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Cardiopulmonary resuscitation

CPR is a combination of rescue breathing and chest compression delivered victims through to be in cardiac arrest.

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Cardiopulmonary resuscitation

  1. 1. www.drjayeshpatidar.blogspot.in CARDIOPULMONARY RESUSCITATION ( CPR ) 18/05/20181
  2. 2. Anatomy And Physiology Of Heart And Lungs Heart Heart is responsible for the circulation of the blood.Heart is actually two pumps in one (1) Propels blood through the pulmonary circulation (2) Propels blood through the systemic circulation Healthy heart pumps approximately 5L per min 18/05/2018www.drjayeshpatidar.blogspot.in
  3. 3. Size And Location 18/05/2018www.drjayeshpatidar.blogspot.in3 Shape of a blunt cone measures About12 x 9cm and weighs 300gms in male ,250gms in female. Obliquely behind body of sternum.
  4. 4. Heart chambers And valves Heart has 4 chambers (1)Right atrium (2)Right ventricle (3)Left atrium (4)Left ventricles Valves are (1)Atrioventricular valve (2)Semilunar valves 18/05/2018www.drjayeshpatidar.blogspot.in4
  5. 5. Conducting system It is made by myocardium that is specialized for initiation and conduction of cardiac impulses.They are (1)Sinuatrial node (2)Atrioventricular node (3)Bundle of his Right And Left (4)Purkinje fiber 18/05/2018www.drjayeshpatidar.blogspot.in5
  6. 6. Blood supply to the heart Arteries; (1)Right coronary artery Branches, (A)Marginal (b)Posterior interventricular (c)Nodal (d)Rt atrial 18/05/2018www.drjayeshpatidar.blogspot.in6
  7. 7. Cont…………….. (e) Infundibular (f) Terminal Areas of distribution (1)Rt atrium (2)Greater part of Rt ventricle & small part of Lt ventricle (3)Posterior part of interventricular septum (4)Whole conducting system except Lt branch of AV Bundle 18/05/2018www.drjayeshpatidar.blogspot.in7
  8. 8. Cont………….. (2)Lt coronary artery Branches, (a)Anterior interventricular (b)Br to the diaphragmatic surface of the Lt ventricle (c)Lt atrial (d)Pulmonary (e)Terminal 18/05/2018www.drjayeshpatidar.blogspot.in8
  9. 9. Cont………. Area of distribution (1)Lt atrium (2)Great part of Lt ventricle and small part of Rt ventricle (3)Part of Lt branch of AV bundle (4)Anterior part of interventricular septum 18/05/2018www.drjayeshpatidar.blogspot.in9
  10. 10. Cont…………. Veins; (1)coronary sinus (2)Anterior cardiac vein (3)Venae cordis minimi 18/05/2018www.drjayeshpatidar.blogspot.in10
  11. 11. Heart sounds 1st heart sound -in the Lt 5th inter costal space near the sternal boarder -prolonged and loud sound like “Lub” -produced by closure of mitral and tricuspid valves 2nd heart sound -in the 2nd intercostal space close to sternum 18/05/2018www.drjayeshpatidar.blogspot.in11
  12. 12. Cont………. -it is short and sharp sound like “Dupp” -sound marks the clinical end of the systole and clinical beginning of the diastole 3rd heart sound -sound is produced by vibration of the ventricular wall produced in the first rapid filling phase of the ventricle 18/05/2018www.drjayeshpatidar.blogspot.in12
  13. 13. Cont………… 4th heart sound -called atrial sound -produced by last rapid filling phase -not audiable by stethoscope Adventitious heart sound (1)Snaps and clicks -stenosis of the mitral valve -caused by high pressure in the Lt atrium with mitral valve displacement 18/05/2018www.drjayeshpatidar.blogspot.in13
  14. 14. Cont…………… (2)Murmers -caused by narrowing of the valves ,malfunctioning of valves ,congenital defect of the ventricular defect,defect b/w aorta pulmonary artery (3)Friction rub - a harsh,grating sound that can be heard both systole &diastole 18/05/2018www.drjayeshpatidar.blogspot.in14
