SARASWATI COLLEGE OF NURSING

UDAIPUR

ASSIGNMENT ON

CARDIO PULMONARY
RESUSCITATION

SUBMITTED TO SUBMITTED BY
MR CHIRAYU SONI MR RAJNISH PATHAK
HOD MSN MSC (N) FINAL YEAR
CARDIOPULMONARY RESUSCITATION

INTRODUCTION:
Cardiopulmonary resuscitation is a technique of basic life support for oxygenating the
brain and heart till appropriate, definitive medical treatment can restore normal heart and
ventilator action. CPR techniques are used to artificially maintain both circulation and
ventilation in persons suffering from cardiac arrest. CPR alone is unlikely to restart the
heart; its main purpose is to restore partial flow of oxygenated blood to the brain and
heart. The objective is to delay tissue death and to extend the brief window of opportunity
for a successful resuscitation without permanent brain damage. Administration of an
electric shock to the subject's heart, termed defibrillation, is usually needed in order to
restore a viable or "perfusing" heart rhythm. Defibrillation is only effective for certain
heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather
than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm
which may be shock able. CPR is generally continued until the patient has a return of
spontaneous circulation (ROSC) or is declared dead.
HISTORY
 5000 - first artificial mouth to mouth ventilation
3000 BC
 1780 – first attempt of newborn resuscitation by blowing
 1874 – first experimental direct cardiac massage
 1901 – first successful direct cardiac massage in man
 1946 – first experimental indirect cardiac massage and defibrillation
 1960 – indirect cardiac massage
 1980 – development of cardiopulmonary resuscitation due to the works of Peter
Safar

DEFINITION:
Cardiopulmonary resuscitation (CPR) is an emergency procedure, performed in an
effort to manually preserve intact brain function until further measures are taken to
restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is
indicated in those who are unresponsive with no breathing or abnormal breathing, for
example, agonal respirations.

Standard

A universal compression to ventilation ratio of 30:2 is recommended. With children, if at

least 2 rescuers are present a ratio of 15:2 is preferred. In newborns a rate of 3:1 is
recommended unless a cardiac cause is known in which case a 15:2 ratio is reasonable. If
an advanced airway such as an endotracheal tube or laryngeal mask airway is in place
delivery of respirations should occur without pauses in compressions at a rate of 8–10 per
minute. The recommended order of interventions is chest compressions, airway,
breathing or CAB in most situations with a compression rate of at least 100 per minute in
all groups. Recommended compression depth in adults and children is about 5 cm (2
inches) and in infants it is 4 cm (1.5 inches). As of 2010 the Resuscitation Council (UK)
still recommends ABC for children. As it can be difficult to determine the presence or
absence of a pulse the pulse check has been removed for lay providers and should not be
performed for more than 10 seconds by health care providers. In adults rescuers should
use two hands for the chest compressions, while in children they should use one, and with
infants two fingers (index and middle fingers)

PURPOSES:
 To maintain blood circulation by external cardiac massages (C).
 To maintain an open and clear airway (A).
 To maintain breathing by artificial ventilation (B).
 To save life of the patients.
 To provide basic life support till medical and advanced life support arrives.

INDICATIONS:
 Cardiac arrest.
 Ventricular fibrillation.
 Ventricular tachycardia
 Asystole.
 Pulse less electrical activity.
 Respiratory arrest
  Drowning
 Stroke
 Foreign body in throat
 Smoke inhalation
 Drug overdose
 Electrocution or injury by lightening
 Suffocation
 Accident / injury.

CPR PROCEDURE
The new first step is doing chest compressions instead of first establishing the airway and
then doing mouth to mouth. The new guidelines apply to adults, children, and infants but
exclude newborns.
The old way was A-B-C -- for airway, breathing and compressions.
The new way is C-A-B -- for compressions, airway, and breathing.
"By starting with chest compressions, that's easy to remember, and for many victims that
alone will be lifesaving," says Michael R. Sayre, MD, chair of the emergency
cardiovascular care committee for the American Heart Association and co-author of the
executive summary of the 2010 AHA guidelines for CPR and emergency cardiovascular
care.
The old approach, he says, was causing delays in chest compressions, which are crucial
for keeping the blood circulating.
The new guidelines may inspire more people to perform CPR, says Sayre, an associate
professor of emergency medicine at Ohio State University, Columbus. "Mouth to mouth
is hard if you're not trained," he tells WebMD. ''Anybody can do chest compressions,
whether they have had a class or not. Good chest compressions really help save lives. In
many cases, there is a reserve of oxygen left in the patient's blood and lungs, from the last
breath, and we can take advantage of that oxygen reserve and just do chest
compressions."
How to Do the New CPR

Here is a step-by-step guide for the new CPR:

 Try to get the person to respond; if he doesn't, roll the person on his or her back.
 Start chest compressions. Place the heel of your hand on the center of the victim's
chest. Put your other hand on top of the first with your fingers interlaced.
 Press down so you compress the chest at least 2 inches in adults and children and
1.5 inches in infants. ''One hundred times a minute or even a little faster is
optimal," Sayre says.
 If you're been trained in CPR, you can now open the airway with a head tilt and
chin lift.
 Pinch closed the nose of the victim. Take a normal breath, cover the victim's
mouth with yours to create an airtight seal, and then give two, one-second breaths
as you watch for the chest to rise.
 Continue compressions and breaths -- 30 compressions, two breaths -- until help
arrives

