طريقة إسعاف وتدليك وتنشيط القلب فى حالات توقف القلب المفاجىء Cardio-Cerebral Resuscitation CARDIOPULMONARY RESUSCITATION (CPR)

1. ‫القلب‬ ‫وتنشيط‬ ‫وتدليك‬ ‫إسعاف‬ ‫طريقة‬
‫المفاجىء‬ ‫القلب‬ ‫توقف‬ ‫حاالت‬ ‫فى‬
Cardio-Cerebral Resuscitation
CARDIOPULMONARY
RESUSCITATION (CPR)
‫د‬.‫رفله‬ ‫مرقس‬ ‫سمير‬
‫طب‬ ‫كلية‬ ‫القلب‬ ‫أمراض‬ ‫متفرغ‬ ‫أستاذ‬
‫اإلسكندريه‬
01001495577

2. DEFINITION
Cardio pulmonary resuscitation (CPR) is a
technique of basic life support for the
purpose of oxygenation to the heart, lungs
and brain until and unless the appropriate
medical treatment can come and restore
the normal cardiopulmonary function.
‫أو‬ ‫القلبي‬ ‫اإلنعاش‬‫تدليك‬‫القلب‬
‫حالة‬ ‫أمامه‬ ‫تحدث‬ ‫ألن‬ ‫معرض‬ ‫إنسان‬ ‫كل‬
‫من‬ ‫لسبب‬ ‫قلب‬ ‫توقف‬‫األسباب‬
‫ما‬‫الرئوي؟‬ ‫القلبي‬ ‫االنعاش‬ ‫هو‬

3. Cardio pulmonary resuscitation is a series
of steps used to establish artificial
ventilation and circulation in the patient
who is not breathing and has no pulse.
‫ق‬ ‫ما‬ ‫شاهد‬ ‫شخص‬ ‫أول‬ ‫على‬ ‫قلبه‬ ‫توقف‬ ‫انسان‬ ‫إنقاذ‬ ‫إمكانية‬ ‫تعتمد‬‫د‬
‫حدث‬.‫هذا‬ ‫فرص‬ ‫من‬ ‫تقلل‬ ‫اسعاف‬ ‫دون‬ ‫المصاب‬ ‫تمرعلى‬ ‫دقيقة‬ ‫كل‬
‫هن‬ ‫الوقت‬ ‫فان‬ ‫لذا‬ ،‫الحياه‬ ‫قيد‬ ‫على‬ ‫البقاء‬ ‫او‬ ‫النجاة‬ ‫في‬ ‫المصاب‬‫يعني‬ ‫ا‬
‫والموت‬ ‫الحياة‬ ‫بين‬ ‫الفرق‬.
‫واالوكس‬ ‫الدم‬ ‫انقطاع‬ ‫تحمل‬ ‫يستطيعان‬ ‫ال‬ ‫وقلبه‬ ‫االنسان‬ ‫دماغ‬ ‫ان‬‫جين‬
‫من‬ ‫آلكثر‬ ‫عنهما‬(6)‫تبد‬ ‫والقلب‬ ‫الدماغ‬ ‫خاليا‬ ‫ان‬ ‫حيث‬ ‫دقائق‬ ‫ستة‬‫أ‬
‫السته‬ ‫الدقائق‬ ‫هذه‬ ‫مرور‬ ‫بعد‬ ‫بالموت‬

4. PURPOSE
• Restore
cardiopulmonary
functioning.
• Prevent irreversible
brain damage from
anoxia.
INDICATION
• Cardiac arrest
• Respiratory arrest
• Combination of both
‫هو‬ ‫القلب‬ ‫إنعاش‬ ‫من‬ ‫الهدف‬
‫للعمل‬ ‫الدمويه‬ ‫الدوره‬ ‫إعادة‬
‫التنفس‬ ‫وكذلك‬.‫والمحافظ‬‫ه‬
‫من‬ ‫المخ‬ ‫على‬‫التلف‬.
‫القلب‬ ‫إنعاش‬ ‫عمل‬ ‫دواعى‬:
‫القلب‬ ‫توقف‬
‫التنفس‬ ‫توقف‬
‫معا‬ ‫اإلثنين‬ ‫توقف‬

