This document provides information on cardiopulmonary resuscitation (CPR), including definitions of common cardiac terms, the importance and objectives of CPR, indications for CPR, equipment used, the procedure, nursing actions and rationale, chest compression, airway management, breathing, algorithms, guidelines for stopping CPR, and conclusions. CPR is performed when someone's heart and breathing have stopped and involves chest compressions and rescue breathing to circulate oxygenated blood to vital organs until normal heart function can be restored.

1. ARY
RESUSCITATIO
N
By cindrella burge
1st
Msc nursing
TMCON

2. INTRODUCTIONINTRODUCTION
Cardiopulmonary resuscitation (CPR) is a
lifesaving technique useful in many emergencies,
including a 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.

3. It's far better to do something than to do nothing at
all if you're fearful that your knowledge or
abilities aren't 100 percent complete.
Remember, the difference between your doing
something and doing nothing could be
someone's life.

4. COMMONLY USED CARDIAC TERMSCOMMONLY USED CARDIAC TERMS
1.1. ADVANCED CARDIAC LIFE SUPPORT( ACLS):ADVANCED CARDIAC LIFE SUPPORT( ACLS):
The treatment provided by paramedics to patients
in cardiopulmonary arrest, including providing
basic life support, patient monitoring, arrhythmia
interpretation, defibrillation, intubation, and
administration of intravenous drugs.
2.2. ARRHYTHMIAARRHYTHMIA: Abnormal electrical activity of the
heart.

5. 3.3. VENTRICULAR FIBRILLATION (VF):VENTRICULAR FIBRILLATION (VF): is a type of
a arrhythmia most commonly associated with the
onset of sudden cardiac arrest.
4.4. DEFIBRILLATION:DEFIBRILLATION: The delivery of an electrical
shock to the heart to treat the arrhythmias most
commonly associated with sudden cardiac arrest
by attempting to restore normal heart rhythm.

6. 5.5. DEFIBRILLATOR (AUTOMATED EXTERNALDEFIBRILLATOR (AUTOMATED EXTERNAL
DEFIBRILLATOR):DEFIBRILLATOR): A portable device that can
deliver electrical current to the heart to treat
arrhythmias. Many are portable and have
electrocardiographic (ECG) monitoring capacity.
It contains sophisticated, computerized
electronics to monitor and identify cardiac
rhythm, which make it possible for lay rescuers
to deliver defibrillation with little training.

7. The AED will only permit the operator to deliver
the shock if ventricular fibrillation or certain
ventricular tachycardias are detected. The new
AED’s are safe, effective, lightweight, low
maintenance, easy to use.

8. 6 . CARDIOPULMONARY RESUSCITATIONCARDIOPULMONARY RESUSCITATION :
Used to keep oxygenated blood flowing to vital
organs until definitive intervention can be
instituted. Steps include airway management,
mouth to mouth or mask ventilation and
external chest compressions.

9. 7. CHAIN OF SURVIVALCHAIN OF SURVIVAL : The chain of action that
the american heart association – recommends
be followed in treating a person who suffers
sudden cardiac arrest to increase the chances of
survival. The system includes 4 steps –
early access to an emergency medical system
(calling …), early CPR, early defibrillation with an
AED and early advanced cardiac life support.

10. 8. COMMUNITY ACCESS DEFBRILLATIONCOMMUNITY ACCESS DEFBRILLATION
PROGRAM (CAD)PROGRAM (CAD) : A comprehensive
community- based defibrillator programs entail
broad, strategic defibrillator placement throughout
a city to ensure that defibrillation therapy is
readily available in the event of a cardiac
emergency. A vital component of a successful
CAD program includes broad-based training.

11. 9. ELECTROCARDIAOGRAM (ECG)ELECTROCARDIAOGRAM (ECG): A graphical
representation of electrical impulses produced by
the heart.
10. EMERGENCY MEDICAL SERVICES (EMS):EMERGENCY MEDICAL SERVICES (EMS):
The organization providing emergency medical
care to a community’s citizens. An EMS system
may include a notification system, paramedics,
EMTs (emergency medical technicians) and fire,
police or ambulance personnel.

