Cpr

cardiopulmonary resucitation

1. Prepared by Mr. Shantilal Mewada CPR

2. CPR

3. CARDIOPULMONARY RESUSCITATION INTRODUCTION C = Cardio (heart) P = Pulmonary (lungs) R = Resuscitation (recover) Cardiopulmonary resuscitation is an emergency procedure performed in an effort to manually pressure intact brain function until further measure are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing.

4. KEY WORDS Cardiac arrest- is defined as abrupt cessation of cardiac function. Respiratory arrest- is the cessation of normal breathing due to failure of the lung to function effectively. Basic life support (BLS) - It is support without the use of special equipment. Advance cardiovascular life support (ACLS)- It is life support with the use of special equipment

5. DEFINITION DEFINITION - Cardiopulmonary resuscitation is a procedure to support and maintain breathing and circulation for a person who stopped breathing (respiratory distress) and or whose heart has stopped. Or Cardiopulmonary resuscitation is the technique used to restore and maintain the circulation and ventilation of the lung following cardiopulmonary arrest.

6. ANATOMY AND PHYSIOLOGY OF CARDIOVASCULAR & RESPIRATORY SYSTEM The cardiovascular system consists of the heart, which is an anatomical pump, with arteries, veins, and capillaries that traverse the whole human body carrying blood. The blood contains oxygen, nutrients, wastes, and immune and other functional cells that help provide for homeostasis and basic functions of human cells and organs.   The respiratory system includes the lungs as well as other organs that help to get oxygen into the blood and carbon dioxide out of the blood. The conducting zone of the respiratory system carries oxygen into the lungs and carbon dioxide out of the lungs. The respiratory zone is where oxygen and carbon dioxide move into and out of the blood.

7. PURPOSES The main purpose of CPR are:- To save life of the patient. To maintain blood circulation by external cardiac massage. To maintain an open and clear airway. To maintain breathing by external ventilation. To provide basic life support till medical and advance life support arrives.

8. INDICATIONS -CPR should be performed immediately on any person who has become unconsciousness and is found to be pulse less Cardiac arrest- ventricular fibrillation ventricular tachycardia Asystole Pulse less electrical activity

9. Respiratory arrest. Drowning Stroke Foreign body in throat Smoke inhalation Drug overdose Suffocation Coma Epiglottis paralysis

10. CONTRAINDICATION:- The only absolute contraindication to CPR is to DO-NOT-RESUSCITATE (DNR) order or other advanced directive indicating a person’s desires do not resuscitate in the event of cardiac arrest. Principles of CPR-   CPR has three main goals called the C-A-B of CPR. They are- Chest compression Airway management Initiate breathing

11.   AMERICAN HEART ASSOCIATION CPR GUIDELINES:- In 2010 the emergency cardiovascular committee (ECC) of the AHA released the associations newest set of guidelines for CPR. Changes for 2010 include the following – The initial sequence of step is changed from ABC (airway, breathing, circulation) to CAB (chest compression, airway, and breathing) except new born. “LOOK, LISTEN and FEEL” is no longer recommended. Compression depth for adults should be at least 2 inches. The compression rate should be at least 100/ min. Emergency cardiac treatment no longer recommended include routine atropine for pulse less electrical activity (PEA) / Asystole , cricoids pressure (with CPR ) and airway suctioning for all newborns. Post cardiac arrest care is to covered with in a new section .

12. HOSPITAL RESUSCITATION TEAM An organized approach to resuscitation is essential, resuscitation should be conducted by a team made up of trained personnel including nurses, physicians, ECG technician, respiratory therapist, and unlicensed personnel to transport special instrument (e.g. pacemaker, defibrilator’s , special tray sets.) Cardiopulmonary resuscitation is divided into subcategory as following- Basic life support (BLS) Advance cardiovascular life support (ACLS)

13. Articles/ Equipment required for CPR Basic life support It is support without the use of special equipment. It is most basic form can be performed anywhere without the need for specialized equipment .Universal precaution ( glove,mask,gown ) should be taken. However CPR is delivered without such protection in the majority of patients who are resuscitated in the out of hospital setting.   Advance cardiovascular life support (ACLS)- It is life support with the use of special equipment. In the hospital setting or when a paramedic or other advanced provider is present. Advance cardiovascular life support (ACLS) guideline call for a more robust approach to treatment of cardiac arrest including the following-

