cardiopulmonary resuscitation is a series of 

basic life support maneuvers designed to resuscitate 

patients of cardiopulmonary collapse 

and this collapse can occur in a variety of situations.

One of them can be uh A 

patient,

for example,

who has had a myocardial infarction and has 

suddenly a potentially fatal arrhythmia 

such as ventricular fibrillation.

About 350,000 people die 

annually outside the hospital who are victims of 

ventricular fibrillation associated with myocardial 

infarction.

Some of these patients can be resuscitated 

initially by cardiopulmonary resuscitation 

Another example in which cpr or cardiopulmonary 

resuscitation is useful is in near 

drowning victims.

A lot of Children each summer are victims of near drowning 

or drowning.

CpR is useful in these situations.

Micro shock from electrocution in the 

household and other places with potentially fatal 

arrhythmias is another situation in which 

patients can be resuscitated,

in which these techniques are used.

There are a lot of hospital patients in which cardiopulmonary 

resuscitation is used.

These patients can have reversible diseases 

and may suffer collapse of the 

cardiac circulatory pulmonary 

voluntary systems.

CpR is useful in these situations.

Now,

CpR has developed since biblical 

times.

Uh,

some of the techniques used are certainly not used 

today.

They have included flagellation,

pouring hot coals on the victim's abdomen or 

chest putting the victim on the back of a horse and 

trying the horse around.

There have been highlights of the evolution of 

CPR,

such as the manual method used in the early 60s 

late 50's And in 

1958 it was recognized 

that airway obstruction was a 

significant cause of lack of successful 

resuscitation of many of these victims of cardiopulmonary 

collapse.

Now,

I want to talk to you about airway obstruction versus 

apnea because airway obstruction universally 

happens in patients who are unconscious and are 

allowed to lie on their backs.

Apnea is a cessation of ventilation 

and this may or may not be present in patients who 

are victims of cardiac arrest.

To give you an idea of what apnea is,

we anesthetize a patient who had 

blood gas values of fairly normal 

levels of a P.

02 of about 82 here with the patient 

breathing room.

Air,

we made the patient unconscious and gave the 

patient a drug called succinylcholine and made the patient 

app nick the patient could not ventilate,

could not breathe,

could not move any air after 60 

seconds of apnea or no 

ventilation.

The p.

0.

2 was 31.

Now,

we can all hold their breath for about a minute and a half,

but this demonstrates that only 60 seconds 

of apnea,

not breathing are necessary for 

significant deterioration in blood gas values of a patient 

who is simply not breathing.

Oh,

obstruction can of course prevent ventilation.

This patient's P.

02 nicely came up to 152 after ventilation 

with 40% oxygen.

Now,

the basic life support techniques,

we'll be talking about our techniques that you can use with 

your own exhaled air and with your own hands 

will also demonstrate some adjuncts to airway 

management that can be used in the hospital 

and some outside the hospital and we'll talk 

about how these can be used in the patient,

for example who is lying on the floor in a 

pulseless unresponsive situation.

These are sequences that the american heart association 

has called witnessed and un witnessed arrest.

And we'll begin to show you some of these uh 

Now dr Kaplan,

Doctor Cantarella will help in the demonstration of some of these 

techniques.

Now we'll have dr Kaplan talk to us about 

airway establishment,

cardiopulmonary resuscitation 

consists of three basic steps the 

A.

B.

And C.

A.

Is establishment and maintenance of a patent 

airway.

B.

Is artificial breathing.

This morning we will be covering these two 

areas of the three A.

Bs and CS.

First establishment of the airway 

in the unconscious victim In the 

supine position the head usually falls 

forward and with this the tongue 

falls against the posterior pharynx wall.

The most common cause of obstruction is in fact 

the tongue.

This can be demonstrated very nicely on this cutaway 

model in the supine victim.

The head falls forward and the tongue totally 

obstructs the airway with 

extension of the neck.

You can see the tongue comes forward and 

clears the airway and a patent airway 

is reestablished.

Now on the victim.

This can be done by placing your upper hand 

on the forehead and your lower hand under his 

neck and then gently extending the 

neck maximally pulling the tongue 

forward off the pharynx.

This in most cases will clear the airway 

occasionally there'll be a foreign body in there,

this could be a tooth or a piece of meat and then 

further steps will have to be taken to clear this.

This can be accomplished by turning the head to the side 

and sweeping your finger in through the 

pharynx to make sure there is no foreign body.

But again,

this is not a common occurrence,

most often extending the head will clear the 

airway.

If this does not then the mandible may also 

be a problem.

The mandible can be pulled forward either by placing your 

thumb in the mouth and then lifting the 

mandible off to post your pharynx.

