Cardio-pulmonary resuscitation Prepared by : Christian Raveina

Cardio-pulmonary Resuscitation • Resuscitation includes all measures that

are applied to revive patient who have stopped breathing suddenly & unexpectedly due to either respiratory or cardiac failure

• Cardiac arrest is one of the common causes of cardio-respiratory failure

Cardio-respiratory failure • The respiratory & cardio-vascular systems are

interdependent • The heart consumes more oxygen than any

other organ in the body, because it is constantly beating

• When the lungs stop working , the heart fail occurs

• Conversely , the ventilation of the lungs fail soon after the heart stops

Cardiac Arrest

Causes of cardiac arrest • Anoxia(low oxygen in blood) caused by airway

obstruction • Myocardial infraction • Anesthetic depression• Hypotension • Retention of carbon dioxide • Drowning & other forms of asphyxia/choking

resulting in an inadequate ventilation of the lungs

• Electric shock • Carbon monoxide & other types of poisoning• Drug reaction • Pulmonary embolism• Extensive hemorrhage• Brain injuries • Hypothermia (below 35 ºC)• Electrolyte disorder & drug therapy

Assessment of cardiac arrest • 3 cardinal symptoms are apnoea ,

absence of carotid & femoral pulse & dilated pupils :• Apnoea : suspension of the breathing,

indicates respiratory failure & diagnosed by the absence of movements of the chest & abdominal muscles

• Absence of carotid & femoral pulse : pulse in the large arteries close to the heart , are palpable even when the peripheral pulse is absent . Carotid pulse can be checked easily , It is palpable by gentle pressure over the depression between the trachea & the sterno-cleido-mastoid muscle at the level with the adam’s apple

• For femoral pulse : Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine.

• Dilated pupils : cerebral hypoxia ( lack of oxygen to the brain tissues ) causes the loss of the muscle control in the entire body , including eyes . Pupils that are dilated & do not react to light indicates that the patient is having a cardiac arrest

• Cyanosis : cyanosis is developed due to the lack of oxygenation of blood resulting from hypoventilation of the lungs & circulatory failure

• Unconsciousness : hypoxia of the cerebral cortex causes unconsciousness

• Fits (grand mal seizures ) :this is also occurring due to cerebral anoxaemia

Sequence of cardio-pulmonary resuscitation

General instruction for CPR• To recognize the signs of cardiac arrest • Protect the patients brain from anoxia by

immediate chest compression & artificial ventilation

• Call for help • CPR is most easily and effectively performed

by laying the patient supine on a relatively hard surface, which allows effective compression of the sternum

• Before beginning ventilations, look in the patient’s mouth for a foreign body blocking the airway

• The person giving compressions should be positioned high enough above the patient, so that he or she can use body weight to adequately compress the chest

• Position of the head for the CPR is head tilt & chin Lift by hyperextending the neck or jaw thrust to open the airway and determine if the patient is breathing

• Place the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers interlocked

• Extend the elbows and the provider leans directly over the patient

• Press down, compressing the chest at least 2 inches

• Give 30 compressions

• Release the chest and allow it to recoil completely

• The compression depth for adults should be at least 2 inches

• The compression rate should be at least 100/min

• The key phrase for chest compression is, “Push hard and fast”

• After 30 compressions, 2 breaths are given; however, an intubated patient should receive continuous compressions while ventilations are given 8-10 times per minute

• This entire process is repeated until a pulse returns or the patient is transferred to definitive care

• Pinch the patient’s nostrils closed to assist with an airtight seal

• Put the mouth completely over the patient’s mouth

• Give each breath for approximately 1 second with enough force to make the patient’s chest rise

• Failure to observe chest rise indicates an inadequate mouth seal or airway occlusion

• After giving the 2 breaths, resume the CPR cycle

• Artificial dentures may be removed if present

• 15 seconds for moving the patient to hard surface & endotracheal intubation

• Locate correctly the lower half of sternum between the two nipples where cardiac compressions are given

• Perform minimum 5 cycles

• Discontinue the procedure only when you are sure that the respiration & circulation are re-established

• Vital signs are watched for 24 to 48 hours because of danger of recurring the another cardiac arrest

• Look for : constriction of pupils , change in the feeling of pulse is regular rhythmic & good in volume , the systemic blood pressure return to normal , improved colour of skin, respiratory movements are taking place rhythmically

Complications of CPR• Damage to spinal cord at cervical region due to

hyperextension of head & neck • Gastric distention with air • Aspiration of vomitus into lungs • Fracture of the ribs , sternum & collar bone etc • Pneumothorax • Hemopericardium & intra-abdominal

haemorrhage

Articles required • Oxygen administration sets • I.V. infusion sets & cut down

sets • Ambu bag & mask device • Endotracheal tubes of

different sizes • Oropharyngeal & nasal

airways • Laryngoscope of different

sizes

• Tracheostomy sets • Suction apparatus • Cardiac monitor &

defibrillator • Mechanical respiratory aids • Emergency drugs such as

epinephrine , sodium bicarbonate , cardiac & respiratory stimulants

• Clean rag pieces or gauze pieces

Preliminary assessment • Because of an emergency no time is lost to

initiate cardio-pulmonary resuscitation procedures

• Rapidly determine the presence of cardiopulmonary arrest in the patient by noting the 3 cardinal signs & symptoms

• Call loudly for help as soon as possible• Lessen the crowd

Procedure

• Clear the crowd surrounding the patient • Maintain patient safety , clear the upper cloth of

patient • Call for emergency help • Activate AED ( automated external defibrillator ) • Immediately Check for carotid pulse & chest rise • No pulse , No breathing • Immediately start the chest compression – sets of

30 compression & 2 breathing , compression at a rate of 100/min

• After each set give the shock with AED • While using AED clear the patient with no touch at

that time change the position of both the person • Again start the next cycle of CPR • Perform 5 cycles • If respiration & circulation are reestablished ,

transfer to near by hospital as early as possible follow-up treatment, emergency drug & continuous observations

After care of patient • The patient should be continuously watched

by skilled persons over a period of 48 to 72 hours

• If patient is not shifted to ICU , shift in the ICU for constant observation & expert care

• Give oxygen continuously for 48 hours following resuscitation, this is necessary because respiration is depressed after the cardiac arrest

• Frequently check the victim’s head & jaw positions because his tongue may fall back & obstruct the airway

• Assess the patient’s respiration by noting the rhythm , rate & depth of respiration

• Check the colour of skin , persisting cyanosis indicates inadequate oxygenation of blood

• Watch for signs of restored circulation & respiration

• Temperature is taken every hour . A high temperature usually indicates cerebral damage or cerebral oedema . Temperature should be brought under normal limits by appropriate methods

• Watch for convulsions it may occur due to brain damage

• Insert the ET tube , if not already in place , this maintains an open airway for the unconscious patient who can not clear secretions by coughing

• Insert Foley’s catheter . Urine output is one of the measures of the cardiovascular status . Report if urinary output is below 30 ml per hour

• Start I.V. fluids to administer enough fluids in the patient • Blood gases should be checked • Watch for complications that might have occurred • Record the procedure : time the victim was discovered ,

type of arrest ( C or R or both ) , any complications during CPR , time at which spontaneous respiration & pulse returned , time at which CPR started & discontinued , vital signs when the CPR team left

Thank you …