CARDIOPULMONARY RESUSCITATION

A LIFE SAVING TECHNIQUE

1. SEMINAR ON cpr BY TH. LANGLEN CHANU MSc. nursing 1 st year The oxford college of nursing

2. terminologies Bls Acls Defebrillation Aed Ventilation Ventricular fibrillation. Ventricular tachycardia Asystole and pea

3. definition Cardio pulmonary resuscitation is a technique of basic life support for oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilator action.

4. Historical review 5ooo 3ooobc 874 1901 1946 1960 1980

5. Purpose of cpr To maintain blood circulation (c) To maintain an open and clear airway (a) To maintain by artificial breathing (b) To save the life of the Patient To provide basic life support till medical and advanced life support arrives

6. Indication of cpr a) cardiac arrest : Ventricular fibrillation Ventricular tachycardia (pulseless) Asystole Pulseless electrical activity B) respiratory arrest Drowning Stroke Foreign body in throat Smoke inhalation Drug overdose Suffocation

7. High quality cpr (aha 2015) Start compression within 10 second Push hard push fast: compress at a rate of 100-120/min with a depth of at least 5cm (2inch) while avoiding excessive chest compression depths greater than 2.4inch for an adult, approx 5cm (2inch) for children and 4cm (1 and half inch) for infants. Allow complete chest recoil , do not lean on after each compression.

8. Contd …. Minimize interruption Give effective breath Avoid excessive ventilation

9. Bls (basic life support) Basic first aid to treat cardiopulmonary arrest C---a---b (CHEST COMPRESSION,AIRWAY AND BREATHING) CHAIN OF SURVIVAL (AMERICAN HEART ASSOCIATION) ADULT PEDIATRIC

10. ADULT CHAIN OF SURVIVAL

11. PEDIATRIC CHAIN OF SURVIVAL

12. BLS STEP FOR ADULT (AHA) Step 1. Assessment and scene safety Make sure the scene is safe for the rescuer and the victim Tap the victim’s shoulder and shout, “are you all right”? Check to see if the victim is breathing .

13. STEP 2. ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET AN aed If The Rescuer Is Alone And Find An Unresponsive Victim Not Breathing, Shout For Help. If No One Responds, Activate The Emergency Response System, Get An AED If Available And The Return To The Victim

14. STEP 3. PULSE CHECK. Palpate The Carotid Pulse If You Do Not Definitely Feel A Pulse Within 10 Second ( For At Least 5 But Not More Than 10sec), Start Chest Compression

15. STEP 4: CHEST COMPRESSION AND BREATH Compression Ventilation Ratio 30:2 Put The Heel Of One Hand On The Centre Of The Victim’s Chest On The Lower Half Of The Breastbone And The Heel Of The Other Hand On Top Of The First Hand. Straighten Your Arms Ans Position, Your Shoulders Directly Over Your Hand. Push Hard And Fast (1oo-120/Min At A Depth Of Atleast 5cm (2inch) While Avoiding Excessive Chest Compression Depths Greater Than 2.4inch For An Adult.

16. CONTD … 5 . Opening The Airway For Breath: Head Tilt Chin Lift:

17. JAW THRUST:

18. 6.WAY OF DELIVERING BREATH: MOUTH TO MOUTH BREATHING MOUTH TO BARRIER DEVICE BREATHING: MOUTH TO MASK ( 1 RESCUER) BAG MASK DEVICE ( 2 RESCUER)

19. STEP 5. AED/ DEFEBRILLATOR. POWEr ON THE AED ATTACH AED PADS TO THE VICTIMS BARE CHEST PLACE ONE AED PAD ON THE VICTIMS UPPER RIGHT CHEST (DIRECTLY BELOW THE COLLAR BONE) OTHER PAD TO THE SIDE OF THE LEFTT NIPPLE, A FEW CENTIMITRES BELOW THE ARMPIT

20. CONTD… “CLEAR” THE VICTIM AND ANALYSE THE RHYTHM. IF THE AED ADVISE A SHOCK, IT WILL TELL YOU TO CLEAR THE VICTIM AND PRESS THE “SHOCK” BUTTON. IF NO SHOCK IS NEEDED OR AFTER ANY SHOCK DELIVERY, IMMEDIATELY RESUME CPR , STARTING WITH CHEST COMPRESSION. AFTER 5 CYCLES OR ABOUT 2MIN OF CPR, THE AED WILL PROMPT YOU TO REPEAT STEPS 3 AND 4 IF NO ADVISED SHOCK IMMEDIATELY RESTART CPR BEGINNING WITH CHEST COMPRESSION.

