg drug, defibrillator machine

5. CARDIAC PULMONARY RESUSCITATION
Heart Attack
Foreign Body Airway Obstruction
Drowning
Stroke
Drug Overdose
Suffocation
Smoke Inhalation
Electrocution
Severe Allergic Reaction

6. ONE MAN CPR D - Danger R - Check responsiveness (Tapping the shoulder)
Look out for unsafe environment
R - Check responsiveness (Tapping the shoulder)
Are you OK?
Call ambulance 995
A - Check airway
by head tilt chin lift (remove foreign body if visible)
B - Check breathing -- (look, listen and feel for breathing )
up to 10 Seconds (no Breathing)
Attempt 2 ventilation
Air Blow (400 to 600mls)allow the lung deflation
between each breath
C - Check Circulation
Check carotid pulse –6 to10 Seconds
No pulse start CPR

7. Determine pulselessness
Proper hand position
Run the middle finger along bottom edge of rib cage to notch at centre (tip of sternum)
Place you index finger next to your
middle finger on notch.
Place the heel of one hand on the
lower half of the sternum next to
the index finger
Release the 2 finger and place the hand on top of the hand on the sternum so that the hand are parallel.
Straight both elbows and lock them into position

8. Tracing Landmark & Position

9. CARDIAC PULMONARY RESUSCITATION
Use your body weight to compress the victim’s chest about
( 4 to 5 cm)
Count:
1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30
Chest compression rate to achieve 100 per mins
Ratio – 30 compressions : 2 breaths
Perform – 5 cycles
Check pulse
Absent – continue compression
Present – Stop compression
Check breathing
Present – Recovery position
Absent – Rescue breathing

10. Rescue Breathing Time for rescue breathing : 1 breath every 5 second
Count:
2 a thousand
3 a thousand
4 a thousand
5 a thousand
Cycle: 12 for one min

11. Summary for one man CPR Check for pulse (carotid) - 6 to 10 seconds
Check for breathing seconds
Time for each breath second per breath
Dept of compression to 5 cm
Air volume to 600 mls
Compression rate per mins
Ratio : 2
Cycle cycles
Rescue breathing cycles
Time for rescue breathing - 1 breath every 5
seconds

12. INFANT CPR D - Danger-Look out for unsafe environment
R - Check responsiveness - (call tap or gently shake the infants shoulder or tickle the sole of the foot to elicit response.)
Are you OK?
Call ambulance 995
A - Check airway-by head tilt chin lift (remove foreign body if visible)
B - Check breathing -- (look,listen and feel for breathing )
up to 10 Seconds (no Breathing)
Attempt 2 ventilation
Air Blow (30 mls)allow the
lung deflation between each breath
C - Check Circulation-Check Brachial pulse
6 to10 Seconds
No pulse start CPR

13. Infant CPR Proper hand position Draw imaginary line between nipples
Place your middle and ring fingers
next to the index finger
Move the 3 fingers to the centre
of the sternum
Position the fingers upright
Lift up the index finger but maintain
the middle and ring fingers on the sternum
Lean forward and place your cheek near
the infants mouth and nose
Use your middle and ring fingers to compress the sternum about 2 cm

14. INFANT CPR Count: Chest compression rate to achieve 100 per mins
1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30
Chest compression rate to achieve 100 per mins
Ratio – 30 compressions : 2 breaths
Perform – 5 cycles
Check pulse
Absent – continue compression
Present – Stop compression
Check breathing
Present – Recovery position(lateral side)
Absent – Rescue breathing

15. Rescue Breathing Time for rescue breathing : 1 breath every 3 second
Count:
2 a thousand
3 a thousand
Cycle: 20 for one min

16. Summary Infant CPR Check for pulse (brachial) - 6 to 10 seconds
Check for breathing - Up to 10 seconds
Time for each breath second per breath
Depth of compression cm
Air volume mls
Compression rate per mins
Ratio : 2
Cycle cycles
Rescue breathing cycles
Time for rescue breathing - 1 breath every seconds
Count a thousand, 3 a thousand