14. Equipments- A tray containing the following articles- Endotracheal tube of various size(7,7.5,8,8.5) An ambu bag with mask Stylet Magil’s forcep A suction catheter Laryngoscope with different size blade , stethoscope Nasal airway Oral airway Gauze pieces Lubricating jelly Adhesive tape with scissor Local anesthetic Gloves Kidney tray, paper bag Mask of various sizes Local anesthetic drug ( xylocain 2% and 4%) Disposable syringe with needles An intravenous set and a cut down set , cannule

15. Others- Oxygen inhalation Suction point Defibrillator manual and automated external ECG monitoring   Drugs- Cardiac arrest drug-first line for I.V. use Adrenaline 1 mg, Amiodrone 300 mg   I.V. fluids- Glucose, D.N.S., Ringer lactate

16. Procedure- CPR has three main goals called the C-A-B of CPR. They are- Chest compression Airway management Initiate breathing   Position of patient -Supine position Position of hands- The other hand is placed over the hand on the sternum. Shoulders should be positioned directly over the hands with elbow locked straight and arm extended. Use upper body weight to compress.

17. Site of compression -The palm of hand is placed in the concavity of that lower half of the sternum 2 fingers above the xiphoid process. Depth of cardiac compression - Sternum must be depressed at least 5 cm. in adults, 2-4 cm. in children and 1-2 cm. in infants. Push hard and fast. Rate and Ratio of CPR - Chest compression – ventilation 30 : 2

18. S.N Steps Scientific rationale 1. Determine if client is unconscious by shaking client & shouting, “Are you OK?” It confirms that client is unconscious. 2. Activate emergency medical services & call for help. Recent studies confirm that survival is linked to early access to defibrillation from emergency medical system. 3. Place the client in supine position on a hard surface or a hard board. A firm is needed for adequate compression of the heart beneath the sternum. 4. Kneel at the level of victim’s shoulder It allows performance of rescue breathing & chest compression without moving.

19. 5. If client is pulse less ,start decompression Place the middle finger on the notch & index finger on the lower end of the notch. It results in maximal compression of heart between sternum & vertebrae. 6. Place the heel of other hand along the lower half of sternum, next to index fingers. Careful attention to hand placement during cardiac compression prevents fractured ribs & organ trauma. 7. Remove first hand from the notch & place heel of that hand parallel over the hand on the chest. Interlock fingers keeping them off client’s chest. This prevents trauma from pressure on ribs. 8. Extends or interlace fingers but keep fingers off chest. Reduces risk for rib fracture during compression.

20. 9. Lock elbows; maintain arms straight & shoulders directly over hands on sternum. Thrust for each compression is straight down in sternum. 10. Compress chest 3.8 cm- 5 cm More deep compressions cause injury to organs. 11. Compress chest 80-100 times per minute. Perform 15 external cardiac compressions with mnemonic. Faster rate increases blood flow with increased flow to brain & heart. 12. Ventilate lungs with 2 ventilations ( breaths ) 13. Reassess the victim after 4 cycles ( 15 compressions, 2 ventilations each cycle) Determines return of pulses & respiration & need to continue CPR.

21. 14. Open the airway Use a head tilt/ chin lift maneuver Use the modified jaw thrust if a neck injury is suspected. Moving the jaw forward lifts the tongue away from back of throat & opens the airway Jaw thrust maneuver can be accomplished without extending the neck & exacerbating a potential neck injury. 15. Prepare for artificial respiration For mouth to mouth resuscitation pinch victim’s nose & occlude mouth with rescuer’s mouth. For mouth to nose resuscitation keep the victim’s head tilted with one hand on forehead . Forms airtight seal to prevent air from escaping nose. In some victims mouth to nose ventilations can be more effective in cases with mouth injury.