12. 11. EMERGENCY MEDICAL TECHNICIAN (EMT):EMERGENCY MEDICAL TECHNICIAN (EMT):
A medical professional certified in basic
emergency care, typically after having received
approximately 110 hours of training. An EMT
provides basic life support with techniques
including CPR and Defibrillation with an AED.

13. 12. HEART ATTACK:HEART ATTACK: Sudden death of a portion
of the heart muscle caused by a sudden
decrease in blood supply to that area. A heart
attack is also referred to as a myocardial
infarction or “MI”. A heart attack may lead to
sudden cardiac arrest but the symptoms, causes
and treatment are different.

14. 13. SUDDEN CARDIAC ARREST (SCA):SUDDEN CARDIAC ARREST (SCA):
Precipitous loss of effective pulse and blood
pressure usually due to cardiac arrhythmia,
primarily ventricular fibrillation.
14. SUDDEN CARDIAC DEATH (SCD):SUDDEN CARDIAC DEATH (SCD): Death
resulting from an abrupt loss of heart function
(cardiac arrest).

15. 15. VENTRICULAR FIBRILLATIONVENTRICULAR FIBRILLATION: A chaotic
arrhythmia that causes the heart to quiver rather
than contract in a coordinated fashion. A victim in
VF has no effective pulse or blood pressure,
loses consciousness almost immediately. Death
follows within minutes if a normal heart rhythm is
not restored through defibrillation.

16. HERE'S ADVICE FROM THE AMERICANHERE'S ADVICE FROM THE AMERICAN
HEART ASSOCIATION:HEART ASSOCIATION:

17. Untrained Trained and ready to go Trained but rusty
If you're not trained in CPR,
then provide hands-only
CPR. That means
uninterrupted chest
compressions of 100 to 120 a
minute until paramedics
arrive. You don't need to try
rescue breathing.
If you're well-trained and
confident in your ability,
check to see if there is a
pulse and breathing. If there
is no breathing or a pulse
within 10 seconds, begin
chest compressions. Start
CPR with 30 chest
compressions before giving
two rescue breaths.
If you've previously received
CPR training but you're not
confident in your abilities,
then just do chest
compressions at a rate of 100
to 120 a minute.

18. UPDATED AMERICAN HEARTUPDATED AMERICAN HEART
ASSOCIATION CPR GUIDELINESASSOCIATION CPR GUIDELINES
In 2010, the American heart association
(AHA) issued revised guidelines for CPR
and Emergency Cardiovascular care
science (ECCS). Among the highlights and
changes:

19.  ABC changed to CAB
The biggest change in the basic life support
sequence is from “A-B-C” (Airway, breathing,
chest compressions) to “C-A-B” (Chest
compressions, airway, breathing) for adults and
pediatric patients (children and infants,
excluding newborn).

20. This means no more ‘looking, listening and
feeling’, as the performance of these steps is
inconsistent and time consuming. The key to
saving a cardiac arrest victim is action, not
assessment. Call 108 the moment you realize
the victim won’t wake up and doesn’t seem to
be breathing right.

22.  HANDS- ONLY / COMPRESSION ONLY (CPR)
is now encourage for the untrained lay rescuer
on adult victims who collapse in front of them.
 CHEST COMPRESSIONS BEFORE GIVING
RESCUE BREATHS.
 INCREASED FOCUS ON METHODS
ENSURING HIGH QUALITY CPR (at
appropriate depth and rate).

23. The new guidelines call for rescuers to
- Push harder on the chest at least 2 inches deep for
adults and children.
- Faster at least 100 compressions per minute or 30
compressions in about 18 seconds.
- With minimal interruptions. Every interruption in
chest compressions interrupts blood flow to the
brain, which leads to brain death if the blood flow
stops too long. It takes several chest compressions
to get blood moving again.