5. Definition of Cardiac arrest:
It is loss of cardiac function, breathing
and loss of consciousness.
‫القلب‬ ‫توقف‬ ‫تعريف‬:
‫وغيبوبه‬ ‫التنفس‬ ‫وتوقف‬ ‫اإلنقباض‬ ‫عن‬ ‫القلب‬ ‫توقف‬

6. ‫الرئوي؟‬ ‫القلبي‬ ‫التوقف‬ ‫حدوث‬ ‫الى‬ ‫تؤدي‬ ‫التي‬ ‫االسباب‬ ‫هي‬ ‫ما‬
‫القلبي‬ ‫التوقف‬ ‫حدوث‬ ‫الى‬ ‫تؤدي‬ ‫التي‬ ‫االسباب‬ ‫من‬ ‫الكثير‬ ‫هناك‬
‫يلي‬ ‫ما‬ ‫منها‬ ،‫الرئوي‬:
‫أمراض‬/‫في‬ ‫مشاكل‬‫القلب‬/‫القلبيه‬ ‫النوبة‬.
‫أمراض‬/‫تنفسيه‬ ‫مشاكل‬.
‫الكهربائيه‬ ‫الصدمة‬.
‫التسمم‬.
‫الغرق‬/‫االختناق‬.
‫القلبيه‬ ‫السكتة‬.
‫الحاد‬ ‫النزف‬/‫الحاده‬ ‫الصدمة‬ ‫او‬.
‫الطريقه‬ ‫بنفس‬ ‫الحاالت‬ ‫هذه‬ ‫جميع‬ ‫مع‬ ‫االولي‬ ‫التعامل‬ ‫ويتم‬.

7. Causes of cardiac arrest (6 H & 4 T):
1) Hypoxia.
2) Hypotension.
3) Hypothermia.
4) Hypoglycemia.
5) Acidosis (H+).
6) Hypokalemia (electrolyte
disturbance).
1) Cardiac Tamponade.
2) Tension pneumothorax.
3) Thromboembolism (pulmonary,
coronary).
4) Toxicity (eg. digoxin, local
anesthetics, insecticides).
‫القلب‬ ‫توقف‬ ‫أسباب‬
‫جلطه‬ ،‫بالقلب‬ ‫جلطه‬
‫كهرب‬ ‫فى‬ ‫خلل‬ ،‫بالرئه‬‫ية‬
‫هبوط‬ ،‫تسمم‬ ،‫القلب‬
،‫السكر‬ ‫فى‬ ‫حاد‬
،‫ومنومات‬ ‫مخدرات‬
‫المحاليل‬ ‫فى‬ ‫خلل‬
(‫بوتاسيم‬)‫إنسداد‬ ،
‫الشعيبات‬،‫الهوائيه‬
‫أرتشاح‬ ،‫حاد‬ ‫نزيف‬
‫التام‬ ‫غشاء‬ ‫فى‬ ‫شديد‬‫ور‬
‫ضغط‬‫على‬‫القلب‬..
‫صدمه‬ ،‫الغرق‬‫كهربيه‬

8. Diagnosis of cardiac arrest
(TRIAD):
1) Loss of consciousness.
2) Loss of apical & central
pulsations
(carotid, femoral).
3) Apnea.
Diagnosis of cardiac arrest
Blood pressure measurement
Taking the pulse on peripheral
arteries
Auscultation of cardiac sounds
‫القلب‬ ‫توقف‬ ‫تشخيص‬(‫ث‬‫الث‬
‫عالمات‬)
‫نبض‬ ‫يوجد‬ ‫ال‬
‫تنفس‬ ‫يوجد‬ ‫ال‬
‫فقدان‬‫الوعى‬
‫القلب‬ ‫توقف‬ ‫تشخيص‬
‫الضغط‬ ‫قياس‬
‫القلب‬ ‫صوت‬ ‫سمع‬‫بالسماع‬
‫الشري‬ ‫فى‬ ‫النبض‬ ‫حساس‬‫ان‬
‫اليد‬ ‫وشريان‬ ‫السباتى‬

