CPR (Cardiopulmonary Resuscitation)
INTRODUCTION
• CPR cardiopulmonary resuscitation is a life saving technique useful in
many emergencies including heart attack or near drowning in which
some one's breathing or heart beat has stopped.
• CPR is an emergency life saving procedure performed in an effort to
manually preserve intact brain function until further measures are
taken to restore spontaneous blood circulation and breathing in a
person in cardiac arrest.
• CPR is an emergency procedure for restoration of cardiac and
respiratory functions after cardiac arrest.
• It consists of artificial respiration and external cardiac massage. C =
Cardio (heart), P = Pulmonary (lungs), R = Resuscitation (recover).
DEFINITION
• Cardiopulmonary resuscitation is a technique of basic life support for
oxygenating brain and heart until appropriate, definitive medical
treatment can restore normal heart and ventilator action.
• It consists of rescue breathing, which delivers oxygen to the client's
lungs, and external chest compressions, which helps to circulate blood
through the heart to vital organs.
• CPR must be performed within 3-5 minutes when the person is
unresponsive, has absence of carotid and femoral pulse and absence
of breath sound or air movement through nose and mouth to prevent
brain damage or death.
Purposes
• To establish effective ventilation, restore and maintain breathing and
circulation.
• To provide oxygen and blood flow to the heart, brain, and other vital
organs.
• To prevent irreversible brain damage from anoxia.
• To provide basic life support till medical and advanced life support
arrives.
Indication
1. Cardiac arrest due to:
• Ventricular fibrillation (VF), Pulseless ventricular tachycardia (VT)
• Pulseless electrical activity (PEA), Pulseless bradycardia
• Asystole
2. Respiratory arrest due to:
• Drowning, suffocation, drug overdose, poisoning
• Accident, injury, stroke, foreign body in throat, Smoke inhalation
• Coma, shocks.
Contraindication
• The only absolute contraindication to CPR is a do-not-resuscitate
(DNR) order or other advanced directive indicating person's desire to
not be resuscitated in event of cardiac arrest.
• If there is no physiological benefit that can be expected because the
vital functions have deteriorated despite maximal therapy.
• A patient with fractured rib may also be contraindicated for CPR to
avoid puncturing the vital organs by fractured rib.
PRINCIPLES OF CPR
• To restore effective circulation and ventilation.
• To prevent irreversible central damage due to anorexia. When the heart
fails to maintain the cerebral circulation for approximately four
minutes the brain may suffer irreversible damage
Articles required for CPR (in hospital setting):
• Ambu-bag with facemask, oxygen with connecting tube
• arrest board/ back board or flat surface, gloves, tongue depressor,
sterile endotracheal tube of different sizes, laryngoscope with 0, 1, 2
size, tongue blades and stylet, magilles forcep, adhesive tape
• scissors, airway, syringe 5, 10 cc, suction apparatus, cardiac monitor,
ECG machine, emergency drugs
Types
Basic Life Support (BLS):
• Basic life support is important in a patient whose heart stops to function.
When someone stops breathing or has no heartbeat in community
setting, the by standers can help save life if they begin BSL until
paramedics arrive.
• Basic Life Support has two parts: Chest compression and breathing
(getting air into the lungs).
• It promotes adequate blood circulation in addition to breathing through
a clear airway.
Advanced Cardiac Life Support (ACLS):
• Advanced Cardiac Life support includes the step in Basic Life Support
and additional ways of restarting the heart.
• These include drug interventions, ECG monitoring, defibrillation,
Invasive airway procedures, routine atropine for pulseless electrical
activity (PEA)/asystole, cricoid pressure (with CPR) and airway
suctioning
Chest compression: Restore blood circulation with chest compressions
Put the person on his/her back on a firm surface. CPR is most easily
and effectively performed by laying the patient supine on a relatively
hard surface, which allows effective compression of the sternum.
Delivery of CPR on a mattress or other soft material is generally less
effective.
Kneel next to the patient's neck and shoulder. Before this assess
circulation, take no more than 10 seconds to palpate carotid pulse.
Place the one hand over the lower half of the body of sternum between
the nipples (two fingers above xiphoid sternum). Place another hand on
the top of the first hand, interlock the hands.
Keep arms straight and the shoulders directly over your hands.
Push hard and fast, compressing chest at least 2 inches. Compress at
least 100 compressions a minute and allow the chest to recoil (equal
compression and relaxation times).
Untrained bystanders should perform Chest Compression-only CPR
(COCPR)
NOTE
For child below 8 years use one hand and for infant (below 1 year) use 2
fingers for chest compressions.
