cardiopulomonary resusitation

1. Rathish Rajan,
22nd batch MSc Nursing

2. INTRODUCTION
 India is home to 60 percent of heart disease
patients worldwide.
 1.2 billion People in India are suffering from Heart
disease.
 Kerala is placed third in the country with high number
of unnatural deaths reported owing to cardiac arrest

5. ORIGIN OF THE CONCEPT OF CPR
 The first city to teach and promote resuscitation was
Amsterdam in Europe
 In August 1767, a few wealthy citizens formed the “society
for recovery of drowned persons” and provided mouth to
mouth ventilation, head low position and warming
techniques
 In 1954, Dr. James Elam together with Dr. Peter Safar
(anesthetists) demonstrated CPR for the first time
 In 1957,Dr. Peter Safar wrote the book ‘ABC of resuscitation’
 In 1970’s CPR was promoted as a technique for the public

6. ORIGIN OF THE CONCEPT OF CPR
 Dr. Peter Safar created the guidelines for community wide
emergency medical service and he found the “
INTERNATIONAL RESUSCITATION RESEARCH
CENTER[IRRC]
 1979 Advanced Cardiovascular Life Support (ACLS) is developed
 1983 AHA convened a national conference on pediatric
resuscitation to develop CPR and ECC Guidelines for pediatric
and neonatal patients
 1988 AHA introduces first pediatric courses, pediatric BLS,
pediatric ALS and neonatal resuscitation, cosponsored with The
American Academy of Pediatrics (AAP)
 1992 International Committee on Resuscitation (ILCOR)
founded;1999 First task force on first aid was appointed; First
International Conference on Guidelines for CPR and ECC

7. ORIGIN OF THE CONCEPT OF CPR
 2005 The 2005 International Consensus on
ECC and CPR Science with Treatment Recommendations
(CoSTR) Conference produces the 2005 American Heart
Association Guidelines for CPR & ECC.
 2008 The AHA releases a statement about Hands-
Only™ CPR
 2010 The 2010 International Consensus on
ECC and CPR Science with Treatment Recommendations
(CoSTR) Conference produces the 2010 American Heart
Association Guidelines for CPR & ECC; 50th Anniversary
of CPR

8. CPR DEFINITION
 “Cardiopulmonary resuscitation (CPR) is a procedure
to support and maintain breathing & circulation for an
infant, child, or adult who has stopped breathing
(respiratory arrest) and/or whose heart has stopped
(cardiac arrest)”.
 “It is a combination of chest compression and
ventilation provided to act in cardiac arrest”

9. CARDIAC ARREST
 Cardiac arrest is the cessation of
normal circulation of the blood due to failure of
the heart to contract effectively.
 Medical personnel can refer to an unexpected cardiac
arrest as a sudden cardiac arrest or SCA.
 Shockable and non-shockable

10. H’s and T’s
 Hs
 Hypovolemia - A lack of blood volume
 Hypoxia - A lack of oxygen
 Hydrogen ions (Acidosis) - An abnormal pH in the
body
 Hyperkalemia or Hypokalemia - Both excess and
inadequate potassium can be life-threatening.
 Hypothermia - A low core body temperature
 Hypoglycemia or Hyperglycemia - Low or high blood
glucose

11.  Ts
 Tablets or Toxins
 Cardiac Tamponade - Fluid building around the
heart
 Tension pneumothorax - A collapsed lung
 Thrombosis (Myocardial infarction) - Heart attack
 Thrombo-embolism (Pulmonary embolism) - A blood
clot in the lung
 Trauma

12. 2010 AHA GUIDELINES FOR CPR
 Change in CPR sequence

13.  No look ,listen and feel
 Emphasis on high quality CPR
Rate 100/min
Depth= 2inches/5cm
Allow complete chest recoil
Use team approach
 Begin chest compression if pulse is not felt within
10 sec

14.  The routine use of cricoid pressure is not
recommended as it may block ventilation
 Manual defibrillation is preferred to an
automated external defibrillator[AED]

15. KEY PRINCIPLES OF CPR [CHAIN OF
SURVIVAL]

16. STEPS IN RESUSCITATION (DRS C-
A-B-D )
 Check for Danger
 Check for Response
 ‘S’ has been added for Send for help
 ‘C’ directs rescuers to perform 30 Compressions to patients
who are unresponsive and not breathing normally,
followed by 2 rescue breaths.
 ‘A’ directs rescuers to open the Airway
 ‘B’ directs rescuers to check Breathing but no need to
deliver rescue breaths
 ‘D’ directs rescuers to attach an AED as soon as it is
available and follow prompts.

