AKAL COLLEGE OF NURSING,

BADUSAHIB

PROCEDURE

ON

CPR

SUBJECT: - MEDICAL AND SURGICAL NURSING

SUBMITTED TO: - SUBMITTED BY:-

DR. PRIYANKA CHAUDHARY SMRITI

ASSOCIATE PROFESSOR MSC. NURSING 1ST YEAR

ACN, BADUSAHIB ACN, BADUSAHIB

SUBMITTED ON:
INTRODUCTION:-

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies,

including cardiac arrest or respiratory arrest, in which someone's breathing or heart beat has
stopped.CPR is effective only if performed within minuites of the cardiac or respiratory
arrest.Nurses are the most important health care personnel who should effectively
careInterventions Cardiopumonary arrest, Initiating basle life support CELS) and a adding in
for patients advanced life support (ALS).

DEFINITOION: -

CPR is the artificial ventilation and maintains blood circulation accompanied by cardiac
massage to facilitate normal breathing and normal heart action in the event of cardiac arrest
or pulmonary arrest.

PURPOSE OF CPR: -

 To maintains blood circulation by external cardiac massages (C).

 To maintains an open and clear air way (A).
 To maintain breathing by external ventilation (B).
 To provide basic life support (BLS) till medical care and advanced life support (ALS)
arrives.

INDICATIONS FOR CPR: -

 The major indicator for initiating CPR is the cardiac arrest or respiratory arrest.
 Cardiac arrest indicators\sign and symptoms:
Ventricular fibrillation (VF)-a rapid heart rate
Ventricular tachycardia (VT)-abnormal heart rate, faster than normal heart rate.
 Asystole-absence of ventricular contraction or a cardiac flat line in Pulse less electrical
activity-in which ECG shows a heart rhythm, but no pulse.
HOW TO PERFORM CPR

 Place the heel of your hand in the centre of the chest with the other hand on top.
 Push hard and fast
 At least 100 bpm
 At least 5 cm depth
 Allow complete chest recoil after each compression
 Minimize interruption
 1 cycle CPR 30:2 (2 minute) with rhythm check.

PRECAUTION ON DOING CPR

 Returned of spontaneous circulation

 Manpower exhausted
 No sign of life
 Family request
 Decision by the caring physician.
COMPLICATIONS OF CPR

 Aspiration Pneumonia
 Fracture Ribs
 Fracture Sternum
 Injury to Heart
 Injury to abdominal internal organ like Liver/Spleen etc.

STEPS OF RECOVERY POSITION

 Kneel beside the person.

 Straighten their arms and legs.
 Fold the arm closest to you over their chest.
 Place the other arm at a right angle to their body.
 Get the leg closest to you and bend the knee. • While supporting the person's head and
neck, gently take the bent knee
 closest to you and very gently roll the person away from you.
 Adjust the upper leg, so both the hip and knee are bent at right angles.
 Ensure the person is steady and cannot roll.
 Tilt the head back and make sure the airways are clear and open.
PURPOSE OF RECOVERY POSITION

If a person is unconscious but is breathing and has no other life-threatening conditions, they
should be placed in the recovery position. Putting someone in the recovery position will keep
their airway clear and open. It also ensures that any vomit or fluid won't cause them to choke.

ACLS refers to a set of clinical guidelines for the urgent and emergent treatment of life-
threatening cardiovascular conditions that will cause or have caused cardiac arrest, using
advanced medical procedures, medications, and techniques.
• These life-threatening conditions range from dangerous arrhythmias to cardiac arrest.

• ACLS algorithms frequently address at least five different aspects of peri cardiac arrest
care-

 Airway management
 Ventilation ill.
 CPR compressions.
 Defibrillation
 Medications
VENTILATION
In the absence of an advanced airway during CPR, current guidelines based on very limited
evidence recommend two positive pressure breaths after every 30 chest compression. These
breaths should be of an inspiratory time of 1s and produce a visible chest wall rise.

CPR COMPRESSIONS
CPR is an emergency procedure consisting of chest compressions often combined with
artificial ventilation.Chest compressions for adults between 5cm and 6cm deep and a rate at
least 100 to 120 per minute.Chest compression to breathing ratios is set at 30 to 2 in adults.
DEFIBRILLATION
Defibrillation depolarize the critical mass of myocardial cell at once.
 1st paddle on the right of the chest just below the clavicle.
 2nd at precordial, region.
 Paddle should be applied with pressure equivalent to 10kg. Paddle Size-
Adult; 13cm
Children; 8cm
Infant; 4.5cm
MEDICATIONS
 Adrenaline(all types of cardiac arrest) 1mg every 3-5 min. • Amidarone(VF,VT)- 1st
dose:300mg IV bolus, 2nd dose 150mg.
 Lidocaine (if amidarone is not available) • Sodium bicabonate(only if cardiac arrest is
associated with hyperkalemia or tricyclic anti-depressent overdose)
 Calcium gluconate.
JOB RESPONSIBILITIES OF ACLS MEMBERS
 Understands and are clear about their role assignments.
 Are prepared to fulfil their role and responsibilities.
 Have working knowledge regarding algorithms.
 Have sufficient practice in resuscitation skills.
 Are committed to the success of the ACLS resuscitation.
PRTOCOLS OF CARDIAC ARREST
ACC. TO ACLS
 CPR Quality,
 Push hard (2-2.4" (5-6 cm)) and fast (100-120 bpm) and allow chest recoil
 Minimize interruptions
 Do not over ventilate.
 If no advanced airway, 30:2 compression to ventilation ratio
 Quantitative waveform capnography
 If ETCO2 <10 mmHg, attempt to improve CPR quality.
SHOCK ENERGY
 Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more
effective than older monophasic waveforms. Follow manufacturer recommendation
(e.g., initial dose of 120 to 200 J; if unknown, use maximum available. Second and
subsequent doses should be equivalent and higher doses should be considered.
 Monophasic: 360 J
Return of Spontaneous Circulation
Return of pulse and blood pressure
Spontaneous arterial pressure waves with intra-arterial monitoring.
ADVANCED AIRWAY
 Supraglottic advanced airway or ET intubation
 Waveform capnography to confirm and monitor ET tube placement
 10 breaths per minute with continuous chest compressions
DRUG THERAPY
 Epinephrine IV/O Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes
after
 Amiodarone IV/O Dose: first dose is 300 mg bolus, second dose is 150 mg
 Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg.
 BIBLIOGRAPHY

BOOK REFERENCES
1. Babu, K. M. Ganesh, B. A. Joshi, and Nisith K. Ray. "Medical Management of
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2. Rachel, D. Anita, and A. Subashini. "Vetiver Finish in Surgical Medical
Products." International Journal of Trend in Scientific Research and
Development Volume-3, Issue-1 (December 31, 2018): 1166–69.
3. Inder, Dr Deep, and Dr Pawan Kumar. "Recommendations for Medical and Surgical
Chemoprophylaxis." Indian Journal of Applied Research 2, no. 2 (October 1, 2011):
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4. Marine, Jeremey, and Jeremey Marine. "Self-Assessment of Medical-Surgical Nurses’
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INTERNET REFERENCES
1. Solanki.M. Cardiopulmonary resuscitation; 2013; Available from:
https://www.slideshare.net/slideshow/cardiopulmonary-resuscitation-ppt/17274053
2. Bishoni. AD. Cardiopulmonary resuscitation; 2018; Avalibale from:
https://www.slideshare.net/slideshow/cpr-ppt-akki/32721773