24. AHA wants you to keep pushing as long as you
can. Push until the AED is in place and ready to
analyze the heart. When it is time to do mouth to
mouth, do it quick and get right back on the
chest.

25. IMPORTANCE OF CPRIMPORTANCE OF CPR
Cardiopulmonary resuscitation (CPR) is a
lifesaving technique. It aims to keep blood and
oxygen flowing through the body when a
person’s heart and breathing have stopped.
CPR can be performed by any trained person. It
involves external chest compressions and
rescue breathing.

26. CPR performed within the first six minutes of the heart
stopping can keep someone alive until medical help
arrives.
CPR can keep oxygenated blood flowing to the brain
and other vital organs until more definitive medical
treatment can restore a normal heart rhythm.
When the heart stops, the lack of oxygenated blood
can cause brain damage in only a few minutes. A
person may die within eight to 10 minutes.

27. OBJECTIVE OF CPROBJECTIVE OF CPR
 To provide oxygen to the brain , heart and other
vital organs until appropriate or definitive
medical treatment can restore normal heart and
ventilatory function.

28. INDICATIONSINDICATIONS

30. BEFORE YOU BEGIN
Before starting CPR, check:
 Is the environment safe for the person?
 Is the person conscious or unconscious?
 If the person appears unconscious, tap or shake
his or her shoulder and ask loudly, "Are you OK?"
 If the person doesn't respond and two people are
available, have one person call 108 or the local
emergency number and

31. get the AED, if one is available, and have the other
person begin CPR.
 If you are alone and have immediate access to a
telephone, call 108 or your local emergency
number before beginning CPR. Get the AED, if
one is available.
 As soon as an AED is available, deliver one
shock if instructed by the device, then begin CPR.

32. THE SEQUENCE OF CPRTHE SEQUENCE OF CPR
The sequence of CPR includes:
CAB
CIRCULATION, AIRWAY AND BREATHING and
begins with an assessment phase to determine the
need for action which includes determining
pulselessness.

33. AIRTICLESAIRTICLES
 Back board or flat surface
 Oral airway
 A piece of lint to place over victim's mouth or oral
barrier device for mouth to mouth respiration
 Mask and ambu bag

34. BACK BOARD

35. AUTOMATED
EXTERNAL
DEFIBRILLATOR

36. AMBU BAGAMBU BAG

37. ORAL AIRWAYORAL AIRWAY

38. MASKMASK

39. PROCEDUREPROCEDURE

40. NURSING ACTIONNURSING ACTION RATIONALERATIONALE
1. Determine the unresponsiveness This will prevent injury from attempted
resuscitation of a person who has not
suffered a cardiac or respiratory arrest.
a. Tap or gently shake the patient while
shouting "are you okay"?
2. Determine pulselessness
a. Check the carotid pulse on one side for
not more than 5 seconds.
Carotid pulse may persist when
peripheral pulses are not palpable.
b. Call for help in hospital setup. Alerts other trained personnel.

41. CHEST COMPRESSION

42. SEQUENCE OF CPRSEQUENCE OF CPR
A. CIRCULATIONA. CIRCULATION
1. Position the back board underneath
victim's chest( when back board is not
available, place victim on firm, flat
surface).
The back board provides a firm
surface allowing for compression of
the heart.
2. Kneel at victim's side. Allows performance of chest
compression and rescue breathing
with efficiency.

43. 3. Using index finger of the hand , locate
the lower rib margin and move the
fingers up to where the ribs connect to
the sternum.
Place the middle finger of this hand on
the notch and index finger next to it.
Place the heel of the opposite hand next
to the index, Ensure that the long - axis
of the heel of hand is parallel to the long
axis of the sternum.
Proper hand positioning
ensures maximum compression
of the heart and prevents injury
to liver and rib.

44. Remove the first hand from the notch
and place on top of the hand that is on
the sternum .
Extend or interlace the fingers , do not
allow them to touch the chest.
Keep the arm straight with shoulders
directly over the hands on the sternum
and lock elbows.
finger on the sternum.