This is an older maneuver or what is 

now recommended is to take the mandible with 

your first finger on each hand and place it 

behind the mandible and lift it forward at the 

same time as you extend the head,

then putting your thumb by the mouth,

further lifting the mandible and opening the mouth 

and third placing your mouth over the victim's 

mouth and breathing for him.

This is what's called the triple maneuver,

one is lifting the mandible to is 

further lifting and opening the mouth and 

three is the ventilation of the patient.

The triple maneuver will almost always clear the 

airway of the victim.

In certain circumstances you may want to use artificial 

aids to help maintain a patent airway.

The first one is the oral airway.

The oral airway can be extremely effective or 

extremely dangerous and the way it can be dangerous 

if the airway is placed incorrectly by 

pushing,

by putting it in in the front of the mouth and pushing the tongue 

posterior.

You can further totally obstruct the airway.

It's important when you put the oral airway in to pull 

the tongue forward.

This can be done either with your finger lifting the 

tongue and mandible and then slipping the oral airway in 

behind it or by 

using a tongue blade and with this 

lifting the tongue forward and then slipping the 

airway behind it.

This will establish a patent airway in 

association with extension of the neck.

Occasionally,

you will not want to use an oil airway and there a 

nasal airway can be used.

This is accomplished by extending the 

bridge of the nose back and then gently sliding the 

nasal airway straight down.

It's important to emphasize the gentleness of this 

because it's very easy to cause a nosebleed and 

severe trauma to the nose with these 

maneuvers even now established a patent 

airway.

The next step is the B.

The artificial breathing.

This is usually done with mouth to mouth 

resuscitation.

The airway is cleared by the extension 

with your upper hand which has been placed on the far ahead,

you now grab the nose and squeeze it closed 

so the only opening is the mouth,

Then your lips are open wide and placed over the 

victim's lips and a general puff of air is 

provided 

notice between each breath.

My mouth comes off the victims so that he can exhale the 

air 

with this,

you are ventilating the patient with approximately 

15% oxygen.

This is your normal exhaled oxygen and is 

plenty for the resuscitated victim.

This will be able to keep him alive until a higher 

percentage of oxygen is provided.

The title volume should be approximately normal 

somewhere between 815 100 

CCs.

For the normal adult patient with this amount 

of ventilation,

the PCO two should be maintained in the 

normal range.

Occasionally you may want to not use mouth to mouth 

ventilation,

but if a mask is available,

use mouth to nose.

Use mouth to mask ventilation.

Excuse me.

This can be done by placing the mask over the 

victim's mouth and then gently ventilating 

through the mask 

again,

allowing exhalation through the mask.

This is aesthetically more pleasing than mouth to mouth 

ventilation and is quite effective 

in rare circumstances.

You may not be able to use mouth to mouth ventilation.

The patient may have a severe injury to his mouth 

or his mandible might even be wired closed.

For example,

in a post surgical patient here it is 

possible to use mouth to nose ventilation 

Again,

the head is extended,

but now the mouth is pulled tightly shut and your 

lips are applied to the victim's nose 

with each inspiration.

The lungs should rise and on expiration it's 

important to open the mouth to allow the air to come 

out,

for example,

and then to allow the air to come out through the mouth.

This is mouth and those ventilation not used very 

commonly but important when necessary 

in hospital situations or in ambulances,

it's very common to have the mask and the artificial 

bag there that you can ventilate the patient with.

There are a variety of bags that can be used 

when using this instrument.

Again,

it's important that it's done correctly.

The head has to be maintained an extension and the 

mandible maintained forward.

Then the mask is placed first over the nose 

and then tightly over the lips.

It is maintained in this position by the thumb 

pushing down over the bridge of the nose,

your first finger pushing down over the lower part of the 

mask and your lower three fingers placed 

right on the mandible,

pulling up to hold the airway and position.

Then general breaths can be applied and 

the lungs ventilated adequately.

The major advantage of this system is that you can 

provide more oxygen by bringing an 

oxygen source into the bag.

Between 40 and 70% oxygen 

can be given to the patient.

A title volume of about 800 to 

1000 CCs can be supplied with the bag,

which is an adequate title volume.

In opposition to this is math to math,

ventilation where you can only give 15% 

oxygen,

but a much larger tidal volume up to your vital 

capacity can be applied if necessary.

Now we have covered airway maintenance 

establishment and artificial 

ventilation.

The patient is now being ventilated adequately and 

is oxygenated.

The next step in airway maintenance at this point 

is to consider whether endotracheal intubation 

ought to be performed.

The laryngoscope and endotracheal tube will frequently be 

available at an arrest.

