Cardio Pulmonary Resuscitation: (CPR)

Introduction:-
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many
emergencies, including a heart attack or near drowning, in which someone's
breathing or heartbeat has stopped.
Particular phase of emergency cardiac care also known as Basic life support
(BLS)
1. Prevents circulatory or respiratory arrest or insufficiency through prompt
recognition and intervention.
2. Externally supports the circulation and ventilation of a victim of cardiac
or respiratory arrest through CPR.
Objectives:
1. To provide oxygen to brain, heart and vital organs until appropriate
definitive medical treatment can restore normal heart and ventilatory
function.
Indication:
1. Cardiac arrest
2. Respiratory arrest resulting from stroke, airway obstruction, electric
shock, foreign body, smoke inhalation, drug overdose, suffocation,
myocardial infarction, coma of any cause leading to airway obstruction.
Sequence of BLS:
ABC’s of CPR - Airway, Breathing, Circulation
Assessment phase to determine need for action which include “determine
unresponsiveness, determine breathlessness and determine pulselessness”
respectively.
Latest easy Sequence of CPR is C A B (Compression, Airway, Breathing)
Articles:
 Arrest board / flat surface
 Oral airway
 A piece of lint to place over
client’s mouth or oral barrier
device for mouth to mouth
respiration
 Ambu bag and mask
Procedure:
Nursing Action Rationale
(A. Determine unresponsiveness)
1. Tap or gently shake client while It will prevent injury of a person
shouting “are you ok” who has not suffered a arrest.
(B. Determine Breathlessness)
2. Check for breathing by keeping cheek CPR should not be administered
against client’s nose and look at chest for with spontaneous respiration
rise and fall and simultaneously listen and because of potential risk of injury.
feel for exhaled breath.
(C. Check for Carotid Pulse)
3. check for carotid pulse on one side for Carotid pulse may persist when
5-10 seconds. peripheral pulses are not palpable.
If No pulse and breathing is found, start CPR
4 Call for Help in hospital Set up. For Trained personnel
5. Position Arrest board under client’s Firm surface allowing for
chest, if Arrest board not available, place compressions of heart
victim on firm, flat surface
6. Kneel at victim’s side Allows performance of rescue
breathing and chest compressions
with efficiency.
7. Open Airway
a. Head tilt chin lift manoeuvre: Place one This support the jaw and helps tilt
hand on forehead and apply backward the head back. Not performed
pressure with palm to tilt the head back. with head and neck injuries.
Then place the fingers of other hand
under bony part of lower jaw near chin
and lift up to bring jaw forward.
b. Jaw thrust manoeuvre: Grasp the
angles of client’s lower jaw and lift with This technique without head tilt is
both hands, one on each side, displacing safest way in presence of
mandible forward. suspected neck injury.
8. Place an airway, if available Keep airway patent
9. a. Occlude nostrils with thumb and To prevent air leakage and
index finger of hand on forehead that is provide full inflation of lungs.
tilted head back. Form a seal over client’s
mouth using your mouth or appropriate
resp. device (Ambu bag and Mask) and
give full breaths of approx. 2 seconds
allow time for both inspiration and
expiration.
b. Observe for rise and fall of chest.
10. Place middle finger of first hand on Proper hand positioning ensues
notch of sternum and index finger next to maximum compression of heart
it, place heel of other hand next to index and prevents injuries to liver and
finger. Remove first hand from notch and ribs.
place on top of other hand that is on
sternum. keep your arms straight and
Interlock the fingers of both hands
together and keep them raised so that they
do not touch the patient’s chest.
Lean forward and make sure that your
shoulders are directly above the patient’s
chest.
11. Compress the adult chest 1.5 to 2
inches at rate of approx. 100 compression
per minute.
12. Release the external chest Release compression allows
compression completely and allow chest blood flow into Heart.
to return its normal position after each
compression.
Do not lift hands off chest Remove hands required more
time to locate exact point for
compressions
13. Do 30compressions and then perform Compressions and rescue
to ventilations, re-evaluate client after breathing should be combined.
four cycles.
(Speak count 1,2,3…..30 ) To keep rhythm and timing.
[Link] performed by one or two rescuers
Compression rate is 100 per minute
Compression ventilation ratio - 30:2
15. while resuscitation proceeds,
simultaneous efforts must be made
Equipment’s for respiration,
Defibrillation, drugs, acid base
disturbances, ongoing monitoring and
skilled care in ICU.
When Stop CPR
1. Revive client as circulation returns
[Link] of Medical team
3. if rescuer become exhausted
4. death confirmed.