22. 16. Administer artificial respiration For mouth to mouth respiration blow 2 quick breaths into mouth. Adequate time for 2 breaths (1-1.5 seconds per breath) should be allowed to provide good chest expansion & decreased gastric distension. For artificial respiration with AMBU bag, compress the bag fully for 2 breaths. In most adults, volume is 800 ml & is sufficient to make chest rise . Excess of air volume & fast respiratory flow rates leads to pharyngeal pressure which causes air to enter in stomach which leads to gastric distension & causes vomiting. It prevents over inflation of lungs.

23. 17. Observe for rise & fall of chest wall with each respiration. If lungs don’t inflate, reposition the head & neck & check for visible airway obstruction such as vomitus . Ensures that artificial respiration enters lungs. 18. Suction secretions from airway. If suction is unavailable, turn head to one side. Prevents airway obstruction .Turning head allows gravity to drain secretions.

24. 19. If person has not begun moving after 5 cycles then automated external defibrillator (AED) is used. Turn on AED. Apply the conduction jelly over the paddles. Set the voltage as advised. Place the paddles on thorax & release it. Prevents burning of tissue. Release of electrical conduction. 20. If still no movements are there resume compressions & follow AED prompts. To regain patient’s cardio-pulmonary function.

25. Nurses role and responsibilities in CPR Before procedure- No time is lost in explaining the procedure and the environment. If someone is free, can explain in simple language to the relatives and ask them to leave the room to lesson distraction and to provide more space to the rescuer to work. The patients may be shifted to a hard surface or hard board is placed under his thorax. Remove or push aside of clothing, which covered the patient’s chest to observe the cardiac beats. Place the patients back on his back without any pillow. Tight clothing around the neck and chest should be removed. Ensure fresh air in the room by opening window and doors.

26. DURING PROCEDURE- Initiate CPR as required until initial assistance arrive and then assume responsibility for airway management. Maintain airway patency with use of airway adjustment as required (suction, high flow oxygen mask with O 2 or bag valve mask ventilation. Assist with intubation and securing of endotracheal tube. Insert gastric tube and facilitates gastric decompression. Assist with ongoing management of airway patency and adequate ventilation .

27. AFTER PROCEDURE- Continuous vigilance must be ensured by a skilled person for 48-72 hours. Monitor ECG, blood pressure and CVP. Check the oral cavity or jaw position as his/her tongue may fail and obstruct the airway. Temperature is taken every hourly. Inserts Foley’s catheter. Start IV infusion to administer enough fluid in the patients. Record the procedure in nurse’s records.

28. SIGN OF EFFECTIVE RESUSCITATION Constriction of pupils, key sign that the brain is sufficiently oxygenated. Blinking upon stimulation of eyelids. Breathing that begins spontaneously. Assess the movements. Decreased cyanosis.

29. COMPLICATION Sternum injury. Ribs injury. Esophageal & liver injury. Lungs injury. Pleura injury.

30. Summary Cardiopulmonary resuscitation (CPR) is an immediate therapy that may be initiated for cardio respiratory failure. Evidence that an individual is breath and pulse less is sufficient to warrant immediately resuscitation effort. Knowledge of CPR enhances the safety of both rescuer and rescue.

31. Conclusion Cardiopulmonary resuscitation is one of the most important life saving procedure. We as a nurse have important role and in responsibilities during cardiopulmonary resuscitation. We should know whom to give, when and how to perform, how to assist the procedure. And we should update our knowledge with the new guidelines and perform CPR and save individuals precious life.

32. Reference:- Books: Delaune , S.C. & Ladner , P.K. (2006). Fundamental of Nursing-Standards & Practices. (3 rd ed.).United States: Thomson Delmar. Jacob, A., Rekha , R. & Tarachand , J.S. (2010). Clinical Nursing Procedures: The art of Nursing Practice. (2 nd ed.).New Delhi: Jaypee . Kozier , B., Glenora , ERB., Berman, A. & Synder , S.J. (2004). Fundamentals of Nursing : Concepts, Process And Practice. (7 th ed.).UK: Dorling Kindersley. Journal - Gyan , R. (2008). CPR: Creating a new trend with its guidelines, a successful chain of survival. Pondichery Journal Of Nursing. 1(1). 18-21. Linda, M. (2007). The ABCs of CPR again. The American Journal Of Nursing. 107(1) 60-70.