2. Cardiac arrest is the cessation
of normal circulation of the blood due to
failure of the heart to contract
effectively. Medical personnel can refer
to an unexpected cardiac arrest as
a sudden cardiac arrest or SCA.

3. Cardiac arrest is classified based upon
the ECG rhythm into:
 Shockable (Ventricular
fibrillation and Pulseless ventricular
tachycardia )
 Non–shockable (Asystole and Pulseless
electrical activity).

4. all cases accompanied with
hypoxia
extracardiac
CAUSES OF CARDIAC ARREST
cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors
4

5. a) Coronary heart disease
-Approximately 60–70% of SCD is related
to coronary heart disease.
- Among adults, ischemic heart disease is
the predominant cause of arrest.
b) Non ischemic heart disease
- cardiomyopathy,
- cardiac rhythm disturbances (VT/VF/
Asystole/PEA)
- hypertensive heart disease
- congestive heart failure.

6. SCD is unrelated to heart problems
in 35% of cases.
- Trauma
- Non-trauma related bleeding (such
as gastrointestinal bleeding, aortic
rupture, and intracranial hemorrhage)
- Medication Overdose ( Ca channel
blockers, Digitalis,Beta-blockers)
- Drowning
- Pulmonary embolism.

7.  Sex :
The lifetime risk is three times greater
in men (12.3%) than women (4.2%)
 Smoking
 Lack of physical exercise
 Obesity
 Diabetes
 Family history.

8. Hs Ts
 Hypovolemia  Tablets or Toxins
 Hypoxia  Cardiac Tamponade
 Hydrogen ions  Tension
 Hyperkalemia Pneumothorax
 Hypokalemia  Thrombosis
 Hypothermia  Thromboembolism
 Hypoglycemia  Trauma.
 Hyperglycemia.

9. The most reliable sign is absence of pulse.
 Unconsciousness
 No breathing
 No Blood Pressure
 Pupils begin dialating within 45 seconds
 Seizures may/maynot occur
 Death – like appearance
 Lips & nail buds turn blue

10.  Cardiac arrest is synonymous with clinical
death.
 Lack of carotid pulse is the gold
standard for diagnosing cardiac arrest.
 Cardiac arrest is usually diagnosed
clinically by the absence of a pulse, but
lack of a pulse (particularly in the
peripheral pulses) may be a result of other
conditions (e.g. shock), or simply an error
on the part of the rescuer.

11.  As the prime causes of cardiac arrest
being ischemic heart disease
- efforts to promote a healthy diet
- exercise
- smoking cessation
 For people at risk of heart disease
- blood pressure control
- cholesterol lowering.

12. This is usually carried out based upon:
 Basic life support (BLS)
 Advanced cardiac life support (ACLS)
 Pediatric advanced life support (PALS)
 Neonatal resuscitation program (NRP)

13.  Cardiopulmonary resuscitation (CPR)
 Defibrillation
 Medications
 Therapeutic hypothermia
 Extracorporeal membrane
oxygenation devices

14.  Out-of-hospital cardiac arrest (OHCA) has
a worse survival rate (2-8% for discharge)
than an in-hospital cardiac arrest (15% for
discharge).
 Although mortality in case of ventricular
fibrillation is high, rapid intervention with
a defibrillator increases survival rate.
 Survival rates following an arrest induced by
toxins are very much dependent on
identifying the toxin and administering an
appropriate antidote.
 The overall survival following cardiac arrest
is 6.8%.

16. (CPR)

17. Cardiopulmonary resuscitation (CPR)
is an emergency procedure which is
performed in an effort to manually
preserve intact brain function until further
measures are taken to restore
spontaneous blood circulation and
breathing in a person in cardiac arrest.

18.  To restore partial flow of oxygenated
blood to the brain and heart who are not
breathing and do not have a pulse.

19.  To delay tissue death and to
extend the brief window of opportunity
for a successful resuscitation without
permanent brain damage.