  15. 15. Lungs Lungs are pair of respiratory organs in the pleural cavity.They are brown or grey in colour.Rt lung weights about 700gms it is heavier than Lt lung.Each lung is conical in shape. FISSURES AND LOBES OF LUNGS Rt lungs 3 lobes by 2 fissures 18/05/2018www.drjayeshpatidar.blogspot.in15
  16. 16. Cont……………… Fissures (1) oblique fissure (2) horizontal fissure Lobes (1) upper lobe (2) middle lobe (3) lower lobe 18/05/2018www.drjayeshpatidar.blogspot.in16
  17. 17. Cont……………. Lt lung Fissure oblique fissure Lobes (1) upper lobe (2) lower lobe 18/05/2018www.drjayeshpatidar.blogspot.in17
  18. 18. Lung sounds Normal sounds 1 bronchial breath sounds 2 vesicular breath sounds Abnormal sounds 1 Crackles a) coarse crackles b) fine crackles 18/05/2018www.drjayeshpatidar.blogspot.in18
  19. 19. Cont…….. 2. Wheezes a) Sonorus wheezes(rhonchi) b) Sibilant wheezes 18/05/2018www.drjayeshpatidar.blogspot.in19
  20. 20. 18/05/2018www.drjayeshpatidar.blogspot.in20 Cardiac Arrest ? Sudden stopping of the pumping action of the heart Unconscious Major pulse absent MI Asphyxia drug overdose in majority of children Myocardial infarction Stroke Electrocution Drowning Choking Trauma Drug overdosage Poisoning In hospital SCA Out of hospital SCA Witnessed arrrest Unwitnessed arrest
  21. 21. Gauging Cardiac monitoring a) ECG b) Blood pressure c) Pulse d) Cardiac ausculation Laboratory examination a) Lipid profile b) Creatine kinase c) Serum electrolytes d) Chest X-ray 18/05/2018www.drjayeshpatidar.blogspot.in21
  22. 22. Human mentation a) CPR should start within 4mins. b) should reassess circulation & breathing in every 2-3 mins. c) Don’t interrupt the CPR more than 7sec. 18/05/2018www.drjayeshpatidar.blogspot.in22
  23. 23. Intensive care 1) For close & Continuous monitoring. 2) Keep patient in recovery position ie left lateral position. 18/05/2018www.drjayeshpatidar.blogspot.in23
  24. 24. PHASES OF CPR Phase--1 Basic Life Support Airway Breathing Circulation Phase--2 Phase--3 Advanced Cardiac Life Support Prolonged Life support Drugs ECG Fibrillation Gauging Human mentation Intensive care 18/05/2018www.drjayeshpatidar.blogspot.in24
  25. 25. 18/05/2018www.drjayeshpatidar.blogspot.in25 Adult BLS -SAFE Approach
  26. 26. 18/05/2018www.drjayeshpatidar.blogspot.in26 Chain of survival
  27. 27. Cardiopulmonary Resuscitation CPR is a combination of rescue breathing and chest compression delivered victims through to be in cardiac arrest. ‘CPR’ the letters indicates, C – Cardio P – Pulmonary R – Resuscitation It means the reestablishment of heart and lung action once it has stopped. 18/05/2018www.drjayeshpatidar.blogspot.in27
  28. 28. 18/05/2018www.drjayeshpatidar.blogspot.in28 CPR Restoration Of Spontaneous Circulation (ROSC) Perform Chest Compression (CC) Rescue Breathing (RB)
  29. 29. 18/05/2018www.drjayeshpatidar.blogspot.in29 SAFETY First SHAKE on shoulders and SHOUT Hey ?Are You all right? Sequence of Action and (Re)/Assessment, Response, What is the response of the victim to your action? 1 Your Actions 2 Victim’s Responses 3 Your assessments
  30. 30. Indications for CPR (1) Absence of carotid pulse (2) Absence of response to stimuli (3) Absence of respiration Steps in CPR Steps in CPR AHA suggests using “ABC” s the are A – Airway B – Breathing C - Circulation 18/05/2018www.drjayeshpatidar.blogspot.in30
  31. 31. CPR for Adult (1) Establish unresponsiveness Gently shake and shout “ Are you ok?” 18/05/2018www.drjayeshpatidar.blogspot.in31
  32. 32. 18/05/2018www.drjayeshpatidar.blogspot.in32 Response of victim No response Shout for help o turn the victim on to his back and then open the airway o With your fingertips under the point of the victim's chin, lift the chin to open the airway.
