CARDIO PULMONARY RESUSCITATION

 INTRODUCTION:-

 Cardiopulmonary resuscitation (CPR) is a life saving technique useful in many emergencies,

including cardiac arrest or respiratory arrest, in which someone’s breathing or heart beat has
stopped.
 CPR is effective only if performed within 7minuites of the cardiac or respiratory arrest.
 Nurses are the most important health care personnel who should effectively care for more
complex cases, including interventions for patients with cardiopulmonary arrest, initiating
basic life support (BLS) and a adding in advanced life support (ALS).

 DEFINITION:-

It is an emergency procedure, often employed after cardiac arrest, in which external cardiac

massage, artificial respiration and drugs are used to maintain the circulation of oxygenated blood
to the brain.

 PURPOSE OF CPR:

 To maintain an open and clear airway (A).

 To maintain breathing by artificial ventilation (B).
 To maintain circulation by external cardiac massage (C).
 To save life of the patient.
 To provide basic life support till medical and advanced life support arrives.

 PRINCIPLES OF CPR :

o To restore effective circulation and ventilation.

o To prevent irreversible cerebral damage due to anoxia.
o When the heart fails to maintain the cerebral circulation for approximately four minutes the
brain may suffer irreversible damage.

 INDICATIONS OF CPR:
 
 Cardiac Arrest:

 Ventricular fibrillation.
 Ventricular tachycardia.
 Asystole.
 Pulseless electrical activity.
 
 Respiratory Arrest:

This may be the result of the following:

 Drowning.
 Stroke.
 Foreign body in throat.
 Smoke inhalation.
 Drug overdose.
 Suffocation.
 Accident, injury.
 Coma.
 Epiglottis paralysis.

 CONTRAINDICATIONS : 

 Do not resuscitate when a decision not to resuscitate has been noted in the chart. 
 Patient on anticoagulant therapy Any history of central nervous system damage.
 Severe uncontrolled hypertension , Recent trauma to head or cranium.
 Neoplasm with increased bleeding risk.
 Active peptic ulceration Known history of ischemic stroke 

 ASSESSMENT : 

 Determine that the client is unconscious.

 Shake the client and shout at him or her to confirm if conscious rather than being asleep. 
 Assessment for the presence of respiration. 
 Assess carotid artery for pulse.

 GENERAL INSTRUCTIONS FOR EFFECTIVE CPR 

 CPR technique is used in person whose respiration and circulation of blood have suddenly
and unexpectedly stopped.

 There are no need of attempting CPR techniques in patients in the last stage of an incurable
illness and in persons whose heartbeat and respiration have been absent for more than six
minutes.

 IMPORTANT POINTS TO START CPR:-

o It is important to start the CPR immediately after the cardiac arrest because brain damage
starts in 4-6 minutes.
o So no time should be wasted in checking blood pressure, peripheral pulse or monitoring
cardiac sound and tone.
o The first indicator of a cardiopulmonary arrest is absence carotid artery pulsation. This is the
main symptom to indicate initiation of CPR.
o Respiratory arrest this is the second indicator for the CPR to be initiated so a quick check of
the carotid pulse and respiratory movement indicate the need for CPR.
o Any patient with sudden syncope or unconsciousness should be suspected for cardiac or
respiratory arrest and the carotid pulse and respiratory assessment must be performed.

CPR PROCEDURE/HOW TO PERFORM CPR:-

 The standard method of CPR has been C-A-B, ‘C’ for compression, ‘A’ for air way, ‘B’
for breathing.

 MAIN STAGES OF RESUSCITATION 


C

(Chest compressions): Chest compressions will be initiated sooner and ventilation only
minimally delayed until completion of the first cycle of chest compressions. 

 A (Airway): Ensure open airway by preventing the falling back of tongue , tracheal
intubation if possible.
 B (Breathing): Start artificial ventilation of lungs.
 SEQUENCE OF EVENTS IN CPR:-

 STEP-1: Before starting CPR, check:-

 If patient is unresponsive, check is the person conscious or unconscious?

 If the person appears unconscious, tap or shack his or her shoulder and ask loudly, “are you
ok?’’
 If the person does not respond, call the local emergency health care number for help.

 STEP-2: Restore blood circulation and respiration with chest compression and
giving breathing:-

 Put the person on his or her back on a firm surface.

 Check carotid pulse within 5-10 seconds.
 If carotid pulse is absent start CPR, place the heel of one hand over the center of the
person’s chest between two nipples.
 Interlock fingers of the other hand.
 Lean forward so the shoulders are over the hands.
 Press straight down with elbows straight.
 Push at least 2 inches or 4-5 cm.
 Push hard and fast at a rate of about 100/120 compressions in a minute.
 Give 30 compression and 2 breath in one cycle (30:2=1 cycle) have to give 5 cycle in 2
minute.
 Allow complete chest recoil after each compression.
 Minimize interruption in chest compressions.
 If carotid pulse is present look for chest rise listen breathe sound and feel for normal
breathing and check if any foreign body in the mouth or air way.
 Then clean the mouth or air way.
 If the breathing is absent begin mouth to mouth or mouth to nose or use the mask breathing,
using head tilt, chin lift or jaw thrust position.
 Don’t allow air to leak while giving breath.
 Give 10-12 breath per minute one breath in every 5-6 seconds and recheck the pulse in
every 2 minute.