20.  5000 -3000 BC - first artificial mouth to mouth
ventilation
 1780 – first attempt of newborn resuscitation by
blowing
 1874 – first experimental direct cardiac massage
 1901 – first successful direct cardiac massage in
man
 1946 – first experimental indirect cardiac
massage
 1960 – Modern CPR-indirect cardiac massage
 1980 – development of cardiopulmonary
resuscitation due to the works of Peter
Safar
 2008- AHA released additional guidelines that
said Compression only CPR

21. a) Cardiac arrest b) Respiratory Arrest
- VF - Drowning
- VT - Stroke
- Asystole - Foreign body airway
- PEA obstruction
- Smoke inhalation
- Drug overdose
- Electrocution (lightening
injury)
- Suffocation
- Accident
- Coma
- Epiglottitis.

22. Cardiac arrest
No blood flow & oxygenation
Brain sustain damage for 4 min &
after 7 min irreversible damage
After1-2 hours-cells of the body die
CPR
Blood is manually forced to circulate to brain & heart
Enough oxygen to Allows heart to remain
brain-delay brain death. responsive till
defibrillation.

23.  Standard method
Standard CPR includes both mouth-to-
mouth resuscitation and chest compression.
 Compression only
involves chest compressions without artificial
respiration. It is recommended as the method of
choice for the untrained rescuer.
 In pregnancy
During pregnancy when a woman is lying on
her back the uterus may compress the inferior vena
cava and thus decrease venous return. So that the
uterus be pushed to the persons left and if this is not
effective either roll the person 30°s or consider
emergency cesarean section.
 Other
Internal cardiac massage

24.  Check for Danger
 Check for Response
 Send for help
 Chest compressions
 Open the Airway
 Check Breathing
 D stands for AED

25.  Recognition of the arrest
 Compressions
 Managing the airway
 Rescue breaths

27.  check for response
 , tap the victim on the shoulder and
shout, “Are you all right?”
 no more than 10 seconds to check for a
pulse
 Adults – Carotid artery
 Infants – Brachial artery

28. R -
Responsivenes
s
› Tap shoulder
and shout
“Are you ok?”

29.  unless
the scene dictates
otherwise
› threat of fire or explosion
› victim must be on a hard
surface
› Place victim level or head
slightly lower than body

30. DIAGNOSIS OF CARDIAC
ARREST
Loss of time !!!
Blood pressure measurement

Taking the pulse on peripheral
arteries

Auscultation of cardiac tones
30

31.  Maintain a head tilt with one hand over the forehead
 Locate the trachea, using 2 fingers of the other hand
 Slide these fingers into the groove between the
trachea $ muscles at the side of the neck, where you
can palpate carotid pulse
 Palpate artery for at least 5 sec $ not more than 10
seconds.

32. Check the pulse on carotid
artery using fingers of the
other hand.
In infants brachial pulse is
more easily located &
palpated than the carotid
pulse.

33.  Push hard &
fast(100/min)
 Compressions to
relaxation ration 50:50
To Ensure full chest recoil
 Minimal interruption

34.  Position yourself at victim’s side
 Make sure the victim is lying on his back on a firm,flat surface.If the victim is
lying face down,carefully roll him onto his back.
 Remove all clothings covering the victim’s chest
 Put the heel of one hand on the center of the victim’s bare chest between
the nipples
 Put the heel of your other hand on the top of the first hand.
 Straighten your arms and position your shoulders directly over
your hands.
 Push hard $ fast.
 At the end of each compression make sure that you allow the chest to recoil
completely.
 Deliver compressions at a smooth fashion at a rate of atleast 100
compressions per minute.

