KRISHNA INSTITUTE OF MEDICAL SCIENCES, DEEMED TO BE

UNIVERSITY KARAD’S

FACULTY OF NURSING SCIENCES, KARAD.

SUBJECT: ADVANCE NURSING PRACTICE.

1ST YEAR MSC NURSING

EVALUATION FORMAT FOR SEMINAR

Name of the Student: Miss Sangita Vasant Patil

Batch: 1st year MSc Nursing

Date:

Topic: Cardio-Pulmonary Resuscitation (CPR)

Name of the supervisor: Mrs.Namrata Mohite Mam

Sr.no Criteria Assigned Marks Obtained Marks
1. Organization 2
2. Content 10
3. Preparation of Environment
*Poise 1
*Clarity of ideas 1
*Modulation 1
*Audibility 1
*Gestures & Mannerism 1
4. AV Aids 2
5. Class Management 1
6. Group Participation 1
7. Grooming 1
8. Bibliography 2
9. Conclusion. 1

Total 25

Remarks: Total:

Date & Signature of the Student: Date & Signature of the

Supervisor:

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KRISHNA INSTITUTE OF NURSING
SCIENCES, KARAD

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 INDEX:
SR.NO. CONTENT PAGE NO.

1. Objectives 2
2. Introduction 3
3. Recognizing heart attack 4
4. Purposes of CPR 5
5. Contraindications Of CPR 5
6. Equipment Of CPR 5
7. Assessment Before Procedure 5
8. BLS Guidelines and Algorithms for Adults 2015 6-14
9. Steps in CPR 8-11
10. BLS Guidelines and Algorithms for paediatric 15-18
and neonates 2015
11 Termination of BLS 19
12. Hazards of CPR 19
13. Responsibilities of nurse During BLS 19—20
14. Summary 21
15. Conclusion 21
16. Bibliography 21

SPECIFIC OBJECTIVES:
At the end of class of student will have in-depth knowledge about the Cardio-pulmonary
Resuscitation according to 2015 guidelines given by American Heart Association and they
will develop desirable attitude and skills during any Emergency situation.

GENERAL OBJECTIVES:
At the end of class student will be able ….

 To define cardio-pulmonary Resuscitation (CPR).

 To recognize heart attack

 To enlist Purpose of CPR.

 To understand Adult as well as Paediatric CPR according to 2015 guidelines given by

American Heart Association.

 To understand nurses Responsibility during CPR.

 To know advanced Techniques OF CPR.

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CARDIO-PULMONARY RESUSCITATION
CARDIO-PULMONARY RESUSCITATION (CPR):

It is an emergency medical procedure for a victim of cardiac arrest or in some

circumstances, respiratory arrest. CPR is performed in hospital or in the community by layer
persons or by emergency response professionals .Cardiac or respiratory arrest can occur at
any time to individual of all ages. It is a crisis event that can be the result of an accident or a
disease process.

Unexpected cardiopulmonary collapse is a medical emergency that requires immediate

institution of the artificial measures to support life.

Cerebral resuscitation is the most important goal of advanced cardiac life support. Once
the heart ceases to function, a healthy human brain may survive without oxygen for up to 4
minutes without suffering any permanent damage. Unfortunately ,a typical emergency
medical system (EMS) response may take 6,8,or even 10 minutes.it is during those critical
minutes that CPR can provide oxygenated blood to the victim’s brain and the heart
,dramatically increasing his chance of survival .and if properly instructed ,almost anyone can
learn and perform.

DEFINITION:

Cardio pulmonary resuscitation (CPR) is a technique of basic life support for the purpose
of oxygenation to the heart, lungs and brain until and unless the appropriate medical
treatment can come and restore the normal cardiopulmonary function.

