Cardiopulmonary Resuscitation

Introduction of Cardiopulmonary Resuscitation:

CPR are an abbreviation for the medical term cardiopulmonary resuscitation. The first part of the word, 'cardio,' means 'heart.' The second part of the word, 'pulmonary,' means 'lungs.' The word 'resuscitation' means to 'revive,' or to 'bring back from death.' So, in short, CPR, or cardiopulmonary resuscitation, means to revive the non-beating heart and/or the non-breathing lungs of an individual.

Definition of Cardiopulmonary Resuscitation:

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person.

Cardiopulmonary resuscitation is a systemic to life support and consist of artificial respiration and manual external cardiac massage.

Purpose of Cardiopulmonary Resuscitation:

The main purpose of CPR is to restore cardiopulmonary functioning and to prevent irreversible brain damage to anoxia.

1. To maintain blood circulation (C)

2. To maintain open & clean airway (A)

3. To maintain artificial breathing (B)

4. To oxygenate heart & lungs

5. To prevent brain death & damage

6. To save the life of the patient

7. To provide Basic life support (BLS) till medical and advance life support arrives.

Types of Cardiopulmonary Resuscitation:

1. Basic life support (BLS):

Basic life support (BLS) is a level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders.

2. Advance Cardiovascular life support (ACLS):

Advanced cardiac life support, or advanced cardiovascular life support, often referred to a set of clinical algorithms for the urgent treatment of cardiac arrest, stroke, myocardial infarction, and other life-threatening cardiovascular emergencies by health care professionals.

Principle of Cardiopulmonary Resuscitation:

The principle of CPR is changed from Airway, Breathing, Circulation (ABC) to CAB

1. Circulation (C)

2. Airway (A)

3. Breathing (B)

Equipment of Cardiopulmonary Resuscitation:

1. Basic Life Support:

a) Respiratory aid

b) Automated external defibrillator

2. Advance Cardiac/Cardiovascular life Support:

a) PPE – Gloves, gown, mask & cap

b) Suction catheter

c) Suction machine

d) ECG

3. Drug:

a) Atropine – can be injected bolus, max 3 mg to block vagal tone, which plays significant role in some cases of cardiac arrest.

b) Adrenaline – large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min.

c) Vasopressin in some cases 40 U can replace Adrenaline

d) Amiodarone-300mg

e) Lidocaine: should be used only in ventricular fibrillation

Indications of Cardiopulmonary Resuscitation:

1. Cardiac Arrest:

a) Ventricular fibrillation.

b) Ventricular tachycardia

c) Asystole

d) Pulseless electrical activity

2. Respiratory Arrest:

a) Drowning

b) Stroke

c) Foreign-body airway obstruction

d) Smoke inhalation

e) Drug overdose

f) Electroculation

g) Suffocation

h) Accident injury

i) Coma

Contraindications of Cardiopulmonary Resuscitation:

1. Inability of patient to extend head.

2. Moderate to severe trauma to the cervical spine or anterior neck.

3. Infection in the epiglottal area.

4. Mandibular fracture or trismus.

5. Mild hypoxia.

6. Uncontrolled oropharyngeal hemorrhage.

7. Intact tracheostomy.

Complications of Cardiopulmonary Resuscitation:

1. Coronary vessel injury

2. Diaphragm injury

3. Hemopericardium

4. Interference with ventilation

5. Liver injury

6. Myocardial injury

7. Pneumothorax

8. Rib fracture

9. Spleen injury

10. Sternal fracture

Procedure of Cardiopulmonary Resuscitation:

There are two main stages to CPR: the preparation stage and the CPR stage.

Preparation Steps

Before performing CPR use the following preparation steps:

Step 1. Call 999

First, check the scene for factors that could put you in danger, such as traffic, fire, or falling masonry. Next, check the person. Do they need help? Tap their shoulder and shout, “Are you OK?”

If they are not responding, call 999 or ask a bystander to call 999 before performing CPR. If possible, ask a bystander to go and search for an AED machine. People can find these in offices and many other public buildings.

Step 2. Place the person on their back and open their airway.

Place the person carefully on their back and kneel beside their chest. Tilt their head back slightly by lifting their chin.

Open their mouth and check for any obstruction, such as food or vomit. Remove any obstruction if it is loose. If it is not loose, trying to grasp it may push it farther into the airway.

Step 3. Check for breathing

Place your ear next the person’s mouth and listen for no more than 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin CPR.

If someone is unconscious but still breathing, do not perform CPR. Instead, if they do not seem to have a spinal injury, place them in the recovery position. Keep monitoring their breathing and perform CPR if they stop breathing. CPR STEPS

Use the following steps to perform CPR:

Step 4. Perform 30 chest compressions

Place one of your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push hard and fast in the center of the chest, slightly below the nipples.

Push at least 2 inches deep. Compress their chest at a rate of least 100 times per minute. Let the chest rise fully between compressions.

Step 5. Perform two rescue breaths

Making sure their mouth is clear, tilt their head back slightly and lift their chin. Pinch their nose shut, place your mouth fully over theirs, and blow to make their chest rise.

If their chest does not rise with the first breath, retilt their head. If their chest still does not rise with a second breath, the person might be choking

Step 6. Repeat

Repeat the cycle of 30 chest compressions and two rescue breaths until the person starts breathing or help arrives. If an AED arrives, carry on performing CPR until the machine is set up and ready to use.

After Procedure Care

1. Continuous vigilance must be ensured by a skilled person for 48-72 hours

2. Monitor ECG, BP, CVP

3. Check the oral cavity or jaw position as his/her tongue may fail or obstruct the airway

4. Temperature should be taken every hourly

5. Procedure should be noted in nurse’s record.

Conclusion

CPR is a life-saving first aid procedure. It can significantly improve someone’s changes of surviving if they suffer a heart attack or stop breathing following an accident or trauma.

The steps vary depending on whether the person is an infant, child, or adult. However, the basic cycle of chest compressions and rescue breaths will remain the same. Only use CPR when an adult has stopped breathing. Check the person to see whether they respond to verbal or physical stimuli before starting CPR.