9. ‫باسعاف‬ ‫تقوم‬ ‫كيف‬/‫بتوقف‬ ‫المصاب‬ ‫انعاش‬‫القلب‬‫الرئتين؟‬ ‫او‬
‫تص‬ ‫ان‬ ‫احذر‬ ، ‫المصاب‬ ‫من‬ ‫اقتربت‬ ‫اذا‬ ‫من‬ّ‫ا‬ ‫وضع‬ ‫في‬ ‫انك‬ ‫من‬ ‫تأكد‬‫بح‬
‫مصابا‬ ‫نفسك‬ ‫انت‬.
‫وحاول‬ ،‫ال‬ ‫ام‬ ‫االستجابة‬ ‫على‬ ‫قادرا‬ ‫المصاب‬ ‫كان‬ ‫اذا‬ ‫ما‬ ‫معرفة‬ ‫حاول‬
‫مقرب‬ ‫وعلى‬ ‫مرتفع‬ ‫بصوت‬ ‫ومناداته‬ ‫كتفيه‬ ‫هز‬ ‫طريق‬ ‫عن‬ ‫ايقاظه‬‫من‬ ‫ة‬
‫اذنيه‬.
‫الماره‬ ‫من‬ ‫او‬ ‫حولك‬ ‫هم‬ ‫ممن‬ ‫النجدة‬ ‫اطلب‬.
‫ت‬ ‫وسائد‬ ‫اية‬ ‫بإزالة‬ ‫وقم‬ ‫صلب‬ ‫سطح‬ ‫أو‬ ‫االرض‬ ‫على‬ ‫المصاب‬ ‫ضع‬‫كون‬
‫رأسه‬ ‫تحت‬.‫وعي‬ ‫فقد‬ ‫قد‬ ‫كان‬ ‫مصاب‬ ‫مع‬ ‫تعاملك‬ ‫حالة‬ ‫في‬ ‫حذرا‬ ‫كن‬‫ه‬
‫بشىء‬ ‫ارتطامه‬ ‫اثر‬.
‫ال‬ ‫إمالة‬ ‫أسلوب‬ ‫استخدم‬ ،ً‫ا‬‫مفتوح‬ ‫التنفسي‬ ‫المجرى‬ ‫ان‬ ‫من‬ ‫تأكد‬‫رأس‬
‫الذقن‬ ‫ورفع‬.‫ال‬ ‫اتبع‬ ،‫مفتوحا‬ ‫التنفسي‬ ‫المجرى‬ ‫ان‬ ‫من‬ ‫وللتأكد‬‫خطوات‬
‫التاليه‬:

10. ‫وارفع‬ ‫المصاب‬ ‫ذقن‬ ‫تحت‬ ‫يديك‬ ‫احدى‬ ‫اصابع‬ ‫من‬ ‫اصبعين‬ ‫ضع‬
‫أعلى‬ ‫الى‬ ‫رأسه‬.
‫أسفل‬ ‫الى‬ ‫اضغط‬ ‫ثم‬ ‫المصاب‬ ‫جبين‬ ‫على‬ ‫االخرى‬ ‫يدك‬ ‫راحة‬ ‫ضع‬.
‫أو‬ ‫غريب‬ ‫جسم‬ ‫اي‬ ‫من‬ ‫فمه‬ ‫خلو‬ ‫من‬ ‫للتأكد‬ ‫المصاب‬ ‫فم‬ ‫داخل‬ ‫أنظر‬
‫صناعية‬ ‫اسنان‬(‫اسنان‬ ‫طقم‬)‫مخاط‬ ‫أو‬.
‫ان‬ ‫عليك‬ ‫فان‬ ‫رضوض‬ ‫أو‬ ‫صدمة‬ ‫أثر‬ ‫من‬ ‫يعاني‬ ‫المصاب‬ ‫كان‬ ‫اذا‬
‫بأسلو‬ ‫التنفسي‬ ‫المجرى‬ ‫فتح‬ ‫وحاول‬ ‫رقبته‬ ‫تحريك‬ ‫تتجنب‬‫الضغط‬ ‫ب‬
‫الفك‬ ‫على‬.
‫ولمدة‬ ‫تحقق‬10‫ثوان‬‫بالطر‬ ‫وذلك‬ ‫ال‬ ‫أم‬ ‫يتنفس‬ ‫المصاب‬ ‫كان‬ ‫اذا‬ ‫فيما‬‫ق‬
‫التاليه‬:‫التحقق‬‫الصدر‬ ‫وهبوط‬ ‫ارتفاع‬ ‫لمالحظة‬ ‫بالنظر‬.
‫وأنف‬ ‫فم‬ ‫من‬ ‫مقربة‬ ‫على‬ ‫أذنك‬ ‫بوضع‬ ‫وذلك‬ ‫بالسمع‬ ‫التحقق‬
‫المصاب‬.
‫خدك‬ ‫على‬ ‫المصاب‬ ‫بزفير‬ ‫تشعر‬ ‫بحيث‬ ‫بالحس‬ ‫التحقق‬.

