CARDIOPULMONARY RESUSCITATION (CPR)

CARDIOPULMONARY RESUSCITATION (CPR) (Definition, Purpose, Equipment, General Instructions, Procedure, Method, Do’s and don’ts in CPR and Complications.

UPDATED 2024

Cardiopulmonary resuscitation is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. The American Heart Association recommends that everyone – untrained bystanders and medical personnel alike – begin CPR with chest compressions.

Resuscitation includes all measures that are applied to revive patients who have stopped breathing suddenly and unexpectedly due to either respiratory or cardiac failure.

Cardiac arrest is one of the common causes for cardio-respiratory failure. When a person stops breathing spontaneously, his heart also stops beating. Clinical death occurs within 4-6 minutes, the cells of the brain which is sensitivity to the paucity of oxygen begin to deteriorate. If the oxygen supply is not restored, the patient suffers irreversible brain damage and biological death occurs.

DEFINTION

Artificial ventilation accompanied by cardiac massage to facilitate normal breathing and heart action in the event of cardiac arrest.

PURPOSE

To re-establish effective ventilation and circulation

EQUIPMENT

Cardiac board
Suction apparatus
Oxygen supply
Box containing Ambu bag
Sterile endotracheal tube (2.5 – 5.5 mm)
Extra-batteries
Laryngoscope with 0, 1, 2 size tongue blades and stillet, Magill forceps, adhesive scissors, airway syringes 1, 2, 5, 10 cc
Intracardiac needle 20 G, 22 G, 6-8 cm length
Needles 23 G and 20 G
Elastoplasts bandage
Ventilation given with ambu-bag

GENERAL INSTRUCTIONS

Identify “RED FLAG” signs of critically ill child-changes in level of consciousness, flaccid posturing, cyanosis severe chest retractions, grunting respiration, increased respiratory rate, shallow respiration, see saw respiration, i.e. abdominal protrusion with inhalation, irregular respirations with periodic deep sighs, apneas, absent pulse, absent heart rate, absent carotid pulse, dilated pupils, unrecordable blood pressure, cold clammy skin
ACT quickly! As child can go into cerebral hypoxia within 3 to 4 minutes which will lead to permanent brain damage
Assess child (look, listen, feel) and if not breathing call for help
Immediately start cardiopulmonary resuscitation (CPR)
Equipment for CPR to be always accessible and is functioning condition
All CPR equipment to be checked at beginning of each shift
All staff to be skillful at CPR

PROCEDURE

Airway: establish patient airway by suctioning oropharynx with catheter, and deflate stomach by aspirating stomach contents

Ventilation by mouth to mouth:

Breathing: establish breathing by artificial ventilation

Place

Ambu bag on mouth and nose, and connect to 100% oxygen. Select ET tube using the formula:

Age in years + 4 /4

Calculate size of ET tube approximately as diameter of child’s little finger. The ET tube is inserted

Circulation: initiate cardiac compression to a distance calculated using the formula (ET size multiply 3 cm)

METHOD

Serial rhythmic compressions of chest that help circulate oxygen containing blood to vital organs

Infant

Site: sternum compression – below level of infant’s nipples
Width one finger breadth
Depth 0.5 – 1 inch
Rate 100 times per minute

Child

Site: lower margin of child’s rib cage to notch where ribs and sternum meet
Avoid compression over notch
Place heel of nurse’s hand over lower half of sternum (between nipple line and notch)
Depth: 1-1.5 inches
Rate: 100 times per minute

Ratio of Cardiac Compression to Ventilation (CPR)

2 persons – 5:1
1 person – 15:2

One Rescuer CPR

Shake shoulders and ask “are you okay”, shout for help. Open the airway: the most important action for successful resuscitation is immediate opening of the airway. Tilt the head by applying firm backward pressure on the victim’s forehead with palm of one hand. Place two or three fingers of the other hand under the bony part of the lower jaw near the chin and lift the chin

Check for breathing: please check close to victim’s mouth and nose. Look at chest to see if it rises and falls. Listen and feel for exhaled air (for at least 5 seconds)

External Cardiac Massage

Breathe: maintain an open airway. Pinch nose. Seal lips around victims mouth and deliver two full breathes watching chest to rise and fall with each breath

Check for circulation: feel for a carotid pulse. Again shout for help/activate EMS system. If pulse is present, continue to give artificial ventilation at the rate of 1 breath or 12 mm

Circulate: if pulse is absent, run fingers along the lower rib to notch in centre of the heart where ribs meet sternum. With middle finger in notch, place index finger on lower end of sternum. Place heel of other hand on lower ½ of sternum next to index finger. Put the heel of 1^st hand on top. With shoulders directly over sternum and elbows locked, compress straight up and down 15 minutes, at the rate of 80 – 100 times a minute, using the count “one and two and three and”, etc. return quickly to victims head to deliver two breaths. Compression depth should be 1.5 – 2 inches

