– Cardiopulmonary resuscitation ( CPR ) is a lifesaving technique.

– This technique is used in many emergencies including the heart attack or near drowning where someone’s breathing or heart beat has stopped.

• ABC of CPR

✓ A – Airway

– To maintain an open and clear airway

✓ B – Breathing

– To maintain breathing by external ventilation

✓ Circulation

– To maintain blood circulation by external massage

• Indications


* Cardiac arrest :

– Ventricular fibrillation

– Tachycardia

– Pulse less electrical activity

* Respiratory arrest

– Stroke

– Drowning

– Drug overdose

– Suffocation

– Smoke inhalation.


• Principles of CPR

– To restore effective ventilation

– To restore effective circulation

– To prevent irreversible cerebral damage.


• CPR procedure


– Patient is relaxed lying with hands on sides

– Perform Chest compression and pulmonary ventilation

– It is important to approach safety

– Shake the shoulder gently to check the response

– Check breathing by listen and feel nrml breathing , donot confuse with agonal breathing with normal breathing.


• Agonal breathing


– It is a Barely, heavy , noisy or gasping breathing occurs shortly after heart stops in upto 40% of cardiac arrest.


– 30 chest compression is performed by placing heel of one hand in centre of chest and other hand on top of it , interlock the fingers.


– Compress the chest : Rate is 100/min,

Depth is 4 to 5 cm and then relaxation.


– Two rescue breaths

Pinch the nose

Taking normal breath

Placing lips over mouth

Blowing until the chest raises

Take about 1 second

Then allow chest to fall

Then repeat the procedure.


• Complications


– Coronary vessel injury

– Diaphragm injury

– Hemothorax

– pneumothorax

– Hemopericardium

– Rib fracture

– Sternal fracture.

• Medical management

– Adrenaline

– Atropine



1) Circulation


– CPR should begin with chest compression .

– Victim should be in supine lying on hard and flat surface.

– Chest compression is given by pushing hard to a depth of 2 inches in children and 1 and half inches in infants .

– Compression rate : 100 per minute

(a) Chest compression in infants ( less than 1 year )


– With both hands child’s chest is encircled

– Fingers are spread around thorax and thumbs brought together at lower half of sternum  and avoid xiphisternum.

–  Sternum is compressed with thumbs and thorax with fingers for counter pressure.

– While the other person maintains the airway and perform ventilation at 15:2 ratio

(b) Two – finger technique


– If the rescuer is alone or unable to encircle the victim’s chest , compression can be done using 2 fingers.

– 2 fingers are placed vertically over the Sternum just below the intermammary line avoiding xiphoid process

• Chest compression in children ( 1-8 yrs )

– Heel of the hand is placed over the lower half of sternum and avoid xiphoid process.

– Rescuer position : vertically above the victim’s chest .

• Chest compression for larger Children’s and those abouve 8 yrs

– Two hand method is used by placing heel of one hand over lower half of sternum and heel of other hand over the first hand , interlocking the fingers of both hand and lifted above the chest wall .

2) Airway

– child is placed supine on hard surface

• Head tilt chin lift maneuver

– One hand is placed over the child’s forehead  and the head is gently tilted backwards .

– At the same time fingers of other hand are place on the lower jaw to lift the chin to open the airway .

– This method should be avoided if there is a trauma to head or neck

• Jaw Thrust

– 2 or 3 fingers are placed under each side of lower jaw to lift the jaw upwards  and outwards.

– If it is unsuccessful , head may be extended slightly .

3) Breathing

• Checking for breathing

– One should check for breathing after opening the child’s  airway

– Should not be confused with agonal breathing

• Bag and mask ventilation

– Prefered technique for emergency ventilation

– Self inflating bags are available in both pediatric and adult sizes.

– Flow inflating bags needs oxygen flow for inflation and can be used in hospital set up .

• Volume of ventilation bag

– Neonates , infants and children less than 8 yrs of age : 450 – 500 ml

– Preterm neonates : 250 ml




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