Introduction to Cardiopulmonary Resuscitation: Focus on Chest Compressions

INTRODUCTION TO CARDIOPULMONARY RESUSCITATION

WORKSHOPS OF PHYSIOLOGY 2nd year of Medicine. 2024/2025 Dr Ana Checa-Ros ana.checaros@uchceu.esIndex

1. Introduction
2. Cardiopulmonary arrest: what it is and how to identify it
3. Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR)

INTRODUCTION

What is CPR?

• CPR stands for Cardiopulmonary Resuscitation: it is the sequence of manoeuvres that we perform when a patient suffers from a cardiopulmonary arrest.
• CPR is a LIFE-SAVING TECHNIQUE

CARDIOPULMONARY ARREST

Cardiopulmonary arrest: definition

• A situation in which a person is unresponsive with absent or abnormal breathing
• Signs of cardiopulmonary arrest:
  1. Unresponsiveness
  2. Absent breathing or Abnormal breathing

How to identify a cardiopulmonary arrest

1) UNRESPONSIVENESS: HOW TO CHECK THE PATIENT'S RESPONSE

• Shake the patient's gently by the shoulders
• Ask 'are you alright?' to the patient If NO response Patient is unresponsive SERC

How to identify a cardiopulmonary arrest: Breathing Check

2) ABSENT BREATHING OR ABNORMAL BREATHING: HOW TO CHECK THE PATIENT'S BREATHING: 1) Open airway:

• Check for foreign bodies . Head-tilt chin-lift manoeuvre: one hand on the forehead and fingertips of the other hand under the point of the chin; gently tilt the victim's head backwards and lift the chin Head-tilt-chin-lift manoeuvre will ONLY be performed if there is NO suspicion of NECK INJURY

How to identify a cardiopulmonary arrest: Checking Breathing

2) ABSENT BREATHING OR ABNORMAL BREATHING: HOW TO CHECK THE PATIENT'S BREATHING: 2) Check breathing by: . Looking: normal chest movements

• Listening: normal breathing sounds
• Feeling: breath against your face B = BREATHING LOOK LISTEN 5. FEEL

Cardiopulmonary Arrest Identification: Breathing Duration

2) ABSENT BREATHING OR ABNORMAL BREATHING: HOW TO CHECK THE PATIENT'S BREATHING: 2) Check breathing by: . Looking: normal chest movements

• Listening: normal breathing sounds
• Feeling: breath against your face Checking breathing should take no more than 10 seconds

Cardiopulmonary Arrest Identification: Airway and Breathing

2) ABSENT BREATHING OR ABNORMAL BREATHING: HOW TO CHECK THE PATIENT'S BREATHING: 1) Open airway 2) Check breathing No breathing or laboured breathing (gasping) Absent or abnormal breathingIdentifying a cardiopulmonary arrest Check response Unresponsive

Open airway: check for foreign bodies and head-tilt-chin-lift* Check breathing: look, listen, feel No breathing or abnormal breathing CARDIOPULMONARY ARREST *NO if suspicion of neck injuryNow that we know how to identify a cardiopulmonary arrest, what are the steps we must take when a patient loses consciousness Let's go straight to learn the Basic Life Support Algorithm

BASIC LIFE SUPPORT (BLS) AND CARDIOPULMONARY RESUSCITATION (CPR)

BLS Guidelines from the European Resuscitation Council

What we are about to learn is based on the most updated guidelines from the European Resuscitation Council https://cprguidelines.eu/guidelines-2021 EUROPEAN RESUSCITATION COUNCIL New ERC Guidelines The ERC Guidelines 2021 are now available! View guidelines Available online at www.sciencedirect.com Resuscitation journal homepage: www.elsevier.com/locate/resuscitation EUROPEAN RESUSCITATION COUNCIL ELSEVIER European Resuscitation Council Guidelines 2021: Basic Life Support Check for updates Theresa M. Olasveengena,*, Federico Semerarob, Giuseppe Ristagno c,d, Maaret Castrene, Anthony Handley', Artem Kuzovlev9, Koenraad G. Monsieursh, Violetta Raffay', Michael Smythi,k, Jasmeet Soar', Hildigunnur Svavarsdottirm,n, Gavin D. Perkins º,P

