CARDIOPULMONARY RESUSCITATION

INTRODUCTION

According to recent statistics sudden cardiac arrest is rapidly becoming the leading cause 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. 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.

DEFINITION

Cardiopulmonary resuscitation (CPR) refers to the care healthcare providers and public safety
professionals provide to patients who are experiencing respiratory arrest, cardiac arrest or airway
obstruction. CPR includes psychomotor skills for performing high-quality cardiopulmonary
resuscitation (CPR), using an automated external defibrillator (AED) and relieving an obstructed
airway for patients of all ages.

INDICATIONS :-

 RESPIRATORY ARREST
If the patient is not breathing but has a definitive pulse, the patient is in respiratory arrest. To care
for a patient experiencing respiratory arrest, ventilations must be given.

 CARDIAC ARREST
If there is no breathing, no pulse and the patient is unresponsive, the patient is in cardiac arrest.
Cardiac arrest is a life-threatening situation in which the electrical and/or mechanical system of
the heart malfunctions resulting in complete cessation of the heart’s ability to function and
circulate blood efficiently.
COMPONENTS OF CPR

 Ensure safety
 Check for response
 Activate EMS
 Chest compressions
 Check airway and ventilate
 Defibrillate

ENSURE SAFETY

 Safety of Self
 Safety of Patient
 Movement of a trauma victim – only when absolutely necessary [unstable cervical spine –
injured spinal cord

ASSESS RESPONSE

 Ask the person “Are you ok?”

 Tap and shout If the client responds
 Leave the client and call for help.
 Return as quick as possible and reassess the condition of the person

ACTIVATE EMS

 Call 108 / 102

 Describe the emergency to the operator-includes where you are (address and location) -
condition of patient

CHANGE FROM A-B-C TO C-A-B

 The vast majority of cardiac arrests occur in adults, and the highest survival rates from
cardiac arrest are reported among patients of all ages who have a witnessed arrest and an
 initial rhythm of VF or pulseless VT. In these patients, the critical initial elements of CPR
are chest compressions and early defibrillation.
 In the A-B-C sequence, chest compressions are often delayed while the responder opens
the airway to give mouth-to-mouth breaths, retrieves a barrier device, or gathers and
assembles ventilation equipment.

CIRCULATION

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

Position of victim

 Must be supine on a firm flat surface for CPR to be effective

 Victim lying facing down – logroll the victim

Prone CPR

Standard CPR is performed with the person in supine position.

Prone CPR or reverse CPR is CPR performed on a person lying on their chest, by turning the
head to the side and compressing the back. Due to the head's being turned, the risk of vomiting
and complications caused by aspiration pneumonia may be reduced.

The American Heart Association's current guideline recommends to perform CPR in the supine
position, and limits prone CPR to situations where the patient cannot be turned.

Pregnancy

During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena
cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to
the woman's left; if this is not effective, either rolls the woman 30° or healthcare professionals
should consider emergency resuscitative hysterectomy.

Cervical spine stabilization

Use cervical collar if available

Any hard objects that restrict neck movement

Firm surface (backboard or floor)

POSITION OF RESCUER

 Firm surface(backboard or floor)

 Kneel beside victim’s chest or stand beside bed
 Heel 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 parallel
 Lock elbows

CHEST COMPRESSION

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

 It Increase intrathoracic pressure and directly compress heart.

CHARACTERISTICS OF GOOD COMPRESSION

 “Push hard push fast”. Push at a rate of 100-120 min.

 Compression depth- at least 2 inches (5cm) not more than 2.5 inches.
 Release completely to allow the chest to fully recoil.
 A compression-ventilation ratio of 30:2.
 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.

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 100-120 /min without pauses for ventilation.

• The rescuer delivering ventilation provides 8 to 10 breaths per minute.

• Rescuers should continue CPR until an AED arrives

GENERAL INSTRUCTIONS

• Clear the airway of false teeth, vomitus, food materials etc.

• Initiate ventilation and external cardiac massage without wasting time.

