cardio pulmonary resuscitation
Post on 08-Nov-2014
19 Views
Preview:
DESCRIPTION
TRANSCRIPT
Introduction:
Unexpected cardiopulmonary collapse is a medical emergency
that requires immediate institution of the artificial measures to support life
and to reverse the initiating pathophysiological event.
Cerebral resuscitation is the most important goal of advanced
cardiac life support. Resuscitation is a continuous process from basic life
support (BLS) to advance cardiac life support (ACLS), where BLS initiates
the process and ACLS aims to restore and maintain spontaneous
respirations and circulations.
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.
It is also called as cardio pulmonary cerebral resuscitation (CPCR) as
oxygenation of brain is more important within 4 minutes otherwise
irreversible brain damage can occur.
Causes
System Reasons
CNS Cerebro-vascular accidents.
Shock.
Pulmonary: COPD.
Airway obstruction.
Atelectasis.
Cardio vascular: Acute M I.
CABG.
Heart failure.
Dysrhythmias.
Heart block.
Miscellaneous: Drowning, Fall, Poisoning.
Emboli, Accident.
Phases of the cardio pulmonary resuscitation:
Phases Steps
Phase-1 Basic life
support
A= Airway
B= Breathing
C= circulation
Phase-2 advanced
cardiac life
support
D= Drugs
E= ECG
F= fibrillation
Phase-3 prolonged life
support
G= Gauging
H= Human Mentation
I= Intensive care
Typically the sequence of BLS consists of assessment and the ABCs of
CPR.
Assessment
It is of crucial importance. It includes
1. Assess responsiveness by calling the person; shouting and
shaking.
2. Assess breathing by look, listen and feel: Look for chest
movements, listen for breath sounds and feel for the
movements of the air flow.
3 Assess circulation- feel the carotid pulse.
Basic life support
1. Airway management
i. Open and clear the airway: This is achieved by head tilt and
chin lift maneuver or if there is suspicion/evidence of head or
neck trauma, the jaw thrust maneuver is used.
HEAD TILT CHIN LIFT MANEUVER:
Place one hand on the victim’s hair line and place the other hand’s index
finger and the middle finger on the chin and apply firm backward pressure.
Head tilt and chin lift maneuver
JAW THRUST MANEUVER:-
It is accomplished by placing one hand on each side of the
victim’s head, grasping the angles of the victim’s lower jaw, lifting
with both hands.
ii) Open and clear the airway by using finger sweep method.
FINGER-SWEEP MANEUVER:-
a) With the victim’s head up, opens the victim’s mouth by
grasping both tongue and the lower jaw between the thumb
and fingers and lifting (tongue-jaw lift).
b) This action draws the tongue from the back of the
throat and away from the foreign body. The obstruction may
be partially relieved by this maneuver.
c) If the tongue-jaw lift fails to open the mouth the
crossed finger technique may be used. This is accomplished
by opening the mouth by crossing the index finger and the
thumb and pushing the teeth apart. The index finger of the
available hand is inserted along the inside of the cheek and
deeply into the throat to the base of the tongue.
d) A hooking motion is used to dislodge the foreign body
and maneuver it into the mouth for removal.
Finger sweep maneuver
Breathing: -
After the airway management if the victim is still not breathing, then
maintaining head tilt, chin lift positions pinch the nostrils and place the
mouth around the victim’s mouth to make a tight seal, take two deep
breaths and deliver two positive pressure ventilations; each at least of two
seconds duration. When performing mouth to mouth ventilation always
assess for chest wall movement.
Other advanced method to deliver breathing are bag and mask
ventilation, tracheal intubations and the use of laryngeal mask
airway.
The volume of air of each ventilation should be approximately 700-
1000ml, which can be determined by noting a rise of 1-2 inches in the
victim’s chest.
Smaller volume (400-600ml) should be attempted during bag and
mask ventilation.
Bag and mask ventilation
Use a resuscitator bag and mask.
Apply the mask to the victim’s mouth and create a seal by pressing
the left thumb on the bridge of the nose and the index finger on the
chin.
Use rest of the fingers of the left hand to pull on the chin and the
angle of the mandible to maintain the head in extension.
Use the rest of the fingers of the left hand to pull on the chin and the
angle of the mandible to maintain the head in extension.
Use the right hand to inflate the lungs by squeezing the bag to its full
volume.
Observe the chest wall for symmetric expansion.
CIRCULATION:
The carotid artery is used to determine the absence of
pulse.
While maintaining the head tilt position with one hand on
the forehead, locate the victim’s trachea with two or three
fingers of the other hand, then slides these fingers into the
groove between the trachea and the muscles of the neck
where the carotid pulse can be felt.
The technique is more easily performed on the side nearest
the rescuer.
If on assessment, there are no signs of circulation start
external cardiac compressions.
External cardiac compressions technique consists of serial
rhythmic application of pressure on the lower half of the
sternum.
The victim is on the horizontal supine position on a flat and
hard surface.
The rescuer should be positioned closed to the side of the
victim’s chest.
