Rescue & Amblance Trainning Section

New International
Guidelines on
Cardiopulmonary
Resuscitation
CPR

Last update dec 2005

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Chain of Survival

Early Early Early

Early Early
Access CPR Defibrillation Advanced
Care

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 For each minute that CPR &
defibrillation is delayed
Survival is reduced by 7 to 10%

Valenzuela, et al. Circulation.

1997;96:3308-13.
 Causes of circulation
arrest
Cardiac Extra-cardiac
 Ischemic heart disease
 airway obstruction
(myocardial infarction,)
 Arrhythmias of different  acute respiratory failure
origin and character
 shock
 Electrolytic disorders
 Valvular disease  drug overdose
 Cardiac tamponade
 electrocution
 Ruptured aneurysm of
aorta  poisoning

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 Importance of CPR

 The goal of CPR is to produce the best

Coronary Perfusion Pressure (CPP)

 Cardiac arrest survival is dependent upon:

• Early CPR.
• CPR performed properly.

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! Important Points
Five key Rate
aspects Depth
to Great Release
CPR

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 Compression-
Decompression
Compression
• Heard is squeezed between
sternum & spine.
• intrathoracic pressure Increase to
force blood out of the heard .
Decompression
• Allow complete chest recoil
after each compression to
maximize the vacuum in the
thoracic cavity to force blood
flow back to the heard

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! Important Points

Five key Rate

aspects Depth
to Great Release
CPR Ventilation

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 New Guidelines for Ventilation

Ventilation:

 Inspiration phase of no more than 1

second.

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! Important Points

Five key Rate

aspects Depth
to Great Release
CPR Ventilation
Uninterrupted
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! Important Points
CPR “protocols” scripted to

minimize hands-off time

Reducing
Initial
Pulse
assessment
Checks

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Rescue & Amblance Trainning Section
 • Is person unresponsive?
Are you
okay?

Check the victim for a response ( AVPU ).

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 Open the airway
&
Maintain the airway open

Head tilt and chin lift

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 Check for breathing

Look listen and feel for normal breathing

&
. LOOK FOR SIGS OF LIFE

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If no signs of life are present

push hard and push fast

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 Land mark

press down on the

sternum 4—5 cm

Place the heel of one hand in Place the heel of your other
the centre of the victim’s chest. hand on top of the first hand.

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For one rescuer : After 30 compressions open the airway again using head tilt and

chin lift give two breaths while watching the chest rise .

For two rescuers : Rotate compressors every 2–3 minutes to minimize fatigu

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 Main changes in adult CPR
 The decision to start CPR is made if a victim is unresponsive
and not breathing normally.
 Rescuers should place their hands on the center of the
chest , rather than to spend more time using the ‘rib
margin’ technique.
 Each rescue breath is given over 1 sec rather than 2 sec
 The ratio of compressions to ventilations is 30\2 .
 Minimize interruptions in chest compressions.
 Rotate compressors every 2–3 minutes to minimize fatigue.

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Rescue & Amblance Trainning Section
 One year of age up to 8

• Ensure the safety of rescuer and child.

• Check the child’s responsiveness.
• open the child’s airway by tilting the head and lifting the chin.
• Keeping the airway open, look, listen and feel for normal breathing
(NOMORE THAN 10 SEC)
• If the child is not breathing
• Give two initial rescue breaths
• The rescuer should provide 5 cycles (a cycle is 30 compressions and 2
breaths) of CPR (about 2 minutes) before
•CALL 999 and get an AED
• start chest compressions (2.5 to 4 cm).
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 To perform chest compression in children over
1 year of age, Position yourself vertically above the
victim’s chest

• place the heel of one hand over the lower third of

the sternum ( NIPPLE LINE LEVEL)

• with your arm straight, compress the lower third

of the sternum. (avoid compressing the upper
abdomen),

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Rescue & Amblance Trainning Section
 Ensure the safety of rescuer and infant .
 Check the LOC.
 open the infant’s airway by tilting on the patient’s ear-side angle
of the jaw & tiding the head back ( do not hyperextend the neck )
 Keeping the airway open, look, listen and feel for normal
breathing (NOMORE THAN 10 SEC)
 If the infant is not breathing
 Give two initial rescue breaths
l The rescuer should provide 5 cycles (a cycle is 30 compressions
and 2 breaths) of CPR (about 2 minutes)
l CALL 999 and start chest compressions (1 to 2.5 cm)(100\min).

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 (One rescuer)
30\2

Compress the sternum

with two fingers
Just below nipple line Just below nipple line

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 Patient Symptoms when
in
Ventricular Fibrillation
 Unconscious
 No Breathing
 No Signs ol life

 Resulting in…

No Oxygen to the Brain or Body Organs

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 ? What does a defibrillator do

 The AED is programmed to analyze

the heart’s electrical activity, and
decide whether the electrical shock
would help. It then builds up an
electric charge and deliver to the
patient when you push the button.

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 AED Don'ts
 Don’t use the AED to monitor PTs
who are awake or have a pulse
 Don’t attach the AED to PTs in
anticipation of arrest.
 Don’t defibrillate the PTs when both
the PT and the defibrillator are in
contact with metal or water .
 Don’t analyze with the AED while
chest compression are in progress.
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 Electrode placement
 Remove electrodes from package (check
expiry date).
 Apply to PT :superior right chest

left lower lateral side of chest

 Wet PTs should be toweled dry.
 Hairy chest may need shaving.
 Can be use with pacemaker, electrode on
right side should be beneath pacemaker.
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• CPR (only) ……………………… 0-2%

• EMS/ER …………………… 5-15%

• CPR+AED…….. 30-75%
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• Don’t Touch Patient During
Analysis
•Except for pulse
Start chest compressions forcheck.
2 minutes
immediately after defibrillation. Without pulse
check
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 AED Changes

 Immediately resume CPR for 2

minutes, no rhythm, breathing or
pulse check(Compressions do not
cause harm if there is a rhythm ).
With past guideline AED’s there was a hands off delay of 29-
37 seconds between first shock and first compression.

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 AED
Algorithm

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Rescue & Amblance Trainning Section