SEMINAR ON CPR

SUBMITTED TO:

GEETA SHIROOR

ASSO. PROFESSOR,BVCON.

SUMITTED BY:

MR.STAWAN UTTAM CHOUGULE

SUBMITTED ON:

CARDIOPULMONARY

RESUSCITATION

INTRODUCTION

According to recent statistics sudden cardiac arrest

is rapidly becoming the leading cause of death in

America. Once the heart ceases to function, a

healthy human brain may survive without oxygen for

up to 4 minutes without suffering any permanent

damage. Unfortunately, a typical EMS response may

take 6, 8 or even 10 minutes.

It is during those critical minutes that CPR (Cardio

Pulmonary Resuscitation) can provide oxygenated

blood to the victim's brain and the heart, dramatically

increasing his chance of survival. And if properly

instructed, almost anyone can learn and perform

CPR.

CPRDEFINITION :

“It is an emergency medical

procedure for a victim of cardiac

arrest or , in some circumstances,

respiratory arrest.”

REVIEW OF ANATOMYAND PHYSIOLOGY

HEART

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HEART

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HEART Hollow, muscular organ

300 grams (size of a fist)

4 chambers

Found in chest between lungs

Surrounded by membrane called

pericardium

Pericardial space is fluid-filled to

nourish and protect the heart.

HODS - November 2006 9

HEART ANATOMY

The heart is a complex

muscular pump that

maintains blood

pressure and flow

through the lungs and

the rest of the body.

The heart pumps about

100,000 times and

moves 7200 liters (1900

gallons) of blood every

day.

HODS - November 2006 10

HEART ANATOMY The heart has four

chambers.

Two atria act as

collecting reservoirs.

Two ventricles act as pumps.

The heart has four valves for:

Pumping action of the heart.

Maintaining unidirectional blood flow.

HODS - November 2006 11

Functions of the Heart

Generates blood pressure

Routes blood

Heart separates pulmonary and systemic circulation

Ensures one-way blood flow

Heart valves ensure one-way flow

HODS - November 2006 12

Functions of the Heart

Regulates blood supply

Changes in contraction rate and force match blood delivery to changing metabolic needs

The Heart: Conduction System

The heart pumps blood through the body

This is accomplished by contraction and relaxation of the cardiac muscle tissue in the myocardium layer.

Intercalated discs allow impulses to travel rapidly between adjacent cells so they function as one rather than individual cells

Cardiac Muscle Tissue

intercalated disc

intercalated disc

Conduction System Continued….

Cardiac conduction system: The

electrical conduction system controls

the heart rate

This system creates the electrical

impulses and sends them throughout

the heart. These impulses make the

heart contract and pump blood.

Components of the Conduction System Sinoatrial node (part I):

Located in back wall of the right atrium near the

entrance of vena cava

Initiates impulses 70-80 times per minute without

any nerve stimulation from brain

Establishes basic rhythm of the heartbeat

Called the pacemaker of the heart

Impulses move through atria causing the two atria

to contract.

At the same time, impulses reach the second part of

the conduction system

Components of the Conduction SyStem Continued ….

Atrioventricular node (part II):

Located in the bottom of the right atrium

near the septum

Cells in the AV node conduct impulses more

slowly, so there is a delay as impulses travel

through the node

This allows time for atria to finish contraction

before ventricles begin contracting

Septum

Atrioventricular Bundle “Bundle of His”

From the AV node, impulses travel through to the right and left bundle branches

These branches extend to the right and left sides of the septum and bottom of the heart.

Atrioventricular Bundle Continued….

These branch a lot to form

the Purkinje fibers that

transmit the impulses to

the myocardium (muscle

tissue)

The bundle of His, bundle

branches and Purkinje

fibers transmit quickly and

cause both ventricles to

contract at the same time

Like a “phone tree”

Atrioventricular Bundle Continued….

As the ventricles contract, blood is

forced out through the semilunar valves

into the pulmonary trunk and the aorta.

After the ventricles complete their

contraction phase, they relax and the SA

node initiates another impulse to start

another cardiac cycle.

1 - Sinoatrial node (SA node)

2 - Atrioventricular node (AV node)

3 – Bundle of His

4 - Right & Left Bundle Branches

which lead to Purkinje Fibers

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CIRCULATION OF BLOOD

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LUNGS

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ANATOMY

LOWER RESPIRATORY SYSTEM

Trachea

Bronchial tree Left and right

main bronchus

Carina

Lobar bronchus

Segmental bronchus

Bronchiole

Alveoli

HODS - November 2006 26

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PURPOSES OF CPR

Restore cardiopulmonary functioning.

Prevent irreversible brain damage from anoxia.

