CARDIOPULMONARY

RESUSCITATION Presenter : Ms Tarika Sharma Nursing Tutor MMCON, MMU Ambala, HR

IntroductionAccording to recent statistics sudden cardiac arrest is becoming one of the leading causes of death. Once the heart ceases to function, a healthy human brain may survive without oxygen for up to 4 minutes without suffering any permanent damage. Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes.

Introduction… It is during those critical minutes that CPR (Cardio

Pulmonary Resuscitation) can provide oxygenated blood

to the victim's brain and the heart, dramatically increasing

his chance of survival. And if properly instructed, almost

anyone can learn and perform CPR.

CARDIO PULMONARY RESUSCITATION

Cardiopulmonary resuscitation (CPR) is an emergency technique used when a person’s heart has stopped beating and breathing has stopped.It is a combination of rescue breathing and chest compression delivered to victims thought to be in cardiac arrest. 

PURPOSE

To maintain the blood circulation (C).To maintain an open and clear airway (A).To maintain breathing by artificial ventilation (B).To save life of the patient.To provide basic life support till medical and Advanced Life Support arrives.To provide a flow of oxygenated blood to the brain

Indications for CPR Sudden Cardiac arrest

Unconsciousness

No respirations or brief irregular, 'gasping' breaths

No Pulse

Contraindications Do-not-resuscitate (DNR) order

A person’s desire to not be resuscitated in the event of cardiac arrest.

If a clinician justifiably feels that the intervention would be medically futile.

Cardiac ArrestCardiac arrest is a sudden stop in effective blood circulation due to failure of the heart to contract effectively or at all.Also known as cardiopulmonary arrest or circulatory arrest.It is a medical emergency

CAUSES OF CARDIAC ARRESTCARDIAC CAUSES

MI Heart failureDysrythmiaCardiac tamponade

PULMONARY CAUSES

Respiratory failureAirway obstructionARDSPneumothoraxPulmonary embolus

CAUSES OF CARDIAC ARREST…ELECTROLYTE IMBALANCE

Hyper kalemiaHyper/hypo calcemia

PROCEDURESPA catheterisationCardiac catheterisationSurgery

OTHERSDrug toxicity

CLASSIFICATION Basic life support

Advanced cardiac life support

ADULT BASIC LIFE SUPPORT

What is BLS?Maintenance of airway

Support of breathing & circulation

Without using equipment other than a simple airway device or protective shield.

Chains of Survival

Chains of survival…

Adult Basic Life Support and CPR Quality

Lay Rescuer CPR (Trained or untrained)Health Care Provider BLS

(Rescuer – all, regardless of training, should provide

chest compression)

COMPONENTS OF BLS1) Ensure safety2) Recognition of cardiac arrest3) Activation Emergency Response System4) Chest compressions5) Check airway and ventilate

SIMPLIFIED ADULT –BLS ALGORITHM (AHA 2015)

ENSURE SAFETY Safety Of Self

Safety Of client

Movement of a trauma victim – only when absolutely necessary

[unstable cervical spine – injured spinal cord] Make sure the environment is safe for rescuers and victim

Recognition of cardiac arrest

Check for responsiveness(Ask the person “are you all right?”Tap and shout)No breathing or only gasping (ie, no normal breathing)No definite pulse felt within 10 seconds(Breathing and pulse check can be performed simultaneously in less than 10 seconds)

Activation Of Emergency Response System

If you are alone with no mobile phone, leave the victim to activate the emergency response system and get

the AED before beginning CPR

Otherwise, send someone and begin CPR immediately; use the AED as soon as it is available

Compression ventilationratio without advanced airway

1 or 2 rescuers30:2

Compression ventilation ratio with advanced airwayContinuous compressions at a rate of 100-120/minGive 1 breath every 6 seconds (10 breaths/min)

Compression rate: 100-120/minCompression depth: At least 2 inches (5 cm), should be no more than 2.4 inches (6 cm).Hand placement: 2 hands on the lower half of the breastbone (sternum)Chest recoil: Allow full recoil of chest after each compression; do not lean on the chest after each compressionMinimizing interruptions: Limit interruptions in chest compressions to less than 10 seconds

Circulation AirwayBreathing

1.Circulation

If pulse is not definitely felt within 10 seconds, proceed with chest compressions

Check pulse

Must be supine on a firm flat surface for CPR to be effectiveVictim lying facing down – logroll the victim

Cervical spine stabilization

Use cervical collar if available

Any hard objects that restrict neck movement

Position of Victim

Kneel beside victim’s chest or stand beside bedHeel of one hand on inter-mammary line (which is the lower half of the sternum)Heel of other hand on top of the first so that the hands are overlapped and

parallelLock elbows

Position of Rescuer

Rhythmic applications of pressure over the lower half of the sternum.

Chest compression

CHEST COMPRESSION TECHNIQUE

Chest compression… Victim should lie supine on a hard surface. Place the heel of the hand on the sternum in the centre

(middle) of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.

Chest compression…

The rescuer should compress the lower half of the victim’s sternum in the centre (middle) of the chest, between the nipples.

Depress the sternum approximately 2 to 2.4 inches. Allow complete chest recoil.

How do they work?Increase intrathoracic pressure and directly compress heartCreates a SBP peaks of 60 – 80 mmHgMAP in carotid artery < 40 mmHgDeliver a small but critical amount of O2 and substrate to brain & myocardium

Rescuer fatigue – Decreased rate , depth, incomplete recoil - switch every 2 min

Characteristics Of Good Compression

“Push hard Push fast”: push at a rate of 100 -120 minute.Compression depth- 2 inches (5cm)- 2.4 inches (6cm) Release completely to allow the chest to fully recoil. Minimize interruptions in chest compressions.A compression-ventilation ratio of 30:2 isrecommended.

