CARDIOPULMONARY RESUSCITATION Prepared by: Ms. Elizabeth D. Cruz, R.N., M.A.N.

CARDIAC ARREST Is a sudden and unexpected cessation of the heartbeat and effective circulation that results in inadequate delivery of oxygenated blood to vital organs

CAUSES: 1. Cardiac arrest - ventricular fibrillation - ventricular tachycardia; asystole - electromechanical dissociation 2. Respiratory arrest - drowning - smoke inhalation - stroke - drug overdose - foreign-body airway obstruction - suffocation - coma - accident, injury SIGNS & SYMPTOMS: 1. 2. 3. 4. CPR: PURPOSE: To provide oxygen to the brain, heart, & other vital organs until appropriate definitive medical treatment can restore the heart and ventilatory function EQUIPMENT: -Trained personnel -arrest board - oral airway - bag & mask device - intravenous setup - defibrillator - emergency cardiac drugs - ECG machine ABCS OF CPR: 1. AIRWAY = Open the airway = Determine whether patient is breathing(look,listen,feel) 2. BREATHING = Rescue breathing (mouth to mouth) = Foreign-body airway obstruction 3. CIRCUATION = Establish presence or absence of pulse = Active emergency medical services(EMS) = Begin chest compression(if pulse absent) Absence of palpable carotid or femoral pulse, pulselessness in large arteries Immediate loss of consciousness Absence of breath sounds or air movement through nose or mouth Ashen gray color

CPR PROCEDURE PROCEDURE ASSESMENT 1. Determine unresponsiveness: tap or gently shake patient while shooting are you OK 2. Call for help 3. Place he patient supine on a firm, flat surface. Kneel at the level of the patients shoulders. 4. Open the airway. 1. This will prevent injury from attempted resuscitation on a person who is not unconscious 3. This enables the rescuer to perform a rescuer breathing and chest compression without moving the knees. RATIONALE

A. Head-tilt/Chin-lift maneuver: Place one A. In the absence of sufficient muscle tone, the hand on the patients forehead and apply tongue and/ or epiglottis will obstruct the firm backward pressure with the palm to tilt pharynx and larynx. the head back. This supports the jaw and helps tilt the head Then, place the fingers of the other hand back under the bony part of the lower jaw near the chin and lift up to bring the jaw forward and the teeth almost to occlusion. B. Jaw-thrust maneuver: Grasp the angles of the patients lower jaw and lifting with both hands, one on each side, displace the mandible forward while tilting the head backward. DETERMINE PRESENCE OR ABSENCE OF SPONTANOUS BREATHING 1. Place ear over patients mouth and 1. Keep maintaining an open airway. nose while observing the chest, look for the chest to rise and fall, listen for air escaping during exhalation, and feel for the flow of air. 2. Perform rescue breathing-mouth to 2. This prevents air from escaping from the mouth : while keeping the air open, patients nose. pinch the nostrils closed using the thumb and index finger of the hand is the forehead. Take a deep breath, open mouth wide, and place it outside of the patients mouth, creating an airtight seal. Ventilate the patient with two full breathe ( 1-11/2 seconds each breathe ) , taking a breath after each ventilation. If the initial ventilation Adequate ventilation is indicated by seeing the chest rise and fall, feeling the air escape during ventilation and hearing the air escape during exhaling

Attempt is unsuccessful, reposition the patients head and repeat rescue breathing. DETERMINE PULSELESSNESS 1. While maintaining head-tilt with one hand 1. Keep maintaining an open airway. on the forehead, palpate the carotid or femoral pulse. If pulse is not palpable, start external chest compression. 2. Perform rescue 2. This prevents air from escaping from the breathing-mouth to mouth : while keeping patients nose. the air open, pinch the nostrils closed using the thumb and index finger of the hand is the forehead. Take a deep breath, open mouth wide, and place it outside of the patients mouth, creating an airtight seal. Ventilate the patient with two full breathe ( 1-11/2 seconds each breathe ) , taking a breath after each ventilation. If the initial ventilation Attempt is unsuccessful, reposition the patients head and repeat rescue breathing. Adequate ventilation is indicated by seeing the chest rise and fall, feeling the air escape during ventilation and hearing the air escape during exhaling

CIRCULATION PROCEDURE DETERMINE PULSELESSNESS 1. While maintaining head-tilt with one hand on the forehead, palpate the carotid or femoral pulse. If pulse is not palpable, start external chest compression. 1. Cardiac arrest is recognized by PULSELESSNESS in the large arteries of the unconscious, breathless patient. Initiate rescue breathing at rate of 12X per minute ( once every 5 sec. ) after initial two breath RATIONALE

EXTERNAL CHEST COMPRESSION PROCEDURE CONSIST OF SERIAL, RHYTHMIC APPLICATIONS OF PRESSURE OVER THE LOWER HALF OF THE STERNUM 1. Kneel as close to side of patients chest as possible. Place the heel of one hand on the lower half of the sternum, 3.8 cm. ( 1 1/2 inches ) from the tip of the xiphoid. The fingers may either be extended or interlaced but must be kept off the chest. 2. While keeping your arms straight, elbows locked, and shoulders positioned directly over your hands, quickly and forcefully depress the lower half of the patients sternum straight down, 3.8-5 cm. (1 1/2-2inches). 3. Release of the external chest 3. Release the external chest compression compression allow blood flow into completely and allow the chest to return to its heart. normal position after each compression. The time allowed for release should equal the time required for compression. Do not lift the hands off the chest or change position. 4. Use 80 compression per minute ( 100 if possible ). For one rescuer, do 15 compressions at a rate of 80-100 per minute and then perform two ventilation; re-evaluate the patient. 4. Rescuer breathing and external chest compression must be combined. Check for return of carotid pulse. If absent, resume CPR with 2 ventilators followed by compressions. For CPR performed by health professionals, mouth-tomask ventilation is an acceptable alternative for rescue breathing. RATIONALE 1. The long axis of the heel of the rescuers hand should be placed on the long axis of the sternum; thus the main force of the compression will be on the sternum and decrease the chance of rib fracture

5. For CPR performed by two rescuers, the compression rate is 80-100 per minute. The compression-ventilation ratio is 15:1 with a pause ( 1 1/2 second ). 6. While resuscitation proceeds, simultaneous efforts are made to obtain and use special resuscitation equipment to manage breathing and circulation and provide definitive care. 6. Definitive care includes defibrillation, pharmacotherapy for dysrhythmias and acid-base disturbances, and ongoing monitoring and skilled care in an intensive care unit.