Recognizing a Heart Attack:

Recognizing the signs and symptoms of a heart attack and knowing what to do can be the
most critical step in saving the life .If an artery leading to the heart becomes blocked it will
prevent blood from getting to certain parts of the heart. The tissue of the heart will almost
instantly start to die. This is called a heart attack.A Heart attack does not mean that the heart
has stopped .Rather it’s a warning, indicating that heart may stop at any moment. Do not
perform CPR on a person that is still breathing of has an obvious pulse.

Signs and Symptoms of Heart Attack:

1.Pain in the chest

2.tightens of the chest

3.Sweating alomg with cool,pale skin

4.Nausea or vomiting

5.Denial

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CPR TIME LINE:

0-4 minutes: Brain damage unlikely

4-6 minutes: Brain damage possible
6-10 minutes: Brain damage probable
Over 10 minutes: Probable brain death.

HOW CPR WORKS:

The air we breathe in that travels to our lungs where oxygen is picked up by our blood and
then pumped by the heart to our tissue and organs. When a person experiences cardiac arrest-
whether due to heart failure in adults and the elderly or an injury such as near drowning or
severe trauma in a child –the heart goes from a normal beat to an arrhythmic pattern called
ventricular fibrillation, and eventually ceases to beat altogether. This prevents oxygen from
circulating throughout the body, rapidly killing cells and tissue. In essence, Cardio (heart)
,Pulmonary (lung) Resuscitation (Revive ,revitalize) serves as an artificial heartbeat and an
artificial respirator. CPR may not save the victims even when performed properly ,but if
started within 4 minutes of cardiac arrest and defibrillation is provided within 10 minutes, a
person has a 40% chance of survival.

PURPOSE:

 Restore cardiopulmonary functioning.

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  Prevent irreversible brain damage from anoxia.

CONTRAINDICATIONS:

Do not resuscitate when a decision not to resuscitate has been noted in chart. This
order is often abbreviated to DNR (do not resuscitate), is sometime referred to as no
code, and is now discussed with the client on admission and is referred to as an
advanced directive.

EQUIPMENTS:

 A hard flat surface.

 No additional equipment is necessary but in hospital setting, an emergency (crash)

cart with defibrillator and cardiac monitor should be brought to the bedside. A crash
cart contains:

 Airway equipment.

 Suction equipment.

 Intravenous equipment..

 Pre packed medication for advanced life support.

ASSESSMENT:

 Determine that the client is unconscious. Shake the client and shout at him or her to
confirm if unconscious rather than being asleep, intoxication or hearing impairment.

 Assess for the presence of respirations.

 Assess carotid artery for pulse

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BLS guidelines and algorithms- Adults:

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 CPR SEQUENCE:
• No Change (from 2010):

• C-A-B

 Initiate chest compressions before ventilations.

• Why?

 Goal: To reduce delay to CPR, sequence begins with skill that everyone can perform

 Emphasize primary importance of chest compressions for professional rescuers

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 Primary Emphasis on Chest Compressions:
 All rescuers should, at a minimum, provide chest compressions.

 If bystander not trained (adult arrest): Hands-Only CPR

 If bystander trained and able: perform compressions and ventilations at rate of 30:2

 Healthcare provider: perform compressions and ventilations at rate of 30:2

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STEPS IN CPR:
1. Verify scene safety:

2. Check responsiveness:

• 2015 guidelines recommend that trained rescuers should check for presence of
breathing and check for pulse at the same time.

• Lay rescuers to directly start with chest compressions.

3. Call for help with defibrillator:

4. Start chest compressions:

Technique of chest compressions:

• Victim should lie supine on a hard and flat surface.

• Rescuer knees besides victim’s thorax.

• Keep arms straight, elbows locked and shoulder directly over the hand.

• Place heel of the hand in the middle of the chest,between the nipples,second hand on
top of the other.

• Interlock fingers.

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Rate & Depth of Chest compressions:

• Compression rate -100-120 per minute.

• Compress at least 2 inches (5cms) but not more than 2.4 inches (6cms)

• Compression ventilation ratio- 30:2 in adults.

