Experts

• Dr Santanu Deb(Convenor)
• Dr Paramanad G Andankar (CO-Convenor)
• Dr Prashant V Kariya
• Dr Janani Shankar
• Dr Cherukuri Nirmala
• Dr Shalu Gupta
• Dr Prahalad Kumar A
 CPR - Cardiopulmonary resuscitation

It's a lifesaving technique used in emergencies when

an adult or child's breathing and/or heartbeat has
stopped (cardiac arrest).

What is CPR involves chest compressions and rescue breaths

to manually pump blood and oxygen throughout the

CPR?
body.

The goal is to keep vital organs perfused until

advanced medical help arrives or normal heart
function is restored.

BLS = Basic Life Support. This term is promoted by

the American Heart Association (AHA)
Among India’s populations, less than 2% are aware of CPR

About 4,280 people per 1 lakh population are getting cardiac

arrest per year in the country

Every minute 112 people are succumbing to cardiac arrest

 Who needs CPR?
• Any victim of sudden cardiac arrest (SCA) would require CPR
• A victim of cardiac arrest can be recognized if any child or adult
suddenly becomes:
• Unconscious and unresponsive
• Stops breathing or is gasping with ineffective breaths and
• Does not have a pulse.
SCA in adults SCA in children

Is often due to cardiac causes Major cause of cardiac arrest in

including rhythm abnormalities like children is due to respiratory
ventricular fibrillation or pulseless failure and/or shock
ventricular tachycardia.
A victim of cardiac arrest has the best chance of recovery, if the CPR is
administered by the person standing next to the victim immediately on
recognition of the condition
Majority of cardiac arrest occurs at home and is witnessed in 85%

95% of those who experience SCA die because of not receiving timely
intervention

CPR has to be initiated immediately upon recognition of SCA (within 4-

6 mins). Every minute delay in initiation of CPR increases the chances of
mortality by 17%
Steps of CPR
Adult CPR
1. Verify scene safety & Check for response
Firmly tap the victim on
shoulder and ask a question
loudly in a language he/she
would understand like -
“Are you okay?” or
“How are you?” or
“Do you need some help?”
2. Activate the emergency response
system & get AED
• You can use mobile device – Call 112 or 108
as applicable
• Or ask bystander to get AED or Defibrillator

3. Breathing & Pulse Check

• Look for normal breathing and carotid pulse
simultaneously
• Breathing & pulse check should not take
more than 10 secs
 4. Determine next action
1. If breathing is normal & • Monitor victim till help arrives or
pulse present victim is taken to hospital