 STEP-3: Use of automated external defibrillator (AED):-

 After 5 cycle and adequate breathing if the person has not begun moving or not giving any
response administer one shock by manual defibrillator or AED, immediately again start CPR
for 5 cycle.
 If that time defibrillator or AED is not available then continue the CPR till the defibrillator or
ambulance reached to the patient.

 POSSIBLE COMPLICATIONS OF CPR PROCEDURE:-

 Coronary vessel injury

 Diaphragm injury
 Hemopericardium
 Hemothorax
 Liver injury
 Pneumothorax
 Rib fracture
 Spleen injury
 Sternal fracture

 EQUIPMENTS NEEDED FOR CPR IN HOSPITAL SETUP:-

 Suction apparatus
 Oxygen supply
 AMBU bag and mask
 Endotracheal tube (ETT)
 Laryngoscope
 Oro pharyngeal airway
 Defibrillator
 Ventilator
 IV equipments and fluids
 Pulse oximeter
 Emergency drugs
 Cardiac monitor

 MEDICATION USED IN CPR:-

 Adrenaline-reduce heart rate, dose-1mg/1ml

 Atropine-increase heart rate, dose-0.5mg/1ml
 Amiodarone-maintain normal heart rate, dose-50mg/1ml
 Dopamine-improve pumping strength of heart, dose-1.6mg/ml
 Dobutamine-used in heart failure, increase heart rate, dose-12.5mg/ml
COMPARISON OF COMPONENTS FOR ADULTS, CHILDREN AND INFANTS CPR:-
COMPONENTS ADULTS CHILDREN INFANTS
Hand placement Place heal of one  Rescuer can use  Here 2 fingers or
hand in center of one or both hand 2 thumb method
chest or between two for compression. is used.
nipple and interlock  Place heel of one  Place two finger
fingers of the other hand in center of or two thumbs
hand chest between on the breast
two nipples. bone just below
 If one hand is not the two nipple
enough use both line.
hands.

Compression depth At least 2 inches or At least 1/3 anterior At least 1/3 anterior
5cm. posterior diameter posterior diameter
about 2 inches or 5 about 1.5 inches or 4
cm. cm.

Compression rate At least 100/120 At least 100/120 At least 100/120

compression per compression per compression per
minute. minute. minute.

Compression- 30:2 for single or 30:2 for single 30:2 for single
ventilation ratio 2- rescuers rescuer and 15:2 for rescuer and 15:2 for
two rescuers. two rescuers.

 SIGNS OF EFFECTIVE RESUSCITATION: 

o Constriction of pupils, key sign that brain is sufficiently oxygenated. 

o Distinct carotid pulsation with each cardiac compression. 
o Blinking upon stimulation of the eyelids 
o Breathing that begins spontaneously.
o Movement and struggling. 
o Decreased cyanosis. 

 SIGNS OF INEFFECTIVE RESUSCITATION 

o Incorrect resuscitative techniques.

 o heart is drained of its blood by hemorrhage or cardiac tamponade. 
o Blood supply to the heart is obstructed by the presence of pulmonary embolus. 
o Severe chronic lung disease has destroyed lungs capacity to oxygenate blood. 
o Lungs are filled with vomitus as a rescue of aspiration during cardiac massage. 

 POST RESUSCITATION MEASURES . 

 Skilled after care is essential for the patient who has suffered an arrest. 
 Continuous vigilance must be ensured by a skilled person for 48-72 hours. 
 If the patient is not in the intensive care unit shift him there for consent observation and
expert care.
 Monitor ECG, CVP and blood pressure. 
 Check the oral cavity and jaw position as his tongue may fall and obstruct the airway. 
 Temperature is taken every hour. 
 A high temperature usually indicates cerebral damage or cerebral edema. 
 Blood gas and Ph determinations are done to detect metabolic acidosis. 
 Amobarbital sodium is given intravenously in case of convulsions.

 NURSING MANAGEMENT:-

o Maintains airway patency with use of air way adjunct.

o Assist with intubation and securing of endotracheal tube (ETT).
o Inserts nasogastric tube.
o If shakable rhythm is present (VT/VF) ensure manual defibrillator pads are applied and
connected.
o Prepare and administered iv fluids.
o Document medications administered with time.

BIBLIOGRAPHY:-
 Brunner and Suddarth’s.(2016), Text book of medical surgical nursing; 12th edition:
publish by. Lippincott Williums and wilkins, page no-843-845
 Dr. Auradha. S.(2018), a text book of fundamentals of nursing; 1 st edition: publish by.
Vijayam publication, prakasam road, tirupati-517501; page no-
 Javed Ansari and Davinden kaur.(2011), Text book of medical surgical nursing volume-ii;
1st edition: publish by pee vee, page no-2033-2039
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017), Roberts medical surgical nursing,
assessment and management of clinical problems; 3rd south asia edition: publish by
RELX India pvt.ltd , new delhi; page no-110-111
 https://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation
 https://www.mayoclinic.org/first-aid/first-aid-chokin
 https://www.webmd.com/first-aid/cardiopulmonary-resuscitation-cpr-treatment