CARDIOPULMONARY RESUSCITATION

by

ROSOS, Lucky Charm D.

SOLIS, Ken

SUCANO, Faith

TREMEDAL, Jorgette Mae A.

WENCESLAO, Dianne

YAP, Mary Aira

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OBJECTIVES

After 5 hours of varied learning activities, the Lecl II nursing students will be able to:

1. define the terms such as:

1.1 Basic Life Support

1.2 Cadio-pulmonary rescuscitation

1.3 Airway

1.4 Ventilation

1.5 Artificial respiration

1.6 Respiratory arrest

1.7 Crackles

1.8 Rales

1.9 Ronchi

1.10 Cardiac arrest

1.11 Resusitation

1.12 Cardioversion

1.13 Defribrillation

1.14 External cardiac compress

1.15 Heimlich maneuver

1.16 Jaw thrust technique

2. State the general principles of breathing anf circulation

3. Discuss the ABC’s of basic life support.

4. Enumerate nad explain the causes w/ respective signs and symptoms of cardian and respiratory arrest.

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5. Explain the meaning and implication of artificial respiration

6. Discuss the cardiopulmonary resuscitaiton and its implication including the technique of external cardiac compression.

7. Show a tabulated comparison in performing CPR in adults, children and infant.

8. Delineate the guidelines in performing CPR. And ways to gauge the effectiveness of its performance.

9. Cite the indication and steps in performing the ff. techniques used in BLS:

9.1 Heimlich Maneuver

9.2 Jaw thrust technique

9.3 Back blows for infants

9.4 Chest thrust

9.5 Finger sweep

10.Demonstrate the beginning skills in perorming:

10.1 One-man recuer CPR

10.2 Tw0-man Rescuer CPR

10.3 Artificial Respiration

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1.1 Basic Life Support – a phase of emergency cardiac case

that is intended to prevent circulatory and respiratory arrest.

1.2 Cardiopulmonary resuscitation – involves the use of artificial

and external chest

compression.

1.3 Airway – passageway through which air normally circulates.

1.4 Breathing – act of inhaling and exhaling.

1.5 Circulation – the movement of blood through the heart and

blood vessels.

1.6 Advanced Life Support – emergency medical care for

sustaining life including defibrillation, airway management, and

drug management.

1.7 Artificial resuscitation – method of forcing air into the lungs

in a person who still has a pulse but whose breathing has

stopped.

1. DEFINITION OF TERMS

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1.8 Cardiac arrest – condition wherein circulation stops, the

pulse disappears and breathing also stops at the same time.

1.9 Respiratory arrest – condition wherein breathing stops but

pulse and circulation may continue for the same time.

1.10 Ronchi – an abnormal sound heard upon auscultation of an

airway obstructed by thick secretions, muscular spasms,

neoplasm or external pressure.

1.11 Crackles – coarse crackles are loud, bubbly sounds best

heard on inspiration.

1.12 Rales – a discontinuous sound consisting of a series of

short, non-musical noises, heard primarily during inhalation.

1.13 External Cardiac Compression – a rhythmic application of

pressure over the

lower portion of the sternum.

1.14 Ventilation – movement of air in and out of airways.

1.15 Cardioversion – The conversion of a cardiac rhythm or

electrical pattern to another, generally from an abnormal one to

a normal one. Cardioversion can be accomplished by using

medications or by electrical shock with a special defibrillator.

1.16 Defibrillation – is a process in which an electronic device

sends an electric shock to the heart to stop an extremely rapid,

irregular heartbeat, and restore the normal heart rhythm.

1.17 Heimlich Maneuver – An emergency treatment for

obstruction of the airway in adults. It may be needed when

someone chokes on a piece of food that has "gone down the

wrong way."

1.18 Jaw-thrust technique – a maneuver for opening the airway

of an unconscious patient. The flats of the hands are

placed on the cheeks with the fingers hooked under the

angles of the jaw so that the jaw can be pulled upwards to

separate the tongue from the back of the pharynx. This method

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is particularly useful when spinal injury is suspected and

movement of the neck is undesirable.