2. If no breathing, but pulse

• Provide rescue breathing
present

3. If no breathing and no
• Start high quality CPR in C-A-B sequence
pulse

C- A – B : Compressions – Airway - Breaths

 5. Begin High Quality CPR
1. Position yourself at victim’s side
2. Place the victim on a flat firm surface; kneel
down on your knees beside the victim
3. Place the heel of your dominant hand over the
lower half of the sternum of the victim.
4. Place your other hand on your first hand,
grasping the fingers of first hand by second
hand
5. Straighten your arms and position your
shoulders directly over your hands
 5. Begin High Quality CPR
6 Cycles of compressions and breaths
(30:2) starting with chest compressions
(C-A-B)
7 Push hard - upto 5-6 cms
8 Push fast - @ 100- 120 /min
9 Deliver compressions in a smooth
fashion
10 Allow complete chest recoil
 5. Begin High Quality CPR
11Minimize interruptions
12Count while delivering compressions
13Open airway to deliver two breaths after
30 compressions
14Use AED as soon as it is available
15 Deliver shock if prompted (shockable
rhythm)
16 Resume high quality CPR
Automated External
Defibrillator
6. Opening airway by head tilt and chin
lift (C-A-B)
7. Breaths (C- A-B)
• A single rescuer can give breaths by –
• Mouth to mouth
• Mouth to barrier device (mask)
• Bag – mask breaths can be given when
there are 2 rescuers
Compression to breaths ratio
Adults Children & Infants
30: 2 15: 2
 Child CPR
• Child
• From the age of 1 year to puberty
• Puberty = Chest or underarm hair on males and any breast
development in females
• Pulse check – Is done either in carotids or femorals depending on size of
the child
3. Compression : Ventilation ratio –
• Single rescuer & 2 rescuers – 15:2
4. Compression technique: Either 1 hand or 2 hand technique is used
5. Compression depth – at least one third of the antero posterior diameter
of the chest (about 2’ or 5 cms)
 Infant CPR
• Infant = age below 12 mo excluding newly
born infants in delivery room
• Pulse check – Brachial pulse
• Technique of compressions – Single rescuer –
2 finger technique
• Single rescuer – 2 finger technique
• 2 rescuers – 2 thumb encircling technique
• Compression depth – at least 1/3 AP
diameter of chest (~ 1.5’ / 4 cms)
• Compression : Ventilation ratio : 15:2 (for 1 &
2 rescuers –
2 rescuers) 2 thumb encircling technique
 AED: Automated External Defibrillator
• The interval from collapse to defibrillation is one of the most important
determinants of survival from SCA due to ventricular fibrillation or pulseless
ventricular tachycardia
• AED - Portable devices that can identify abnormal cardiac rhythms that
need shock
• Prompt the providers by advising to shock or not to shock
• One rescuer continues high quality CPR, other rescuer attaches AED –
Delivers the shock when prompted by AED
• While AED is analyzing rhythm, rescuers can “switch” their positions
• AEDs are available at many public places such as airports, railway stations
etc
 Relief of choking in adults & children > 1 yr

Action
Signs Ask the victim “Are you
Cannot breathe or choking”? If the victim
increased respiratory The block is nods YES and is unable
effort Severe to talk, severe choking
Cannot talk is present
Becomes cyanosed ↓
Universal choking sign Heimlich maneuver
Heimlich maneuver
• Go behind victim
• Wrap your arms around victim from under the
axilla
• Make a fist with one hand
• Put the thumb side of the fist well below the
breast bone and above the belly button
• Grasp with the other hand and give quick
upward thrusts into the belly
• Give thrusts until the foreign body comes out
or victim starts coughing/talking or victim
becomes unresponsive
Relief of choking in infants
Choking is common in infants
In severe choking - risk of mortality is high
Clearing an object from an infant’s airway requires a
combination of back slaps & chest thrusts
Back slaps – Chest thrusts
• Kneel or sit with infant on lap
• Hold the infant face down with head slightly lower
than chest, resting on your forearm
• Support infants face & jaw with your hand
• Rest forearm on lap or thigh to support the infant
• Deliver 5 back slaps forcefully between infant’s
shoulder blades, using heel of your hand.
• Deliver slaps with sufficient force to attempt to
dislodge the foreign body Back slaps
 Back slaps – Chest thrusts
• After delivering back slaps – place your free hand on
infant’s back, supporting the back of the infant’s head
with palm of your hand
• Turn the infant as a unit while carefully supporting the
head & neck.
• Infant’s face is held up with forearm resting on the thigh.
Head is held lower than trunk
• Provide 5 quick downward chest thrusts in the middle of
the chest over the lower half of the breast bone Chest thrusts
• Chest thrusts should be provided @ 1 per sec with enough
force to dislodge the foreign body
Don’ts in choking
• Don’t panic
• Don’t intervene when the victim is coughing
• Don’t perform blind finger sweep in the oral cavity of infants &
children :this may push the foreign body back in the airway blocking
it
• If the victim becomes unresponsive, stop efforts to dislodge the
foreign body and begin CPR
 IAP CPR app
Available for download from play store
 iapalsbls.com
Upcoming courses can be seen
and joined

Several courses are available

for non health care workers

Details of nearest CPR centre,

Course coordinator are
available
 Available on the website of AIIMS Patna
aiimspatna.edu.in
After completion of the eBLS course, participants can go for hands on training
Thank you