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INDICATIONS OF CPR1 .CARDIAC ARRESTa) Ventricular fibrillation.b) Ventricular tachycardiac) Asystoled) Pulseless electrical activity2.RESPIRATORY ARREST :-a) Drowningb) Strokec) Foreign –body airway obstructiond) Smoke inhalatione) Drug overdosef) Electroculation/injury by lightningg) Suffocationh) Accident/injuryi) Coma

ADULT

BASIC LIFE SUPPORT

(BLS)

OBJECTIVES

Students should be able to demonstrate:

How to assess the collapsed victim

How to perform chest compression and rescue

breathing

How to place an unconscious breathing victim in

the recovery position.

BACKGROUND

Approximately 700,000 cardiac arrests per year in Europe

Survival to hospital discharge presently approximately 5-10%

Bystander CPR vital intervention before arrival of emergency services – double or triplesurvival from SCA (sudden cardiac arrest)

Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

CHAIN OF

SURVIVAL

CHAIN OF SURVIVAL

AHA ECC Adult Chain of Survival

The links in the new AHA ECC Adult Chain of Survival are as follows:

1. Immediate recognition of cardiac arrest and activation of the emergency response system

2. Early CPR with an emphasis on chest compressions

3. Rapid defibrillation

4. Effective advanced life support

5. Integrated post–cardiac arrest care

BASIC LIFE SUPPORT

SEQUENCES OF PROCEDURES PERFORMED TO

RESTORE THE CIRCULATION OF OXYGENATED BLOOD

AFTER A SUDDEN PULMONARY AND/OR CARDIAC

ARREST

CHEST COMPRESSIONS AND PULMONARY

VENTILATION PERFORMED BY ANYONE WHO KNOWS

HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT

ANY OTHER EQUIPMENT

Protective devices

APPROACH

SAFELY

CHECK RESPONSE

Shake shoulders gently

Ask “Are you all right?”

If he responds

• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

CHECK

RESPONSE

SHOUT FOR HELP

CHECK FOR CAROTID

PULSERESCUE BREATH FOR THEM:

- 1 breath every 5 to 6 seconds

for about 10-

12 per minute (each breath should

be

delivered over 1 second making

the chest

rise)

- Recheck pulse every 2 minutes

IF THE VICTIM DOES NOT HAVE CIRCULATION (NO PULSE)

Start chest compressions, at the center of the chest at

the nipple line with the heal of one hand on top of the

other, at a ratio of:

- 30 compressions to 2 ventilation at a rate of

100 per minute and a depth of 1 ½” to 2”

- Reassess after 5 cycles of 30 compressions to 2

breaths, after 2 minutes

• Place the heel of one hand

in the centre of the chest

• Place other hand on top

• Interlock fingers

• Compress the chest

– Rate at least 100 / min

– Depth at least 2 inches

– Equal compression :

relaxation

• When possible change CPR

operator every 2 min

CHEST COMPRESSIONS

OPEN AIRWAY

HEAD TILT & CHIN LIFT

JAW THRUST

HEAD-TILT CHIN-LIFT

The head-tilt chin-lift is the

primary maneuver used in

any patient in whom cervical

spine injury is not a

concern. The simplest way

of ensuring an open airway

in an unconscious patient is

to use a head tilt chin lift

technique, thereby lifting the

tongue from the back of the

throat. This is taught on

most first aid courses as the

standard way of clearing an

airway.

JAW THRUST

The jaw-thrust maneuver is an effective airway technique,

particularly in the patient in whom cervical spine injury is a concern.

The jaw thrust is a technique used on patients with a

suspected spinal injury and is used on a supine patient. The

practitioner uses their thumbs to physically push the posterior (back)

aspects of the mandible upwards - only possible on a patient with

a GCS < 8 (although patients with a GCS higher than this should also

be maintaining their own patent airway). When the mandible is

displaced forward, it pulls the tongue forward and prevents it from

occluding (blocking) the entrance to the trachea, helping to ensure a

patent (secure) airway.

FOREIGN-BODY AIRWAY

OBSTRUCTION (FBAO)

Approximately 16 000 adults and children receive treatment for FBAO in the UK yearly

SIGNS MILD obstruction SEVERE obstruction

“Are you choking?” “YES” Unable to speak,

may nod

Other signs Can speak, cough,

breathe

Can not

breathe/wheezy

breathing/silent

attempts to cough/

unconsciousness

ADULT FOREIGN BODY AIRWAY

OBSTRUCTION TREATMENT

BACK BLOWS

ABDOMINAL THRUSTS

RESCUE BREATHS

Pinch the nose

Take a normal breath

Place lips over mouth

Blow until the chest

rises

Take about 1 second

Allow chest to fall

Repeat

RESCUE BREATHS

RECOMMENDATIONS:

- Tidal volume

500 – 600 ml

- Respiratory rate

give each breaths over about 1s with enough

volume to make the victim’s chest rise

- Chest-compression-only

continuously at a rate of 100 min

CONTINUE CPR

30 2

DEFIBRILLATION

AUTOMATED

EXTERNAL

DEFIBRILLATOR

(AED)

Some AEDs will

automatically switch

themselves on when

the lid is opened

Automatic External

Defibrillator

- Why we use the AED?

