Ppt on CARDIO PULMONARY RESUSCITATION

CPR CARDIO PULMONARY RESUSCITATION

1. CARDIO PULMONARY RESUSCITATION BY ARUSHI NEGI M.Sc. Nursing Ist year

2. INTRODUCTION: Resuscitation includes all measures that are applied to the patients who have stopped breathing suddenly and unexpectedly due to either respiratory or cardiac failure. Emergency Cardiac Care includes all responses necessary to deal with sudden and often life-threatening events affecting the cardiovascular, cerebrovascular, and pulmonary systems. CODE BLUE

3. DEFINITON: Cardio-pulmonary resuscitation includes those techniques which are used to revive circulation and breathing in patients whose respiration and circulation of blood have suddenly and unexpectedly stopped.

4. BLS VS ACLS ?

5. BLS Basic Life Support. It involves a variety of life-saving skills and techniques, like CPR , a combination of chest compressions and rescue breaths and pulse checks. Also involves using Automatic External Defibrillators and bag valve masks. BLS is performed mostly by healthcare professionals but also first responders like police officers and firefighters. 

6. Fundamental aspects of BLS includes

7. INDICATIONS :

8. Causes of Cardiac Arrest

9. Signs and Symptoms of Cardiac Arrest Apnoea Absence of Carotid and Femoral Pulse Dilated Pupils Cyanosis Unconsciousness Fit (grand mal seizure)

10. CONTRA - INDICATIONS OF CPR :

11. CHAIN OF SURVIVAL (BLS)

12. CARDIO-PULMONARY RESUSCITATION

13. BLS ALOGRITHM

14. STEPS OF BLS :

15. PROCEDURE (A) To maintain circulation Position the patient on his back on a flat, firm surface. Kneel along one side of the patient's chest. To locate the lower part of the sternum, follow the following steps: Place the heel of one hand on the lower third of the sternum about 4 cm from the tip of the xyphoid process. Place the heel of other hand on the top of the first hand. Fingers may be kept interlocked. Using the heel of the hand exert pressure only on the sternum. Pressure elsewhere can create rib fracture if excessive force is used.

16. To provide effective chest compressions, push hard and push fast a rate of at least 100 compressions per minute with least 2 inches/5 cm depth. Rescuers should allow complete recoil of the chest after each compression, to allow the heart to fill completely before the next compression (ROSC). Compression-ventilation ratio of 30:2 is recommended . Approx in 1 minute 120 compressions and 8-10 breaths are delivered. Only after 5 cycles , the rescuers should switch.

17. Assess for a return of the carotid pulse. Resume CPR within 7 seconds if the carotid pulse is absent. Reassess the pulse every few minutes. If the carotid pulse is present check for spontaneous breathing for 3-5 seconds. If the client is breathing stop cardiopulmonary resuscitation but continue monitoring. If breathing is absent continue artificial breathing and keep monitoring pulse. Periodically assess the vital signs.

18. (B) To maintain the airway clear HEAD - TILT CHIN LIFT JAW THRUST

19. Hyper extend the head and neck of the patient to prevent the tongue falling back and obstructing the airway. If breathing is restored, place an oro-pharyngeal airway which also prevents biting of the tongue, should the patient develops a fit. If breathing is not restored start artificial ventilation.

20. (C) TO INITIATE BREATHING

21. METHODS:

22. Ventilation With Bag and Mask The Bag-Mask Device Inlet valve Pressure relief valve that can be bypassed Oxygen reservoir Non - rebreathing outlet valve

23. Ventilation With an Advanced Airway Ventilations are delivered at the rate of 1 breath about every 6 to 8 seconds Which will deliver approximately 8 to 10 breaths per minute.

24. (D) Defibrillation With an AED Defibrillation is a treatment for life-threatening cardiac dysrhythmias, specifically ventricular fibrillation (VF) and non-perfusing ventricular tachycardia (VT). A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart.

25. Defibrillation Sequence Turn the machine on. Bare the chest. Dry it off , If excessive hair, shave it off. Place one pad on the patient’s upper right chest above the nipple. Place the other pad on the patient’s lower left ribs below the armpit.

26. Resuscitation electrodes placement

27. Follow AED prompts. Stand Clear. Do not touch the patient while the AED analyzes. If the AED says, “Shock advised, charging…,” shout, “Clear” , make sure no one is touching the patient. Push the shock button when the AED tells you to Biphasic - (150-200 J ), monophasic - 360J If no shock is advised, give CPR if the patient is not moving and not breathing. As soon as the shock has been delivered, give 30 chest compressions followed by 2 breaths. The AED will reanalyze every 2 minutes and prompt for a shock if needed.

28. When to give shock ? Ventricular fibrillation is a type of abnormal heart rhythm (arrhythmia). Disorganized heart signals cause the ventricles to twitch uselessly. As a result, the heart doesn't pump blood to the rest of the body. Symptoms Chest pain, tachycardia , Dizziness, Nausea ,Shortness of breath Causes Problem in the heart's electrical properties or by a disruption of the normal blood supply to the heart muscle. Sometimes, the cause of ventricular fibrillation is unknown.