17. BLOOD FLOW MECHANISM
DURING CPR
 Cardiac pump theory
 Thoracic pump theory

18. CPR PRACTICE
 Single rescuer
 Two rescuer
 Team of experts

19. SINGLE RESCUER ADULT CPR

20.  Assessment and scene safety
 Activate emergency response system and get an
AED
 Check pulse
 Begin cycles of 30 compressions and 2 breaths

23. METHODS TO OPEN THE AIRWAY
 Head –tilt –chin –lift method

24. Jaw thrust method

25. Breathing techniques
 Mouth to mouth breathing
 Mouth to mask breathing

26.  Bag-mask breathing

27. TWO RESCUER ADULT CPR
 Rescuer -1
 At the victim’s side
 Perform chest compressions
 Give 30 compressions(count loud)
 Allow complete chest recoil
 Rescuer 2
 At the victim’s head
 Open airway
 Head-tilt chin- lift
 Jaw thrust
 Give 2 breaths, watch for chest rise
 Switch duties after every 5 cycles

28. DEFIBRILLATION
 VF and Pulseless VT
 Automated external defibrillator [AED]
 TYPES
 Mono phasic- recommended energy level is 360 J
 Biphasic- recommended energy level is 200 J

30. SPECIAL SITUATIONS
 CPR in children from 1 year of age to puberty
 Steps
 The sequence is similar to that of adult CPR
 Assess response. If not sure, assume that the child is not breathing
 Activate the emergency response system and get an AED
 Check pulse[carotid or femoral pulse]
 Start 30 compressions
 May use 1 or 2 hands
 Rate :100/min
 Depth: 2 inches(5cm or 1/3rd chest depth)
 Give 2 rescue breaths
 Cover the child’s mouth with your mouth and pinch the nose with
fingers

31.  In case of two rescuer, ratio is 15:2
 After 5 cycles get an AED
 Choose correct size AED pads. If using standard pads,
make sure they do not touch or overlap.

32. CPR for infants
PEDIATRIC CHAIN OF SURVIVAL
 Prevention of arrest
 Early high quality bystander CPR
 Rapid activation of emergency response system
 Effective advanced life support
 Integrated post cardiac arrest care

34. Steps
 Assess response: rub or tap soles or feet or shoulder or
chest; don’t hurt the baby.
 Shout for help!!
 Activate emergency response system and get an AED
 Check pulse
 Brachial pulse is checked [5-10 sec]
 If pulse present, give 1 breath every 3 sec
 Do compressions if pulse is less than 60/min or no pulse
 Recheck pulse every 2 min

35. CHEST COMPRESSIONS
Technique Single rescuer Two rescuer
Rate 100/min 100/min
Ratio 30:2 15:2
Depth 1.5 inches[4cm] 1.5 inches[4cm]
Compression technique  Place infant on a firm flat
surface
 Place two fingers in the center
of the chest just below the
nipple line
 Push hard and fast
 Allow chest recoiling, minimize
interruptions
Two thumb encircling hands
technique
 With your hands, encircle the
chest and place thumbs on the
lower half of the breast bone
 Depress the breast bone
 Deliver compressions
 Switch roles every 2 minutes

37. Open airway and provide breaths
Mouth to mouth and
nose
Mouth to mouth
Most preferred
Make an air tight seal
with your mouth and
nose
Blow 2 breaths, make
sure that chest is rising
Pinch victim’s nose
tightly with thumb and
fore finger
Make a mouth to mouth
seal
Provide 2 breaths, make

38. Use AED
 Infant pads must be used
 2-4 joules/kg
 Recheck pulse and start compressions immediately if
needed

39. CPR with advanced airway
 When advanced airway [laryngeal mask airway, supra-
glottic or endo-tracheal tube] is in place, rescuers
must not pause chest-compressions in order to provide
breaths. Give one breaths every 6-8 sec ie. 8-10
breaths/min. Endo-tracheal tube remains the gold
standard for air way maintenance in CPR

40. SUMMARY OF STEPS OF CPR FOR ADULTS, CHILDREN
AND INFANTS

42. In 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 recommended for
this reason that the uterus be pushed to the persons
left and if this is not effective either roll the person
30°s or consider emergency cesarean section.

