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.
8. 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.
9. • 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
10. Respiratory arrest.
• Drowning
• Stroke
• Foreign body in throat
• Smoke inhalation
• Drug overdose
• Suffocation
• Coma
• Epiglottis paralysis
11. • 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
12. 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.
13. 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)
14. • 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-
15. • 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
16. 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
17. 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.
18. • 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
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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.
25. 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.
26. 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.
27. 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 O2 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.
28. 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.
29. 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.
31. 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.
32. 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.
33. Reference:-
Books:
• Delaune, S.C. & Ladner, P.K. (2006). Fundamental of Nursing-
Standards & Practices. (3rd ed.).United States: Thomson Delmar.
• Jacob, A., Rekha, R. & Tarachand, J.S. (2010). Clinical Nursing
Procedures: The art of Nursing Practice. (2nd ed.).New Delhi: Jaypee.
• Kozier, B., Glenora, ERB., Berman, A. & Synder, S.J. (2004).
Fundamentals of Nursing : Concepts, Process And Practice.
(7thed.).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.
