Rationalization of CPR
Compiled by: Prof. Precy P. Lantin
Prof. Evangeline Pasamba
IMPLEMENTATION
ACTION RATIONALE
1. Assess responsiveness. If the patient Assessing responsiveness prevents
is not responsive, call for help, pull call starting CPR on a conscious
bell, and call the facility emergency victim. Activating the emergency
response number. Call for the response system initiates a
automated external defibrillator (AED). rapid response.
IMPLEMENTATION
ACTION RATIONALE
2. Put on gloves, if available. Position the Gloves prevent contact with blood and
patient supine on his or her back on a body fluids. The supine
firm, flat surface, with arms alongside position is required for resuscitative
the body. If the patient is in bed, place a efforts and evaluation to be
backboard or other rigid surface effective. Backboard provides a firm
under the patient (often the footboard surface on which to apply
of the patient’s bed). compressions. If the patient must be
rolled, move as a unit so
the head, shoulders, and torso move
simultaneously without
IMPLEMENTATION
ACTION RATIONALE
3. Use the head tilt–chin lift maneuver to This maneuver may be sufficient to open
open the airway (Figure 1). Place one hand on the airway and promote spontaneous
the victim’s forehead and apply firm,
respirations.
backward pressure with the palm to tilt the
head back. Place the fingers of the other
hand under the bony part of the lower jaw
near the chin and lift the jaw upward to bring
the chin forward and the teeth almost to
occlusion. If trauma to the head or neck is
present or suspected, use the jaw-thrust
maneuver to open the airway (Figure 2).
Place one hand on each side of the patient’s
head. Rest elbows on the flat surface under
the patient, grasp the angle of the patient’s
lower jaw, and lift with both hands.
IMPLEMENTATION
ACTION RATIONALE
4. Look, listen, and feel for air exchange. These techniques provide information
Take at least 5 seconds and no more about the patient’s breathing and the
than 10 seconds (AHA, 2006). need for rescue breathing.
IMPLEMENTATION
ACTION RATIONALE
5. If the patient resumes breathing or The recovery position maintains
adequate respirations and signs of alignment of the back and spine
circulation are noted, place the patient while allowing for continued observation
in the recovery position. and maintains access
to the patient.
IMPLEMENTATION
ACTION RATIONALE
6. If no spontaneous breathing is Sealing the patient’s mouth and nose prevents
noted, seal the patient’s mouth air from escaping. Devices such as masks
and nose with the face shield, reduce the risk for transmission of infections.
one-way valve mask (Figure 3A),
or Ambu-bag (handheld
resuscitation bag), if available
(Figure 3B). If not available, seal
the patient’s mouth with
rescuer’s mouth.
IMPLEMENTATION
ACTION RATIONALE
7. Instill two breaths, each lasting 1 Breathing into the patient provides oxygen
second, making the chest to the patient’s lungs. Hyperventilation
rise. results in increased positive chest pressure
and decreased venous return. Blood flow
to the lungs during CPR is only about 25%
to 33% normal; patient requires less
ventilation to provide oxygen and remove
carbon dioxide. Longer breaths reduce the
amount of blood that refills the heart,
reducing blood flow generated by
compressions. Delivery of large, forceful
breaths may cause gastric inflation and
distension.
IMPLEMENTATION
ACTION RATIONALE
8. If you are unable to ventilate or the Inability to ventilate indicates that the
chest does not rise during ventilation, airway may be obstructed. Repositioning
reposition the patient’s head and maneuvers may be sufficient to open the
reattempt to ventilate. If still unable to airway and promote spontaneous
ventilate, begin CPR. Each subsequent respirations. It is critical to minimize
time the airway is opened to administer interruptions in chest compressions, to
breaths, look for an object. If an object is maintain circulatory
visible in the mouth, remove it. If no perfusion.
object is visible, continue with CPR.
IMPLEMENTATION
ACTION RATIONALE
9. Check the carotid pulse, Pulse and other assessments evaluate
simultaneously evaluating for breathing, cardiac function. The femoral pulse may
coughing, or movement. This be used for the pulse check.
assessment should take at least 5
seconds and no more than 10 seconds.
