CPR involves chest compressions and rescue breathing to manually support circulation and breathing when the heart stops pumping blood. It can provide a small amount of blood flow to the heart and brain until normal heart function resumes. CPR is performed by pushing hard and fast on the chest at a rate of 100 compressions per minute, alternating with rescue breaths. Drugs like epinephrine may also be administered during CPR to help restart the heart. The goal of CPR is to try to restore spontaneous circulation until advanced life support can take over.

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CARDIO
PULMONARY
RESUSCITATION
MS RADHIKA. M. R
I YEAR MSC NURSING
HOLY CROSS COLLEGE ON NURSING,
KOTTIYAM

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DEFINITION
 CPR is a combination of rescue breathing and chest
impressions delivered to victims thought to be in cardiac
arrest. When cardiac arrest occurs the heart stops pumping
flood.
 CPR can support a small amount of blood flow to the
heart and brain to "take time" until normal heart function
is restored.

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CAUSES OF CARDIAC ARREST
 Myocardial infarction
 Electric shock
 Drowning
 Poisoning
 Suffocation
 Smoke inhalation

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CAUSES OF CARDIAC ARREST
 Choking of food
 Anaphylactic shock
 Trauma
 Medical reasons
 Hypovolemic shock
 Drug reaction

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RISK FACTORS
 Cigarette smoking
 Hypertension
 High blood cholesterol
 High fat, cholesterol diet

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SIGN AND SYMPTOMS
 Pain (sub sternal)
 Uncomfortable pressure
 Squeezing,
 Fullness and tightness around the chest

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SIGN AND SYMPTOMS
 Spread of pain to a shoulder, an arm, neck
 Shortness of breath
 Perspiration
 Nausea

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10. z CPR: PROCEDURE
Before starting CPR, Check
 Consciousness of person
 If unconscious, shake his /her shoulder/ neck
 Spell C-A-B
 Remove person from any immediate danger
 Check for spinal injury
 Position the person

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Circulation
 Put the person on his or her back on a firm surface
 Place his or her arms at his side and proceed to establish
an open airway
 Straighten the person’s leg
 Kneel next to the person’s neck or shoulders
 Place the heal of one handover the center of the person’s
chest, between the nipple place other hand on the top of
the first hand

12. z CIRCULATION
 Keep elbow straight and position shoulders directly above
hands
 A compression consists of a thrust which compresses the
heart and a release which allows the heart to refill with blood.
The compressions are delivered at the rate of approximately
100/ min. It is recommended to push hard and fast to make
sure adequate depth and rate of compressions are maintained.
 When performing compressions elbow should be locked and
push straight down

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CIRCULATION
 Do use enough force to push the causalty’s sternum down
11/2 -2 inches (4-5cm)
 Release the pressure completely so that sternum resumes its
normal position, but do not remove the heel of hand from
compression site.
 The nurse should establish a definite rhythm when
performing external chest compressions. The release part of
cycle should be equal in time to the thrust part of the cycle.
Both part should be distinct- Do not bounce.

15. z Airway
 After 30 chest compressions, open the person’s airway
using the head-tilt, chin left maneuver, put palm on the
person’s forehead and gently tilt the head back
 Then with the other hand, gently lift the chin forward to
open the airway
 Check for normal breathing. Look for the chest motion,
listen breath sounds
 If the persons is not breathing normally begin mouth to
mouth breathing

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Airway
 Jaw –thrust method is preferred for establishing an airway.
The jaw-thrust method moves the casualty’s tongue forward
without extending his neck.
 Kneel behind the casualty’s head
 Rest elbows on the surface on which the casualty is lying
 Place one hand on each side of the casualty’s head
 Place the tips of index and middle fingers under the angles
of the casualty’s jaw

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Airway
 Place the thumbs on the casualty’s jaw just below the
level of teeth
 Lift the jaw upward with finger tips. The mouth
should not be closed as this could prevent air from
entering the casualty’s airway.

19. z Breathing
 Rescue breathing can be mouth to mouth ( mouth to mouth
resuscitation) or mouth to nose breathing
 Keep the casualty’s airway open by maintaining the head
tilt/ chin-lift
 Take a deep breath
 Close the nostrils of casualty
 Place mouth over the casualty’s mouth cover completely and
sure an airtight seal. So that air will not escape.

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Breathing
 Blow a breathe at a slow rate into the casualty’s mouth
 After blowing quickly break the seal over his mouth
 Take a breath of air, exhale and then take another deep
breath

21. z Breathing
 Seal month over the casualty’s mouth again and
continue mouth to mouth resuscitation
 Mouth to mouth
 Mouth to nose
 Mouth to stoma

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CPR PROCEDURE
Continue CPR until there are signs of movement
 Do cycles of 5 chest compressions and 1 breath
 Repeat the above procedure at a rate of one ventilation
ever 5 sec until 10 -12 ventilations
 Check the carotid pulse after every 10-12 breaths.
 If the casualty begins breathing on his own, maintain
airway

25. z EFFECTS OF CHEST
COMPRESSIONS
 The heart is located between the sternum and the spine. If the
sternum is pressed down, the heart is compressed. Blood is
than forced out of the ventricles and into the arteries
 When the pressure is removed from the sternum, it rises to its
normal position and the heart resumes its normal shape
 Each pressure-release cycle is roughly equal to one heartbeat.

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COMPLICATIONS OF CPR
 Fracture rib bones or sternum
 Gastric insufflations
 Vomiting
 Aspiration

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DRUGS USED DURING CPR
First Line Drugs
 Epinephrine 1mg every 3-5 minute
 Vasopressin 40units
 Atropine sulfate ( Bradycardia )
 Amiodarone ( Pulseless VT)

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Other drugs
 Calcium chloride
 Magnesium sulphate
 Procain amide
 Phenytoin
 Na HCO3(Hyperkalemia)
 Lignocaine(antirrhythmic)

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POST RESUSCITATIVE CARE
Post resuscitation lab test
 ABG
 CBC
 Blood chemistry
 Arterial po2
 Potassium

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POST RESUSCITATIVE CARE
BP support
 Mean arterial pressure should be maintained
>80mmHg
IVline
Dysrrhythmia treatment
Neurologic support

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POST RESUSCITATIVE CARE
Maintenance support
Maintenance of cerebral perfusion pressure
Induce mild hypothermia

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