Emergency management

1. CPR Mangla B.Bodade
M.Sc.Nursing 1st Year
L.P.P.N.C
Akola

2. GENERAL OBJECTIVES
 At the end of the class students are able to know about
1) Students will come to know that the definition of cardio pulmonary
resuscitation.
2) Students can get idea about how to performed CPR on patients.
3) Students will know about risk factor of CPR and also about cardiac
arrest and the its causative factors.
4) Students will thoroughly know about procedure of CPR.
5) Students will also cum to know about guideline given by American
heart association for CPR.

3. 6) Students can get ideas about the drugs used in CPR and
post care of CPR.
7) Students will come to know about definition of death.
8) Students will also have the knowledge about physiological
changes after death.
9) Students will have knowledge about dead body care and
its purpose.
10)Students can have the knowledge of procedure for death
body care.

4. SPECIFIC OBJECTIVE
CPR
 Introduction of CPR
 Definition of CPR
 Causes of cardiac arrest and its risk factors
 Procedure of CPR
 American Heart Association guidelines on CPR.
 Drugs used in CPR
 Post care

5.  Introduction of death
 Definition of death
 Physiological changes after death
 Dead body care
 Purpose of dead body care
 Procedure for dead body
SPECIFIC OBJECTIVE
Care of death

6. INTRODUCTION
CPR
 It is an emergency medical procedure for a victim of cardiac
arrest or its some circumstances respiratory arrest.
 Cardiac or respiratory arrest can occur at any time to
individuals of all ages.
 It is a crisis event that can be the result of an accident or a
disease process.
 Once the heart ceases to function a healthy human brain
may survive without oxygen up to 4 minute without suffering
any permanent damage.
 Unfortunately a typical emergency system response may
takes 6,8 or 10 minutes that CPR can provide oxygenated
blood to the victims brain and the heart , and increasing the
chance of survival.

7. DEFINITION
 CPR or cardiopulmonary resuscitation is an emergency life
saving procedure performed when the heart stops
breathing. Immediate CPR can double or triple chances of
survival after cardiac arrest.
 CPR is the basic life saving skill that is utilized in the
event of cardiac, respiratory or cardio pulmonary arrest to
maintain tissue oxygenation.
 CPR is a combination of rescue…. breathing and chest
compression delivered to victim through to be in cardiac
arrest. When cardiac arrest occurs the hearts stops
pumping the blood.

8. HISTORICAL REVIEW
 5000 BC – First artificial mouth to mouth respiration.
 3000 BC –Ventilation
 1780 BC –First attempt of new born resuscitation by
blowing.
 1874 – First experimental direct cardiac massage.
 1901 –First successful direct cardiac massage in man.
 1946 - First experimental indirect cardiac massage and
defibrillation.
 1960- Indirect cardiac massage.
 1980-Development of cardio pulmonary resuscitation due
to the work of peter safar.

9. CPR TIME LINE
0-4 Minutes : Brain damage unlikely.
4-6 Minutes : Brain damage possible.
6-10 Minutes: Brain damage probable.
 Over 10 minute probable brain death.

10. How is CPR Performed?
 There are two commonly known versions of CPR:
1) For healthcare providers and those trained: conventional CPR using chest
compressions and mouth-to-mouth breathing at a ratio of 30:2 compressions-
to-breaths. In adult victims of cardiac arrest, it is reasonable for rescuers to
perform chest compressions at a rate of 100 to 120/min and to a depth of at least 2
inches (5 cm) for an average adult, while avoiding excessive chest compression depths
greater than 2.4 inches [6 cm].
2) For the general public or bystanders who witness an adult suddenly collapse:
compression-only CPR, or Hands-Only CPR. Hands-Only CPR is CPR without mouth-to-
mouth breaths. It is recommended for use by people who see a teen or adult suddenly
collapse in an out-of-hospital setting (such as at home, at work, or in a park).

11. The 6 links in the adult out-of-hospital Chain of
Survival are
1)Recognition of cardiac arrest and activation of the emergency response
system.
2) Early CPR with an emphasis on chest compressions
3) Rapid defibrillation
4) Advanced resuscitation by Emergency Medical Services and other
healthcare providers
5) Post-cardiac arrest care
6) Recovery (including additional treatment, observation, rehabilitation,
and psychological support)

12. 2 STEPS TO SAVE A LIFE
 Call 108 (or send someone to do that)
 Push hard and fast in the centre of the chest

13. CAUSES OF CARDIAC ARREST
 Myocardial infarction
 Drowing
 Electrical shock
 Poisoning
 Suffocation
 Smoke inhalation
 Choking of food
 Anaphylactic shock
 Trauma

14. SIGN AND SYMPTOMS
 Pain (Sub-sternal)
 Uncomfortable pressure
 Squeezing
 Fullness and tightness around the chest
 Spread of pain to shoulder arm and neck
 Shortness of breath
 Perspiration
 Nausea

15. CPR PROCEDURE
 Before starting CPR check
1) Consciousness of person.
2) If unconscious , shake his/her shoulder/neck.
3) Spell C-A-B.
4) Remove person from any immediate danger.
5) Check for spinal injury.
6) Position the person.
7) Put the person on his or her back on a firm surface.
8) Straighten the person leg.
9) Kneel next to person neck or shoulders.
10) Place the heal of one hand over the centre of the persons
chest , between the nipple , place other hand on the top of
the first hand.
108