6. Airway & Ventilation:

• Open the airway with ‘head tilt, chin lift’

• Trained rescuers can use jaw thrust (triple manouver)

• Give 2 slow rescue breaths. (face mask,AMBU bag or mouth to mouth)

• One breath over one second

• Avoid rapid ventilation.

• Sufficient tidal volume to ensure visible chest rise.

Triple maneuver:

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7. Rescue breath:

 Pinch the nose

 Take a normal breath
 Place a lips over mouth
 Blow lips over mouth
 Blow until the chest rises
 Avoid excessive ventilation

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  Take about 1 second
 Allow chest to fall
 Repeat

High quality chest compressions:

• 100-120 compressions/min

• Depth of compressions at least 2 inches (5cms) but not more than 2.4 inches (6cms)

• Compression ventilation ratio- 30:2

• Allow complete chest recoil between compressions.

• Minimize interruptions. (<10seconds)

• Switch compressor every 2minutes.

Updated CPR:
Chest compression 2010 2015
Depth >5cm 5-6 cm
Rate >100 100-120
Respiratory rate >8-10 10
D-(early) Defibrillation:
• Single greatest advance in CPR

• The survival rate is 90% if the patient is defibrillated within 1 min and only 10%if it
is delayed till 10mins

(Circulation 1984;69:943-8.)

• Survival rate after cardiac arrest has been reported to go up from 30% to 49%.

• 2015 AHA guidelines recommend early defibrillation.(goal of shock <3min from

collapse)

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PEDIATRIC BLS AND NEONATAL:
Pediatric BLS highlights:

• C-A-B sequence for pediatric BLS

• Separate new algorithms for single rescuer and multiple rescuer CPR

• Upper limit of 6cm for depth of chest compression in adolescents

• The rate of chest compressions same as adults i.e. 100-120/min

• Compression ventilation both important I pediatric BLS.

Pediatric BLS sequence-Single rescuer:

• Verify scene safety

• Check responsiveness of the child.

• Witnessed collapse-Shout for help or activate emergency response system through

mobile device and ask for help and AED.

• Check for breathing and pulse simultaneously (not more than 10 seconds)

• Unwitnessed collapse- if patient is unresponsive and if there is no nearby help or

mobile device,don’t leave the side of the patient.Give CPR 2 minutes and then leave
the patient to call for help and resume as early as possible.

• Use AED as soon as available.

Multiple rescuers:

• Verify scene safety

• Check for responsiveness.

• If victim is unresponsive, first rescuer remains with victim and begins CPR while the
other activates the emergency response system and retrieves the AED and emergency
equipment.

• The first rescuer continues chest compression and ventilation in the ratio 30:2 and
changes to 15:2 after the second rescuer arrives back

Pediatric chest compressions:

 C-A-B.

 100 -120 compressions/min.

 Allow complete chest recoil between compressions.

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  Depth of compressions: 1/3 of AP diameter of chest.(in children- 2inches/5cms;
infants- 4cms).Adolescents depth same as adults atleast 2 inches (5cms) but <2.4
inches (6cms)

 Compression ventilation ratio: 30:2 (lone rescuer); 15:2 ( two rescuers)

 Lower part of sternum, below nipple line.

 Site of chest compressions:

 Lower part of sternum

 Below nipple line.

Technique of compressions:

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 •
•

• Two finger technique

• Used in infants.

• Sole rescuer.

• Compress sternum with two fingers below inter mammary line.

Technique of chest compressions:

•
• 2 thumb encircling technique.

• Used in neonates & infants.

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 • Two rescuers present.

• Encircle chest with both hands,spread your fingers over chest wall and place two
thumbs over lower end of sternum.

• Better technique-generates better coronary perfusion pressures.

Technique of chest compressions:

• One hand technique.

• Used in older children.

• Compress lower end of sternum with heel of one hand or two hands.