35. C. Circulation
Restore the circulation, start
external cardiac massage
35

36.  EFFECTIVE CHEST
COMPRESSIONS

37.  Effective
CPR provides 1/4 to
1/3 normal blood flow
 Rescue breaths contain 16%
oxygen (21%)

38. 2 mechanisms explaining the
restoration of circulation by external
cardiac massage
Cardiac Thoracic
pump pump
38

39. Cardiac pump during the cardiac
massage
Blood pumping is assured
by the compression of
heart between sternum
and spine
Between compressions
thoracic cage is
expanding and heart is
filled with blood
39

40. Thoracic pump at the cardiac massage
Blood circulation is restored
due to the change in intra
thoracic pressure and jugular
and subclavian vein valves
During the chest
compression blood is directed
from the pulmonary
circulation to the systemic
circulation. Cardiac valves
function as in normal cardiac
cycle.
40

41.  HEAD TILT- CHIN LIFT
 Place one hand on the victim’s forehead $ push with your
plam to tilt the head back.
 Place the fingers of the other hand under the bony part of
the lower jaw near the chin.
 Lift the jaw to bring the chin forward.
 JAW THRUST
 INDICATION:
 Cerviacal spine injury
 Place one hand on each side of the victim’s head,resting
your elbows on the surface on which the victim is lying.
 Place your fingers under the angle’s of the victim’s lower
jaw $ lift with both hands , displacing the jaw forward.
 If the lips close, retract the lower lip with your thumb.

42. A – Airway
› Open the airway
› Head tilt chin lift

43. A (Airway)
ensure open
airway
43

45.  Deliver each rescue breath over 1 second
 visible chest rise
 compression to ventilation ratio of 30 chest
compressions to 2 ventilations.
 Advanced airway
 give 1 breath every 6 to 8 seconds without
attempting to synchronize breaths between
compressions
 8 to 10 breaths/min

46.  Mouth-to-Mouth Rescue Breathing
 Mouth-to–Barrier Device Breathing
 Mouth-to-Nose and Mouth-to-Stoma
Ventilation
 Ventilation With Bag and Mask
 Ventilation With a Supraglottic Airway
 Ventilation With an Advanced Airway

47.  Hold the victim’s airway open with a head tilt-
chin-lift
 Pinch the nose closed with your thumb $ index
finger (using the hand on the forehead)
 Take a regular breath (not deep) $ seal your
lips around the victim’s mouth, creating an
airtight seal
 Give 1 breath over 1 sec $ watch for chest rise.
 If the chest doesn’t rise, repeat the head tilt-
chin-lift
 Give a second breath $ watch for chest rise.

48. 48

50. › Can’t open mouth
› Can’t make a good seal
› Severely injured mouth
› Stomach distension
Mouth to stoma
(tracheotomy)

51.  Position yourself at the victim’s side
 Place the mask on the victim’s face, using the bridge
of the nose as a guide for correct position
 Seal the mask against the face.
# using the hand that is closer to the top of the
victim’s head, place the index finger $ thumb along
the border of the mask.
#place the thumb of your other hand along the
lower margin of the mask.
 Place the remaining fingers closer to the victim’s
neck along the bony margin of the jaw $ lift the jaw.
 Deliver air over 1 second to make the victim’s chest
rise.

52.  Masks
 Shields

56.  Position yourself directly above the victim’s head
 Place the mask on the victim’s face.
 Use the E_C clamp technique to hold the mask in
place
# Perform head tilt
# Use thumb $ index finger of 1 hand to make a
“c”,pressing the edges of the mask to the face.(3
fingers form an E)
# Use the remaining fingers to lift the angles of the
jaw.
 Squeeze the bag to give breaths while watching for
chest rise.

57. The EC clamp technique of bag-mask ventilations.
Berg M D et al. Circulation 2010;122:S862-S875
Copyright © American Heart Association

58.  Shout and gently
tap the child on the
shoulder. If there is
no response,
position the infant
on his or her back
 Begin chest
compressions

60.  If the baby is NOT
breathing give 2 small
gentle breaths.
 Cover the baby's mouth
and nose with your
mouth.
 Each breath should be 1
second long.
 You should see the
baby's chest rise with
each breath.