1.19 Resuscitation - restoration to life of one apparently dead.

GENERAL PRINCIPLES OF BREATHING AND CIRCULATION

Air that enters the lungs contains about 21 percent oxygen and only a trace of carbon dioxide. Air that is exhaled from the lungs contains about 16 percent oxygen and 4 percent carbon dioxide.

The right side of the heart pumps blood to the lungs, where the blood picks up oxygen and releases carbon dioxide.

The oxygenated blood then returns to the left side of the heart, from where it is pumped to the tissues of the body.

In the body tissues the blood releases oxygen and takes up carbon dioxide, after which it flows back to the right side of the heart.

All tissues of the body require oxygen, but the brain requires more than any other tissue. It is generally estimated that if the brain is totally deprived of oxygenated blood for a period of 4 to 6 minutes, it will suffer irreversible damage.

When breathing and circulation stop, this is called clinical death.

When the brain has been deprived of oxygenated blood for a period of 6 minutes or more and irreversible damage has probably occurred, this is called biological death.

2. PRINCIPLES

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Both ventilation and circulation are required to maintain life.

When breathing stops, the pulse and circulation may continue for some time, a condition known as respiratory arrest. In this case only artificial respiration is required, since the heart action continues to circulate blood to the brain and the rest of the body. Common causes of respiratory arrest are drowning, electric shock (usually high voltage), suffocation, strangulation, and drug overdose.

When circulation stops, the pulse disappears and breathing stops at the same time or soon thereafter. This is called cardiac arrest. When cardiac arrest occurs, both artificial respiration and artificial circulation are required to oxygenate the blood and circulate it to the brain. Common causes of cardiac arrest are heart attack, electric shock (usually low voltage), hemorrhage, and--as a final phase of drowning--suffocation and other forms of respiratory arrest.

ABC’S OF LIFE SUPPORT

- Level of medical care which is use d for patients with life threatening illness or injuries until the patient can be given full medical care at a hospital.

Be provided by:o Trained medical personnelo Emergency medical technician

3. DISCUSS THE ABC’S of BLS

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o Paramedicso Laypersons- received BLS training

- Is used in the pre-hospital setting and can be provided without medical equipment.

- Provided in the field increases the time available for higher medical responders to arrive and provide ALS (Advance life support) care.

AIRWAYo Protection and maintenance of a clear

passageway for gases (O2 and CO2) to pass between lungs

1. Head tilt- chin lift method

- manually open the patients airway.

Steps:

1. Position yourself at the person’s head.

2. Place your fingers behind the angle of the jaw and lift upward and forward.

3. Place the other hand on the person’s forehead and press downward o tilt the head backward and lift the chin.

2. Head tilt-neck lift method

- open the patient's airway.

- tilt the head back by lifting behind the neck with one hand while pushing down on the forehead with the other.

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BREATHINGo Inflation and deflation of the lungs via

airway.o Actual flow of air through respiration,

natural or artificial respiration, often assisted by emergency oxygen

To check for breathing:

1. Look for the person’s chest to rise and fall.

2. Listen for sounds of inhaled or exhaled air.

3. Feel for exhaled air by putting our cheek near the person’s mouth.

CIRCULATIONo Providing an adequate blood supply to tissue,

esp. critical organ such as deliver of O2 to al cells and remove metabolic waste via perfusion of blood throughout the body.

o Include bleeding control or Cardiopulmonary resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action.

To asses for circulation:

Feel for a pulse, by gently palpating the carotid pulse. If a pulse is absent or questionable, start external heart compression.

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Enumerate and explain the causes with respective signs and symptoms of cardiac and respiratory arrests.

Causes of Cardiac arrest

RESPIRATORY CAUSES CIRCULATORY CAUSES

Upper airway obstruction

(croup, epiglottitis, foreign body)

Lower airway disease

(asthma, bronchiolitis, pneumonia)

Respiratory depression

(drugs, convulsions, raised ICP)

Fluid loss

(hemorrhagic shock and blunt trauma, gastroenteritis)

Fluid maldistribution

(sepsis, anaphylaxis, spinal injury)

Cardiac disease

(cardiac failure, arrhythmias)

RESPIRATORY FAILURE CIRCULATORY FAILURE

4. ENUMERATE AND EXPLAIN

CARDIAC ARREST

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Signs and symptoms of cardiac arrest

Loss of consciousness Absence of pulse rate and respiration No measurable blood pressure Pallor/cyanosis Darkening of blood

Causes of respiratory arrest

Aspiration of foreign objects (such as part of a hotdog, peanuts, candy or small toys in the airway )

Airway infections (such as croup and epiglottitis) Poisoning and drug overdose Near drowning accidents and electrocution Sudden infant death syndrome (death of a child or infant that

remains unexplained after a complete autopsy)

Signs and symptoms of respiratory arrest

Bradycardia or slowed heart rate Episodes of apnea Gasping Agonal or uncoordinated respirations Hypotension Absence of breath sounds No response to painful stimuli

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Explain the meaning and implications of artificial respiration

a. Mouth-to-mouth

Artificial ventilation with the mouth-to-mouth technique is quick, effective way to provide oxygen to the patient

The exhaled air contains enough oxygen to supply the patient’s needs

b. Mouth-to-nose

It is effective when the patient’s mouth cannot be opened (lock jaw), extensive facial or dental injuries occur, or an air tight seal of the mouth cannot be achieved.

5. EXPLAIN

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c. Mouth-to-stoma

A stoma is a permanent opening in the neck through which the person breathes following the removal of the larynx

When a person with a laryngectomy requires rescue breathing, direct mouth-to-stoma ventilation should be performed

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d. Mouth-to-mask

The mouth-to-mask breathing device includes a transparent mask with a one-way valve mouthpiece.

The one-way valve directs the rescuers breathe into the patient’s airway while directing the patient’s exhaled air away from the rescuer.

e. Mouth-to-mouth and nose

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It is usually done for infants and children whose mouths are very small for effective mouth-to-mouth resuscitation

Artificial respiration is inflated and maintained in essentially the same manner.

d. Bag valve mask

This is a simple device, manually operated by the rescuer, which involves squeezing a bag in order to expel air into the patient

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Cardiopulmonary resuscitation (CPR) is an emergency

procedure which is performed in an effort to manually preserve

intact brain function until further measures are taken to restore

spontaneous blood circulation and breathing in a person in cardiac

arrest. It is indicated in those who are unresponsive with no

breathing or abnormal breathing, for example agonal respirations. It

may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm deep and at

a rate of at least 100 per minute in an effort to create artificial

circulation by manually pumping blood through the heart. In

addition, the rescuer may provide breaths by either exhaling into

the subject's mouth or nose or utilizing a device that pushes air into

the subject's lungs. This process of externally providing ventilation

is termed artificial respiration. Current recommendations place

emphasis on high-quality chest compressions over artificial

respiration; a simplified CPR method involving chest compressions

only is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart; its main purpose is

to restore partial flow of oxygenated blood to the brain and heart.

The objective is to delay tissue death and to extend the brief

6. DISCUSS THE CPR

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window of opportunity for a successful resuscitation without

permanent brain damage. Administration of an electric shock to the

subject's heart, termed Defibrillation, is usually needed in order to

restore a viable or "perfusing" heart rhythm. Defibrillation is only

effective for certain heart rhythms, namely ventricular fibrillation or

pulseless ventricular tachycardia, rather than asystole or pulseless

electrical activity. CPR may succeed in inducing a heart rhythm

which may be shockable. CPR is generally continued until the

subject regains return of spontaneous circulation (ROSC) or is

declared .dead

Adult and Children/ Infant Compression Characteristics

ARTIFICIAL RESPIRATION

ADULT CHILD INFANT

Opening of the Airway

Maximum tilt of the head and

Chin Lift

Maximum tilt of the head and chin

lift

Neutral position. Don’t hyperextend the infant’s neck

Method Mouth to mouth Mouth to mouth Mouth to mouth and nose

Breaths Full slow ( 1-2 Full slow ( 1-15 Gentle slow( 1- 15

7. SHOW A TABULATED COMPARISON

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sec/ breath) sec/breath) sec/ breath)