21. BLS FOR CHILDREN FROM 1YR OF AGE TO PUBERTY: PULSE– CAROTID OR FEMORAL PULSE. COMPRESSION VENTILATION RATIO 1 RESCUER – 30: 2; AND 2 RESCUER– 15:2 COMPRSSION DEPTH: APPROXIMATELY 5CM COMPRESSION TECHNIQUE MAY USE 1 OR 2 HANDED CHEST COMPRESSION.

22. CONTD… WHEN TO ACTIVATE EMERGENCY RESPONSE SYSTEM : IF YOU DID NOT WITNESS THE ARREST AND ARE ALONE, PROVIDE 2MIN OF CPR BEFORE LEAVING THE CHILD TO ACTIVATE ERS AND GET THE AED. IF THE ARREST IS SUDDEN AND WITNESSED LEAVE THE CHILD TO ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET THE AED.

23. FOR INFANT: PULSE: BRACHIAL ARTERY TECHNIQUE OF DELIVERING COMPRESSION SINGLE RESCUER: TWO FINGER TWO RESCUER : THUMB ENCIRCLING HAND TECHNIQUE. COMPRESSION VENTILATION RATIO 1 RESCUER – 30: 2; AND 2 RESCUER– 15:2 COMPRSSION DEPTH: APPROXIMATELY 4CM

24. ACLS ( ADVANCED CARDIAC LIFE SUPPORT) ACLS IS DONE AFTER THE COMPLETION OF BLS SURVEY. ASSESSMENT, INTERVENTION WTH CARDIAC ARREST, DYSRHYTYMIA. SIX MEMBER ARE COMPULSORY TO PERFORM THE INTERVENTION TEAM MEMBER, AIRWAY ( AT HEAD END), COMPRESSOR, IV/ IO MEDICINE, OBSERVER/ RECORDER, MONITOR/ DEFEBRILLATOR.

25. ASSESSMENT: HISTORY TAKING PHYSICAL ASESSMENT 12 LEAD ELECTROGARDIOGRAM. CARDIAC ENZYM ANALYSIS: LDH, CREATININEKINASE, TRANSAMINASE, TROP I

26. AIRWAY MANAGEMENT MAINTAIN AIRWAY PATENCY IN UNCONCIOUS PATIENT BY USE OF HEAD TILT CHIN LIFT. USE ADVANCED AIRWAY MANAGEMENT IF NEEDED IF USING ADVANCED AIRAWAY DEVICES: CONFIRM PROPER INTEGRITY OF CPR AND VENTILATION. PHYSICAL EXAMINATION QUANTITATIVE WAVEFORM CAPNOGRAPHY. SECURE THE DEVICE TO PREVENT DISLODGEMENT.

27. BREATHING GIVE SUPPLEMENTARY OXYGEN WHEN INDICATED. MONITOR THE ADEQUACY OF VENTILATION AND OXYGENATION AVOID EXCESSIVE VENTILATION

28. CIRCULATION MONITOR CPR QUALITY QUANTITATIVE WAVEFORM CAPNOGRAPHY ( IF PETCO2 < 10MM OF HG TO IMPROVE THE QUALITY OF CPR) INTRA ARTERIAL PRESSURE (IF DIASTOLIC PRESSURE IS < 20MM OF HG, ATTEMPT TO IMPROVE CPR) ATTACH MONITOR/ DEFEBRILATTOR FOR ARRYTHMIAS DEFEBRILLATOR OBTAIN IV/ IO ACCESS GIVE IV/ IO FLUIDS

29. DIFFERENTIAL DIAGNOSIS: 5T S AND 5H S HYPOVOLEMIA HYPOXIA HYDROGEN ION HYPO/ HYPERKALEMIA HYPOTHERMIA TENSION PNEUMOYHORAX TEMPONADE CARDIAC TOXIN THROMBOSIS ,PULMONARY THROMBOSIS, CORONARY

30. COMPLICATION OF CPR STERNAL AND RIB FRACTURE PNEUMOTHORAX HAEMOTHORAX INJURY TO HEART AND GREAT VESSEL ORGAN LACERATION ASPIRATION OF STOMACH NECK HYPER EXTENSION VERTEBRAL FRAGMENT RUPTURED STOMACH GASTRIC DISTENTION

31. NURSING MANAGEMENT

32. THANK YOU