Introduction

Continuous blood supply [oxygen +nutrients] to body's cell is important to maintain their
function. The cardiopulmonary system is responsible for this function . Suddenly cessation in
cardiopulmonary system function known as cardiopulmonary arrest leads to life threating
conditions as brain damay that begins 4-6 minutes after cardiopulmonary arrest and becomes
irreversible after 8-10minutes from the onset of cardiopulmonary arrest.Death will occur if
his condition not managed properly and quickly using cardiopulmonary resuscitation (cpr).

Goal

1.Maintain adequate circulation 2. Maintain airway patency. 3.Initiate breathing.

Causes

1. Hypoxia 2. Hypo / Hyperthermia 3. Hypo / Hyperkalemia 4.Tamponed 5.Tension

pneumothorax 6.Thromboses ( pulmonary/cardiac)
Signs

Loss of consciousness
Pulselessness large arteries.
Dilated pupilS.
Gasping or absent respiration

The cain of survival

The interventions that contribute to a successful outcome after the cardiopulmonan Can be
conceptualized as the chain of survival. It consists of :

1. Surveillance and prevention

2. Immecfiate recognition & activation o the emergency response system.
3. Immediate high quality CPR
4. Rapid defibrillation
5. Advanced life support and post cardiac arrest care

The sequence we will use is considered in the following steps (SRAP CABD)

l. S Safety environment (staff and patients).

2. R Response check.
3. A Activation of EMS Or code blue
4. P Pulse and breathing check simultaneously.
5. C Circulation (Chest compressions)
. A airway
7.B breathing
8. D Defibrillation

Steps"
-Ensure that environment is safe (dry, organized, and clean with no electrical haards - Wear
personal protective barriers.
-Tap on shoulder Firmly and shout "Are you okay?" To check response.
-activate a if no response:Code management team ( EMS) and get emergency cart to
complete the chain of survival with advanced life support care
-pulse and respiratory check (p) :check pulse and breathing stimultaneously within 10
second To determine which scenario To be followed based on absence/present of pulse and
breathing
Scenario 1 : if patient is unresponsive but has breathing and pulse
*Put pt on recovery position
*Check for pulse/respiration every 2 minutes until emergency responders arrive.
Scenario 2 : if patient is unresponsive with no breathing but has pulse.
Provide rescue breathing using MRB
*Open airway using head-tilt chin lift or jaw thrust and insert airway
*connect MRB to oxygen source
*adjust O2 flow rate of 10 to 12 L/min
*deliver each bresth over 1 second every 5-6 seconds
*observe for chest rise
•If there is no adequate chest rise
Ensure adequate airway opening/ventilation volume and deliver another breath
If second breath doesn't achieve adequate chest rise, consider airway obstruction

*Recheck breathing & pulse every 2 min

Scenario 3 : if pt is unresponsive with no pulse and has no respiration
*Ensure pt is in supine position on hard surface
*expose pt chest
* begain 5 cycle of 30 chest compression and 2 ventilations
N.B/ chest compression are forceful rhythmic application if pressure over the lower half of
the sternum by directly increase intrathoracic pressure to generate blood flow and oxygen
delivery to myocardium and brain

Chracteristics of high quality chest compression:

• Hand position.
• Kneel by the side of the victim
• Place heel of dominant hand on center of lower half of the sternum of bare chest
between nipples. To prevent fracture.
• Place heel of other hand on top of first hand.
• Interlace & raise fingers of both hands away from a patient's chest.
• Keep elbow straight
• Position shoulders directly over hands and the each hard & fast straight down the
victim's chest bone at rate of 100-120 compression/min.To use body weight to the
victim's breastbone
• Press down 5-6 cin in depth & count loudly
• Allow complete chest recoil after each compression with equal duration
• Minimian interruptions compression to less than 10 seconds. To prevent increase in
intra pressure & significant des coronary perfusion associad Incomplete chest recoil.
.Recheck breathing & pulse every 2 minutes.
If patient is not intubated CPR can be Performed by one rescuer and can also be
Performed by two rescuers in a synchronized Manner.
 If patient is intubated CPR must be performed By two rescuers simultaneously If two
Rescuers
Switch duties every 2 minutes (Take less than 5 seconds to switch) To maintain
continuity ofCPR. Continue untill
• Patient shows signs of life.
• Defibrillator arrives & ready for use.
• Rescuer is too exhausted to continue.
(To ensure adequate perfusion to Vital organs)

Initiate early defibrillation with AED (when available) within3 minutes from collapse
( To treat ventricular fibrillation (VF) which is a common cause of cardiac arrest )

N.B Continue to do CPR until attaching victim to AED and turning it on and following
the
AED prompts & resuming chest compression immediately after the delivery of shock

Perform post resuscitation care for victims who revived

Documentation
• Time of starting CPR
• Pericxl for providing CPR
• Causes of cardiopulmonary arrest.
• Patient's response / complication
• Defibrillation of arrhythmias, time, response
• Received (medications,infusion )

Recovery Position

The recovery position is used for unresponsive adult victims who clearly have a
breathing and effective circulation. The position should be stable, near a true lateral
position, with the head dependent and with no pressure on the chest to impair
breathing as following:

1. Place arm nearest to you out at RT angles to body, elbow bent with hand palm
upper most
2. Bring far arm across chest, hold back of hand against victim's cheek nearest to
you
3. With your other hand, grasp the far leg just above knee; pull it up, keeping the
foot on the ground.

Post-Procedure Complications

1. Regurgitation during CPR

Regurgitation of stomach contents is common during CPR due to artificial respiration

using non-invasive ventilation methods which result in gastric insufflation. This can
lead to vomiting, which can further lead to airway compromise or aspiration.
If regurgitation occurs:
Tum the victim away from you.
Keep him on his side and prevent him from toppling on to his front.
Ensure that his head is turned towards the floor and his mouth is open and at the
lowest point, thus allowing vomit to drain away.
Clear any residual debris from his mouth with your fingers; and immediately turn
him on to his back, re-establish an airway, and continue rescue breathing and chest
compressions at the recommended rate.

2-stomach (gastric) distention

Causes:-
Rescue breathes given too fast
Rescue breathes given too forcefully
Partially or completely blocked airway

Prevention :-
Blow just hard enough to make chest rise
Keep the airway open during inhalations and exhalations
Use mouth to nose method
Re tilt head to open airway

3-Chest compression related injuries :-

Types:- Rib fractures

Rib separation
Air and / or blood in chest cavity – bruised lung
Lacerations of the lung, liver or spleen

Prevention:-
Use proper hand location on chest
Avoid pressing chest too deeply
Keep fingers off victim's rib
Press straight down
Give smooth, regular and uninterrupted compression

4-dentures, loose or broken teeth, or dental appliances

Prevention:-
Leave tight fitting dentures in place
Remove loose or broken teeth, dentures, and / or dental appliances

Specific considerations in CPR in relation to age :-

Check the pulse in brachial artery in infants