  33. 33. (2) Check for airway and establish an airway Turn the victim’s body on his back and assess the airflow by keeping ear close to victims nose and observe for raise and fall of chest and feel the air flow by placing cheek.if resp is absent, maintain, -Head tilt and chin lift with the hand on the forehead -Pinch the nose -Deliver 2 full breaths lasting about 1.5 sec 18/05/2018www.drjayeshpatidar.blogspot.in33
  34. 34. 18/05/2018www.drjayeshpatidar.blogspot.in34 Airway Assessment Keeping the airway open, look, listen, and feel for normal breathing- ten seconds Look for chest movement Listen at the victim's mouth for breath sounds Feel for air on your cheek
  35. 35. 18/05/2018www.drjayeshpatidar.blogspot.in35 Rescue breathing Ensure head tilt and chin lift Pinch the victim’s nose closed with the index finger and thumb of your hand on his forehead Open his mouth a little, but maintain chin lift Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out
  36. 36. 18/05/2018www.drjayeshpatidar.blogspot.in36 Jaw thrust…
  37. 37. 18/05/2018www.drjayeshpatidar.blogspot.in37 If no visible chest rise on RB….? Check the victim's mouth and remove any visible obstruction. Recheck that there is adequate head tilt and chin lift. Do not attempt more than two breaths each time before returning to chest compressions If you see a foreign body, remove it.
  38. 38. 18/05/2018www.drjayeshpatidar.blogspot.in38 Cont………….. General Please do not Hyperventilate Opening the airway priority for an unresponsive trauma victim Breaths in all age groups should be delivered over 1 second and should produce visible chest rise. When the victim has an advanced airway (eg, endotracheal tube) in place, CPR is no longer performed as "cycles" of compressions with pauses for breaths. The compressor gives continuous compressions. The rescuer giving breaths should give 1 breath every 6 to 8 seconds (about 8 to 10 breaths/minute)
  39. 39. 18/05/2018www.drjayeshpatidar.blogspot.in39 Give 2 Rescue Breaths Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise to all forms of ventilation during CPR, including mouth-to-mouth and bag-mask ventilation and ventilation through an advanced airway, with and without supplementary oxygen (Class IIa)
  40. 40. (3) Assess for presence of pulse Assess thee carotid pulse .if there is no pulse start compression. (a)Location Of the compression site; - locate xiphoid process,put the index finger of the same hand on the lower end of the patients sternum, - place your hand alongside your fingers 18/05/2018www.drjayeshpatidar.blogspot.in40
  41. 41. 18/05/2018www.drjayeshpatidar.blogspot.in41 Hand Placement
  42. 42. 18/05/2018www.drjayeshpatidar.blogspot.in42 Hand Placement…
  43. 43. (b) Position your hand - position your free hand on the top of the hand that placed on the hand. - interlocate your finger. - elbow of the hand should be stright and shoulder is directly over hands. (C)Perform chest compressions - apply firm,heavy pressure depress the sternum - after each compression allow chest to return normal position 18/05/2018www.drjayeshpatidar.blogspot.in43
  44. 44. - 30 compressions and 2 breaths in a cycle. 18/05/2018www.drjayeshpatidar.blogspot.in44