Locate landmark notch hands in the centre of the chest,
right between the nipples and four fingers above the
xiphoid process.
Position hands, arms and shoulders.
Elbows should be locked and arms are straight.
Rescuer’s shoulders position directly over hands.
Begin compression.
Pressure should come from the shoulders.
Compression should depress victim’s sternum
approximately 1.5- 2 inches.
Don’t allow the fingers to touch the chest wall.
Allow chest to rebound to normal position after each
compression.
Perform compression at the rate of 100/min.
Maintain correct position at all times.
Check for signs of circulation every 3-5 min.
Compression: ventilation ratio is 30:2 irrespective of
number of rescuer.
Exhalation occurs between the two breaths and during the
first chest compression of the next cycle.
Perform four complete cycles and then reassess for signs
of breathing and circulation.
Drugs:
Name Action Dose Indica-
tions
Side-
Effects
Nsg manage-
Ment
Calcium
gluconate:
Electrolyte and
water balance
agent.
Essential element of
the body;helps to
maintain the
functional integrity of
the nervous and
muscular systems;
helps to maintain
cardiac
functions,blood
coagulation.
Adult:
10mg/kg
Iv with in
10mins.
Paed:
20mg/kg
in1:1dilution
iv.
Ionized
hypocalcimia
.
Osteoporosis
.
Hyperkalaemi
a.
Hypermagne
samia.
Ca blocker
over dose.
Hypercalcimia
Tingling sensation
Hypotension
Brady cardia
Arrhythmia
Cardiac arrest.
Avoid
Extravasations of
The iv injection.
Do not
Administer oral
drugs with
In 1-2 hrs of
Antacid
Administration.
Monitor the
Cardiac response.
Scalp vein
Should be avoided.
Name action Dose Indica- Side- Nsg management
Tions Effects
Adren-aline.
Class:
Adreno
receptor
agonists.
Increases the force
and rate of contraction
of the heart.
.5-1mg iv
bolus
repeated
every 3-5mns.
Max.18
Mg(for adult)
.01mg/kg
body weight
(for pead)
Restoration
of the cardiac
rhythm in
cardiac
arrest.
Attacks of
transitory av
block and
syncope
seizures.
Cns: tremors,
anxity,
insomnia,head
ache,dizziness,
confusion.
Cv:
Palpitation,tac
hycardia,
hypertension
Nausea
vomiting.
Use extreme caution when
calculating and preparing
the doses.
Protect drug solutions from
sun light.
Maintain -adrenergic
blockers.
Maintain a - adrenergic
blockers.
Name Action Dose Indications Side effects Nsg
management
Lidocain
Hydrochloride.
Local
anaesthetic
effects by
binding to and
inhibiting
sodium
channels.
Depress
conduction
velocity(phase-0)
and slope of
phase.
Adult:
1mg/kg.iv bolus
maintenance:
2-4mg/mn.
Paed:1mg/kg 1:1
dilution.
In prophylaxis
on treatment of
ventricular
arrythmias.
Digitalis
intoxication.
Drowsiness,
dizziness,
restlessness,
confusion,
euphoria.
Resp arrest and
depression.
Hypotension,
bradycardia etc
Monitor ecg.
Watch for
increased
vetriculareeto
pic beats.
Check
electrolytes.
Monitor vital
signs.
CPR
ECG
ECG is the graphical representation of the electrical
activity of the cardiac muscles. During cpr the cariac muscles.
During CPR the victim’s ecg should be continuously monitored
for monitored for monitoring evaluating and recording.
DEFIBRILLATION:
It is asynchronous cardio-version that is used in emergency
situation. Defibrillation completely depolarizes the all myocardial
cells at once, allowing the sinus node to recapture its role as the
pacemaker.
KEY POINTS TO REMEMBER WHILE DEFIBRILLATING.
Use a conducting agent between the skins the paddles
such as saline pads or electrode paste. This decreases the
electrical impedance and helps to prevent burns.
The paddles are placed on the chest wall one the sternal
paddle is placed to the right of the sternum, 2’nd
intercostals space just below the clavicle. The apex paddle
is placed on the left 6’Th intercostals space mid axillary
line.
Switch on the defibrillator.
Move the knob of the defibrillator to the required amount of
joules. Shock at 200,300,360 joules.
Exert 20-25 pounds of pressure on each paddle to ensure
good skin contact.
Press the charge button.
Call “stand clear” to ensure that personal are not touching
the patient or the bed at the time of discharge.
The defibrillator is then discharged by depressing the
buttons on the both paddles simultaneously.
GAUGING:
Identify the cause of cardiac arrest by:
1. Cardiac monitoring,
2. Lab examination of the blood.
Human mentation:
Start CPR within 4 min as brain can only survive
for four min with out oxygen.
Do not interrupt the CPR more than 7min.
Reassess for breathing and circulation every 2-
3min.
INTENSIVE CARE:
If the victim’s condition is stable, send the victim to the ICU
for close and continuous monitoring.
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.
top related