CARDIO-PULMONARY RESUSCITATION

                                                 CARDIOPULMONARY RESUSCITATION 

 

What is CPR?

CPR is a combination of rescue breathing (mouth-to-mouth resuscitation) and chest compressions to restore circulation of oxygen-rich blood to the brain. Without oxygen, permanent brain damage or death can occur in less than 8 minutes

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.

Indications of CPR:

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 CAN BE DUE TO FOLLOWING:

•       Drowning
•       Stroke
•       Foreign body in throat
•       Smoke inhalation
•       Drug overdose
•       Electrocution or injury by lightening
•       Suffocation
•       Accident, injury
•       Coma
•       Epiglottis paralysis.

  Metabolic Indications : 

•       Hypoglcemia
•       Electrolyte Imbalane

        Fluid Balanace:

•       Hypovolemic Shock
•       Hemorrhage

       Neurologic Indications :

•       Massive CVA

       Poisons or Substance Overdose:

•       CO Poisoning
•       Proipanolol Overdos

Purpose of CPR:

•      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

Warning Sings of Cardio Pulmonary Arrest:

•       Loss of consciousness
•      Convulsions
•      Apnea or stridor
•      Dilated pupils
•      Absence of heart rate or weak thready pulse
•      Cyanosis
•      Hypothermia

Procedure of CPR:

Check for response by tapping on shoulder & saying "HEY ARE YOU OK?''

Airway :

•      Head Tilt Jaw Left Manoeuvre :While pushing the forehead back tilt the chin forward
•      Jaw Thrust Manoeuvre : This is to be performed while neck injury by pushing the face forward with index finger by holding cheeks with both the hands 

Breathing : Look, Listen & Feel for breathing & pulse. Breathing can be initiated by :

•      Mouth to Mouth Ventilation
•      Mouth to Mask Ventilation
•      Bag Mask Ventilation

Circulation : Check for pulse:

•      Adult : Carotid artery
•      Infant : Brachial artery

Chest Compressions :

Interlock fingers of both the hand by placing heel of domninant hand on the centre of chest & other hand on its top.

For infants : Place 2 fingers or 2 thumbs on the breast bone & give downward thrust by tilting the head back of infant

Universal Compression to Ventilation Ratio:

•       For Adult - 30:2
•       For Infant & Children - 15:2
•       For Newborn - 3:1

Recommended Depth of Compression:

•      In adult & children- 5 cm [2 inches]
•      In infants - 4 cm [1.5 inches]

Rate of Compression = 100/min

Complications of CPR:

•      Rib & Spleen fracture
•      Pneumothorax & Hemothorax
•      Injury to diaphragm, Myocardial muscle
•      Aspiration
•      Vomiting

Medical & Nursing Management during CPR

•       Adrenaline: to enhance cerebral and myocardial blood flow by preventing arterial collapse
•       Noradrenaline : to restore normal circulation
•       Atropine: to block vagal tone completely & enhances automacticity and conduction of both sinoatrial and atriventricular node.
•       Amiodarone or Lidocaine : to dilate coronary artery  leading to vasodilatation and reduction in afterload and systemic blood pressure.
•       Calcium Gluconate :enhances the contractile force of cardiac muscle
•       Sodium Bicarboinate :to alkalinaze urine in drug over dose
•       Magnesium : to stabilize myocardial cell membrane
•       Intubation & Oxygenation
•       Administer IV fluids
•       Documentation of Vitals & urine output
•       Maintain appropriate ventilation