1. Basic Life Support (BLS)

2. CPR CPR (CPCR- cardio-pulmonary-cerebral resuscitation)

3. 3 The heart is too good to die !

5. 5 CPR BLS ACLS POST CPR STABLIZATION OR ORGAN PROTECTION TECHNIQUE OF CARDIOPULMONARY RESUSCITATION (CPR )

6. ACLS ( Advance Cardiovascular Life Support) Focus: more advanced assessments and treatments BLS ( Basic Life Support) Focus: basic CPR and defibrillation

7. 7 EARLY ACCESS EARLY CPR EARLY DEFIBRILLATION (AED ) EARLY ACLS

8. 8 Early ACCESS Early CPR Early DEFIB Early ACLS Chain of Survival

9. 9 American Heart Association : “Textbook of Advanced Cardiac Life Support”

10.  Check for SAFETY  Check for RESPONSE  Gentle SHAKE & SHOUT No Response? Shout for HELP

11. 11  Before initiating the BLS approach;

12. CABD instead of traditional ABC C: Circulation A: Airway B: Breathing

13.  Check for central pulse (Not peripheral!)  If there is not pulse resume chest compression immediately.  Compression to breathing ratio?  Difference between adults and pediatrics?

14.  Adults: 30:2  Pediatrics: 1 rescuer: 30:2 2 rescuers: 15:2  Infants: 5:1  Neonates: 3:1  Change rescuers after 5 cycles(2 min) since pulse checking.

15.  Rate 100/min  Depth 4-5 cm  50% compression, 50% relaxation  Systolic BP ~ 60-80 mmHg MAP < 40 mmHg  CO ~ 30% normal

16. CHEST COMPRESSIONS AND CORONARY PERFUSION PRESSURE CPP at 5:1 Ratio CPP at 30:2 Ratio

17.  not intubated 30 compression : 2 ventilation  intubated 100/min compression : 8-10 ventilation /min Asynchronous COMPRESSION RATIO FOR 1& 2 RESCUER Perfusing rhythm : 10-12 ventilation /min COPD : 6-8 ventilation /min

18. FATIGUE

19. 19

20. 20

21. 21

22. Hard and Fast Release completely Minimize interruptions only interrupt for 1. ventilation (until an advanced airway is placed) 2. rhythm check 3. shock delivery Rotate compression every 2 minutes with rhythm check CHEST COMPRESSION

23.  CHECK- Remove foreign body/debris  OPEN - Head tilt/chin lift or jaw thrust (Consider Tracheostomy/Laryngectomy Patients)

25. Head-tilt Chin-lift Maneuver

27. BREATHING

29. Rescue Breathing: “Gas flows down the path of least resistance” Gas can flow to the lungs or stomach Distribution of gas depends on – Peak airway pressure Inspiratory time Tidal volume – Lower esophageal sphincter opening pressure

30. PROBLEMS WITH HYPERINFLATION 1. Gastric inflation --> aspiration Solution: cricoid pressure (Sellick maneuver)

31. 2. In COPD - rapid CO 2 wash out Alkalosis - auto PEEP (air trap) intrathoracic pressure Venous return BP (especially if hypovolemic) Problems with hyperinflation

32. How to Prevent Gastric Inflation Use a longer inspiratory time – 1 to 2 seconds for bag-mask ventilation with oxygen – 2 seconds for mouth-to-mouth or bag-mask ventilation with air Use a smaller tidal volume – Less tidal volume = lower peak airway pressure

33. ASSESS SEVERITY SEVERE AIRWAY OSTRUCTION INEFFECTIVE COUGH UNCONCIOUS?STARTCPRCONCIOUS? 5 BACK BLOWS 5 ABDOMINAL THRUSTS MILD AIRWAY OBSTRUCTION EFFECTIVE COUGH ENCOURAGE COUGH CHECK FOR DETERIORATION OR INEFFECTIVE COUGH OR RELIEF OF OBSTRUCTION

34.  Stand to one side and slightly behind  Lean casualty forward & support chest with one hand  Give up to 5 back blows

35.  Stand behind casualty and lean them forwards  Place fist between navel and breastbone  Grasp with other hand, pull sharply inwards and upwards  Repeat up to 5 times

36.  Pregnant victims  Very obese patients

37. 37

39. 39 AED

40. 40

41. 41 AED