The question is,

should we use it?

And the answer to that is it depends on the situation.

It's an elective procedure that should only be 

done when the airway is established and the 

patient ventilated and oxygenated.

Then endotracheal intubation should be performed.

If one of the following indications occurs,

it is done to prevent airway 

aspiration.

If the patient has a full stomach or a markedly 

distended stomach,

it would be important to place an endotracheal tube with a 

cuff as quickly as possible to prevent 

aspiration.

It should also be used if the difficulty is 

encountered in clearing the airway,

the endotracheal tube and an obese patient with a short 

neck will sometimes provide an airway when it cannot be 

provided Otherwise.

It also should be used if the patient is going to be given 

high percentages of oxygen,

possibly with the use of positive and xperia 

torrey pressure on artificial ventilation 

after the arrest,

Important if you're going to intubate a patient 

at an arrest.

It should be done by an expert because at 

no time should cardiopulmonary resuscitation 

be stopped for more than 15 seconds 

to in debate.

A victim in 15 seconds.

Takes an experienced person.

It should be done rapidly but safely without 

creating a lot of trauma.

It's usually performed by extending the head,

then opening the mouth widely 

then placing the laryngoscope in the back of the 

pharynx and gently lifting the tongue 

and epiglottis away from the patient without 

rocking on the teeth.

The head is extended,

the pharynx is exposed,

the epiglottis is visible and the bottom of the 

cords are seen.

Then the endotracheal tube is slid in under the 

epiglottis between the vocal cords into the 

trachea and endotracheal intubation is 

accomplished in this situation where a full 

stomach is the problem.

The endotracheal tube cuff is then inflated 

gently to provide a seal in the trachea.

Then artificial ventilation can be 

maintained through the endotracheal 

tube and the patient further 

resuscitated.

Head extension is done in this 

manner which opens the airway 

and the patient breathe spontaneously through the mask.

The volume is measured by the mental a meter,

the chest is moving.

There's no retraction,

there's no evidence of airway obstruction.

After this maneuver is done,

This patient again is unconscious but not ethnic.

In those situations where the airway cannot be 

cleared.

The triple airway maneuver is used.

The mandible is lifted forward with the fingers 

and ventilation is then felt for 

occasionally.

A nasal airway will be used and lubricant is placed on 

the nose and then very gently the nasal airway 

has slipped into the posterior pharynx.

Again,

ventilation is felt for through the airway.

Then an Ambu bag is placed over the patient's 

mouth and successful ventilation via 

the nasal airway is accomplished.

You can see the chest rising with each ventilation.

In this patient,

an oral airway is now placed by lifting the tongue with 

the tongue blade and then placing the oral airway 

behind the tongue.

The lips are cleared so as not to cut them and then 

the jaw is extended and the mask placed 

in the patient who is vomiting and unconscious.

The head is quickly turned to the side,

the mouth is opened,

wiping gravity and suction are 

used to clear the airway of vomiting and foreign bodies 

and the patient who is a victim of cardiac arrest.

Often they have a firmly clenched 

jaw and this maneuver is used to open the 

jaw so that something 

can be put between the teeth to 

suction or wipe out foreign bodies.

It is important for resuscitation to be 

performed properly.

There are some common errors performed in resuscitation.

There are important too omit.

There are no no shaking shot maneuver was provided this 

patient,

no adequate ventilation is provided.

Head extension is not done.

Chest thump is inappropriate.

In the situation of an unwitting cardiac arrest,

unsuccessful attempts at ventilation are 

pursued.

No hand position was located.

External compression is being performed inadequately 

improperly with quick down strokes,

which does not into the heart of blood 

ventilation has never been appropriately provided this 

patient.

These are some common errors in resuscitation that need to be 

avoided because resuscitation,

even with properly performed techniques 

provides borderline cardiac output and 

borderline gas exchange function in the lungs.

These are some examples of common eras,

ventilation has never never been adequately done 

in this patient.

Okay,

okay.

Head extension is the common era in the situation or the 

lack of head extension innovation should not be 

done to provide.

Let's get the E.

K.

G machine over here.

External compression should not be stopped for more than five 

seconds for any purpose except for intubation 

or stairwell transportation.

Repeated attempts at innovation 

compromise the patient further because of lack of ventilation.

Go ahead and breathe for the stop 

Annie.

Wake up any what's wrong?

You were just talking to me and the witness to rest is 

the only indication for the chest thump.

The witness arrest is when cpr begins within one 

minute of the arrest and the victim's 

heart is still assumed to be oxygenated and 

not ASA dot IQ and airways 

established.

The pulses felt for after the patient 

is determined to be unresponsive.

