1. CPR (CARDIO-PULMONARY RESUCITATION)
Submitted by :
Meenakshi Vyas
(M.Sc Nsg - 1st Year)

2. OBJECTIVES OF TODAY’S TEACHING:
.
At the end of session you will be able to:
• Define the CPR.
• Purposes of CPR
• Indications of CPR
• Treatable causes of cardio-respiratory arrest
• Pathophysiology of Cardiac arrest
• S/S of Cardiac Arrest
• Articles/Equipments required for CPR
• Sequence and Steps of CPR
• Nursing Responsibilities during CPR

3. INTRODUCTION
Cardiopulmonary resuscitation (CPR) is a
lifesaving technique useful in many
emergencies, including heart attack or near
drowning, in which someone's breathing or
heartbeat has been stopped.

4. DEFINITION
Angela Morrow RN
Cardiopulmonary resuscitation
(CPR) is a procedure used when a
patient’s heart stops beating and
breathing stops. It can involve
compressions of the chest or
electrical shocks along with rescue
breathing.
Mosby medical dictionary
CPR is a basic emergency
procedure for life support
consisting of artificial and manual
external cardiac massage.

5. PURPOSES OF CPR
 To restore cardiopulmonary circulation by external cardiac massages (C).
 To Maintain open and clear airway (A).
 To maintain breathing by external ventilation (B).
 To save the life of patient.
 To prevent irreversible brain damage from anoxia.
 To provide basic life support till medical and advance life support arrives.

6. INDICATION OF CPR
1. Shockable
- Ventricular tachycardia
- Ventricular fibrillation
- Pulseless ventricular
tachycardia
2. Non-shockable
- Asystole
- Pulseless Electrical Activity
1. Drowning
2. Stroke
3. Foreign body in Throat
4. Smoke inhalation
5. Drug overdose
6. Suffocation
7. Accident/injury
8. Coma
Respiratory Arrest
Cardiac Arrest
May be due to:

7. TREATABLE CAUSES OF CPR
1. Hypoxia
2. Hypothermia
3. H+ Less(Acidosis)
4. Hypo/Hyperkalemia
5. Hypovolemia
1. Thrombosis-Coronary(MI)
2. Cardiac Temponade
3. Tension Pneumothorax
4. Toxins
5. Pulmonary Thrombosis(PE)
5 Ts
5 Hs

8. PATHOPHYSIOLOGY
CARDIAC ARREST
NO BLOOD OR TISSUE OXYGENATION
BRAIN SUSTAIN DAMAGE FOR 4 MIN
AFTER4-7 MINS,IRREVERSIBLE DAMAGE OCCURS
CPR
CAUSES BLOOD TO CIRCULATE TO BRAIN AND HEART
DELAYS BRAIN DEATH
ALLOWS HEART TO REMAIN RESPONSIVE TILL DEFBRILLATION

9. SIGN AND SYMPTOMS OF CARDIOPRESPIRATORY ARREST
No response
No breathing
No pulse
Loss of consciousness

10. COMPONENTS OF CPR (Cardiopulmonary Resuscitation)
A level of emergency medical care which is used
for victims of life threatening illness or injuries
until they can be given full medical care at a
hospital.
A set of all clinical interventions (airway
management , use of monitors , medicines and
post cardiac arrest care)
for the urgent treatment of cardiac arrest, stroke
and other life-threatening medical emergencies.
ACLS { ADVANCE CARDIAC LIFE SUPPORT }
BLS { BASIC LIFE SUPPORT }

11. COMPONENTS OF CPR (Cardiopulmonary Resuscitation)
Chain of survival guidelines by AHA

12. EQUIPMENTS
Laryngoscope
Suction Apparatus
Ambu Bag
Endotracheal Tubes
OXYGEN CYLINDER

13. CPR PROCEDURE
.
Before you Begin : Check ;
1. Is the environment safe for the person?
2. Is the person conscious or unconscious?
3. If the person is unconscious, tap or shake the hid/her shoulder and ask
loudly “are you ok?”
4. If no response, call emergency number for help immediately.
5. Check pulse
Adults - Carotid pulse
Children- Brachial pulse
Infants - Femoral pulse, for 10 seconds, if no pulse, begin CPR

14. SEQUENCE OF CPR
ACLS - C A B D
BLS – C A B
•C (Circulation) –
Restore the circulation by external cardiac massage.
•A (Airway) –
Ensure an open airway.
•B(Breathing)) –
Start artificial ventilation of lungs.
• D (Drugs, Defibrillation) –
Use emergency medication and electric defibrillation.

15. POSITION OF CPR (SAME IN BLS AND ACLS)
 Patient should be in supine position on a relatively hard
surface.
 The person giving compressions should be positioned at high
enough above the patient.
 The hands of rescuer must be held state at the elbow in order
to maximize the effect of the compressions.

16. PROCEDURE OF CPR……………..contd
• APPROACH SAFELY
• CHECK RESPONSE
• SHOUT FOR HELP
• CHEST COMPRESSIONS( C)
• CALL 108
• OPEN AIRWAY(A )
• CHECK BREATHING (B)
• 2 RESCUE BREATHS
IMPORTANT STEPS TO FOLLOW

17. CPR ( STEPS )……SAME FOR BLS AND ACLS
 Kneel as close to side of patient’s chest just as possible.
 Palpate the Xiphoid process .
 Place the palm of one hand on the lower half of the
sternum , 2 inches(5 cm) from the tip of Xiphoid process.
 Place other hand on the top of first hand .
 Interlock fingers
 Compress the chest ;
Rate – 100-120/min Depth - 2-2.4 inches
Compression: ventilation = 30:2
 Push hard and fast. Allow complete chest recoil and minimize
interruption in compressions
C - COMPRESSIONS

18. CPR…….IN CONT
 HEAD TILT – CHIN LIFT :
- Non health care workers IN ADDITION TO BLS AIRWAY MANAGEMENT:
- Bag-Mask Ventilation
 JAW THRUST MANEUVER ;
- in case of suspected neck injury - Endotracheal Intubation
 HEAD TILT – CHIN LIFT + JAW THRUST
- For health care workers
A – AIRWAY ( BLS)

19. CPR (IN CONT…………….)
 Look , listen and feel for normal breathing or agonal breathing.
AGONAL BREATHING :
 described as heavy, noisy or gasping breathing.
 recognize as a sign of cardiac arrest .
RESCUE BREATHS
 Pinch the nose.
 take a normal breath.
 place lips over the mouth.
 blow until the chest rises.
 take about 1 second .
 Allow chest to fall. REPEAT.
B - BREATHING

20. IN CONT……………..
D- DEFIBRILLITION
Defibrillation is a process in which an
electrical device called a defibrillator deliver a therapeutic dose of electric shock to the heart, to stop
an arrhythmia resulting in the return of a productive heart
rhythm.
Specially used in :
- Ventricular fibrillation
- Pulseless ventricular tachycardia
D- DEFIBRILLITION, DRUGS

21. IN CONT……………..
D- DEFIBRILLITION
Key issues in Defibrillition :
Paddle Site :
Rt Intraclavicular region(2nd or 3rd intercostal space)
Lt. lower Axillary region(4th or 5th ICS, mid axillary line)
Paddle Size :
adult –– 8cm - 13 cm
Wave form patterns :
Monophasic – Current deliver in one direction
Energy level = > 360 J
Biphasic - Current deliver in two directions
Energy level = 120-200 J
D- DEFIBRILLITION, DRUGS

22. IN CONT……………..
STEPS FOR DEFIBRILLATION :
Test defibrillator for fully battery charge
Switch on power button.
Change and select paddle mode
Assess rhythm
Press paddles firmly over the chest
Deliver the shock
Resume CPR

24. IN CONT……………..
1. ADRENALINE – Main drug used during resuscitation from cardiac arrest.
- 1 mg I/V every 3-5 mins
2. AMIODARONE – an antiarrythmic drug
First Dose – 300mg IV bolus After 5 mins. Second Dose – 150 mg II/V
OR
LIDOCAINE - First Dose – 1-1.5 mg/kg IV , Second Dose – 0.5-0.75 mg/kg IV
3. ATROPINE - Single dose of 3 mg is sufficient to block vagal
tone completely
4. DOPAMINE - Primary uses: bradycardia, hypotension
Dose: 2-20mcg/kg/min infusion
D - DRUGS

25. POST CARDIAC ARREST CARE

26. NURSING MANAGEMENT
PRE- PROCEDURE RESPONSIBILITIES :
1. To recognize the signs of cardiac arrest.
2. Call for help. The cardio-pulmonary resuscitation must be
initiated within 4 minutes in order to prevent permanent brain
damage.
3. Have the Resuscitation cart ready with all equipments and
necessary drugs at the bedside.
4. Make the oxygen sources and suction machine available at bed
side.
5. Clear the airway of false teeth, vomitus, food materials etc.

27. NURSING MANAGEMENT
DURING PROCEDURE RESPONSIBILITIES :
1. Monitor airway breathing and circulation .
2. Assist with intubation and securing ETT.
3. Keep the oxygen sources ready in working codition.
4. Insert IV cannula start IV drugs and fluids as prescribed.
5. Insert gastric tube to facilitate gastric decompression .
6. Suction when necessary.
7. Monitor the oxygen saturation level frequently .
8. Keep the defibrillators and cardiac monitor ready at the patient bedside.

28. NURSING MANAGEMENT
POST PROCEDURE RESPONSIBILITIES :
• Insert gastric tube to facilitate gastric decompression post intubation as
required.
• Arrange the used articles and equipments at their designated space,after
proper cleaning and disinfection.
• Document medication administered including dose and the time.
• Teach the co-workers and less experienced staff.
• Provide psychological support to patient and to the relatives.

29. POSSIBLE COMPLICATIONS
 Rib Fracture
 Sternal Fracture
 Rupture Spleen
 Punctured Lungs
 Cervical Neck Injury
 Gastric Distension
 Coronal Vessel Injury
 Diaphragmatic Injury
 Pneumothorax , Hemothorax
 Myocardial Injury

30. CONCLUSION
CPR is the responsibility of team of personnel and not one person in isolation. For
cardiac arrest we strive to prevent when possible, treat effectively when challenged
and support humanly when death is eminent……..

31. WHAT DID YOU LEARN FOR?
1. When should CPR be used?
2. What is the first thing you or someone else should do before beginning CPR?
3. What do the CAB stands for?
4. What do you do if spinal injury is suspected
5. Which pulse to be palpated in case of adults and in case of children?
6. Which is the most important drug in resuscitation?
7. What is the ratio of compressions: ventilation?
8. What do you understand by the term DNR?