17. Infant : conscious to unconscious choking
Assess for sign of complete airway obstruction ( choking)
Support the infants head and body between your hands and forearms using the sandwich manoeuvre
Hold the infants face down and rest your forearm on your thigh
Keep the head lower than the trunk
Deliver 5 back blows forcefully between the shoulder blades with the heel of your other hand
Support the infants head and body between your hands and forearms after delivering the 5 back blows
Turns the infant over on his/her back resting on your thigh
Deliver 5 chest thrusts over the lower half of the sternum by counting 1,2,3,4,5

18. Infant : conscious to unconscious choking
Reassessment
Check if foreign body is expelled after every set of 5 back blows and 5 chest thrusts and remove if it is visible. If the airway remains obstructed and the infant is conscious, repeat the sequence of 5 back blows and 5 chest thrusts until the foreign body is expelled or the infant becomes unconscious.

19. Infant unconscious choking
When infant becomes unconscious .
Position infant on a firm , flat surface
Call the ambulance 995

20. Infant unconscious choking
A - Check airway - by head tilt chin lift (remove foreign body if visible)
B - Check breathing
(look,listen and feel for breathing up to 10 Seconds
No Breathing – Attempt ventilation(1st attempt)
If airway is blocked, reposition the infant’s head and re-attempt to ventilate ( 2nd attempt)
If airway is still blocked, relieved obstruction by performing 30 chest compression ( The landmark and technique for chest compression is the same as for infant CPR)
REPEAT THE STEP UNTIL ABLE TO GIVE 2
SUCCESSFUL VENTILATIONS
C - Check circulation:
Absent – continue compression
Present – Stop compression
Check breathing
Present – Recovery position(lateral side)
Absent – Rescue breathing

21. Adult Obstruction Conscious Victim Ask “Are you choking" I can help)
Determine if victim can
Speak
Breath
Cough
Stand behind the victim
Put your arms around the casualty's abdomen
and locate for the navel
2 finger above navel perform inward upward thrust
Make a fist with one hand
Place thumb side of the fist against the
abdomen above 2 fingers spacing
Release the 2 fingers spacing but maintaining
the fist against the abdomen
Give 5 successive inward-upward thrust
Check if foreign body is expelled after every set of 5 abdominal thrust
Every thrusts until the foreign body is dislodged or the casualty becomes unconscious

22. Position (Pregnancy & Obese)
Stand behind the person, position one foot between the casualty's legs
Locate landmarks:
Place arms under the casualty’s armpits to encircle the chest
Make a fist with one hand
Place thumb side of fist on the
middle of the person’s breaths bone
Grasp the fist with the other hand and
give successive quick backward thrust
Check if foreign body is expelled after
every set of 5 chest thrusts
Repeat thrust until the foreign body is dislodged or the person becomes unconscious

23. ADULT UNCONSCIOUS CHOKING
Unconscious Victim
Position the victim –lie on flat surface
Establish unresponsiveness
Activate EMS - Call 995
Check for :
Airway
Breathing
If the breathing is absent, attempt to ventilate ( 1st attempt)
If airway is blocked, re-position the casualty’s head
and re-attempt to ventilate ( 2nd attempt)
If airway is blocked , relieve obstruction by
Performing 30 compression (position & landmark as CPR)
Repeat Step until able to give 2 successful ventilators
Check for : Circulation –pulse
Absent – Start CPR
Present – Stop compression
Check breathing
Present – Recovery position
Absent – Rescue breathing
Reassessment - Recovery position

24. Step 2 – Recovery Position Step 1 – Recovery Position
4/14/2017
Step 2 – Recovery Position
Step 1 – Recovery Position
Step 3 – Recovery Position
Step 4 – Recovery Position
JO/CPR/04

25. And the patient gets a chance at life
Remember
CPR can SAVE LIVES.
Do it WELL.
Do it RIGHT.
And the patient gets a chance at life

26. The end Cardio-Pulmonary Resuscitation Module 10
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