61. Component Adults Children Infants
Recognition Unresponsive (for all ages).No breathing or no
Normal breathing No breathing or only
(ie, only gasping) gasping
No pulse palpated within 10 seconds for all ages
CPR C-A-B
sequence
Check pulse Carotid pulse Brachial
(<10 sec) pulse
Compression Center of the breast bone between nipples just below nipple line on breast
location bone.
Compression At least 100/min
rate
Compression Heel of 1 hand,other hand on the top 2 fingers(2 thumb encircling hands in
method 2 rescuer CPR
Compression At least 2 At least 1⁄3 AP diameter At least 1⁄3 AP diameter
depth inches (5 cm)
About 2 inches (5 cm) About 1. inches (4 cm)
Chest wall Allow complete recoil between compressions.rotate compressors every 2 minutes
recoil
Compression Minimize interruptions in chest
interruptions compressions.Attempt to limit
interrruptions to <10 seconds
Airway Head tilt–chin lift (suspected
trauma: jaw thrust)
Compression-to- 30:2 1 or 2 30:2(Single rescuer)
ventilation rescuers 15:2 (.2 rescuers)
ratio
Ventilations:untrai Compressions only
ned
Ventilations with 1 breath every 6-8 seconds (8-10 breaths/min).Asynchronous with chest compressions . About 1
advanced airway second per breath Visible chest rise

62.  One should kneel down at the victim’s
side and perform CPR ,while the other
kneel at the opposite side near the
victim’s head an deliver artificial breaths.
 Switch roles every 2 minutes.

63.  The person revives and starts breathing
again on their own.
 Medical help, such as ambulance
paramedics, arrive to take over.
 The person performing the CPR is forced to
stop from physical exhaustion
 Death of the victim
 CPR continued for 30min if the time to onset
of CPR is <6min.
 Onset of CPR >6min CPR can be
terminated after 15min

64.  Lung expansion
 Pupil will react to light / will appear
normal
 Normal heart beat will return
 A spontaneous gasp/breathing will
occur
 May move legs / arms and colour may
improve.

65.  Who do not awaken immediately after CPR- most
important determination is neurologic recovery.
 Coma > 24hrs - 10% chance of neurologic
recovery.
 Coma > 72hrs - 5% chance of neurologic
recovery.
 Coma > 2wks - no chance of full neurologic
recovery.
 72hrs point or GCS<5 – little or no chance of
neurological recovery.

66.  timing devices
 those that assist the rescuer to achieve
the correct technique, especially depth
and speed of compressions, and
 those which take over the process
completely

67.  Delay in starting
 Improper procedures (ex. Forget to
pinch nose)
 No ACLS follow-up and delay in
defibrillation
› Only 15% who receive CPR live to go
home
› Improper techniques
 Terminal disease or unmanageable
disease (massive heart attack)

68.  local blunt trauma
 Gastric inflation
 bruising or fracture of the sternum or ribs
 Compression at the xiphoid process
causes laceration of liver

69.  Vomiting
› Aspiration
› Place victim on left side
› Wipe vomit from mouth with
fingers wrapped in a cloth
› Reposition and resume CPR

70.  Air in the stomach
› Creates pressure against the
lungs
 Prevention of Stomach
Distension
› Don’t blow too hard
› Slow rescue breathing
› Re-tilt the head to make sure the airway is
open
› Use mouth to nose method
› Cricoid pressure

72.  CARDIAC ARREST
 CARDIOPPULMONARY RESUSCITATION
 DEFINITION
 PURPOSE
 HISTORY
 INDICATIONS
 PATHOPHYSIOLOGY
 METHODS
 STEPS IN CPR
 STOP THE CPR
 SUCCESSFUL CPR
 ADJUNCT DEVICES
 COMPLICATIONS
 CONCLUSION