Mnemonic rule for BLS algorithm

Mnemonic rule to remember the BLS algorithm DR'S ABCD D = Danger R = Response S = Shout (seek help) A = Airway B = Breathing C = Circulation (chest compressions) D = Defibrillation (if available) (we will not review defibrillation in this workshop) IFOR ADULTS AND PATIENTS WHO ARE NOT DROWNING Algorithm of Basic Life Support (BLS): steps to follow when a patient loses consciousness DR'S AB: Danger-Response-Shout-Airway-Breathing Unresponsive with absent or abnormal breathing Call emergency services (112/061) Give chest compressions (C:circulation of DR'S ABC) until the automated external defibrillator (AED) arrives

BLS Algorithm for Adults

FOR ADULTS AND PATIENTS WHO ARE NOT DROWNING Algorithm of Basic Life Support (BLS): steps to follow when a patient loses consciousness DR'S AB: Danger-Response-Shout-Airway-Breathing Unresponsive with absent or abnormal breathing Call emergency services (112/061) Give chest compressions (C:circulation of DR'S ABC) until the automated external defibrillator (AED) arrives

Basic Life Support: step-by-step DR'S AB

Basic Life Support: step-by-step 1) DR'S AB:

• Danger: make sure that you, the victim and any bystanders are safe
• Response: check for the patient's response
• Shout: if no response, shout for help
• Airway: open airway by checking for foreign bodies and performing head-tilt-chin-lift manoeuvre (only if there is no suspicion of neck injury)
• Breathing: check breathing (look, listen, feel)If the patient is unresponsive with abnormal or absent breathing continue with the algorithm

BLS Algorithm for Unresponsive Patients

FOR ADULTS AND PATIENTS WHO ARE NOT DROWNING Algorithm of Basic Life Support (BLS): steps to follow when a patient loses consciousness DR'S AB: Danger-Response-Shout-Airway-Breathing Unresponsive with absent or abnormal breathing Call emergency services (112/061) Give chest compressions (C:circulation of DR'S ABC) until the automated external defibrillator (AED) arrives

Basic Life Support: Calling Emergency Services

Basic Life Support: step-by-step 2) CALL EMERGENCY SERVICES (112/061):

• If there are 2 rescuers, one can call the emergency services and bring the AED (if available), whereas the other can proceed with CPR . If you are on your own, DO NOT LEAVE the victim, but start CPR

BLS Algorithm for Adults (Continued)

FOR ADULTS AND PATIENTS WHO ARE NOT DROWNING Algorithm of Basic Life Support (BLS): steps to follow when a patient loses consciousness DR'S AB: Danger-Response-Shout-Airway-Breathing Unresponsive with absent or abnormal breathing Call emergency services (112) Give chest compressions (C:circulation of DR'S ABC) until the automated external defibrillator (AED) arrives

Basic Life Support: Effective Chest Compressions

Basic Life Support: step-by-step 3) C: CIRCULATION OF DR'S ABC: Effective chest compressions: . On the lower half of the sternum (on the centre of the chest)

• Arms straight and fingers interlocked
• Compress to a depth of at least 5 cm (no more than 6 cm)
• Rate of 100-120 compressions/min (2 compressions/sec aprox) . Allow the chest to expand completely after each compression (do not lean on the chest) PUSH HARD & FAST 5 CM ]

BLS Algorithm for Children and Drowning Victims

FOR CHILDREN AND ADULTS WHO ARE DROWNING DR'S AB: Danger-Response-Shout-Airway-Breathing Unresponsive with absent or abnormal breathing Algorithm of Basic Life Support (BLS) Call emergency services (112) Give 30 chest compressions (C:circulation of DR'S ABC) Give 2 rescue breaths Continue CPR 30:2 until the automated external defibrillator (AED) arrives

Basic Life Support: Unresponsive with Normal Breathing

Basic Life Support: what to do if the patient is unresponsive but has normal breathing If the patient is unresponsive but has normal breathing, then it is not a cardiopulmonary arrest Recovery position Place the patient in the recovery position and reevaluate breathing HAND SUPPORTS HEAD KNEE STOPS BODY FROM ROLLING ONTO STOMACH

TAKE-HOME MESSAGES

BLS 2021 Top Messages

BLS 2021 5 TOP MESSAGES EUROPEAN RESUSCITATION COUNCIL

1. RECOGNISE CARDIAC ARREST AND START CPR
2. ALERT EMERGENCY MEDICAL SERVICES
3. START CHEST COMPRESSIONS
4. GET AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
5. LEARN HOW TO DO CPR