There is no pulse and the chest thump 

is provided by striking the mid portion of the 

sternum about the nipple lined with the 

fleshy part of the fist by raising the fist 8 

to 12 inches off the chest wall.

The army's kept level and this provides about 

wonderful watch seconds of energy that may 

convert a ventricular tachycardia.

In this situation,

the tachycardia was not converted because there is no 

pulse the pulse has again felt for after four ventilation 

czar quickly provided after the chest thump.

If there is no no pulse,

cpr is continued.

As in the unwillingness sequence.

Proper hand position is located,

the fingers are kept off the chest wall,

the elbows are straight,

the shoulders are over the victim,

and the rescuer kneels on the firm surface 

with the victim on a firm surface next to 

the patient.

15 Starting compressions are provided to 

ventilation between 15 compressions and 

five and 12 and three 

and four and 10 and one and 

234 

patient is lying supine on the ground and mr 

Cantarella will help us demonstrate how an un 

witnessed arrest sequence is accomplished.

The first maneuver used as a shaken shout maneuver which 

establishes unresponsiveness of the patient.

This prevents trying to resuscitate a patient who is simply 

fainted.

The next maneuver used is simple head extension to 

establish the airway and apnea is 

determined by feeling,

listening and looking at the chest for exhaled air and 

for chest movement.

This patient is ethnic and now 

four mouth to mouth ventilation Czar,

given quickly.

1234 and a stair step maneuver.

Now for the first time,

the the circulation is checked by feeling for the 

carotid pulse Two fingers are put on the same 

side of the victim's carotid area which is 

next to the thyroid cartilage in the groove in front of the sternal 

colloidal master and muscle at least 5 to 10 

seconds are taken to feel for the absence of a 

pulse.

This victim is indeed 

pulseless.

External compression is accomplished by running the third 

finger up the groove of the rib 

between the rib and the Z.

Four junction.

Second finger is put on the sternum and 

the heel of the left hand in this case is put next to the 

second finger.

External compression is done at a rate of 80 

per minute pneumonic 

one and two 

is talked out loud to 

determine the number and rate of compressions.

After 15 external compressions to ventilation.

Czar quickly provided the patient's hand position 

is rechecked each time the hands are put back on the 

sternum by feeling for the groove between the rib and 

the junction.

Two cycles of 15 compressions 

to ventilation Czar provided each time the ventilation is 

done.

Hit extension is performed to establish the 

airway.

Notice that the rescuers shoulders 

are over the victim.

The elbow straight,

slight abdominal tone is used by the 

rescuer to accomplish compression of the sternum towards the 

vertebral column of 1.5 

to 2 inches.

There is a varying amount of force necessary to 

accomplish this compression.

Notice the ratio is equal for 

down and up.

The heart cannot be compressed with a hammer.

After four cycles of 15 and two ventilation 

stone compression,

the carotid pulse is checked.

The pupils are checked.

The peoples are still dilated after a good 

five seconds of feeling for karate impulse,

there is an absent pulse.

Two rescuers 

can effectively perform 

resuscitation 

rate is slowed to a rate 

of 60 per 2nd,

60 per minute,

one per second.

Notice that there is no pause between the storm 

compression and ventilation.

One breath is provided between every 

fifth.

External compression on 

three.

Next time.

1 1002,

1003.

1000 with experienced 

rescuers.

There is no pause necessary 

for performing the 

switch between external 

compressions and ventilation.

Again,

with two rescuers,

external compression is performed at a rate of one per 

2nd,

60 per minute and one breath is interpose 

between every fifth.

Sternal compression between five 

breathe and six.

The fatigue rescuer performing stern compression calls for 

the switch.

There is no pause hand position is quickly 

locate located.

External compression is assumed by the previous Rescuer 

doing ventilation 1 

1002.

1003.

1004.

51 1001.

1002,

3 1001.

Now we have showed you resuscitation and 

applications of basic life support techniques 

in a patient and in fact a mannequin lying on the 

floor.

This is an artificial situation and most patients 

are victims of cardiopulmonary collapse are not 

mannequins lying on the floor.

We hope though that you will learn these standards because these are 

accepted standards that have been set in 

1973 and have been published in 

a J.

M.

A supplement in 1974.

These are the standards that we think are applicable 

now and the best ones we have.

There can be significant deviations from these 

standards if the basic approach is 

learned first.

So we've shown you Cpr,

as it is known today,

that can provide adequate support in the 

initial collapse of a patient or victim of cardiac 

arrest in the first five minutes of 

their resuscitation.

We hope they will be useful.

We hope you'll we use these standards and we appreciate your 

help them to teach us to you.