Characteristics Of Good Compression …

Perform 30 chest compressions at a rate of 100 to 120 compressions per minute.

Your shoulders should be located over the victim's chest.

Your arms should be straight. Use your body weight to perform chest compressions

Characteristics Of Good Compression…Keep constant contact between the heel of your compression hand and the skin of the victim's chest. Do not rock back and forth as you do chest compressions.    Do not bounce your hands up and down on the victim's chest.NEVER use the PALM of your hand,use the HEEL of your hand. 

CHEST COMPRESSIONS When 2 or more rescuers available,

switch the compressor about every 2 minutes (or after 5 cycles of compressions and ventilations at a ratio of 30:2).Accomplish this switch in ≤5 seconds.

Advanced airway and 2 rescuers-continuous chest compressions at a rate of 100 to 120/min without pauses for ventilation. The rescuer delivering ventilation provides 8 to 10 breaths per minute.

Lay rescuers should continue CPR until an AED arrives

2.Airway

OPEN THE AIR WAYHead tilt – chin lift

Used by lay rescuers and health care providersRecommended if no evidence of spinal cord injury

Jaw thrust maneuverJaw thrust method

In trauma patients where we suspect spinal cord injuryBy trained rescuer only

Jaw thrust maneuver

Look in the mouth Do a jaw lift and look in the mouth.If you see food or a foreignobject ,follow up with a finger sweepNever do a blind finger sweep.You should be able to see an object in the mouth before you perform a finger sweep

3.BREATHING

Check breathing

After the first set of chest compressions, the airway is opened and the rescuer delivers 2 breaths.

How rescue breathing works ….Rescue breaths contain 16% oxygen

Early arrest – O2 content of blood remains normal, O2 delivery to organs is limited more by reduced blood flow ( C.O.) than reduced O2.Prolonged/Asphyxial arrest

- reduced O2 content also there

GIVING RESCUE BREATHS Deliver each rescue breath over 1 second. Give a sufficient tidal volume to produce visible chest rise (500-600ml).Avoid rapid or forceful breaths. When an advanced airway is in place during 2-person CPR, ventilate at a rate of 10 breaths per min.

Rescue breathing

Compression: ventilation ratio - 30 : 2Minimal pauses in between chest compressionsIf no chest rise , re-position head & ensure tight seal

Rescue breathingDuring CPR , C.O. is 25 – 33% of normal so oxygen uptake from the lungs and CO2 delivery to the lungs are also reduced.Tidal vol : 6-7 ml/kg = 500-600 ml [ 1-2 L bag]

Risk of:-Reduced venous return to heart.-Gastric inflation – regurgitation , aspiration, splinting of lung

by diaphragm.

METHODS Mouth-to-Mouth Rescue BreathingMouth-to–Barrier Device BreathingMouth-to-Nose and Mouth-to-Stoma VentilationVentilation With Bag and MaskVentilation With an Advanced Airway

METHODS OF VENTILLATION

Mouth-to-mouth rescue breathingOpen the victims air wayPinch the victims nose and create an airtight mouth to mouth seal and give 1 breath over 1 second by taking a regular breathIf victims chest does not rise do head tilt chin lift and give 2nd breath

Mouth-to-barrier device

Use barrier devices like face shields, masks etc

Mouth-to-Nose and Mouth-to-Stoma VentilationIf impossible to ventilate through victims mouthIf mouth cannot be openedIf mouth to mouth seal is difficult to achieve

VENTILLATION WITH BAG AND MASK

Can provide ventilation with room air or oxygenCan provide positive pressure ventilation of sufficient tidal volumeMay produce gastric inflation and its complicationsUse an adult (1 to 2 L) bag to deliver approximately 600 ml tidal volume

Recovery position The recovery position is used for unresponsive adult victims who have normal breathing and effective circulation.

Designed to maintain a patent airway and reduce the risk of airway obstruction and aspiration.

The victim is placed on his or her side with the lower arm in front of the body. Adjust the top leg so that both the hip and knee are bent at right angles. Gently tilt the head back to keep the airway open

1) Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost

2) Bring the far arm across the chest, and hold the back of the hand against the victim’s cheek nearest to you.

4)Keep the head tilted to keep the airway open. Keep the face downward to allow fluids to go out

3)With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.

COMPLICATIONS Spinal cord Injury Internal organ damage Vomiting Risk for aspiration Gastric distension Punctured lungs, lacerated liver, fractured ribs and sternum--

caused by chest compressions Disease transmission, including Influenza, Staph infection,

and TB etc- due to inadequate or no protective mask.

CPR CONSIDERATIONS FOR OLDER CLIENT

Assess for fractured sternum after CPRBe certain the health care team implements the patient’s desire for Do Not Resusitate or Do not intubate ordersConsider family presenceKeep in mind the effect of medications due to delayed clearance & altered metabolic response

 

Difference between BLS & ACLS

SUMMARYIntroductionDefinitionIndicationsClassificationAdult BLS

ConclusionIn the years since the publication of the 2005 AHA Guidelines for CPR and ECC, many resuscitation systems and communities have documented improved survival for victims of cardiac arrest. However, too few victims of cardiac arrest receive bystander CPR. We know that CPR quality must be high and that victims require excellent post–cardiac arrest care by organized teams with members who function well together. Education and frequent refresher training are likely the keys to improving resuscitation performance.

Thank

you…