SUB:ADVANCED NURSING PRACTICE

PRESENTED BY:s.y.p.b.b sc nsg

students

INTRODUCTION CPR (or cardiopulmonary resuscitation) is a

combination of rescue breathing (mouth-to-mouth resuscitation) and chest compressions. If someone isn't breathing or circulating blood adequately, CPR can restore circulation of oxygen-rich blood to the brain. Without oxygen, permanent brain damage or death can occur in less than 8 minutes

CPR alone is unlikely to restart the heart; its main purpose is to restore partial flow of oxygenated blood to the brain and heart. It may delay tissue death and extend the brief window of opportunity for a successful resuscitation without permanent brain damage.. CPR may however induce a shockable rhythm. CPR is generally continued until the person regains return of spontaneous circulation (ROSC) or is declared dead.

DEFINITION

Cardiopulmonary resuscitation (CPR) is a combination of mouth-to-mouth resuscitation and chest compressions that delivers oxygen and artificial blood circulation to a person who is in cardiac arrest. It can be life-saving first aid.

INDICATION Cardiac Arrest Heart disease – the most common cause of cardiac arrest Ventricular fibrillation (VF) Ventricular tachycardia (VT) Asystole Pulse less electrical activity Respiratory Arresst This may be result of following: Drowning Stroke Foreign body in throat Smoke inhalation Drug overdose Electrocution or injury by lightening Suffocation Accident, injury Coma Epiglottis paralysis.

PURPOSE

To maintain an open and clear airway (A). To maintain breathing by external ventilation (B). To maintain Blood circulation by external cardiac

massages (C). To save life of the Patient. To provide basic life support till medical and advanced

life support arrives

PRINCIPLES

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.

PATHOPHYSIOLOGY

CPR is used on people in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive.

Blood circulation and oxygenation are required to transport oxygen to the tissues. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes.

Typically if blood flow ceases for one to two hours, the cells of the body die. Because of that CPR is generally only effective if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures as sometimes seen in near-drownings prolong the time the brain survives.

Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts

STANDARD/RATIO

Universal Compression To Ventilation Ratio:

For Adult- 30:2 For Children And Infant- 15:2 For New Born- 3:1

Recommended compression depth in adults and children is about 5 cm (2 inches) and in infants it is 4 cm (1.5 inches).

GENERAL POINTS

CPR techniques are used in persons whose respirations and circulation of blood have suddenly and unexpectedly stopped.

There is 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.

The immediate responsibilities of the resuscitator are:

To recognize the signs of cardiac arrest Protect the patient’s brain from anoxia by

immediately starting artificial ventilation of the lungs and external cardiac massage.

Call for help. The cardio Pulmonary resuscitation must be

initiated within three to four minutes in order to prevent permanent brain damage.

Strike the centre of the chest sharply with the side of the clenched fist twice.

Call for assistance. Clear the airway of false teeth, vomits food

material etc.

Initiate ventilation and external cardiac massage without wasting time.

-The CPR techniques should not be discontinued for more than five seconds before normal circulation and ventilation of lungs are established except

When the patient is moved to a hard surface. When endotracheal intubation is being carried out

( maximum time allowed for these two procedure is 15 seconds ).

-Before CPR is attempted in a patient, make sure that the airway is clear. It may be obstructed due to many reasons; so keep the patient’s neck hyper extended after confirming that he is having any cervical injury.

CPR

Before starting CPR, check: Is the person conscious or unconscious? If the person appears unconscious, tap or shake his or

her shoulder and ask loudly, "Are you OK?" If the person doesn't respond and two people are

available, one should call 108 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 108 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 108 or the local emergency number.

If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

In 2010, the American Heart Association changed its long-held acronym of ABC to CAB — circulation, airway, breathing — to help people remember the order to perform the steps of CPR. This change emphasizes the importance of chest compressions to help keep blood flowing through the heart and to the brain.

CIRCULATION: RESTORE BLOOD CIRCULATION WITH CHEST COMPRESSIONS

Put the person on his or her back on a firm surface. Kneel next to the person's neck and shoulders. Place the heel of one hand over the center of the

person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.

AIRWAY: CLEAR THE AIRWAY

If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and continue chest compressions

BREATHING: BREATHE FOR THE PERSON

Rescue breathing can be mouth to mouth breathing or mouth to nose breathing if the mouth is seriously injured or can’t be opened.

WARNING

If the person has normal breathing, coughing, or movement, do not begin chest compressions. Doing so may cause the heart to stop beating.[1]

Be sure to survey the scene for danger before you attempt to administer CPR.

Remember that CPR is different for adults, children and infants; this CPR is meant to be administered to an adult.

Always wear gloves and use a breathing barrier when possible to make transmission of diseases less likely.

Do not move the patient unless they are in immediate danger or are in a place that is life threatening.

AFTER CPR

Review the person’s condition if signs of life return (coughing, movement or normal breathing). If the person is breathing on their own, stop CPR and place them on their side with their head tilted back.

If the person is not breathing, continue full CPR until the ambulance arrives.

Be ready to recommence CPR if the person stops breathing or becomes unresponsive or unconscious again. Stay by their side until medical help arrives. Talk reassuringly to them if they are conscious.

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