11. ‫؟‬ ‫ال‬ ‫أم‬ ‫المصاب‬ ‫يتنفس‬ ‫هل‬
‫االس‬ ‫سيارة‬ ‫وانتظر‬ ‫االنقاذ‬ ‫وضع‬ ‫في‬ ‫ضعه‬ ‫يتنفس‬ ‫المصاب‬ ‫كان‬ ‫اذا‬‫عاف‬.
‫يتنفس‬ ‫ال‬ ‫المصاب‬ ‫كان‬ ‫اذا‬:
‫سيارة‬ ‫يستدعي‬ ‫ان‬ ‫بمساعدتك‬ ‫يقوم‬ ‫الذي‬ ‫الشخص‬ ‫من‬ ‫اطلب‬‫اسع‬‫اف‬.
‫ب‬ ‫مرتين‬ ‫المصاب‬ ‫فم‬ ‫في‬ ‫بالنفخ‬ ‫الصناعي‬ ‫التنفس‬ ‫باجراء‬ ‫قم‬‫بطء‬
‫يسمى‬ ‫ما‬ ‫بطريقة‬(‫الحياه‬ ‫قبلة‬)‫ا‬ ‫ونصف‬ ‫ثانية‬ ‫مدى‬ ‫على‬ ‫وذلك‬‫لى‬
‫ثانيتين‬.‫وانت‬ ‫فمه‬ ‫في‬ ‫النفخ‬ ‫بعد‬ ‫المصاب‬ ‫صدر‬ ‫ارتفاع‬ ‫راقب‬‫حتى‬ ‫ظر‬
‫واثانيه‬ ‫االولى‬ ‫النفخة‬ ‫بين‬ ‫صدره‬ ‫يهبط‬.
‫لمدة‬ ‫ذلك‬ ‫فافعل‬ ‫السباتي‬ ‫النبض‬ ‫جس‬ ‫على‬ ‫مدربا‬ ‫كنت‬ ‫اذا‬10‫على‬ ‫وذلك‬ ‫ثوان‬
‫التالي‬ ‫النحو‬:‫قم‬‫الحنجرة‬ ‫مكان‬ ‫بتحسس‬(‫آدم‬ ‫تفاحة‬)‫وذلك‬ ‫الرقبة‬ ‫في‬
‫يدك‬ ‫اصابع‬ ‫من‬ ‫اصبعين‬ ‫باستخدام‬.
‫الن‬ ‫لجس‬ ً‫ال‬‫قلي‬ ‫واضغط‬ ‫للحنجرة‬ ‫المحاذي‬ ‫المجرى‬ ‫في‬ ‫اصبعيك‬ ‫مرر‬،‫بض‬
‫عالمات‬ ‫من‬ ‫عالمة‬ ‫اية‬ ‫عن‬ ‫فابحث‬ ‫النبض‬ ‫جس‬ ‫على‬ ‫مدربا‬ ‫تكن‬ ‫لم‬ ‫إن‬ ‫أما‬
‫المصاب‬ ‫على‬ ‫الحياة‬.