43. POST RESUSCITATION CARE
 Adequate oxygenation
 Provide side lying position[recovery]
 Continuous monitoring
 Life saving drugs
 Induced hypothermia for 24 hrs with cold IV fluids (32-34
degree Celsius)
 Maintenance of cerebral perfusion
 Seizure treatment and supportive care
 Stable vital signs
 Maintain blood oxygen levels and blood chemistry
 Blood sugar maintenance

44. LONG TERM MANAGEMENT
 Thrombolysis
 Coronary angiography
 PCI’s
 Artificial pacemaker
 Implantable cardioverted defibrillator(ICD)
 CABG
 Mechanical ventilation
 Catheter ablation therapy
 Medications to stabilize the heart function, blood
chemistry and seizures
 Heart transplantation if needed
 Rehabilitation

45. ALTERNATIVE CPR TECHNIQUES
 Interposed abdominal compression CPR(IAC)
 High frequency (rapid manual) CPR
 Vest CPR
 Chest compression only CPR
 Prone CPR(reverse CPR)
 Precordial thump
 Invasive CPR

49. DEVICES TO SUPPORT
CIRCULATION
 IABP
 Ventricular assistive devices

50. SIGNS OF SUCCESSFUL CPR
 Lung expansion
 Pupil will react to light / will appear normal
 Normal heart beat will return
 A spontaneous gasp/breathing will occur
 May move legs / arms and color may improve.

51. COMPLICATIONS
 Faulty techniques of CPR can result in
 local blunt trauma
 bruising or fracture of the sternum or ribs
 Compression at the xiphoid process causes laceration
of liver.
 Cardiac tamponade
 Pneumothorax
 Hemopericardium
 Lung laceration

52. LEGAL AND ETHICAL
CONSIDERATIONS
 CPR can be given without fear of any legal actions
 The lay rescuers should not be afraid of any harm if
the patient dies after the CPR attempt.
 Avoid CPR in conditions where there is DO NOT
ATTEMPT RESUSCITATION(DNAR OR DNR) order,
because we have to respect patient’s wish
 Withhold CPR in case of DNR order of physician

53. WHEN TO STOP CPR?
 Victim starts to move
 AED arrives
 Trained helpers arrive
 When you become too exhausted
 Signs of death become apparent

54. NURSE’S ROLE IN CPR
 Nurses play a key role in the management of victims in
hospitals. Often they are the first on the scene of an arrest-
initiating CPR as well as summoning advanced life support
team
 All nurses are expected to manage a collapse situation
 Skilled clinical assessment and recognition of the
prodromes of collapse may decrease the incidence of in-
hospital cardiac arrests.
 Nurses must be aware of the CPR procedure and must
update it.
 Nurse must be able to provide defibrillation
 Nurses must take initiation in educating common people
about CPR

55. NURSING DIAGNOSIS AND
INTERVENTION
 Ineffective tissue perfusion r/t decreased cardiac output as
evidenced by absence of pulse.
 Goal
 Will demonstrate adequate tissue perfusion as evidenced
by presence of pulse.
 Nursing interventions:
 Provide a safe environment and asses response
 Monitor carotid and peripheral pulse
 Activate the emergency team and provide CPR
 Provide rapid defibrillation if needed
 Provide post-resuscitation care

56.  Impaired gas exchange r/t ventilation perfusion mismatch as
evidenced by absence of breathing
 Goal
 Maintains effective gas exchange as evidenced by return of
normal breathing pattern, visible chest rise
 Nursing interventions:
 Reassess breathing pattern
 Provide resuscitation and rescue breaths
 Administer oxygen
 Assess vital signs and record
 Monitor for arrhythmias
 Obtain ABG values
 Administer medications

57.  Risk for potential complication like rib fracture related to
CPR
 Goal
 Remains free from rib fracture, injury as evidenced by good
outcome
 Nursing interventions:
 Place the victim in a safe environment
 Provide CPR effectively using the correct procedure
 Place hands properly on the chest
 Do not apply vigorous force
 Assess for any complication
 Provide appropriate management for any complication

58. POST CPR NURSING DIAGNOSIS
 Activity intolerance r/t fatigue secondary to cardiac
insufficiency/compromised cardiac function as
evidenced by weakness
 Imbalanced nutrition less than body requirement r/t
npo status, decreased intake, anorexia secondary to
disease condition
 Risk for dysarrythmias r/t decreased cardiac output
 Anxiety related to prognosis and fear of death
 Deficient knowledge regarding long term
management of disease condition