Place the patient in the recovery
position if breathing resumes (Figure 4).
IMPLEMENTATION
ACTION RATIONALE
10. If patient has a pulse, but remains Rescue breathing maintains adequate
without spontaneous breathing, oxygenation.
continue rescue breathing at a rate of
one breath every 5 to 6 seconds, for a
rate of 10 to 12 breaths per minute.
IMPLEMENTATION
ACTION RATIONALE
11. If the patient is without signs of Proper hand positioning ensures that
circulation, position the heel of one the force of compressions is
hand in the center of the chest between on the sternum, thereby reducing the
the nipples, directly over the lower half risk of rib fracture, lung
of the sternum. Place the other hand puncture, or liver laceration..
directly on top of the first hand. Extend
or interlace fingers to keep fingers above
the chest. Straighten arms and position
shoulders directly over hands.
IMPLEMENTATION
ACTION RATIONALE
12. Perform 30 chest Direct cardiac compression
compressions at a rate of 100 and manipulation of
per minute, counting “one, intrathoracic pressure
two, etc.” up to 30, keeping supply blood flow during
elbows locked, arms straight, CPR. Compressing the
and shoulders directly over chest 11⁄2 to 2 inches
the hands. Chest ensures that compressions
compressions should depress are not too shallow and
the sternum 1 1⁄2 to 2 inches. provides adequate blood
Push straight down on the flow. Full chest recoil
patient’s sternum. Allow full allows adequate venous
chest recoil (re-expand) after return to the heart.
each compression (Figure 5).
IMPLEMENTATION
ACTION RATIONALE
13. Give two rescue breaths after each Breathing and compressions simulate
set of 30 compressions. Do five lung and heart function,
complete cycles of 30 compressions and providing oxygen and circulation.
two ventilations.
IMPLEMENTATION
ACTION RATIONALE
14. Defibrillation should be provided at The interval from collapse to
the earliest possible moment, as soon as defibrillation is the most important
AED becomes available. determinant of survival from cardiac
arrest (AHA, 2005b).
IMPLEMENTATION
ACTION RATIONALE
15. Continue CPR until advanced care Once started, CPR must continue until
providers take over, the patient starts to one of these conditions is met. In a
move, you are too exhausted to hospital setting, help should arrive
continue, or a physician discontinues within a few minutes.
CPR. Advanced care providers will
indicate when a pulse check or other
therapies are appropriate (AHA, 2006, p.
34).
IMPLEMENTATION
ACTION RATIONALE
16. Remove gloves, if used. Perform Removing PPE properly reduces the risk
hand hygiene. for infection transmission and
contamination of other items. Hand
hygiene prevents transmission of
microorganisms.
IMPLEMENTATION
ACTION RATIONALE
EVALUATION The expected outcome is achieved when
CPR is performed effectively without
adverse effect to the patient; the patient
regains a pulse and respirations; the
patient’s heart and lungs maintain
adequate function to sustain life;
advanced cardiac life support is initiated;
and the patient does not experience
serious injury.
IMPLEMENTATION
ACTION RATIONALE
DOCUMENTATION Document the time you discovered the
Guidelines patient unresponsive and started CPR.
Continued intervention, such as by the
code team, is typically documented on a
code form, which identifies the actions
and drugs provided during the code.
Provide a summary of these events in
the patient’s medical record.
IMPLEMENTATION
ACTION RATIONALE
Sample Documentation 09/06/21- 0700H Called to patient’s
room by wife. Patient noted to be
without evidence of respirations or
circulation. Emergency response system
activated, CPR initiated. See code
sheet.
—Precy P. Lantin, RN
Lynn, P. [Link] (2011). Skill Checklists for Taylor’s Clinical Nursing
Skills A NURSING PROCESS APPROACH. THIRD EDITION. Wolters
Kluwer Health | Lippincott Williams & Wilkins.