12. ‫يزال‬ ‫ال‬ ‫المصاب‬ ‫قلب‬ ‫ان‬ ‫أو‬ ‫الحياة‬ ‫قيد‬ ‫على‬ ‫يزال‬ ‫ال‬ ‫المصاب‬ ‫ان‬ ‫على‬ ‫تدل‬ ‫عالمات‬ ‫هناك‬ ‫هل‬
‫ينبض؟‬‫اذا‬‫يلي‬ ‫بما‬ ‫المباشرة‬ ‫فعليك‬ ‫بال‬ ‫االجابة‬ ‫كانت‬:
‫بواقع‬ ‫العمل‬ ‫الى‬ ‫قلبه‬ ‫اعادة‬ ‫بهدف‬ ‫المصاب‬ ‫صدر‬ ‫على‬ ‫اضغط‬30‫مرة‬‫باتباع‬ ‫وذلك‬
‫يلي‬ ‫ما‬:
‫ج‬ ‫على‬ ‫يديك‬ ‫بوضع‬ ‫وذلك‬ ‫للمصاب‬ ‫السفلي‬ ‫للضلع‬ ‫الخارجي‬ ‫الحد‬ ‫تحسس‬‫انبي‬
‫الصدري‬ ‫قفصه‬.
‫ع‬ ‫عند‬ ‫اصابعك‬ ‫تلتقي‬ ‫ان‬ ‫الى‬ ‫السفلية‬ ‫االضالع‬ ‫حدود‬ ‫يدك‬ ‫بأصابع‬ ‫تتبع‬‫صدر‬ ‫ظم‬
‫المصاب‬.
‫الوسطى‬ ‫اصبعك‬ ‫ضع‬(‫المصاب‬ ‫قدمي‬ ‫باتجاه‬ ‫الواقعة‬ ‫يدك‬ ‫من‬)‫عظم‬ ‫على‬
‫الوسطى‬ ‫االصبع‬ ‫جانب‬ ‫الى‬ ‫الشاهد‬ ‫اصبعك‬ ‫ضع‬ ‫ثم‬ ‫الصدر‬.
‫الوسطى‬ ‫االصبعين‬ ‫مكان‬ ‫المصاب‬ ‫صدر‬ ‫عظم‬ ‫على‬ ‫االخرى‬ ‫يدك‬ ‫راحة‬ ‫ضع‬
‫والشاهد‬.
‫تشابك‬ ‫وضع‬ ‫في‬ ‫يديك‬ ‫كلتا‬ ‫اصابع‬ ‫جاعال‬ ‫يدك‬ ‫راحة‬ ‫فوق‬ ‫االخرى‬ ‫يدك‬ ‫ضع‬.
‫ل‬ ‫بالنسبة‬ ‫عمودي‬ ‫بشكل‬ ‫وكوعاك‬ ‫كتفاك‬ ‫فيه‬ ‫يكون‬ ‫وضع‬ ‫في‬ ‫جسمك‬ ‫اجعل‬‫يديك‬.
‫على‬ ‫الضغط‬ ‫اجراء‬ ‫في‬ ‫باشر‬ ‫ثم‬ ‫استقامة‬ ‫وضع‬ ‫في‬ ‫وظهرك‬ ‫ذراعيك‬ ‫ان‬ ‫تأكد‬
‫ذراعيك‬ ‫عضالت‬ ‫وليس‬ ‫ظهرك‬ ‫عضالت‬ ً‫ا‬‫مستخدم‬ ‫المصاب‬ ‫صدر‬ ‫عظم‬.
‫بواقع‬ ‫أسفل‬ ‫الى‬ ‫الصدر‬ ‫عظم‬ ‫على‬ ‫اضغط‬4‫الى‬5‫وبمعدل‬ ‫سم‬80‫الى‬100‫الدقيقه‬ ‫في‬ ‫مرة‬

13. ‫الصناعي‬ ‫التنفس‬ ‫بإعطاء‬ ‫قم‬‫مرتين‬.‫دورة‬ ‫إعطاء‬ ‫في‬ ‫استمر‬‫من‬‫التنفس‬
‫الصناعي‬(‫أي‬30‫النعاش‬ ‫ضغطة‬‫القلب‬‫الرئتين‬ ‫النعاش‬ ‫اثنتان‬ ‫ونفختان‬)‫ث‬‫م‬
‫النبض‬ ‫افحص‬.
‫سيارة‬ ‫وصول‬ ‫حين‬ ‫الى‬ ‫االنقاذ‬ ‫عملية‬ ‫في‬ ‫استمر‬ ‫نبض‬ ‫هناك‬ ‫يكن‬ ‫لم‬ ‫اذا‬
‫دقائق‬ ‫بضعة‬ ‫كل‬ ‫النبض‬ ‫تفقد‬ ‫في‬ ‫االستمرار‬ ‫مع‬ ‫االسعاف‬.

