University of Cebu College of Nursing Banilad, Cebu City In Cooperation with Community Extension Services and Development (CESDEV)
presents BSN 4N
A Seminar on Cardiopulmonary Resuscitation (CPR)
After 60 minutes of interactive lecture-discussion, the level III students will acquire desirable attitude, beginning knowledge and develop beginning skills on the concept of Cardiopulmonary Resuscitation.
Specifically, they will be able to:
1. Describe what is CPR.
2. Define related terms:
2.4 First Aid
2.5 Emergency Nursing Care
2.6 Cardiopulmonary Resuscitation (CPR)
3. Enumerate the Principles of Emergency Care
4. Explain the goal of emergency care.
5.Classify when to initiate and discontinue CPR.
6. Be familiar with the Chain of Survival.
7. Demonstrate the BLS sequence.
8.Appreciate the role of the nurse in the performance of CPR .
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of mouth-to-mouth rescue breathing and chest compression that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.
What is CPR?
When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing.
Definition of terms Emergency defined as a sudden illness or injury requiring immediate intervention Accident defined as an unpleasant or unexpected happening Disaster defined as a disorganized event
First Aid Cardiopulmonary Resuscitation Emergency Nursing Care defined as an emergency, temporary medical care and treatment of an injured person defined as the assessment, diagnosis, and treatment of perceived, actual, potential, sudden or urgent, physical or psychosocial problems that are episodic or acute defined as an emergency first aid procedure to help someone who has lost their ability to breathe and their pulse
Principles of Emergency Care Survey the scene Is the scene safe? What happened? How many are injured? Is there anyone around who can help? Do a primary survey of the victim – check the ABC’s Airway – Does the victim have an open airway? The most important action for successful resuscitation is to immediately open an unconscious victim’s airway using tilt & chin lift / jaw thrust methods.
Breathing – Is the person breathing? Look for rise and fall of chest. Listen for breathing. Feel for air coming out of victims nose and mouth. If not breathing – give 2 full breaths/ ventilations to get into the lungs; this is called reserve breathing. Circulation – Is the person’s heart beating? Check for pulse. Feel the pulse at the side of the neck, the carotid pulse. Is the person bleeding profusely and severely?
Goal of Emergency Care Prompt, effective resuscitation and stabilization of critically ill or injured clients.
Initiating and Discontinuing CPR
Criteria for not starting CPR include :
Obviously fatal trauma
Unwitnessed death in the presence of serious, chronic, debilitating disease in the terminal stage of a fatal illness
When to stop CPR :
Replaced by another trained rescuer
Rescuer is exhausted and can no longer effectively apply CPR
Scene becomes unsafe
A physician tells you to stop
If the victim’s heart no longer responds to CPR
The Chain of Survival Encompasses the events initiated after the patient’s collapse until the arrival of the Emergency Medical Service (EMS) personnel to provide care. First Link: Early Access CPR is most effective when started immediately after the patient collapse. The chances of successful resuscitation of an out-of-hospital collapse depend on prompt by-stander CPR. Second Link: Early CPR
. Early ACLS is another critical link. ACLS brings equipment to support ventilation, established intravenous access, administer drugs, control arrhythmias and prepare the patient for transport. Third Link: Early Defibrillation Studies done in the USA have shown that early defibrillation is most likely to improve survival rates. Emergency personnel should be trained to perform CPR and in the use of defibrillators Fourth Link: Early Advance Cardiac Life Support
Adult Basic Life Support (BLS) Sequence
Check for response
To check for response, tap the victim on the shoulder and ask, “Are you alright?” If the victim responds, but is injured or needs medical assistance, call for medical assistance. If the victim does not respond call for help.
Call ambulance or local EMS Inform of the : - location of the victim - the telephone number which you are calling from - what happened - the number of persons who need help - ask for an immediate ambulance or EMS hang up only after being told to. Let the operator put down the phone first. Second Step: Activate EMS Third Step: Position Let the victim or patient lie on his back, on a firm, flat surface. Put backboard if possible.
Position victim in a supine position (face up). If victim is in face down position, roll the victim to supine position. Open Airway Head tilt chin lift technique – for both injured and uninjured victim. Jaw thrust technique – for victim suspected of spinal injury Fourth Step: Check airway
Fingers must not press deeply into the soft tissue under the chin, which might obstruct airway.
The thumb should not be used for lifting the chin.
If head/neck injury is suspected, the head tilt must not be carried out as this involves movement of the bones at the back of the neck.
Instead, do the jay thrust or gentle chin lift.
While maintaining an open airway – look, listen and feel for breathing. LOOK for the rise and fall of the chest. LISTEN for signs of air coming out of the nose or mouth. FEEL for any signs of air coming out. Check for 10 seconds If no breathing – give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise. May be given to all forms of ventilation, may be mouth to mouth, or bag-mask ventilation. Step Five: Check breathing
Different routes in giving air:
mouth to mouth
mouth to nose
mouth to stoma
bag - mask ventilation
Note: If there is resistance to first introduction of air, re-check position of the head for airway patency or check for any obstruction.
Deliver each rescue breath over 1 second.
Give sufficient tidal volume (mouth-to-mouth/mask) to produce visible chest rise.
Avoid rapid or forceful breaths.
Guidelines for rescue breaths :
Check pulse – carotid pulse best site ( 5 – 10 seconds) Position hand in the middle of the chest. Compress hard and fast. Artificial resuscitation if with pulse – give rescue breathing 10 – 12 breaths/minute or 1 breath/5-6 seconds. Step Six: Check circulation Step Seven: Proper Hand Position and Compression or artificial resuscitation.
No pulse- Give chest compression Depth: 1 ½ - 2 inches > adult 1 / 3 – ½ of the depth of the chest > child and infant Compression – Ventilation Ratio: 30 : 2 adult/child/infant - one man rescue 30 : 2 adult - two man rescue 15 : 2 child/infant - two man rescue 5 repetitions of 30:2 cycles must be completed within two minutes and recheck pulse.
Don'ts in applying chest compression:
Bouncer – the rescuer’s hand is bouncing on the chest. The hand or heel of the hand must always be in place on the chest of the victim. Rocker – rescuer rocking his/her body back and forth while performing compression. Massager – performing inadequate compression as in like massaging. Double Crosser – rescuer’s hands is not interlocked and in an open palm. Bender – the rescuer’s elbows are bended while compressing.
Step Eight: Recovery Assist patient assume recovery position. If on spinal problem, lay patient on his back, flat or supine position. Do secondary survey. Look for signs of bleeding or disability
The Good Samaritan Law is a law protecting rescuers from possible lawsuit arising out in helping victims of accident and disaster. And is only applicable if the person doing a good heart of helping is a trained personnel.