• To prevent tongue falling back and obstructing the airway, tilt the head and neck into a
hyper extended position.

• The artificial breathing and cardiac massage should correspond to the normal respiration
and pulse rate.

• Watch for the complications that may occur during the CPR.

• Discontinue the procedure only when you are sure that his respiration and circulation.
 PROCEDURE

NURSING ACTION RATIONALE

This will prevent injury from attempted
• DETERMINE THE resuscitation of a person who has not suffered a
UNRESPONSIVENESS cardiac or respiratory arrest
1. Tap or gently shake the patient while
shouting “ARE YOU OK”?

• DETERMINE PULSELESSNESS Carotid pulse may persist when peripheral

1. Check for carotid pulse on one side for not pulses are not palpable.
more than 5 seconds
• Call for help in hospital set up. • Alerts other trained personnel

b. Jaw thrust maneuver – • Jaw thrust technique without head tilt is

Grasp the angles of the patient’s lower jaw the safest method for opening the
and lift with both hands One on each side, airway in the presence of suspected
displacing the mandible forward. neck injury.
 Place an airway if available • Keep airways patent.

• SEQUENCE OF CPR • The arrest board provides a firm surface

A. CIRCULATION allowing for compression of the heart.
• Position the arrest board underneath
victim’s chest. • Allows performance of chest

• Kneel at victims side. • Compression and rescue breathing

with efficiency.
• Using index finger of the hand, locate • Proper hand positioning ensures
the lower rib margin and move the maximum compression of the heart and
fingers up to where the ribs connect to prevents injury to liver and ribs.
the sternum.
• Place the middle finger of this hand on
the notch and index finger next to it.

 Place the heel of the opposite hand next

to the index finger on.

• Keep the arm straight with shoulders • Release of external chest compression
directly the hands on the sternum and allows blood flow in to the heart.
lock elbows.

• Compress the adult chest at least 2 • Rescue breathing and chest

inches at least 100 per minute. compression should be combined.

• Release the chest compression

completely and allow the chest to return
to its normal position after each
compression.

• Do 30 compression and then perform 2

ventilation, re-evaluate the patient after
four cycles.

• To CPR performed by one or two

rescuers, the compression rate is 100
per minute
 • The compression ventilation ratio is
30:2

B. AIRWAY • This supports the jaw and helps tilt the

• Head tilt chin lift maneuver- Tilt the head back.
head back and lift the chin until the
teeth almost touch. Look and listen for
breathing.

C.BREATHING
• Occlude nostrils with thumb the head
back orm a tight seal over the patients
mouth or place an appropriate
respiratory arrest device (ambu bag and
mask) and give two full breaths of
appropriately 0.5 to 2 seconds allowing
time for both inspiration and expiration.

SIGNS OF SUCCESSFUL CPR

• Lung expansion will occur with each ventilation and pulse will be perceptible each time
the sternum is compressed

• The pupils will react to light or appear normal.

• Normal heart beat will return.

• A spontaneous breathing will occur.

• Victims may move legs or arms.

• Colour of skin may improve.

WHEN TO STOP CPR

• Return of spontaneous circulation.

• Arrival of arrest team or medical help.

• If the rescuer becomes exhausted.

• When death is confirmed.

AFTER CARE

• The patient should be continually watched by skilled persons over a period of 48 to 72 hours

• Give oxygen continuously for 48 hour.

• Watch for the sign of restored circulation and respiration

• Check the colour of the skin.

• Temperature is taken every hour.

• Start intravenous infusions to administer enough fluids in the patient.

• Record the procedure on the nurse record with date and time
 ROHILKHAND COLLEGE OF NURSING

DEMONSTRATION
ON
CARDIO PULMONARY RESUSCITATION

SUB : MEDICAL SURGICAL NURSING

SUBMITTED TO: SUBMITTED BY:

MR. MANOJ SHARMA KHYATI SHARMA
ASST. PROFESSOR M.SC. NURSING 1stYEAR

SUBMITTED ON: