CARDIOPULMONARY

RESSUCITATION

PRESENTED BY
SIWANI RAI
M.SC. NURSING-I
What Is Cardiac Arrest ?

⚫Abrup cessation of spontaneous

tand effective ventilation and
systemic
perfusion
How Do you Recognize a Cardiac Arrest?

EARL
Y
Unresponsiveness
In case of adults absence of carotid
pulse and in case of infants Brachial
pulse
Absence of normal respiration( the
victim is not breathing or only gasping)
LATE SIGN


Cyanosis

Cold clammy skin

Dilated pupils

ECG –Asystole / PEA/ pulse less VT/
VF
 REVERSABLE CAUSES
‘HIT THE TARGET’
H – Hypoxia
I – Increased H Ions [Acidosis],
T – Tension Pneumothorax,
T – Toxins/Poisons,
H – Hypovolaemia,
E – Electrolyte Imbalance [Hypo-/Hyperkalaemia],
T – TamponadeCardiac,
A – Acute Coronary Syndrome,
R – Raised Intracranial Pressure [SubarachnoidHaemorrhage]
G – Glucose [Hypo-/hyperglycaemia],
E – Embolism (Pulmonary Thrombosis),
T – Temperature [Hypothermia]).
 CARDIO-PULMONARY RESUSCITATION

A basic life support for the purpose of

oxygenating the brain, heart and other
vital organs until the appropriate
definite medical treatment can restore
the normal heart and lung function.
Core Links In BCLS
 High quality CPR criteria

 Compression rate is 120/min

 Compression depth is now 2-2.4 inches in adults

 Allow complete chest recoil after each compression

Minimize interruption during chest compression(<

10secs)
 Avoid hyperventilation.

 Rotate compressor every 2 mins

 STEPS OF BASIC LIFE SUPPORT
1. Assessment and Activate ERS & get an AED
 Make sure that scene is safe

 Check for response --Tap & shout "Are you all right?"

 Check pulse & breathing for absent or abnormal

breathing
simultaneously
 Activate code blue (7201) & get an AED/Defibrilator
 STEPS OF BASIC LIFE SUPPORT
2. Chest compression
Check for pulse for 10 sec.
If no pulse within 10 sec. start CPR with
chest compressions first followed by 2
breaths at 5 sec interval over 1 sec
Two-finger chest compression technique in infant (1 rescuer).
Two thumb-encircling hands chest compression in infant
(2 rescuers)
 STEPS OF BASIC LIFE SUPPORT
>Position self correctly (i.e. close to and adequately
above patient, kneel on the bed close to patient),
>Locate correct hand position. (2 finger above the
xyphoid sternum)
>Push hard at 2-2.4 inches & Push fast at the rate of
120/minute
STEPS OF BASIC LIFE SUPPORT

3. Opening Airway

Clean the airway by finger sweep in case of
visible foreign body, or oral suction

Tilt the head back and lift the chin((using head
– tilt/chin – lift), Double maneuver –
SNIFFING POSITION
 STEPS OF BASIC LIFE SUPPORT
4. Giving mouth- to-mouth breaths

The nostrils of the victim are pinched closed to assist with an
airtight seal

The provider puts his mouth completely over the patient’s

If victim is not breathing or only gasping GIVE 2 RESCUE BREATHS

mouth
If victim is not breathing or only gasping, GIVE 2 RESCUE BREATHS
Observe for visible chest
&
Observe for visible chest
&
rise
rise
 STEPS OF BASIC LIFE SUPPORT
4. Using bag –mask device

The provider ensures a tight seal between the mask and
the patient’s face.

The bag is squeezed with one hand for 1 second, forcing at
least
500 mL of air into the patient’s lungs.
DEFIBRILLATION
Defibrillation is the
application of
electrical shock to
help restore the
heart’s regular
rhythm
 Shockable (VT)


Monomorphic VT 
Polymorphic VT
– Broad complex rythm – Torsade de
– Rapif rate pointes
– Constant QRS morphology
VENTRICULAR TACHYCARDIA

Fast heart rhythm which does not allow

the heart to fill properly and cardiac
output is compromised and reduced
 Shockable (VF)


Bizarre irregular 
Uncoordinated electrical
waveform activity

No recognisable 
Coarse/fine
QRS 
Exclude artefact
complexes – Movement

Random frequency and – Electrical interference
amplitude
 Non-shockable (Asystole)


Absent ventricular (QRS) activity

Atrial activity (P waves) may persist

Rarely a straight line trace

Adrenaline 1 mg IV then every 3-5 min
 Non-shockable (Pulseless Electrical Activity)


Clinical features of cardiac arrest

ECG normally associated with an output

Adrenaline 1 mg IV then every 3-5 min
 Non-shockable (Pulseless Electrical Activity)


Clinical features of cardiac arrest

ECG normally associated with an output

Adrenaline 1 mg IV then every 3-5 min
 Placement of Defibrillator's Paddles
⚫There are two accepted positions to optimize
current delivery to the heart:
⚫(1) Anteroapical – Sternal paddle is placed to the right of
the sternum just below the clavicle on mid-clavicular line,
and the Apex paddle is centred lateral to the normal cardiac
apex in the mid-axillary line on 4th to 5th intercostal space
⚫(2)Anteroposterior – the anterior pad/paddle is placed
over the praecordium or apex, and the posterior pad/paddle
is placed on the back in the left or right infrascapular
region.
Mid
Amount of Jule

Adult – 120-J , 120J ,120J ,200J,200J

Paediatric- 2-4J /kg of BW
 DO’S & DON’TS
DO'S
Be ready with a defibrillator
Assess shock-able rhythm
Remove metallic items from patient's body
Maintain PAAS(P-power cord, A-attach
defibrillator lead, A-analyze shock, S-
shock)
Apply jelly properly
Apply 25lb pressure on paddle for fixation
Be clear before shock(I clear, you clear ,
all clear)
DON'T
⚫Do not -
s
Defibrillate on ECG lead
Defibrillate on hairy or wet
chest
Defibrillate over a pacemaker
generator box(permanent pace maker)
Defibrillate until temporary pacemaker is turned
off Have any direct or indirect contact with the
patient Have the patient in contact with the metal
fixtures
Use loose or extension cord
Charge or discharge paddles in the air
Pass charged paddles to another members of
the staff
Discharge over medication
Drug interventions
 Common complications due to CPR
Complications are
rib fracture,

sternal fractures,

bleeding in the anterior

mediastinum, heart contusion,

hemopericardium

upper airway Complications,

damage to the abdominal viscera -

lacerations of the liver and spleen,

fat emboli,

pulmonary complications -
pneumothorax, hemothorax, lung
contusions.
??????????????????????

Thank You
BASIC CARDIO-PULMONARY
RESUSCITATION

Sadhana
Chattopadhya
y