Cardiopulmonary resuscitation (CPR) preceded by short, shallow breathing

that becomes increasingly labored.

- is a combination of oral resuscitation
- It is vital that all nurses be trained to
(mouth-to-mouth breathing or use of a
perform CPR so resuscitation measures
mask), which supplies oxygen to the
can be initiated immediately when a
lungs, and external cardiac massage
cardiac or respiratory arrest occurs.
(chest compression), which is intended
Nurses also can be instrumental in
to reestablish cardiac function and
increasing community awareness of the
blood circulation.
need for CPR training and ensuring its
- CPR is also referred to as basic life
availability.
support (BLS). The AHA issues revised
- Each health care facility has policies and
standards for CPR every five years (e.g.,
procedures for announcing
2010, 2015). It covers all aspects of
cardiac/respiratory arrest and initiating
emergency cardiac care and simplifies
interventions, as well as a name by
CPR procedures so more health care
which this emergency is referred; such
professionals and lay rescuers might
emergencies are often referred to as a
learn them and perform them correctly.
“code.”
The complete guidelines are available
- There may be a button at the head of
online.
each bed for calling a code, an
- A cardiac arrest is the cessation of
extension dialed on the phone, or it
cardiac function; the heart stops
may be a special phone used to
beating. Often a cardiac arrest is
announce the emergency.
unexpected and sudden. When it
- It is critical that each member of the
occurs, the heart no longer pumps
client care team know the procedure
blood to any of the organs of the body.
for announcing this emergency. Calling
Breathing then stops, and the person
the code summons the code team to
becomes unconscious and limp. Within
the location of the emergency. The
20 to 40 seconds of a cardiac arrest, the
code team is made up of specially
victim is clinically dead. After 4 to 6
trained staff who can handle the
minutes, the lack of oxygen supply to
emergency. Individuals are needed to
the brain causes permanent and
perform rescue breathing, deliver chest
extensive damage. The three cardinal
compressions, administer medications,
signs of a cardiac arrest are apnea,
and make a record of the code
absence of a carotid or femoral pulse,
activities. One person must be
and dilated pupils. The person’s skin
designated as the code leader—the
appears pale or grayish and feels cool.
person who directs the activities of the
Cyanosis is evident when respiratory
other team members. Some clients
function fails before heart failure. A
have requested via an advance directive
respiratory arrest (pulmonary arrest) is
that, should they arrest, they not be
the cessation of breathing. It often
resuscitated. It is every person’s right to
occurs because of a blocked airway, but
make an advance directive of their
it can occur following a cardiac arrest
wishes, and a client’s code status
and for other reasons. A respiratory
should always be documented, per
arrest may occur abruptly or be
agency policy, in the medical record
 (e.g., do not resuscitate [DNR]). Under
most circumstances, if there is no DNR
order in the record, all clients who
arrest will have resuscitation efforts
begun. Both legally and ethically, there
is no such thing as a “partial code,”
“slow code,” or “mini code.”
Throughout any emergency situation,
the nurse must remember the person
behind all of the technology. There is a
client with spiritual and emotional
needs who requires a personal
connection. Holding a hand, making eye
contact, talking directly to them—brief,
seemingly small things make a huge
difference to clients. To humanize
health care is always a goal. Nursing
therapeutic presence is the key. This
should be extended to family members
as well.
- First aid is as easy as ABC – airway,
breathing and CPR (cardiopulmonary
resuscitation). In any situation, apply
the DRSABCD Action Plan.
DRSABCD stands for:
• Danger – always check the danger to
you, any bystanders and then the
injured or ill person. Make sure you do
not put yourself in danger when going
to the assistance of another person.
• Response – is the person conscious? Do
they respond when you talk to them,
touch their hands or squeeze their
shoulder?
• Send for help – call triple zero (000).
Don’t forget to answer the questions
asked by the operator.
• Airway – Is the person’s airway clear? Is
the person breathing?
• If the person is responding, they are
conscious and their airway is clear,
assess how you can help them with any
injury.
• If the person is not responding and they
are unconscious, you need to check
their airway by opening their mouth
and having a look inside. If their mouth
is clear, tilt their head gently back (by
lifting their chin) and check for
breathing. If the mouth is not clear,
place the person on their side, open
their mouth and clear the contents,
then tilt the head back and check for
breathing.
• Breathing – check for breathing by
looking for chest movements (up and
down). Listen by putting your ear near
to their mouth and nose. Feel for
breathing by putting your hand on the
lower part of their chest. If the person is
unconscious but breathing, turn them
onto their side, carefully ensuring that
you keep their head, neck and spine in
alignment. Monitor their breathing until
you hand over to the ambulance
officers.
• CPR (cardiopulmonary resuscitation) – if
an adult is unconscious and not
breathing, make sure they are flat on
their back and then place the heel of
one hand in the centre of their chest
and your other hand on top. Press
down firmly and smoothly (compressing
to one third of their chest depth) 30
times. Give two breaths. To get the
breath in, tilt their head back gently by
lifting their chin. Pinch their nostrils
closed, place your open mouth firmly
over their open mouth and blow firmly
into their mouth. Keep going with the
30 compressions and two breaths at the
speed of approximately five repeats in
two minutes until you hand over to the
ambulance officers or another trained
person, or until the person you are
resuscitating responds. The method for
CPR for children under eight and babies
is very similar and you can learn these
skills in a CPR course.
• Defibrillator – for unconscious adults
who are not breathing, apply an
 automated external defibrillator (AED)
if one is available. They are available in
many public places, clubs and
organisations. An AED is a machine that
delivers an electrical shock to cancel
any irregular heart beat (arrhythmia), in
an effort get the normal heart beating
to re-establish itself. The devices are
Procedure Steps
very simple to operate. Just follow the
instructions and pictures on the
machine, and on the package of the
pads, as well as the voice prompts. If
the person responds to defibrillation,
turn them onto their side and tilt their
head to maintain their airway. Some
AEDs may not be suitable for children.