If you haven't been trained in CPR, continue chest compressions until
there are signs of movement or until emergency medical personnel
takeover. If you have been trained in CPR, go on to checking the airway
and rescue breathing.
Airway (clear the airway)
• If you are trained in CPR and you have performed 30 chest
compressions, open the person's airway using head-tilt, chin-lift
maneuver.
• Place one hand on the victim's forehead and two fingers under the
chin, bringing the chin forward. Gently tilt the head back and lift the
chin forward to open the airway
• Check for normal breathing, taking no more than 5-10 seconds. Look
for chest motion (rise of chest), 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, assist him/her in breathing. If 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 (breath for the person)
Rescue breathing can be mouth to mouth breathing or mouth to nose
breathing (if mouth is seriously injured or can't be opened).
With the airway open (using head-tilt, chin-lift maneuver), pinch the
nostrils with thumb and index finger of hand that is on the forehead.
Take a deep breath and cover the person's mouth with yours, making a
tight seal for mouth-to-mouth breathing. Blow the air into the mouth
until the chest rises.
Prepare to give two rescue breaths. Inflate the victim's lung by 2 full
breaths. Give the first rescue breath lasting one second and watch to
see if the chest rises. If it rises, give the second breath. If the chest does
not rise, repeat the head-tilt, chin-lift maneuver and then give the
second breath. 30 chest compressions followed by two rescue breath is
considered one cycle.
Resume chest compression to restore circulation (30 compressions and
2 rescue breaths) until there are signs of movement or emergency
medical personnel takes over.
The pupil should also be checked every few minutes. If the CPR is
effective, the pupils will begin to constrict.
Place the patient in recovery position if pulse and respirations
resume; continue to monitor breathing regularly.
Terminate CPR as indicated: Guidelines for termination of CPR are
as follows:
• Return of cardiac rhythm (spontaneous circulation) and spontaneous
respiration.
• Another trained first aider or qualified help arrives and takes over.
• Become physically unfit to continue.
• When death is confirmed or physician ordered cessation.
Note: In accordance with the American Heart Association:
• Untrained: If you're not trained in CPR, then provide hands-only CPR
ie uninterrupted chest compressions of about 100 bits per minute until
paramedics arrive, no need to try rescue breathing.
• Trained and ready to go: If you're well-trained and confident in your
ability, begin with chest compressions instead of first checking the
airway and doing rescue breathing. Start CPR with 30 chest
compressions before checking the airway and giving rescue breaths.
• Trained but rusty: If you've previously received CPR training but
you're not confident in your abilities, then just do chest compressions at
a rate of about 100 minute.
• CPR-child (1 to 8 years old): The following steps are based on
instructions from the American Heart Association
• Check for alertness: Shake or tap the child gently. See if the child
moves or makes a noise. Shout, "Are you OK?"
• If there is no response, shout for help: Do not leave the child alone
until you have done CPR for about 2minutes.
• Carefully place the child on his or her back: If there is a chance the
child has a spinal injury, two people should move the child to prevent
the head and neck from twisting.
Perform chest compressions:
• Place the heel of one hand on the breastbone -just below the nipples.
Make sure your heel is not at the very end of the breastbone.
• Keep other hand on the child's forehead, keeping the head tilted back.
• Press down on the child's chest so that it compresses about 1/3 to 1/2 the
depth of the chest.
• Give 30 chest compressions. Each time, let the chest rise completely.
These compressions should be fast and hard with no pausing.
• Count the 30 compressions quickly;"1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, off."•
• Open the airway: Lift up the chin with one hand. At the same time, tilt
the head by pushing down on the forehead with the other hand.
• Look, listen, and feel for breathing: Place your ear close to the child's
mouth and nose. Watch for chest movement. Feel for breath on your
cheek.
• If the child is not breathing:
Cover the child's mouth tightly with your mouth.
Pinch the nose closed. Keep the chin lifted and head tilted.
Give 2 rescue breaths. Each breath should take about a second and make
the chest rise.
• Continue CPR (30 chest compressions, followed by 2 breaths, then
repeat) for about 2 minutes.
• After about 2 minutes of CPR, if the child still does not have normal
breathing, coughing, or any movement, leave the child if you are alone
and call help.
• Repeat rescue breathing and chest compressions until the child recovers
or help arrives. If the child starts breathing again, place him or her in the
recovery position. Periodically recheck for breathing until help arrives.
Complications
• Broken ribs, brain damage, lungs contusion, aspiration pneumonia,
abdominal distention, anterior mediastinal hemorrhage, body fluid
exposure and disease transmission including hepatitis, HIV, etc
