CARDIO PULMONARY RESUSCITATION ADULT & PAEDIATRIC

DEFINITION OF CARDIAC ARREST:

Cardiac arrest is defined as sudden cessation of spontaneous respiration and effective

circulation systemic perfusion.
CAUSES:
A cause of cardiac arrest varies. They are:

In adult they are:

Cardiac- coronary artery disease,

myocardial infarction,
congestive heart failure.
Respiratory- respiratory failure,
neuromuscular disease,
pulmonary embolism.
Drugs- poisonous drugs,
drug toxicity,
anti depressant,
relaxant,
cardiac drugs.
Mechanical-obstruction,
drowning,
accident,
burns,
gas and smoke inhalation.
Metabolic and electrolyte- hypo and hyper electrolyte,
hypo and hyper glycaemia,
metabolic acidosis,
magnesium imbalance.
SIGNS AND SYMPTOMS OF CARDIAC ARREST ARE OF TWO TYPES:
Early Late

1.unresponsiveness 1.dilatation of pupils

2.abrupt or complete unconsciousness 2.cold and clammy skin
3.apnooe and gasping 3.cyanosis(both periphery and
4.absence of heart rate general)
5.no carotid pulse

DEFINITION OF CARDIO PULMONARY RESUSCITATION:

CPR is defined as techniques of basic life support for the purpose of oxygenating the
brain and heart until appropriate medical treatment can restore the normal heart and
ventilatory action.
ASSESSMENT OF CPR:
  Assess the victim for a response. If no response shout for help.
 If you are alone, activate the emergency response team and get an crash cart.

 Assess the victim's level of consciousness by asking loudly and shaking at the

shoulders "Are you okay?" and scan chest for breathing movement visually. If no
response call for help by shouting for ambulance or EMS and ask for an AED( which
is available in offices and building floors).

Assess If the patient is breathing normally, and pulse is present then the patient should be
placed in the recovery position and monitored. Transport if required, or wait for the EMS to
arrive and take over.
 If patient is not breathing assess pulse at the carotid on your side for an adult, at the
brachial for a child and infant for 5 seconds and not more than 10 seconds; begin
immediately with chest compressions at a rate of 30 chest compressions in 18 seconds
followed by two rescue breaths in 5 seconds each lasting for 1 second.

 If the victim has no suspected cervical spine trauma, open the airway using the head-
tilt/chin-lift maneuver; if the victim has suspected neck trauma, the airway should be
opened with the jaw-thrust technique. If the jaw-thrust is ineffective at
opening/maintaining the airway, a very careful head-tilt/chin-lift should be performed.
 Continue chest compression at a rate of 100 compressions per minute for all age
groups, allowing chest to recoil in between. For adults push up to 5 cm and for child
up to 4 cm. For infants up to 3 cm or 1/3 of the chest diameter antero-posteriorly.
Keep counting aloud. Press hard and fast maintaining the rate of at about 100/minute.
Allow recoil of chest fully between each compression. After every 30 chest
compressions give two rescue breaths in adult and child victim, Continue for five
cycles or two minutes before re-assessing pulse.

 Attempt to administer two artificial ventilations using the mouth-to-mouth technique,

or a bag-valve-mask (BVM). The mouth-to-mouth technique is no longer
recommended, unless a face shield is present. Verify that the chest rises and falls; if it
does not, reposition (i.e. re-open) the airway using the appropriate technique and try
again. If ventilation is still unsuccessful, and the victim is unconscious, it is possible
that they have a foreign body in their airway. Begin chest compressions, stopping
every 30 compressions, re-checking the airway for obstructions, removing any found,
and re-attempting ventilation.

 If the ventilations are successful, assess for the presence of a pulse at the carotid
artery. If a pulse is detected, then the patient should continue to receive artificial
ventilations at an appropriate rate and transported immediately. Otherwise, begin CPR
at a ratio of 30:2 compressions to ventilation's at 100 compressions/minute for 5
cycles.
  After 5 cycles of CPR, the BLS protocol should be repeated from the beginning,
assessing the patient's airway, checking for spontaneous breathing, and checking for a
spontaneous pulse as per new protocol sequence C-A-B. Laypersons are commonly
instructed not to perform re-assessment, but this step is always performed by
healthcare professionals (HCPs).
If an AED is available it should be activated immediately and its directives followed
and (if indicated), call for clearance before defibrillation/shock should be performed.
If defibrillation is performed, begin chest compression immediately after shock.