You are likely to be presented with a resus mannequin and told that you have found the patient
collapsed, either on a corridor in the hospital or somewhere outside. Either way, the algorithm to follow
is fairly similar.

Step 1 - Danger
Initially you should assess if there is any danger in the situation either for you or for the patient.

Step 2 - Response
You should check if there is any response from the patient. Do this by gently shaking the patient's
shoulders and loudly shouting into both ears, asking them "Can you hear me?"

If there is no response you should shout for help. If there is anyone present then you should also ask
them to get an Automated External Defibrillator (AED) if there is one available.

Check for a response

Step 03 - Airway
Check if the patient's airway is patent. Perform the head tilt (unless there is any chance of cervical spine
injury) and jaw thrust to open the airway. Ensure that there is no physical blockage by their tongue,
vomit, or anything else.
Check the patients airway

Step 04 - Breathing
Check the patients breathing, do this by maintaining the head tilt and jaw thrust, placing your face and
ear over the mouth to feel for any respiratory effort whilst observing the chest for any movement. You
should assess for normal breathing for up to 10secs.

Check for breathing and circulation

Step 05
If breathing is normal, place the patient in the recovery position and find help.

Recovery position

Step 06
If breathing is absent you should call for the emergency services.
Step 07
Once you have called for support, you should begin chest compressions.

Place one hand over the sternum roughly in the middle, interlock your fingers and lock your elbows
positioning yourself vertically above your hands. Depress the sternum 5-6 centimeters and release the
pressure. Repeat this 30 times at a rate of 100 to 120 per minute.

Begin chest compressions

Step 08
Start to give a combination of 2 rescue breaths and 30 chest compressions. For the rescue breaths
ensure the head tilt and jaw thrust are in place, pinch the soft part of the nose so that it is closed, open
the mouth, seal your lips around theirs and blow steadily for 1 second. Watch the chest to check that it
rises and falls with the breath. Once the breaths are given, return to giving 30 chest compressions.

Pinch nose and tilt head

Breathe into patient

Step 09
If there is anyone who can assist, you should share out the work. One of you should perform the breaths
and the other the compressions, swapping when tired.

Step 10
You should continue this cycle of 2 rescue breaths and 30 chest compressions until either further help
arrives, the patient regains consciousness, or you can no longer physically continue.