14. ‫اإلنعاش‬ ‫بعمل‬ ‫القيام‬ ‫طريقة‬‫القلبي‬
‫أوال‬‫وضع‬ ‫في‬ ‫الحالة‬ ‫تلك‬ ‫وتكون‬ ‫إصابه‬ ‫أو‬ ‫حالة‬ ‫اي‬ ‫وجود‬ ‫عند‬
‫الهواء‬ ‫مجرى‬ ‫بفتح‬ ‫تقوم‬ ‫فإنك‬ ‫اإلغماء‬
‫تقوم‬‫النبض‬ ‫كان‬ ‫فإذا‬ ‫غائب‬ ‫أم‬ ‫موجود‬ ‫هو‬ ‫هل‬ ‫النبض‬ ‫بتحسس‬
‫النبض‬ ‫كان‬ ‫اذا‬ ‫إما‬ ‫القلبي‬ ‫األنعاش‬ ‫لعمل‬ ‫داعي‬ ‫ال‬ ‫يعني‬ ‫هذا‬ ‫موجود‬
‫كالتالي‬ ‫القلبي‬ ‫بإلنعاش‬ ‫القيام‬ ‫علينا‬ ‫فيجب‬ ‫موجود‬ ‫غير‬
:‫للخلف‬ ‫الرأس‬ ‫ودفع‬ ‫الذقن‬ ‫برفع‬ ‫الهواء‬ ‫مجرى‬ ‫افتح‬

15. In essence, cardio (heart) pulmonary (lung)
resuscitation (revive, revitalize) serves as an
artificial heartbeat and an artificial respirator.
• CPR may not save the victim even when
performed properly, but if started within 4 minute
of cardiac arrest and defibrillation is provided
within 10 minutes, a person has a 40% chance
of survival.

16. EQUIPMENTS
• A hard flat surface.
• No additional equipment is
necessary but in hospital setting,
an emergency (crash) cart with
defibrillator and cardiac monitor
should be brought to the bedside. A
crash cart contains:
• Airway equipment.
• Suction equipment.
• Intravenous equipment.
• Laboratory tubes and syringes.
• Pre packed medication for
advanced life support.
‫المستلزمات‬
‫لتدليك‬ ‫صلب‬ ‫سطح‬
‫فوقه‬ ‫المريض‬ ‫قلب‬
‫هوائي‬ ‫قصبه‬ ‫أنبوبة‬‫ه‬
‫كهربيه‬ ‫صدمه‬ ‫جهاز‬

17. StepsPhases
C= circulation
A= Airway
B= Breathing
Basic life supportPhase-1
D= Drugs
E= ECG
F= fibrillation
Advance cardiac life
support
Phase-2
Post resuscitation careProlonged life
support
Phase-3
PHASES OF THE CARDIO PULMONARY
RESUSCITATION:

18. What is basic life support (BLS)?
It is life support without the use of special
equipment.
• What is Advanced Life Support (ACLS)?
It is life support with the use of special
equipment (eg. Airway, endotracheal tube,
defibrillator).

19. CHAIN OF SURVIVAL

20. 1) EARLY RECOGNITION
Assessment is of crucial
importance. It includes :
1) Unresponsiveness
• Check the victim for a response.
• Shake shoulders gently
• Ask “Are you all right?’’
‫ه‬ ‫تشخيص‬ ‫كيفية‬‫ل‬
‫ال‬ ‫أم‬ ‫متوقف‬ ‫القلب‬

21. ‫ال‬ ‫أم‬ ‫متوقف‬ ‫القلب‬ ‫هل‬ ‫تشخيص‬ ‫كيفية‬
2) No breathing or no normal breathing (i.e.,
only gasping)

22. 3) No pulse felt within 10 seconds.