BLS protocols continue until (1) the patient regains a pulse,

 (2) The rescuer is relieved by another rescuer of equivalent or higher training.

 (3) the rescuer is too physically tired to continue CPR, or

 (4) The patient is pronounced dead by a medical doctor.

 At the end of five cycles of CPR, always perform assessment via the AED for a
shockable rhythm, and if indicated, defibrillate, and repeat assessment before doing
another five cycles.

THE STEPS OF CHEST COMPRESSION ON AN ADULT.

STEP ACTION
1 Position yourself at the victim's side.

2 Make Sure the victim is lying on his back on a firm flat surface.
3 Remove all clothing covering the victim chest
4 Draw an imaginary line between the two nipples.
Put the heel of one hand on the center of the victim's bare chest between the
nipples.
5 Put the heel of other hand on the t0p of the first hand.
6 Straighten your arms and position your shoulders directly over "your hands.
7 Push hard & fast. Press down 1/2 to 2 inches with compressions. For each
compression make sure that you push straight down on the victim’s breast
bone.
8 At the end of each compression make sure you allow the chest to recoil or
re-expand completely.
9 Deliver compression in a smooth rate of 100 per minute.
10 Elbow should be straight 90°.

STEPS OF MOUTH TO MOUTH BREATHING-

STEPS ACTION
1 Hold the victim’s airway open with a head-tilt-chin lift.
2 pinch the nose closed with your thumb and index finger(using the hand on the
forehead)
3 Take a regular (not deep) breath and seal your lips around the victim’s mouth
 creating an airtight seal.
4 Give one breath (below for 1 sec). watch for the chest to rise as you give the
breath.
5 If the chest does not rise, repeat the head-tilt-chin lift.
6 give a second breath (below for 1 sec). watch for the chest to rise.

CAUTION-

 Do not press deeply into the soft tissue under the chin because this might obstruct the
airway.
 Do not use the thumb to lift the chin.

In hospital situation, use the Ambu bag for mouth-to-mask breathing.

AMBU= ARMSTRONG MANUAL BREATHING UNIT

The CPR cycle is often abbreviated as 30:2 (30 compressions, 2 ventilations or breaths). CPR
for infants and children uses a 15:2 cycle when two rescuers are performing CPR, but still
uses a 30:2 if there is only one rescuer. Two person CPR for an infant also requires the "two
hands encircling thumbs" technique for the rescuer performing compressions.

DEFIBRILLATION: I AED [ AUTOMATED EXTERNAL DEFIBRILLATOR]

 Turn power source on.

 Attach defibrillator monitor on.
 Assess for cardiac rhythm. Identify rhythm and take a strip for
 legal purposes.
 If Asystole / PEA [ Pulseless Electrical Activity] do not
 defibrillate. Continue CPR.
 If VT or VF then give one shock with 360 Joules in case of
 monophasic defibrillator. In case of biphasic defibrillator use 120-200 joule and in
case of unknown rhythm use 200 Joule.
 Apply gel on the pad. Place sternum paddle on the Rt side of the chest in the 2nd
intercostal space above the nipple and the Apex paddle between left 5th to 6th ICS at
the mid axillary line below the nipple.
 Charge defibrillator with Joule.
 25 pound pressure should be applied in both the paddle during placement of the
paddle on the chest wall.
 Confirm charge on the screen.
 Tell - you clear, I clear and everybody clear.
 Discharge shock.
 Note the rhythm on the screen.
 Charge defibrillator for another shock with same joules if require.
DO NOT DEFIBRILLATE ON----

 Over ECG leads

 When Temporary Pacing on .

 Do not pass charged paddle to another member .

 Do not use loose power cords

 Do not shock on permament pacemaker Allow paddle to contact each other.

NB: When shock is being given when the temp. pacing is on the T.P

Can over ride the defibrillater current.

Whereas in PPJ the shock which is given on PPI machine can spoil the instrument and make
it of no use.

DEFIBRILLATION DURING OPEN CHEST:

Here less energy is required ten autonomous defibrillator. Wet sponge 4x4 with normal saline
and hold the heart between the paddles. Sterile paddle should be placed.

Monophasic: Burst of energy travels in one direction require longer shock in patient with
higher impedance.