45. 4. Compress the adult chest at
least 2 inches (5cm) at the
rate of at least 100/minute.
5. Release the chest
compression completely and
allows the chest to return to its
normal position after each
compression.
Time allowed for release
should be equal to the time
required for compression.
Release of external chest
compression allows , blood
flows into the heart.
Removing hands from the
chest will result in more time
required to locate the exact
point for chest compressions.

46. 6. Do 30 compressions and then
perform 2 ventilations, re-evaluate
the patient after 4 cycle.
Rescue breathing and chest
compression should be combined.
7. For CPR performed by one or 2
resucuers, the compression rate is
100 /minute.
The compression ventilation ratio is
30:2 .

47. AIRWAY

48. B. AIRWAYB. AIRWAY
1. Open the victim's airway by using
one of the following maneuvers:
a) Head tilt chin lift maneuver. Place
one hand on victim's forehead and
apply firm backward pressure with
the palm to tilt the head back.
This support the jaw and helps tilt
the head back. This maneuver
should not be performed for victims
of suspected head and neck injury.

49. Then place the fingers of the
other hand under the bony
part of the lower jaw near the
chin and lift up to bring the
jaw forward.

50. b) Jaw thrust maneuver. Grasp
the angles of the patient's jaw
and lift with both hands, one
on each side, displacing the
mandible forward.
Place an airway if available.
Jaw thrust technique without
head tilt is the safest method
for opening the airway in the
presence of suspected neck
injury.
Keep airway patent.
Occluding the nostrils and
forming a seal over the
patient's mouth will prevent air
leakage and provide full
inflation of the lungs.

51. Excessive air volume and
rapid respiratory flow rates
can create pharyngeal
pressure that is greater than
esophageal opening pressure.
This will allow air into the
stomach resulting in gastric
distension and increased risk
of vomiting.

52. BREATHING

53. C.C. BREATHINGBREATHING
1. Occlude nostrils with thumb and index
finger of the hand on forehead that is tilting
the head back. From a tight seal over the
patient's mouth or place an appropriate
respiratory arrest device i.e. ambubag and
mask and give 2 full breaths of
approximately 0.5 to 2 seconds allowing
time for both inspiration and expiration.
2. Observe for rise and fall of the chest.

54. WHEN TO STOP CPRWHEN TO STOP CPR
Guidelines for termination of resuscitation are:-
Return of spontaneous circulation.
Arrival of arrest team or medical help.
If the rescuer becomes exhausted.
When death is confirmed.

55. ALGORITHM FOR BASIC LIFEALGORITHM FOR BASIC LIFE
SUPPORTSUPPORT

56. Check for unresponsiveness(Shake /shout)
Check for carotid pulse( not more than 5 sec.)
No circulation (compress the chest at least 100/min. In
ratio of 30compressions to breaths)
Open airway(head tilt-chin lift thrust method)
Breathe(2 effective breaths)

57. CONCLUSIONCONCLUSION
The emergency substitution of heart and lung
action to restore life to someone who appears
dead. The two main components of conventional
cardiopulmonary resuscitation (CPR) are chest
compression to make the heart pump and mouth-
to-mouth ventilation to breath for the victim.

58. Hands-only CPR is a form of resuscitation that
involves continuous, rapid chest compressions
only, and although effective, it is not as beneficial
as conventional CPR in a patient who is not
breathing.

59. BIBLIOGRAPHYBIBLIOGRAPHY
WEBSITES-
 http://www.momsteam.com/cpr
 http://www.momsteam.com/health-safety/cardiac-
safety/general/updated-american-heart-association-
cpr-guidelines
 http://www.momsteam.com/health-safety/commonly-
used-cardiac-terms-a-glossary?page=0%2C1
 http://circ.ahajournals.org/content/132/18_suppl_2/S
315.long

60. BOOKS
 Sr. Nancy (2015), K.P.H nursing books,
student edition, A reference manual for
nurses on CORONARY CARE NURSING
 Kluwer W. , 10th
Edition, Lippincott manual of
Nursing Practice