23. 2) CPR Sequence
A Change From A-B-C to C-A-B

24. (A) Chest compressions (cardiac massage)
The human brain cannot survive more than
3 minutes with lack of circulation. So chest
compressions must be started immediately
for any patient with absent central pulsations.
‫بسرعه‬ ‫التدليك‬ ‫يبدأ‬ ‫أن‬ ‫يجب‬.‫مر‬ ‫لو‬3،‫متوقف‬ ‫والقلب‬ ‫دقائق‬
‫يتلف‬ ‫المخ‬

25. TECHNIQUE OF CHEST COMPRESSION
- Pt must be placed on a hard surface (wooden
board).
- The palm of one hand is placed in the
concavity of the lower half of the sternum 2
fingers above the xiphoid process. (AVOID
xiphisternal junction → fracture & injury).
‫اليدين‬ ‫وضع‬ ‫كيفية‬
‫التدليك‬ ‫وكيفية‬

26. The other hand is placed over the
hand on the sternum.
• Shoulders should be positioned
directly over the hands with the
elbows locked straight and arms
extended. Use your upper body
weight to compress.
• Sternum must be depressed at
least 5 cm in adults, and 2-4 cm in
children, 1-2 cm in infants .
‫اليدين‬ ‫وضع‬ ‫كيفية‬
‫التدليك‬ ‫وكيفية‬

27. PUSH HARD AND PUSH FAST

28. Must be performed at a rate of 100-120/min
• During CPR the ratio of chest compressions
to ventilation should be as follows:
• Single rescuer = 30:2
• In the presence of 2 rescuers chest
compressions must not be interrupted
for ventilation
‫بمعدل‬ ‫التدليك‬100‫الدقيقه‬ ‫فى‬ ‫مره‬
‫كل‬30‫مرتين‬ ‫تنفس‬ ‫عمل‬ ‫يعقبها‬ ‫مره‬

29. 30
2

30. Chest compressions must be continued for 2 minutes
before reassessment of cardiac rhythm.
► (2 minutes = equivalent to 5 cycles 30:2).
► Golden rules:
• Ensure high quality chest compressions: rate, depth,
recoil.
• Plan actions before interrupting CPR.
• MINIMIZE interruption of chest compressions.
• Early defibrillation of shockable rhythm.
‫النب‬ ‫على‬ ‫الكشف‬ ‫إعادة‬ ‫قبل‬ ‫دقيقتين‬ ‫القلب‬ ‫تدليك‬ ‫يستمر‬ ‫أن‬ ‫يجب‬‫ض‬

31. Assessment of the adequacy of
chest compressions:
• Systolic BP: 60-80 mmHg
• Diastolic BP: > 40 mmHg
• COP = 30% of normal
‫التدليك‬ ‫نجاح‬ ‫تقييم‬

32. PROBLEMS AND
COMPLICATIONS OF CHEST
COMPRESSIONS
• 1. RIB FRACTURES
• 2. FRACTURE STERNUM
• 3. RIB SEPARATION
• 4. PNEUMOTHORAX
• 5. HEMOTHORAX
• 6. LUNG CONTUSIONS
• 7. LIVER LACERATIONS
• 8. FAT EMBOLI
• 9. HIV, HEPATITIS
• 10.INFECTIONS
MANAGE ACCORDINGLY BUT CONTINUE CPR
‫الصدر‬ ‫على‬ ‫الضغط‬ ‫مضاعفات‬
‫القلب‬ ‫وتدليك‬

33. Airway
►Loss of consciousness often results in
airway obstruction due to loss of tone in
the muscles of the airway and falling back
of the tongue.
CLEAR THE AIRWAY
‫الهواء‬ ‫مجرى‬ ‫فتح‬

34. (A) Basic techniques for airway patency:
1) Head tilt, chin lift: one hand is placed on the
forehead and the other on the chin the head is
tilted upwards to cause anterior displacement of
the tongue.
‫الهواء‬ ‫مجرى‬ ‫فتح‬

35. 2) Jaw thrust:

36. 3) Finger sweep: Sweep out foreign body in the
mouth by index finger (in unconscious pt only. This
is NOT advised in a conscious or convulsing patient).