,Sternum»»»»»> Apex

Biphasic: Burst of energy travel sequentially in alternating direction. Two phase of energy
travels. First the current flows through the heart and in the second phase it reverses the
direction and pass through the apex to compensate for thorax irnpedence. Reduction in
myocardial injury and dysfunction in defibrillated threshold.

Sternum»»»>Apex »»»>Sternum»»»>Apex

When IV or 10 access is available , give the following drugs during CPR and when the
patient is getting VT NF. Theyare------

Adrenaline: It is a alpha adrenergic effects ie vasoconstriction. It increases cerebral &

coronary blood flow during CPR. It can be given through ET & IV route. 1mg=1ml. It can be
given upto 18mg.lt is having four action. That is—

Inotropic= = =increases the force of contraction.

Chronotropic=== Increases the heart rate.

Domotropic=== Increases the conduction.

Bathmotropic=== Increases the irritability of the heart.

Atropine: It is a vagolitic parasympathetic and anticholinergic drug. It inhibits nerve
impulses and then increases the heart rate and decreases the secretions due to its constriction
ability.

1 ml= 0.6 mg.lt can be given upto 3mg.

Xylocard: It is an antiarrythmic drug. It increases the electrical stimulation threshold of the

ventricle during diastole & reduces the automaticity of the myocardium and thus lessens the
ventricular ectopic activity. This is a class-1 antiarrythmic agent.

1 Vial=1000mg ie 1 ml=20mg.

It will be given 1 ml/ Kg

Sodium-Bicorbonate[NaHco3]: It is an alkaliniser. It neutralizes the lactic acid and forming

water ,NaCI & Carbondioxde.lt reduces acidosis.

1 amp =25ml or 10ml. 1 rnmol / Kg of body weight.

Amiodrone : It is an 111 b antiarrythmic drug .300mg IV push slowly after diluting with
D5W. It is 1 amp== 150mg==3ml.

Calcium gluconate: Ii increases myocardial contraction and force of contraction. Jt helps in

coagulation of blood and maintain electrolyte balance.

It is1amp=1000mg=10ml.

10mg I Kg body weight will be given .

Vasopressin: It is a noradrenergic peripheral vasoconstrictor. It is available in vial or amp. 1

ml=40u.

It is given single dose and one time only.

Magnesium chloride: It is an antiarrythmic drug. Consider loading dose 1 to 2 g IV if

hypomagnesaemia / polymorphic ventricular tachycardia.

POST RESUSCITATION THERAPY:

1.Determine & treat cause of arrest.

2. Respiratory support

3. Respiration is supported until patient is awake, alert & co-operative.

4. The patient must be able to protect his/her own airway.

5. Cardiovascular system support

6. Aim for BP which is equal to usual BP or systolic greater than 10mmHg.

7. If BP falls, adrenaline is given in increments ( 0.1 mg ) or infusion until fluid status can be
assessed by JVP, CVP,CXR.

CONCLUSION-

Many countries have guidelines on how to provide basic life support (BLS) which are
formulated by professional medical bodies in those countries. The guidelines outline
algorithms for the management of a number of conditions, such as cardiac
arrest, choking and drowning. BLS does not include the use of drugs or invasive skills, and
can be contrasted with the provision of Advanced Life Support (ALS). Firefighter, lifeguards,
and police officers are often required to be BLS certified. BLS skills are also appropriate for
many other professions, such as daycare providers, teachers and security personnel and social
workers especially working in the hospitals and ambulance drivers.

BIBLIOGRAPHY-

 1.American Heart Association Guidelines for Cardiopulmonary Resuscitation and

Emergency Cardiovascular Care Science, Part 5: Adult Basic Life Support. 2010.

2.  "Public-access defibrillation and survival after out-of-hospital cardiac arrest". The New

England Journal of Medicine 351 (7): 637–46. 2004. 

3. Lewis, Heitkemper, Dirksen, Bucher. Medical surgical nursing. Elsevier India private
limited; 2013.p 137-8.
 GROUP PRESENTATION
ON
CARDIOPULMONARY
RESUSCITATION

SUBMITTED TO SUBMITTED BY

Mrs S Srimani

Lecturer(nursing)

Dept of rehabilitation Nursing M.Sc nursing 1styr

N.I.O.H, Kolkata BATCH- 2015-2017

N.I.O.H, Kolkata

SUBMITTED ON-22/02/2016