Rate

10- 12 breath/ min. breathing

every 4 to 5 seconds

20 breaths/ min. or breath every

second

20 breaths/min. or 1 breath every 30

seconds

Cycles 3 5 5

Compression Area

Measure up to 2 fingers from the

sudsternal notch; 1-2 cm above xyphoid

process (sternum)

Measure up to 1 finger from the substernal notch

1 finger width below imaginary

nipple line

Depth 1 ½- 2 inches 1 ½- 2 inches ½ inches

Compress 2 heels of the hand over the

sternum

1 heel of the hand over the sternum

2 fingers over the sternum

Compression ventilation Ratio

One- rescuer( 30:2)

Two- rescuer (30:2)

One- rescuer (30:2)

Two-rescuer (15:2)

15:2

Prompt action is vitally important to the success of CPR.

8. DELINEATE THE GUIDELINES

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When a person stops breathing spontaneously and his heart stops beating, “clinical death” has occurred. Within 4 to 6 minutes, the cells of the brain begin to deteriorate due to lack of oxygen. If the oxygen supply is not restored immediately, the patient will suffer irreversible brain damage and “biologic” death occurs.

It is only used when absolutely necessary since it also poses some danger to the patient.

o Indicated during: Absence of carotid pulse, Absence of response to stimuli, Slow, absent, or gurgling respirations, and A deathlike appearance to the face.

Remember the ABC’s of CPR. (Airway, Breathing, Circulation)

Before performing CPR, make sure that the airway is open and can allow for the passage of air into the bronchi.

If the patient is an infant or a small child, less force is used, and small “puffs” of air are sufficient to inflate the lungs.

Make sure that your client is lying in a hard steady surface before starting cardiac compression.

An effective squeezing of the heart is extremely difficult, if not impossible, when the patient is lying on a soft surface that will move downward each time the chest is compressed.

Position your hands properly in the lower half sternum. Do not let your fingers touch the chest wall.

This is very important because improper positioning of the hands for pressure on the heart will not circulate blood and may damage ribs and external organs.

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Position yourself directly over the patient so that you can apply pressure downward vertically, thus using the weight of your upper body to compress the heart.

Apply firm, heavy pressure, keeping the arms straight.

The amount of the pressure varies with the anatomy of the victim, but the goal is to push the sternum down 1 ½ to 2 inches in order to squeeze the heart against the spinal column.

Never interrupt the rhythm of the chest compressions. (60 times per minute for adults and 80 to 100 times a minute for children and infants) This happens in a two-man CPR.

Indications and steps in performing the following:

Heimlich Maneuver

Indications: The person cannot speak or cry out. The face turns blue from lack of oxygen. The person desperately grabs at his or her throat. The person has a weak cough, and labored breathing

produces a high-pitched noise.

9. CITE THE INDICATION

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The person does all of the above, then becomes unconscious.

Steps:

Heimlich Maneuver for Choking Adults (Conscious)

1. From behind, wrap your arms around the victim's waist.2. Make a fist and place the thumb side of your fist against the

victim's upper abdomen, below the ribcage and above the navel.

3. Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands.

4. Repeat until object is expelled.

Heimlich Maneuver for Choking Adults (Unconscious)

1. Place the victim on back.2. Facing the victim, kneel between the victim's shoulder. With

one of your hands on top of the other, place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the victim's upper abdomen with a quick upward thrust.

3. Repeat until object is expelled. If the Victim has not recovered, proceed with CPR.

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4. The Victim should see a physician immediately after rescue.5. Don't slap the victim's back. (This could make matters

worse.)

