CPR SKILL

Learning Objective
Upon completion of this training program, a student
will be able to

Describe how to recognize and provide treatment for sudden cardiac

arrest.
Explain how to perform effective chest compressions for adults, children,
and infants.
Describe how to perform effective rescue breaths using a CPR mask for
adults, children, and infants.
Describe how to perform effective rescue breaths using a bag-mask device.
Describe the steps of the primary assessment for an unresponsive patient.
Describe the steps of performing CPR as a single provider for adults,
children, and infantsIdentify basic skills in cardiopulmonary arrest
resuscitation
Demonstrate the basic psychomotor skills in cardiopulmonary arrest
resuscitation

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SKILL Objective
Correctly demonstrate how to perform external
chest compressions for adults, children, and
infants.
Correctly demonstrate how to perform rescue
breaths using a CPR mask.
Correctly demonstrate how to perform rescue
breaths using a bag-mask device.
Correctly perform a primary assessment for an
unresponsive patient.
Correctly demonstrate CPR as a single provider
for adults, children, and infants.
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Pediatric Chain of Survival

prevention

Early CPR

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EMS

Rapid PALS

Intergrated
Post-cardiac
Arrest care

M. D. et al. Circulation 2010;122:S862-S875

 Not SICK
SICK

Stable
Stable
potential
potential unstable.
unstable.
UnStable
UnStable Level 1

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Level 2
Level 3
Level 4
Level 5

Resuscitative
Emergent
Urgent
Less urgent
Non-urgent

patients with cardiac arrest

survival rates and neurologic outcomes are poor,
early appropriate resuscitation(CPR),
early defibrillation,
appropriate postcardiac arrest care,
leads to improved survival and
neurologic outcomes.

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Diagnosis of cardiac arrest

Loss
of time
!!!
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Symptoms of cardiac
arrest
Absence of pulse on central
arteries
a pathognomonic symptom
Respiration arrest
may be in 30 seconds after
cardiac arrest
Enlargement of pupils
may be in 90 seconds after
cardiac arrest
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all cases
accompanied with
hypoxia

EXTRA CARDIAC

CARDIAC
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
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disorders, mechanical factors

CPR
A technique combining artificial
ventilation and chest compressions
designed to perfuse vital organs or
restore circulation in cardiac
standstill.

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CPR Indications
should be performed immediately on
any person who has become
unconscious and is found to be
pulseless

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For the purpose of resuscitation,

children are divided into 3 age
groups:
Infants:

under one year of age

Small children: 1 to 8 years of age

Older children/adults: 9 years and over

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Technique
ABC ?? or
CAB ??

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American Heart Association

(AHA) guidelines 2010
standard for CPR comprises 3 steps:
chest compressions,
airway, and
breathing

(CAB),
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performed by
healthcare
providers and
not by
rescuers

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Preparation
1. Position a child on a hard
surface.
2. Position a neonate or infant on a
hard surface or on the forearm of
the rescuer with the hand
supporting the head.

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Determine Responsiveness
Gently tap on shoulder and speak
loudly.
If responsive, place in position of
comfort

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Brachial pulse check in infant

Circulation 2000;102:253I--290Isil
Copyright 2000 American Heart Association

Carotid pulse check in child

Circulation 2000;102:253I--290I-

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Copyright 2000 American Heart Association

Circulation, Circulation,
Circulation

Push hard
Push fast

High quality CPR

Chest compressions of appropriate rate and
depth.
"Push fast": push at a rate of at least 100
compressions per minute.
"Push hard": push with sufficient force to depress
the chest (at least 1/3 of the AP diameter of the
chest or approximately 1 in. = 4 cm in infants
and approximately 2 in. = 5 cm in children)
allowing complete recoil of the chest after each
compression
minimizing interruptions in compressions
avoiding excessive ventilation

High quality CPR = Effective

PALS
the cornerstone of a
system of care that can
optimize outcomes
beyond return of
spontaneous circulation
(ROSC).
Return to a prior quality of
life and functional state of
health is the ultimate goal
of a resuscitation system
of care.
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 INFANT CPR

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Infant CPR
Place infant on firm
surface and maintain
airway.
Place two fingers in the
middle of the sternum.
Use two fingers to
compress the chest
about 1" at a rate of
least 100/min
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CPR Infant
Compression depth:
1/3 of the depth of the chest

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Finger/Thumb
position:
lower 1/2 of the sternum

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 Allow sternum to return

briefly to its normal
position between
compressions.
Coordinate rapid
compressions and
ventilations in a
15:2 or 30 :2
ratio.
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 CHILD
CPR
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One-hand chest compression

technique in child

Circulation 2000;102:253I--290Isil

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 After each compression

allow the chest to recoil
fully
because complete chest
reexpansion improves
blood flow into the
heart
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 should be performed 5 times - 30

compressions and 2 breaths
check the victim's artery for pulse
(for no longer than 10 seconds) and
other signs of consciousness.
If you not feel a pulse within 10
seconds, you should begin cycles
of chest compressions and
ventilations.

 Minimize interruptions in
compressions
Avoid excessive ventilation
Rotate compressor every 2 minutes
If no advanced airway, 15:2
compressionventilation ratio.
If advanced airway, 8 -10 breaths
per minute with continuous chest
compressions

Drug Therapy
Epinephrine IO/IV Dose:
0.01 mg/kg (0.1 mL/kg of 1:10,000
concentration). Repeat every 2- 3
minutes.
If no IO/IV access, may give
endotracheal dose: 0.1 mg/kg (0.1
mL/kg of 1:1,000 concentration).
Amiodarone IO/IV Dose:
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Advanced Airway
Endotracheal intubation or
supraglottic advanced airway
Waveform capnography or
capnometry to confirm and monitor
ET tube placement.
Once advanced airway in place give
1 breath every 3- 6 seconds (10 -20
breaths per minute)
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AIRWAY

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Airway Opening Manoeuvres

Chin lift/head tilt

Infants
Neutral head position
with chin lift
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Smaller children
Sniffing position
with chin lift

Airway Opening Manoeuvres

Chin lift/head tilt

Older children/adults
Backward head tilt
with pistol grip
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Airway Opening Manoeuvres

Use when concerned re

cervical spine injury
May also facilitate
bag and mask
ventilation

Jaw thrust

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Jaw thrust

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Bag to Mask Ventilation

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Monitor the Effectiveness of

Ventilation

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Visible chest rise with each breath.

Oxygen saturation.
Heart rate.
Blood pressure.
Distal air entry.
Patient response

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cpr
Any question ?

Check for pulsE

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