Emergency Assessment and Management:

Cardiopulmonary Resuscitation

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 LEARNING OBJECTIVES

On completion of this chapter, the learner will be able to:

I. Recognize the main steps in cardiopulmonary resuscitation.
II. Identify the technique of Compression.
III. Describe how to maintain airway and breathing.
IV. Identify situations when to stopped CPR?
V. Understand medications which may be used in CPR?

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 Introduction
Cardiopulmonary resuscitation (CPR) provides blood flow to vital organs
until effective circulation can be reestablished. Following the recognition
of unresponsiveness, a protocol for basic life support is initiated.
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 The four main steps in CPR are as follows:
1. Recognition of sudden cardiac arrest.
The patient is checked for
Main Steps in
responsiveness and breathing.
Cardiopulmonary
Resuscitation 2. Activation of the Emergency Response
System (ERS). Within a medical
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facility, a call is made to alert the
emergency response team, often called
the “Code 4” or “Code Blue” team.
Outside of a medical facility, 997 is
called to activate the Emergency
Medical Service (EMS).
 3. Performance of high-quality CPR. If no
carotid pulse is detected and no
Main Steps in defibrillator is yet available, chest
Cardiopulmonary
Resuscitation compressions are initiated. Rescue
breathing may be added by a health care
5 provider in a ratio of 30 compressions to
2 ventilations.
4. Rapid cardiac rhythm analysis and
defibrillation as soon as it is available.
Patients in ventricular fibrillation must
be defibrillated as soon as possible.
Defibrillator
 Compressions
• Compressions are performed with the

patient on a firm surface such as the

floor or a cardiac board. The provider,

facing the patient’s side, places one

hand in the center of the chest on the

lower half of the sternum and positions

the other hand on top of the first hand.

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 • Rescue breathing is no

Maintaining longer recommended unless

health care providers are
Airway and
present; if that is the case, it
Breathing is then started after chest
compressions.

• The airway is opened using

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a head-tilt/chin-lift maneuver,
and any obvious material in
the mouth or throat is
removed. An oropharyngeal
airway may be inserted if
available to help maintain
patency of the airway.
 Maintaining • Rescue ventilations are

Airway and provided using a bag-valve

Breathing mask or mouth-mask device.

• Oxygen is given at 100%

during resuscitation to
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correct hypoxemia and
improve tissue oxygenation.
Excessive ventilation is
avoided by the 30 to 2 ratio
of compressions to
ventilations.
 • As soon as a monitor/defibrillator
is available, monitor electrodes
are applied to the patient’s chest
Defibrillator and the heart rhythm is analyzed.
When an

• Automated external defibrillator

(AED) is used, the device is
turned on, the pads are applied to
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the patient’s chest, and the
rhythm is analyzed by the
defibrillator to determine whether
a shock is indicated. When the
ECG shows ventricular fibrillation
or pulseless ventricular
tachycardia, immediate
defibrillation is the treatment of
 Defibrillator

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The survival time decreases for every
minute that defibrillation is delayed.
Following defibrillation, high-quality
CPR is resumed immediately.
Survival after cardiac arrest has been
improved by extensive education of
health care providers and by the use
of AEDs.
 Advanced
Cardiovascular
Life Support

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• Additional care may be indicated for
patients in cardiac arrest. Placement
of an advanced airway such as an
Endotracheal tube may be performed
by a physician, nurse anesthetist, or
respiratory therapist during
resuscitation to ensure a patent airway
and adequate ventilation.
 • Endo tracheal intubation must
Proper Location be confirmed by assessment

of Endotracheal of specific parameters:

auscultation of breath sounds,
Intubation observation of chest
expansion, and a carbon
dioxide detector. A chest x-ray
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is always obtained after ET
tube placement to confirm
that the tube is in the proper
position within the trachea.
Arterial blood gases may also
be obtained to assess
ventilation and oxygenation.
edications May Used in Cardiopulmonary Resuscitation

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 When CPR Stopped?

CPR may be stopped when:

(1) A pulse and blood pressure are detected,

(2) Respirations are detected,

(3) When the patient responds,

(4) Rescuers are exhausted (Length of time for initiation of life
support)

(5) Death is considered to be inevitable,

(6) The patient does not respond to therapies given during the arrest.
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What are complications of cardiopulmonary resuscitation
(CPR)?

1. Performing chest compressions may result in the fracturing of ribs or

the sternum, though the incidence of such fractures is widely

considered to be low.

2. Artificial respiration using noninvasive ventilation methods (e.g.,

mouth-to-mouth, bag-valve-mask [BVM]) can often result in gastric

insufflation. This can lead to vomiting, which can further lead to

airway compromise or aspiration.

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 The care provided to the patient
following resuscitation is
Follow-Up another determinant of survival:
Monitoring • The patient may be transferred
and Care to an ICU for close monitoring.

• Continuous ECG monitoring

and frequent blood pressure
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6 assessments are essential
until hemodynamic stability is
established.

• Factors that precipitated the

arrest such as dysrhythmias or
electrolyte or metabolic
imbalances are identified and
treated.
 The care provided to the patient
following resuscitation is
Follow-Up another determinant of survival:
Monitoring • Patients who are comatose
and Care may benefit from therapeutic
hypothermia protocols. These
induce a drop in core body
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7 temperature to 32° to 34°C for
12 to 24 hours post
resuscitation in order to
decrease the cerebral
metabolic rate and need for
oxygen. Specific protocols will
be applied.
SUMMARY
 Cardiopulmonary resuscitation (CPR) provides blood flow to vital organs
until effective circulation can be reestablished.
 Oxygen is given at 100% during resuscitation to correct hypoxemia and improve
tissue oxygenation.
 The survival time decreases for every minute that defibrillation is delayed. Ensure
that the supply of gloves, gowns, masks, and eyewear is adequate.
 Endo tracheal intubation must be confirmed by assessment of specific parameters:
auscultation of breath sounds, observation of chest expansion, and a carbon dioxide
detector.

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 REVIEW
QUESTIONS

1. When you try to give an unresponsive adult a rescue breath and the chest does
not appear to rise, what would you do next?
A. Perform abdominal thrusts.
B. Begin CPR. D
C. Go call 997.
D. Repeat the head tilt/chin lift maneuver and attempt the breath again. 19
 REVIEW
QUESTIONS

2. Before responding to a first aid scenario, what is the first question you should
ask at the scene?
A. Age of the injured or ill person.
B. Safety of the scene.
C. Nature of the injury.
B
D. Time of the injury.
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