Two-rescuer CPR: two medical professional arriving at same time – no

CPR in Progress

First rescuer

Determine unresponsiveness

Opens the airway

Checks for breathing

Ventilates twice, watching chest movement

Checks for carotid pulse: give command to begin compressions if pulse is absent

Second rescuer

Locates landmark and proper hand position on sternum

Begins chest compressions on command – at rate of 80-100 per minute, counting “one and two and three and four and five and”

Pauses after each fifth compression to allow for ventilation

Calls for a switch when fatigued. Give clear signal “change and two and three and four and five”

Both rescuers change simultaneously

Compression moves to victim’s head. After checking for pulse, give breath and command to continue compressions

Ventilator moves to chest: finds landmark and properly positions hands, begins compressions on command pausing after each 5^th compression for breath

If CPR is in progress by lay person, rescue team enters after completion of cycle of 15 compressions and 2 ventilations and start with a reassessment

If CPR is in progress by a professional rescuer, the 2^nd professional rescuer takes over compressions at the end of a cycle and after 1^st rescuer reassesses pulse and gives another breath

DO’S AND DONOT’S IN CPR

DO’S

Reassure victim that help is on the way
For major injuries call 9-1-1 immediately
Check victim’s status regularly
Use direct pressure to stop bleeding
Check to see if victim’s airways are clear
If no pulse or respiration, start CPR
To prevent transmission of disease, use latex gloves
Keep victims in shock warm (use blanket, etc)
Assume spinal injury when blunt force trauma is present
Raise head if bleeding in upper torso area
Raise feet if bleeding in lower torso areas
Flush all burns and chemical injuries with clean water
Have MSDS sheets on the jobsite for 9-1-1 responders
Call the Poison Control Center for chemical ingestion

DON’TS

Do not move the victim unless absolutely necessary
Always suspect “spinal injury” (and don’t move the victim)
Do not set fractures and breaks (simply immobilize the victim)
Do not apply a tourniquet (use “direct” pressure to stop bleeding)
Do not remove items imbedded in the eye (cover with a Dixie cup)
Do not use burn ointments
Do not hesitate to call 9-1-1

COMPLICATIONS

Cardiopulmonary resuscitation, or CPR, is a technique used to support the circulation of blood and oxygen in the body of a victim who is not breathing and does not have a pulse. CPR is physically invasive for the victim and techniques used during CPR carry risks and the chance of complications. Ultimately, the risk of complications is small and should not deter the use of CPR for a victim in need

Broken bones

Rib fractures are the most common complication of CPR. Chest compressions administered during CPR are given quickly and with enough force to compress the chest about 1 inch in depth. This provides pressure to the ribs, which can be strong enough to cause ribs to fracture. Victims who are elderly, small in stature or children have the highest risk of developing rib fracture during chest compressions. Additionally, the chest bone, or sternum, also endures pressure and stress during chest compressions and can fracture as well

Internal Injuries

Internal organs lie within the area pressured by chest compressions. As the chest is compressed during CPR, ribs and chest bones can break, puncturing the lungs and liver. Additionally, internal bruising of the heart and liver can occur

Vomiting and Aspiration

As chest compressions are administered, pressure builds inside the body, which can force stomach contents up the esophagus and result in vomiting. This causes the risk of aspiration, or absorbing the vomit into the respiratory system. Aspiration is a serious complication which makes it difficult to provide the victim with adequate air and can ultimately damage lung tissue or result in infection, like pneumonia.

Body Fluid Exposure

CPR presents the risk of exposure to body fluids. It provides mouth-to-mouth rescue breathing to a victim without use of a mask results in saliva exposure between victim and rescuer. Blood and vomit may also be present during CPR, which carries the risk of communicable disease such as hepatitis and AIDS. The American Heart Association encourages the use of a barrier mask when administering rescue breathing during CPR for protection against contamination

Gastric Distention

Rescue breathing during CPR provides air directly into the lungs of the victim. If air is delivered too forcefully or for too long a time, the victim can accumulate air build-up in the stomach, called gastric distension. Gastric distension causes the stomach to swell and places pressure on the lungs. CPR efforts can become complicated if gastric distension occurs due to reduced ability to deliver adequate oxygen to the lungs, and can also result in vomiting and aspiration. Gastric distension can often be avoided by proper, careful administration of rescue breathing during CPR

ADMISSION PROCEDURE

CARE OF PATIENT UNIT