Prepared by:Sangita shrestha

Manisha dhungana

Cardiopulmonary Resuscitation(CPR)

Introduction

Life saving procedure given to those who develop cardiopulmonary arrest.

Defined as chest compression and assisted ventilation.

Time interval between collapse to initiation of CPR and collapse to defibrillation is most important.

Consists of Basic life support and Advanced life support.

Definition

CPR is a basic emergency procedure for life support consisting of artificial respiration and manual external cardiac massage.

Purposes

To establish effective ventilation and circulation.

To prevent irreversible brain damage from anoxia.

To decrease immature mortality rate of patient in hospital.

Indications

1.Respiratory arrest resulting from drowning stroke foreign body drug overdose smoke inhalation suffocation myocardial infraction coma; of any cause leading to

airway obstruction.

Cont..

2.Cardiac arrestSudden and complete loss of cardiac

function.Sudden collapse with loss of consciousness.Pulse absent(femoral and carotid).No respiration.NOTE: If CPR is not given within 4-6 minutes,

death may occur.

Types of CPR

A. Basic life support(BLS)B. Advance life support(ALS)

BASIC LIFE SUPPORT

It is the sequences of procedures preformed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest.

Chest compressions and pulmonary ventilation performed by anyone who knows How to do it, anywhere, immediately, without any other equipment.

Aim

To ensure open airway and adequate ventilation.

To maintain circulation until help comes and definite treatment with advanced life support can be administered.

ADVANCE LIFE SUPPORT

Airway secured with advanced technology,Breathing is maintained with some means of

breathing apparatus, andCirculation is maintained by BLS along with: - IV access

- Defibrillator, and - Appropriate drugs.

Procedure of CPR

Check for responsiveness of victim. If you suspect that victim has sustained spinal or neck injury , do not shake or move him. Otherwise shake victim gently and shout ‘Are you okay?’ to see if there is any response. If there is no response no breathing quickly call for emergency help and follow following steps:

Circulation assessment - Establish presence or absence of carotid pulse by

placing two fingertips on his carotid artery for 5 to 10 secs.

- Start chest compression immediately if the carotid pulse is absent or questionable.

Procedure:

Cont…

1.Chest compression: The rhythmic application of pressure over the lower half of the sternum.

Kneel as close to side of the victim’s chest as possible.

Place the heel of one hand in the center of victim’s chest between the nipples.

Place the other hand on top of the first one and interlock the finger and the finger’s of both hands directed away from rescuer.

Cont…

In children it is done with one hand where as in infants it is done with two fingers(index and middle finger)

Compression rate should be 100 compression/minute with a compression depth of 1.5-2” (approx. 4-5 cm)

Allow the chest return to its normal position completely after each compression with equal compression and relaxations.

Cont…

Assess after 1 minute , if circulation present(heart beat returns back) stop compressions immediately but continue rescue breathing and check circulation in each minute.

If the victim remains unresponsive , check the airway.

Cont…2.Assess Airway: Assess for any visible

obstructions in the airway. Clear airway by removing

any loose obstruction, (mucus, blood, foreign body) from mouth and pharynx.

In case of unconscious victim, tongue is the most common cause of airway obstruction.

If the victim is still not breathing, then open airway by head tilt and chin lift or jaw thrust.

Cont… Note : The jaw thrust is a technique used on

patients with a suspected spinal injury and is used on a supine patient.

If the victim is still not breathing on in his own after the airway has been you will have to assist him breathing.

Cont…

3.Assess breathing: Look, listen, feel. Place ear

over the victim’s mouth and nose, looking toward the victim’s chest and stomach. Watch to see if the victim’s chest is raising.

Pinch the nostrils closed with the thumb and index fingers of the hand that is on the forehead.

Take a deep breath, open mouth wide, place it outside of the victim’s mouth making a tight seal.

Cont…

Inflate the victim’s lung by 2 full breaths each breath over 1 sec allowing the victim’s lungs to relax.

If resistance is experienced, then recheck airways.

Note: • Avoid rapid or forceful breath.• Rate:10-12 breaths/min.

Continue the cycle of 30 chest compressions and 2 rescue breaths until spontaneous circulation is returned or until the arrival of medical help.

Guidelines for termination of resuscitation:

Return of spontaneous circulation.Arrival of arrest team or medical help. If the rescuer becomes exhausted.When death is confirmed.

Points to remember:

Assess the victim (look, listen, feel) and if not breathing call for help.

Compression should be smooth, regular and uninterrupted.

The pressure on the chest should be completely released after each compression, although the palm of the hand remains in contact with the chest wall.

Cont…

The xiphoid process should not compressed because of the danger of lacerating the liver.

Immediately start cardiopulmonary resuscitation.

The victim should be stabilized before transportation to a more convenient site.

The presence of a palpable carotid pulse and constriction of pupils are evidence of effective circulation and oxygenated blood.

All staff is to be skillful at CPR.

Cont…

All CPR equipment is to be checked at the beginning of each shift.

Ratio of cardiac compression to ventilation:30:2 Compression rate =100 compression/minute Compression depth

Adult =5cm Child =4cm Neonate =3cm

References

1. Giri M, Sharma P, Essentials of Fundamentals of Nursing, 1st edition, Pp:385-386.

2. Pathak S, Devkota R, A Text Book of Fundamentals of Nursing, 2010 edition, Pp:333-337.

3. Kozier and Erb’s, Fundamentals of Nursing, 8th edition, Pp:1419-1420.

4. Brunner & suddharth’s Textbook of Medical- Surgical Nursing, 12th edition, Pp: 843-845.