• Do not press on xiphoid or ribs.

Pediatric defibrillation:
• Energy: 2J/kg for first shock;4J/kg for subsequent shocks. Even higher energy levels
may be considered for subsequent shocks.

• Max upto 10J/kg.

• Preferable to use manual defibrillator or AED with pediatric dose attenuator for
children <1year.

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 • But in cases of emergency, AED can be used.

• Preferably use pediatric pads,but adult pads can be used in emergency.

TERMINATION OF BASIC LIFE SUPPORT:

CPR is stopped as a result of a number of circumstances; these are typically restoration of
spontaneous respiration and circulation, complete rescuer exhaustion, or medical decision.
Signs of restored ventilation and circulation include:

 Struggling movements

 Improved color

 Return of or strong pulse

 Return of systemic blood pressure

POTENTIAL HAZARDS OF CPR:

1. Sternal and rib fractures
2. Pneumothorax ,haemothorax or both
3. Injuiry to the heart and then Great vessels
4. Organ lacerations
5. Aspirations of stomach contents

RESPONSIBILITIES OF NURSE DURING CPR:

(USUALLY SENIOR WARD NURSE);

 Identifies self as Nursing Team Leader, responsible for co- coordinating and directing
emergent nursing care of the patient.

 Checks appropriate emergency call has been placed

 Starts timer as soon as the Emergency trolley arrives.

 Delegates available staff to roles appropriate to their level of practice: Airway,

Compression, Monitor & Medications and Runner to collect or remove extra
equipment, supplies, labs etc.

Establishes the patient’s weight and delegates someone to print out an Emergency Drug
Worksheet (Icon on desktop of clinical computers

 Ensures that the patient is placed on CPR back board.

 Ensure someone is assigned to support family members.

 Documents initial and ongoing vital signs and cardiac rhythm, medication
administration, procedures and patient’s response to interventions

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  Monitors the time interval between adrenaline administration and prompts the Team
Leader when 4 minutes has passed since last dose administered.

AIRWAY NURSE:

 Someone help and initiates CPR as required until initial assistance arrives and then
assumes responsibility for airway management

 Maintains airway patency with use of airway adjuncts as required (suction, high flow
oxygen,, or bag valve mask ventilation).

 Assist with intubation and securing of ETT

 Inserts gastric tube and/or facilitates gastric decompression post intubation as

required.

 Assists with ongoing management of airway patency and adequate ventilation

 Supports less experienced staff by coaching/guidance e.g. drug preparation

COMPRESSION NURSE:

 If CPR in progress, assume responsibility for cardiac compressions (this includes

ensuring that staff doing compressions are changed at regular intervals (e.g. every 2
minutes) to avoid fatigue resulting in inadequate compressions being delivered)

 Assess pulses (including pulse volume) and capillary refill as required

SPECIAL CONSIDERATION:

Although aids isn’t known to be transmitted in saliva, some health care professionals may
hesitate to give rescue breath, especially if the victim has AIDS. For these reason, it is
recommended that all health care professional should know how to use disposable air way
equipments.

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SUMMARY:

Today we have been discussed definition, purposes, contraindications, assessment for CPR,
BLS guidelines and algorhythms for adults and paediatrics and nurses responsibility during
Cardio-pulmonary Resuscitation.(CPR).

CONCLUSION:

CPR is the responsibility of a team of personnel and not one person in isolation. For cardiac
arrest we strive to prevent when possible, treat effectively when challenged and support
humanely when death is imminent

BIBLIOGRAPHY:

1.Sheeber P B and Khan Y.A Concise Textbook of Advanced Nursing Practice.1st edition
,ZMMESS Publications. page no.294-305.

2.www.slideshare.net/mobile/abdulsherwani/aha-cpr-update-2015.

3.www.slideshare.net/mobile/drsaeidsafari/cardiopulmonary-resuscitation –cpr-aha-2015.

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