5. Some not so celebrated instances …
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6. CPR through the ages
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• 1956 James Elam and Peter Safar
Mouth-to-mouth resuscitation
• 1960 Dr Kouwenhowen and team
External chest compression
• 1963 AHA formally endorses CPR
• 1966 First conference on CPR Standardize training and
performance standards
• 1972 Mass citizen’s training in CPR
Over 100,000 trained over 2 years
• 1970’s More than 60% bystanders will
perform CPR
7. CPR in Malaysia…
• 1985 CPR training started in HKL
• 1986 1st ACLS conducted in Malaysia
• 2008 Formation of Malaysia
Resuscitation Council
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8. 8
Challenges today
• Too few people know CPR
• Too few people willing to perform CPR
• We are not training the most important group of
people
• Trained providers cannot remember how to
perform CPR
• We have forgotten the importance of time
• Our duty to train other
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9. 9
CPR according to Guidelines 2000
“ Things we all do ?wrongly ”
• Too many interruptions to chest compressions
(up to 48% of total time the heart was not beating)
• Rate too slow
(28% achieved rates of only 60 bpm)
• Compression too soft and shallow
(40% did not achieve desired depth)
• Hyperventilation
(almost all the time, up to 37 breaths per min)
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11. Malaysia Guideline
• NCORT (National COmmittee for Resuscitation
Training) for MOH Hospitals was formed in 2008.
• A policy booklet was published in February 2009
& circulated to all hospital.
• NCORT reviewed the ILCOR (International Liaison
Committee on Resuscitation) consensus
document & will be use for BLS training till 2016.
• Therefore National Guideline for BLS will be
available soon.
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13. BLS
= recognition of sudden cardiac arrest
+ activation of the emergency response system
+ early cardiopulmonary resuscitation (CPR)
+ rapid defibrillation with an automated external
defibrillator (AED)
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17. Shout
• Shout after suspecting cardiac arrest
`Kecemasan! Kecemasan! Bawa troli resusitasi &
defibrilator!’
`Emergency! Emergency! Bring the resuscitation
trolley & defibrillator!’
• Positioning of victim
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18. Airway
• Open airway after
shouting for help –
head tilt chin lift
manouver.
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19. Breathing
• Looking at chest, neck & face not more than
10 seconds.
• Absence of breathing or presence of abnormal
breathing (include agonal breathing)= cardiac
arrest.
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21. • Chest compressions consist of forceful rhythmic
applications of pressure over the lower half of the
sternum or centre of chest.
• To provide effective chest compressions, push
hard and push fast.
• It is reasonable for laypersons and healthcare
providers to compress the adult chest :
at a rate of at least 100 compressions per minute
a compression depth of at least 2 inches/5 cm.
allow complete recoil of the chest after each
compression to allow the heart to fill completely
before the next compression
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24. • minimize interruptions in compressions
• compression-ventilation ratio of 30:2 is recommended.
Rescue breath
• Once chest compressions have been started, a trained rescuer
should deliver rescue breaths by mouth-to-mouth or bag-mask to
provide oxygenation and ventilation:
A healthcare provider should use the head tilt– chin lift maneuver
to open the airway of a victim with no evidence of head or neck
trauma
Deliver each rescue breath over 1 second
Give a sufficient tidal volume to produce visible chest rise
(estimated about 500-600mls)
1 breath every 6 to 8 seconds (8 to 10 ventilations per minute)
should be performed when advanced airway placed. (ETT, LMA)
24BLS PAHANG
27. 27
The critical role of perfusion of the brain
• “Why is it that every time I press on his chest, he
opens his eyes, and every time I stop to breathe
for him, he goes back to sleep?”
• Maintenance of cerebral perfusion is vital to neurological
function.
• In the first 10 minutes, the most important determinant of
cerebral perfusion, is the arterial pressure generated
during chest compressions
Cardio-cerebral resuscitation, Ewy GA. Circulation 2005
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28. If chest compression not properly
perform may result in…..
• Puncture lungs.
• Lacerated liver.
• Fracture ribs & sternum.
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29. Defibrillation
1 rescuer : after activating the emergency
response system the lone rescuer should next
retrieve an AED (if nearby and easily
accessible) and then return to the victim to
attach and use the AED. The rescuer should
then provide high-quality CPR.
2 rescuers : one rescuer should begin chest
compressions while a second rescuer activates
the emergency response system and gets the
AED.
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30. Defibrillation Sequence
● Turn the AED on.
● Follow the AED prompts.
● Resume chest compressions immediately
after the shock (minimize interruptions).
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33. Reassessment during CPR
• After every 5 cycles or 2 minutes of CPR,
rescuers should check for normal breathing.
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34. When to stop CPR?
• Victim recovers with normal breathing.
• Rescuer is exhausted
• Advanced life support assistance arrives.
• Rescuer shall be encourage to switch chest
compression every 5 cycles or 2 minutes to
avoid fatigue
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35. Recovery position
• No single position is perfect for all victims.
• The position should be stable, near a true
lateral position, with the head dependent and
with no pressure on the chest to impair
breathing.
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38. Hands-only CPR
• Only about 20% to 30% of adults with out-of-
hospital cardiac arrests receive any bystander
• Hands-Only (compression-only) bystander CPR
substantially improves survival following adult
out-of-hospital cardiac arrests compared with no
bystander CPR.
• For the rescuer providing Hands-Only CPR, there
is insufficient evidence to recommend the use of
any specific passive airway (such as
hyperextending the neck to allow passive
ventilation
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39. PAEDIATRIC BASIC LIFE SUPPORT
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Prevention Early CPR Prompt access to
EMS
PALS
Intergrated post
cardiac care
40. • Asphyxial cardiac arrest is the commonest
cause of arrest in infants & children.
• Infants : < 1 year of age
• Child : 1 year till puberty (~8 years old)
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41. • D - danger
• R - responsiveness
• S – shout for 999
• A - airway
• B - breathing
• C – circulation (chest compression)
• D - defibrillation
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42. Danger
• Assess safety for rescuer
and victim.
• Wear glove
Responsiveness
• Gently tap & asked loudly “
Hello. Are you okay?”
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Shout
• If child is unresponsive/gasping
shout for help immediately.
2 rescuer : one start CPR & the
other activate ERS.
Lone rescuer : call 999 without
leave the victim. If not possible
do 2 minutes CPR before
activate ERS
43. Airway
• Open airway- head tilt chin lift/jaw thrust.
• Check for foreign body.
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44. Breathing
• Look for chest
movement.
• Listen for breath sound.
• Feel for air movement
on your cheek.
• Should not more than
10 seconds.
• If child has regular
breathing then put child
in recovery position.
• Maintaining open airway,
give 2 effective rescue
breath.
• Make up 5 attempts to
achieve effective breath.
• When giving rescue breath:
• Each breath should take
about 1 second with
sufficient chest rise.
• If chest doesn’t rise,
reposition the head, make a
better seal with mouth &
try again.
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55. Adult choking (conscious)
• No finger sweep unless foreign body visible
• In conscious pt, give 5 back slaps following
with 5 abdomen thrust/chest thrust
• No abdominal thrust in unconscious pt but
CPR instead.
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