  45. 45. Name of drug Action Indication 1.Epinephrine (adrenaline) Adult: I V 0.1- 1mg/kg 5 mins as needed Child: I V 0.01mg/kg 5 mins as needed Increase the systemic vascular resistance and blood pressure, strengthens myocardial contractions, increase cardiac output and cardiac rate. Cardiac arrest caused by asystole, ventricular tachycardia or ventricular fibrillation. 2. Atropine Adult : I V 0.5-1 mg q 1-2 hr Child : I V 0.01-0.03mg/kg for 1-2 doses Blocks parasympathetic action increase SA node automaticity and AV conduction Sinus bradycardia or asystole during CPR 18/05/2018www.drjayeshpatidar.blogspot.in
  46. 46. Name of drug Action Indication 3. Sodium bi carbonate Adult IV 1meq/kg at 7.5 or 8.4% solution over 1-2 mins Child IV 0.5-1meq/kg at 4.2% solution over 1-2 mins 4.Vasopressin Restores buffering capacity of the body and neutralizes excess acid Increase the permeability of renal tubular epithelium &promotes reabsorption of water Metabolic acidosis Diabetic insipid us Post operative abdominal distention 5.Lindocaine hydrochloride Decrease depolarization ,automaticity ,and excitability in ventricular phase Ventricular arrhythmias Cardiac surgery Cardiac catherization 18/05/2018www.drjayeshpatidar.blogspot.in46
  47. 47. Electrical current may be on delivered through paddles or conductor pads both paddles placed on the front of the chest. 18/05/2018www.drjayeshpatidar.blogspot.in47
  48. 48. Points to be remember during defibrillation 1)Maintain good contact between the pads & the patient’s skin 2)Ensure that no one is in contact with patient or anything that is touching the patient 3)Use conducting agents between pads and skin 18/05/2018www.drjayeshpatidar.blogspot.in48
  49. 49. 4)Ensure that monitoring leads are attached to patient 5)Don’t charge the device until ready to shock 6)Before pressing the shock discharge button call clear 3 times 7)Record delivery energy and the results 8)After the event inspect the skin under pads for burns 18/05/2018www.drjayeshpatidar.blogspot.in49
  50. 50. Defibrillation - Is a treatment for the tachydysrhythmias. - They are usually used to deliver an external current to depolarize a critical mass of myocardial cells 18/05/2018www.drjayeshpatidar.blogspot.in50
  51. 51. 18/05/2018www.drjayeshpatidar.blogspot.in51
  52. 52. 18/05/2018www.drjayeshpatidar.blogspot.in52
  53. 53. 18/05/2018www.drjayeshpatidar.blogspot.in53
  54. 54. Signs of successful CPR (1) You should feel the carotid pulse. (2) Chest should raise and fall with all ventilation. (3) A heart beat may return. (4) A spontaneous gasp of breathing may occur. (5) Skin colour may improve. 18/05/2018www.drjayeshpatidar.blogspot.in54
  55. 55. Complications of CPR (1) Fracture of the sternum. (2) Pneumothorax. (3) Hemothorax. (4) Lacerations to the lungs. 18/05/2018www.drjayeshpatidar.blogspot.in55
  56. 56. 18/05/2018www.drjayeshpatidar.blogspot.in56 Future of CPR -- in You most important determinant of survival from sudden cardiac arrest Presence of a trained rescuer who is Ready, able, willing and equipped to act
  57. 57. BIBLIOGRAPHY (1) www.americanheart.org (2) Chaudhuri.coinise medical physiology.central publishers.4th edition.157-62 (3) BD Chaurasias’s .human anatomy.cbs publishers.4th edition.181-92. (4) J.David Bergaon,gloria Bizjak.First responder.5th edition.812-14. 18/05/2018www.drjayeshpatidar.blogspot.in57
  58. 58. Cont…………. (5) Lehman ,Sands ,Phils.Medical-surgical nursing.Mosby publishers.5th edition.812- 14. (6) Brunner,Suddarth’s. Text book of medical-surgical nursing.10th edition.480- 81,665-66,810-12. 18/05/2018www.drjayeshpatidar.blogspot.in58
  59. 59. Thank You 18/05/2018www.drjayeshpatidar.blogspot.in59