37. Heimlich manoeuvre: if the pt is conscious or the foreign body cannot
be removed by a finger sweep. It is done while the pt is standing up or
lying down. This is a subdiaphragmatic abdominal thrust that elevates
the diaphragm expelling a blast of air from the lungs that displaces the
foreign body. In infants his can be done by a series of blows on he back
and chest thrusts.

38. Breathing: Breathe for the person
Rescue breathing can be mouth-to-mouth
breathing or mouth-to-nose breathing if the
mouth is seriously injured or can't be opened.
• With the airway open (using the head-tilt, chin-
lift maneuver), pinch the nostrils shut for mouth-
to mouth breathing and cover the person's mouth
with yours, making a seal.
‫بالفم‬ ‫التنفس‬ ‫عمل‬ ‫كيفية‬
‫الحياه‬ ‫قبلة‬

39. (A) Basic techniques include:
1) Mouth to mouth breathing: with the airway
held open, pinch the nostrils closed, take a
deep breath and seal your lips over he
patients mouth. Blow steadily into the
patients mouth watching the chest rise as if
the patient was taking a deep breath.
‫بالفم‬ ‫التنفس‬ ‫عمل‬ ‫كيفية‬
‫الحياه‬ ‫قبلة‬

40. 2) Mouth to nose breathing: seal the mouth
shut and breathe steadily though the nose.
3) Mouth to mouth and nose: is used in
infants and small children.

41. Assessment of restoration of
breathing and circulation
Contraction of pupil
Improved color of the skin
Free movement of the chest wall
Swallowing attempts
Struggling movements
‫الحياه‬ ‫عودة‬ ‫عالمات‬

42. Signs of restored ventilation
and circulation
include:
• Struggling movements
• Improved color
• Return of or strong pulse
• Return of systemic blood
pressure
‫الحياه‬ ‫عودة‬ ‫عالمات‬

43. When to terminate BLS
• Pulse and respiration returns
• Emergency medical help
arrives
• Physician declared patient is
deceased
• In a non health setting
,another indication
to stop BLS would be that the
rescuer was exhausted and
physically unable to
continue to perform BLS.
‫إستك‬ ‫عن‬ ‫تتوقف‬ ‫متى‬‫مال‬
‫اإلنعاش‬

44. ADVANCED LIFE SUPPORT
• ALS includes:
• Circulation by cardiac massage
• Airway management by equipments
• Breathing by advanced techniques
• Defibrillation by manual defibrillator
• Drugs.

45. CHEST COMPRESSION
‫القلب‬ ‫تدليك‬

46. ►Expired air contains 16% O2 so
supplemental 100% O2 should be used as soon
as possible.
►Successful breathing is achieved by delivery
of a tidal volume of 800-1200 ml in adults at a
rate of 10-12 breaths/min in adults.
(B) Advanced techniques include:
►1) Self-inflating resuscitation bag (Ambu
bag)
►2) Mechanical ventilator in OR or in ICU

47. 3) DEFIBRILLATION
• Defibrillation consists of delivering a
therapeutic dose of electrical energy to the
affected heart with a device called a
defibrillator

48. Summary of Key Issues and Major Changes
• Refinements have been made to
recommendations for immediate recognition and
activation of the emergency response system based
on signs of unresponsiveness, as well as
initiation of CPR if the victim is unresponsive with
no breathing or no normal breathing (i.e victim is
only gasping).
“Look, listen, and feel for breathing” has
been removed from the algorithm.
• Continued emphasis has been placed on
high-quality CPR

49. Managing the Cardiac Arrest Team
► During cardiac arrest the team leader should
allocate and assign the various roles and tasks to
the team members.
Assign one person for each of the following roles:
– Airway management & ventilation (Eg. bag &
mask.
Intubation).
– Chest compressions
– IV drug administration.
– Defibrillation (DC shock)
– Timing and documentation.

50. • The person responsible for the airway may take
turns with the person responsible for chest
compressions in order to diminish fatigue &
exhaustion.
• ► It is also the responsibility of the team leader to
use the 2-minute periods of chest compressions to
plan tasks, give orders and eliminate & exclude/
correct the reversible causes of cardiac arrest.