Heimlich Maneuver for Choking Infants

1. Lay the child down, face up, on a firm surface and kneel or stand at the victim's feet, or hold infant on your lap facing away from you. Place the middle and index fingers of both your hands below his rib cage and above his navel. Press into the victim's upper abdomen with a quick upward thrust; do not squeeze the rib cage. Be very gentle. Repeat until object is expelled.

2. If the Victim has not recovered, proceed with CPR. The Victim should see a physician immediately after rescue.

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The Heimlich Maneuver for Choking (Oneself)

1. Make a fist and place the thumb side of your fist against your upper abdomen, below the ribcage and above the navel.

2. Grasp your fist with your other hand and press into your upper abdomen with a quick upward thrust.

3. Repeat until object is expelled.4. Alternatively, you can lean over a fixed horizontal object

(table edge, chair, railing) and press your upper abdomen against the edge to produce a quick upward thrust. Repeat until object is expelled.

5. See a physician immediately after rescue.

Jaw thrust technique

Indications: Possible cervical spine injury Unresponsive patient Patient is unable to protect his or her own airway Patient is resistant to opening mouth

Steps:1. Position yourself at the top of the victim’ head

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2. Place the meaty portion of the base of your thumbs on the arches of the jaw, and hook the tips of your index fingers under the angle of the mandible, in the indent below the ear

3. While holding the victim’s head still, displace the jaw forward and open the victim’s mouth with your thumb tips

Baby Blows for Infants

Indications Babies that are choking. If a baby is suddenly unable to cry or cough.

Steps:

1. Carefully position him faceup on one forearm, cradling the back of his head with that hand.

2. Place the other hand and forearm on his front. He is now sandwiched between your forearms.

3. Use your thumb and fingers to hold his jaw and turn him over so that he's facedown along the other forearm. Lower your arm onto your thigh so that the baby's head is lower than his chest.

4. Using the heel of your hand, deliver five firm and distinct back blows between the baby's shoulder blades to try to

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dislodge the object. Maintain support of his head and neck by firmly holding his jaw between your thumb and forefinger.

5. Next, place your free hand (the one that had been delivering the back blows) on the back of the baby's head with your arm along his spine. Carefully turn him over while keeping your other hand and forearm on his front.

Chest Thrust Indication:

For obese or pregnant victims. Baby that are choking.

Chest thrust for choking babies

1. Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby's head lower than the rest of his body

2. Place the pads of two or three fingers in the center of the baby's chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.

Chest Thrust for Conscious Patient Standing or Sitting Stand behind the patient with your arms under

the patient’s axillae to encircle the patient’s chest.

Place the thumb side of your fist on the middle of the patient’s sternum, taking care to avoid the xiphoid process and the margins of the rib cage.

Grasp your fist with the other hand and perform backward thrust until the foreign body is

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expelled or the patient becomes unconscious. Each thrust should be administered with the intent of relieving the obstruction. All thrust should be in rapid sequence.

Chest Thrust for Conscious Patient Lying- Unconsious

1.Place the patient on the back and kneel close to the side of the patient’s body.

2.Place the heel of your hand on the lower half of sternum.

3.Deliver each chest thrust slowly and distinctly with the intent relieving the obstruction.

FINGER SWEEP Indication:

Finger sweeps should be used only in the unconscious victim who does not have good reflexes or the ability to bite the rescuer’s finger.

Steps:1. Open the adult patient’s mouth by grasping both

tongue and lower jaw between the thumb and

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fingers and lifting the mandible. This maneuver is to be used only in unconscious patient. This action draws the tongue way from the back of the throat and away from the foreign body that may be lodged there.

2. If a foreign body is visible in the mouth, insert the index finger of the other hands down along the inside of the cheek and scrape across the back of the throat.

3. Use a hooking action to dislodge the foreign body and maneuver it into the mouth for removal.. Care is used to avoid foreign the object deeper into the throat.