- How to use the AED?

- Indications for the AED?

- Contraindications to AED?

Objectives for this

subject

Defibrillation is

the application

of electrical

shock to help

restore the

heart’s regular

rhythm

Defibrillator is the device

used to deliver that shock

and it can be manual or

automatic.

Early defibrillation is the single

most important factor in

determining survival from cardiac

arrest.

AED

Most common initial rhythms patients go into as they enter into cardiac arrest are:

“2 Shockable Rhythms”

V-Tach and V-Fib

Ventricular Tachycardia:Fast heart rhythm which does not

allow the heart to fill properly and

cardiac output is compromised and

reduced.

Ventricular Fibrillation:disorganized series of electrical

discharges in the ventricles. Where

the ventricles “quiver”.Stops Cardiac

output and hearts pumping ability.

AED’s that are available are

automatic and semi-

automatic.

Automatic: where machine

does all of the work.

Semi Automatic: where

machine tells you when to

push button to deliver shock.

Apply AED

as soon as

you

determine

that your

patient is not

breathing

and does not

have a pulse.

Always making sure that

CPR is still in progress while

you are setting up the AED.

If by yourself, apply the AED.

Ensure before putting pads on chest, it is clear of all patches, paste or pacemakers. Don’t cover something up with pad.

ATTACH PADS TO CASUALTY’S

BARE CHEST

Now attach the

adhesive pads to

the cables

remembering-

White is negative,

anterior chest wall.

Red is positive ,

left anterior axillary

line.

“Red on Ribs! White on right!”

Now turn on

machine and

wait for AED to

analyze the

patients

rhythm. Making

sure that CPR

has been

stopped for

machine to

detect rhythm.

When machine advises a

shock is indicated,

”CLEAR”

your patient.

Ensuring that no one is

touching patient or stretcher.

When the AED delivers a shock

it will go back and reanalyze the

rhythm.

If another shock is appropriate

“Clear Patient”

and

deliver the shock.

Sets of 3 shocks are called

stacked shocks and they are

done without any pauses to

check patients pulse or

administer CPR

IF VICTIM STARTS TO BREATHE

NORMALLY PLACE IN RECOVERY

POSITION

If “No shock” is indicated:

-Check breathing

give appropriate oxygen therapy.

-Check pulse, if no pulse!

Start CPR for

1 minute and then have the AED

reassess.

Safety should always be

maintained by the provider:

-Not using near or around water

-Ensuring all med patches and pastes are

off the patient.

-Making sure that everyone is clear of the

patient when the shock is delivered.

Indications for AED

* Unresponsive

* Apneic

* Pulseless patients.

Adult Patients

> 8 years old

> 55 lbs.

Unresponsive,pulseless and

apneic.

Contraindications:

Infants and children

< 8 years old

< 55 lbs.

Contraindications:

!! Hypothermia !!

(Contact medical control)

Contraindications:

Rigor / Livor Mortis

No Code /DNR

The AED can’t properly

analyze patient in

moving ambulance.

It is recommended that you

stop the medic and let AED

do it’s job.

CONTINUE RESUSCITATION

UNTIL

Qualified help arrives and takes over

The victim starts breathing normally

Rescuer becomes exhausted

TERMINATION OF BLS

Signs of restored ventilation and

circulation include:

1. Struggling movement

2. Improved color

3. Return of stronger pulse

4. Return of systemic B.P.

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COMPLICATIONS OF CPR

1. Broken bones

2. Internal injuries

3. Vomiting and aspiration

4. Body fluid expose

5. Gastric distension.

NURSES

RESPONSIBILITY

research

OUTCOMES OF CHEST COMPRESSION ONLY CPR

VERSUS CONVENTIONAL CPR CONDUCTED BY LAY

PEOPLE IN PATIENTS WITH OUT OF HOSPITAL

CARDIOPULMONARY ARREST WITNESSED BY

BYSTANDERS: NATIONWIDE POPULATION BASED

OBSERVATIONAL STUDY.

BIBLIOGRAPHY

1. Tortora Grabowski,principles Of Anatomy And

Physiology,wiley,9th Edition.

2. Anatomy And Physiology Gary A. Thibodeau And Kevin T.

Patton.Mosby,5th Edition

3. Medical And Surgical Nursing Phipps,cassmeyer ,Sands

,Lehman,5th Edition.

4. Advanced Nursing Practise,emmess Medical

Publisher,shabeer P.Basheer And S.Yaseen Khan,1st

Edition.

5. BLS For Health Care Provider,michael R Saure,md.

6. Cardiopulmonary Resuscitation (Cpr)(encyclopedia Of

Nursing And Allied Health)-enote.Com

THANK YOU