29. Ventricular tachycardia It is a heart rhythm disorder (arrhythmia) caused by abnormal electrical signals in ventricles. Symptoms Dizziness Shortness of breath Lightheadedness Feeling as if your heart is racing (palpitations) Chest pain (angina)

30. Carry out cardio-pulmonary resuscitation until one of the following occurs: a)Client regains a satisfactory pulse Constriction of pupils. The systemic blood pressure is returned to normal. There is improved colour of the skin. The respiratory movements are taking place rhythmically b)The client is declared dead by the doctor

31. ACLS ACLS stands for Advanced Cardiovascular Life Support. It involves healthcare professionals interpreting a patient’s heart rhythm . Based on this heart rhythm, decisions are made regarding treatment options. ACLS providers must have the skills and knowledge to place advanced airways and insert an IV (Intravenous) or IO (Intraosseous) line for the administration of fluids and medications. BLS is component of ACLS.

32. CHAIN OF SURVIVAL Recognition of early warning signs Activation of the EMS system Basic CPR Management of the airway and ventilation Defibrillation Intravenous administration of medications

33. Commonly Used Medications in ACLS.

34. EPINEPHRINE Increase myocardial and cerebral blood flow during CPR. The recommended dose of epinephrine is 1.0 mg (10ml of a 1:10,000) solution administered IV every 3 to 5 minutes during resuscitation. ATROPINE Increases heart rate and conduction through the AV node. DOSE - Bolus 1.0 mg IV. Repeat at 3 - 5 minute intervals, not to exceed approximately 3mg

35. AMIODARONE Prolongs the recovery period of cardiac cells after they have carried an impulse and effects sodium, potassium, and calcium channels. DOSE - VF/VT-Cardiac arrest: 300mg IV, may repeat 150mg in 3 - 5min Infusion: 900mg/500mL (1.8mg/mL) / Infuse @ 1mg/min (33mL/hr) x 6hrs then 0.5mg/min (17mL/hr) Max combined daily dose 2.2grams in any 24 hour period

36. LIDOCAINE Depresses ventricular irritability and automaticity and increases fibrillation threshold Dosage: VF & Pulseless VT = 1.0 - 1.5mg/kg. Repeat at half dose if necessary. Max: 3mg/kg Infusion: Maintenance Infusion: Mix 2gm/500mL D5W (4mg/mL) Infuse @ 1 - 4mg/min (15 - 60 mL/hr)

37. NURSE'S RESPONSIBILITY

38. Equipments:

39. Preparation of the Patient and the Environment

40. AFTER CARE OF THE PATIENT

41. 6.Check the colour of the skin. Persisting cyanosis indicates inadequate oxygenation of blood. 7.Watch for the signs of restored circulation and respiration. They are : (a) Contraction of pupils. (b) Improved colour. (c) Change in the quality of pulse. (d) Free movements of the chest wall and no retraction of muscles over the intercostal space. (e) Return of systemic blood pressure. (f) Struggling movements.

42. 8.Temperature is taken every hour. A high temperature usually indicates cerebral damage or cerebral oedema. 9.Watch for convulsions. It may occur due to brain damage or acidosis. 10.Insert endotracheal tube, if not already in place. This maintains an airway an open airway for the unconscious patient who can not clean secretions by coughing. 11.Insert Foley's catheter. Urine output is one of the measures of the cardiovascular status . 12.Start I.V. infusions to administer enough fluids in the patient. 13.Blood gas and pH determinations are done to detect metabolic acidosis. .

43. 14.Watch for the complications that might have occurred duringthe procedure: (a) Damage neck to the cervical spine due to hyperextension of the neck. (b) Fracture of the rib and xiphoid process. (c) Haemopericardium, pneumothorax, haemorrhage etc. (d) Gastric distension with air. 15.Record the procedure on the nurse's record with date and time. Record the following: (a) Time the victim was discovered. (b) Type of arrest (respiratory or cardiac both). (c) Any complications developed during the CPR. (d) Time at which spontaneous respiration and pulse returned. (e) Time at which CPR started and discontinued. (f) Vital signs when the CPR team left the patient

44. VIDEO ON BLS AND ACLS: BLS - https://youtu.be/fkFjT5-g2CA ACLS - https://youtu.be/dGMSxrT3VL4

45. SUMMARY Through this we learnt about cardio pulmonary resuscitation, BLS,ACLS, cardiac arrest, cardio- respiartory failure, contraindications , chain survival of bls , steps , the procedure, chest compressions, airway, breathing through various equipments, defibrillator, ventriculary fibrillation and ventricular tachycardia, ACLS chain survival, common drug used, nurses responsibility and after care .

46. CONCLUSION The critical lifesaving steps of are: Immediate Recognition and Activation of the emergency response system, Early CPR, Rapid Defibrillation ,Hospitalization,Post care. When an adult suddenly collapses, whoever is nearby should activate the emergency system and begin chest compressions (regardless of training). Chest compressions should be delivered by pushing hard and fast in the center of the chest (ie, chest compressions should be of adequate rate and depth). Rescuers should allow complete chest recoil after each compression and minimize interruptions in chest compressions.

47. BIBLIOGRAPHY Nancy Sr., Principles and practices of nursing Senior nursing procedures, volume 2 , fourth edition, 2005, N.R. Publishing house ,pg no 236-248. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.970939