CARDIO-RESPIRATORY FAILURE:
The cardio-respiratory failure is marked by hypoxia. If there is an insufficient pressure of
oxygen in the blood to load the hemoglobin molecules with oxygen, the oxygen content
of blood falls. When the heart fails to get an adequate supply of O2, arrhythmia occurs.
If hypoxia is severe, cardiac arrest occurs. At the same time, other tissues of the body are
also affected such as brain tissues. Within 4-6 minutes the cells of the brain, which are
sensitive to O2, begin to deteriorate. If the O2 supply is not restored, the patient suffers
irreversible brain damage and biological death occurs.

SIGNS AND SYMPTOMS OF CARDIAC ARREST:

 Sudden loss of consciousness.
 Absence of carotid pulses.
 Cessation of respiration.
 Dilatation of pupils.
 Marked cyanosis (later).

THREE CARDINAL SIGNS OF CARDIAC ARREST:

 Apnea – This indicates respiratory failure.
 Absence of carotid and femoral pulse- carotid pulse can be palpated by gentle
pressure over the depression between the trachea and the sterno-cleido-mastoid
muscle at the level with Adam’s apple.
 Dilated pupils- cerebral hypoxia causes loss of muscle control in the entire body
including eyes.

PRINCIPLES OF CARDIOPULMONARY RESUSCITATION

 To restore effective circulation and ventilation.
 To prevent irreversible cerebral damage due to anoxia. When the heart fails to
maintain the cerebral circulation for approximately four minutes the brain may
suffer irreversible damage.

PREPARATION OF THE PATIENT AND THE ENVIRONMENT:

 No time is lost in explaining the procedure to the patient and his relatives.
 If someone is free, can explain in simple language to the relatives and ask them to
leave the room to lessen distractions and to provide more space to the rescuer to
work.
  The patient may be shifted to a hard surface or a hard board is placed under his
thorax.
 Remove or push aside the clothing, which covered the patient’s chest to observe
the cardiac beats and respiration.
 Tight clothing around the neck and chest should be removed.
 Ensure fresh air in the room by opening windows and doors.
 External cardiac massage must be started within 4-6 min. following cardiac arrest
or irreversible brain damage will occur as a result of oxygen deprivation and lack
of circulation.

Indications

CPR should be performed immediately on any person who has become unconscious and
is found to be pulseless. Assessment of cardiac electrical activity via rapid “rhythm strip”
recording can provide a more detailed analysis of the type of cardiac arrest, as well as
indicate additional treatment options.

Loss of effective cardiac activity is generally due to the spontaneous initiation of a

nonperfusing arrhythmia, sometimes referred to as a malignant arrhythmia. The most
common nonperfusing arrhythmias include the following:

 VF
 Pulseless VT
 PEA
 Asystole
 Pulseless bradycardia

Although prompt defibrillation has been shown to improve survival for VF and pulseless
VT rhythms, CPR should be started before the rhythm is identified and should be
continued while the defibrillator is being applied and charged. Additionally, CPR should
be resumed immediately after a defibrillatory shock until a pulsatile state is established.
This is supported by studies showing that “preshock pauses” in CPR result in lower rates
of defibrillation success and patient recovery.

In a study involving out-of-hospital cardiac arrests in Seattle, 84% of patients regained a

pulse when defibrillated during VF. Defibrillation is generally most effective the faster it
is deployed.

Contraindications
The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order or other
advanced directive indicating a person’s desire to not be resuscitated in the event of
cardiac arrest.

A relative contraindication to performing CPR may arise if a clinician justifiably feels

that the intervention would be medically futile, although this is clearly a complex issue
that is an active area of research.

COMPLICATIONS

Whilst CPR is a last resort intervention, without which a patient without a pulse will
certainly die, the physical nature of how CPR is performed does lead to complications
that may need to be rectified. Common complications due to CPR include rib fractures,
sternal fractures, bleeding in the anterior mediastinum, heart contusion, hemopericardium
upper airway complications, damage to the abdominal viscus - lacerations of the liver and
spleen, fat emboli, pulmonary complications - pneumothorax, hemothorax, lung
contusions

The most common injuries sustained from CPR are rib fractures, with literature
suggesting an incidence between 13% and 97%, and sternal fractures, with an incidence
between 1% to 43%. Whilst these iatrogenic injuries can require further intervention
(assuming the patient survives the cardiac arrest), only 0.5% of them are life threatening
in their own right

The type and frequency of injury can be affected by factors such as gender and age. For
instance, women have a higher risk of sternal fractures than men, and risk for rib
fractures increases significantly with age Children and infants have a low risk of rib
fractures during CPR, with an incidence less than 2%, although when they do occur, they
are usually anterior and multiple.

Where CPR is performed in error by a bystander, on a patient who is not in cardiac arrest,
only around 2% suffer injury as a result (although 12% experienced discomfort)[