Cardiopulmonary Resuscitation – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Cardiopulmonary Resuscitation
Definition of Cardiopulmonary Resuscitation (CPR):
Cardiopulmonary resuscitation is a medical procedure designed to restore normal breathing after cardiac arrest that includes the clearance of air passages to the lungs, the mouth-to-mouth method of artificial respiration, and cardiac massage by the exertion of pressure on the chest.
Or,
CPR stands for cardiopulmonary resuscitation. It is an emergency lifesaving procedure that is done when someone’s breathing or heartbeat has stopped. This may happen after an electric shock, heart attack, or drowning.
Purposes of Cardiopulmonary Resuscitation:
1. To maintain and open airway
2. To maintain breathing with external ventilation.
3. To maintain blood circulation by external cardiac messages
4. To save life of the patient.
5. To provide basic life support till medical and advanced life support arived.
Important steps before going to give CPR:
1. Is the person conscious or unconscious
2. If the person appears unconscious, tap or shake his or her shoulder &ask loudly “Are you ok?”
3. If the does not respond and two people are available, one should call local emergency number or blue code and one should begin CPR
4. Then perform spell C-A-B
- C means compression
- A-Airway,
- B-Breathing,
Which help people remember the order to perform the steps of CPR.
Steps of Providing Cardiopulmonary Resuscitation:
There are three physical symptoms that indicate a need for CPR to be performed immediately and for emergency medical support to be called: unconsciousness, not breathing, and no pulse detected.
A. Compressions: Restore blood circulation
a) Put the person on his or her back on a firm surface.
b) Kneel next to the person’s neck and shoulders.
c) Place the heel of one hand over the center of the person’s chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
d) Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.
e) If you haven’t been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.
| Chest compressions come first now New cardiopulmonary resuscitation guidelines show the importance of starting chest compressions immediately instead of opening the victim’s airway and breathing into their mouth first. CPR revised guidelines: Think C-A-B | ||
COMPRESSIONS Push at least 2 inches on adult breastbone, 100 times per minute, to move oxygenated blood to vital organs.
| AIRWAY Open the airway and check for breathing or blockage: watch for rise of chest, and listen for air movement.
| BREATHING Tilt chin back for the unobstructed passing of air; give two breaths, and resume chest compressions.
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Note: Those untrained in CPR can simply do chest compressions until help arrives.
B. Airway: Clear the airway
a) If you’re trained in CPR and you’ve performed 30 chest compressions, open the person’s airway using the head-tilt, chin-lift maneuver. Put your palm, on the person’s forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.
b) Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, 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 and 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 breathing and continue chest compressions.
C. Breathing: Breathe for the person
a) Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can’t be opened.
b) With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person’s mouth with yours, making a seal.
c) Prepare to give two rescue breaths. Give the first rescue breath-lasting one second -and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn’t rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.
d) Resume chest compressions to restore circulation.
e) If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR-starting with chest compressions – for two more minutes before administering a second shock. If you’re not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn’t available, go to step 5 below.
f) Continue CPR until there are signs of movement or emergency medical personnel take over.
Indications of CPR
A. Cardiac arrest
- Ventricular fibrillation (VF)
- Pulseless ventricular tachycardia (VT)
- Pulseless electrical activity (PEA)
- Asystole
- Pulseless bradycardia
B. Respiratory arrest
- Drowning
- Stroke
- Foreign body in throat
- Smoke inhalation
- Suffocation
- Coma
- Epiglottis paralysis
Contraindications of CPR
The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order or other advanced directive indicating a person’s desire to not be resuscitated in the event of cardiac arrest. A relative contraindication to performing CPR is if a clinician justifiably feels that the intervention would be medically futile
provide CPR to baby
Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know the baby has an airway obstruction, perform first aid for choking. If you don’t know why the baby isn’t breathing, perform CPR.
To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don’t shake the baby.
If there’s no response, follow the CAB procedures below and time the call for help as follows:
1. If you’re the only rescuer and CPR is needed, do CPR for two minutes – about five cycles-before calling 911 or your local emergency number.
2. If another person is available, have that person call for help immediately while you attend to the baby.
A. Compressions: Restore blood circulation
- Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.
- Imagine a horizontal line drawn between the baby’s nipples. Place two fingers of one hand just below this line, in the center of the chest.
- Gently compress the chest about 1.5 inches (about 4 centimeters).
- Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 compressions a minute.
B. Airway: Clear the airway
- After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
- In no more than 10 seconds, put your ear near the baby’s mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.
C. Breathing: Breathe for the baby
- Cover the baby’s mouth and nose with your mouth.
- Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby’s mouth one time, taking one second for the breath. Watch to see if the baby’s chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath
- If the baby’s chest still doesn’t rise, examine the mouth to make sure no foreign material is inside. If an object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking baby.
- Give two breaths after every 30 chest compressions.
- Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
- Continue CPR until you see signs of life or until medical personnel arrive.
Complications of CPR:
1. Coronary vessel injury
2. Diaphragm injury
3. Hemopericardium
4. Interference with ventilation
5. Liver injury
6. Myocardial injury
7. Pneumothorax
8. Rib fracture
9. Spleen injury
10. Sternal fracture.
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