16. 11) Keeps elbow straight and position shoulder directly above
hands.
12) The compressions are delivered at the rate of
approximately 100/minute.(It is recommended to push
hard and fast to make sure adequate depth and rate of
compression are maintain)
13) When performing compressions elbow should be locked
and push straight down.
14) Do use enough force to push the casualty's sternum down
1 and half to 2 inches(4-5 Cm)

17. AIRWAY
Clear the airway
 After 30 chest compressions , open the persons airway
using head tilt , chin left maneuver, put palm on the
persons forehead and gently tilt the head back.
 With the other hand gently lift the chin forward to open
the airway.
 Check for normal breathing.look for the chest motion ,
listen breath sounds.
 If the person is not breathing normally begin mouth to
mouth breathing.

18. BREATHING
1. Rescue breathing can be mouth to mouth or mouth to
nose breathing.
2. Mouth to mouth breathing is also called as mouth to
mouth resuscitation.
3. Keep the casualty's airway open by maintaining the head
tilt/chin lift.
4. Take a deep breath.
5. Close the nostrils of casualty.
6. Place mouth over casualty's mouth over his mouth
completely and sure an air tight seal . So that air will not
escape.

19. 7. Blow a breath at slow rate into the casualty's mouth.
8. Take a breath of air, exhale and then take another deep
breath.
9. Breathing can be done by –Mouth to mouth
-Mouth to nose
- Mouth to stoma.
Continue CPR until there are signs of movements.
10. Do cycle of 5 chest compressions and 1 breath.
11. Repeat the above procedure at a rate of 1 ventilation
every five second until 10 to 12 ventilations.
12. Check the carotid pulse after every 10 to 12 breaths. If the
casualty's begin own breathing, maintain airway.

20. COMPLICATION OF CPR
 Fracture rib bone or sternum
 Gastric insufflation
 Vomiting
 Aspiration

21. AMERICAN HEART ASSOCIATION CPR
GUIDELINE 2010
 Initial sequence of step changed from A-B-C to C-A-B
except for new forms.
 Look , listen and feel is no longer recommended.
 Compression depth for adult should be at least 2
inches.(instead of up to 2 inch)
 Compression rate should be at least 100 per minute.
 Emergency cardiac treatment no longer recommended
include routine atropine for pulseless electrical activity.
 Post cardiac arrest care is a new section.
 Effective teamwork technique should be learned and
practice regularly.

22. DRUGS USED IN CPR
 FIRST LINE DRUGS:
 Epinephrine 1 mg every 3-5 minute
 Vasopressin 40 units (alternate of epinephrine)
 Atropine sulphate(Bradycardia)
 OTHER DRUGS:
 Calcium chloride(Routine)
 Mgso4 (Hypomagnesemia)
 Phenytoin
 NaHCo3( Hyperkalaemia )
 Lignocaine( Antiarrhythmic )

23. RESPONSIBILITIES OF NURSES IN CPR
1) The nurse is initial rescuer performing CPR.
2) Managing defibrillation: the ward nurse need to elevate the skills to
recognize shockable rhythms and deliver defibrillation.
3) Managing airway and ventilation.
4) The nurse need to be famillier with insertion of an oral airway and
effective use of a bag mast ventilator.
5) Managing lines , drugs and tubes.
6) Intravenous lines need to be placed for drug and food delivery and
tubes such as catheter and intra arterial lines can enhance the
circulation management.
7) Nurses are generally the first responders to a cardiac arrest and
initials the basic life support.
8) Rapid response nurse can help with trauma interventions.
9) Nurse defrilator must be primary role rather than extended role.

24. POST RESUSCITATIVE CARE
 Post resuscitation lab test.
ABG
CBC
Blood chemistry
Arterial PaCo2
Potassium
 BP Support
Mean arterial pressure should be maintain.
IV line.
Dysarrhthymia treatment.
Neurological support.
Maintainance of oxygenation.
Maintainance of cerebral perfusion.
Induce mild hypothermia.

25. CARE OF DEATH
INTRODUCTION
 Life and death are the two main stages in a human being
life.
 Where we come across many challenges , diseases and
other problems.
 Earlier person with chronic disease terminal illness and
dying is viewed as taboo topics ,Due to which few new
concept developed for the care of person who is at their
end stage
 One of those topics is end of life.

26. DEFINITION
Legal definition of death in most states requires
‘irreversible cessation of all functions of the entire
brain,including the brain death’

27. SIGNS OF DEATH
 Absence of heart beat.
 Fixed pupils.
 Skin colour turns to a waxen pallor and extremities may
darken.
 Body temperature drops.
 Muscles and sphincters relax , sometimes resulting in
release of stool or urine.

28. PHYSIOLOGICAL CHANGES AFTER DEATH
1) RIGOR MORTIS
2) ALGOR MORTIS
3) LIVOR MORTIS
4) DECOMPOSITION

29. 5 STAGES OF DYING
Elizabeth Kubler-Ross Theory
1. Denial: The doctor is wrong
2. Anger: ”Its unfair, why me”?
3. Bargaining : I’ll be kinder if I can just live to see my
grandson graduate
4. Depression: What is the point in living another day
5. Acceptance: I have had a good life.