INTRODUCTION:-

 Cardiopulmonary resuscitation (CPR) is a life saving technique useful in many

emergencies, including cardiac arrest or respiratory arrest, in which someone’s
breathing or heart beat has stopped.
 CPR is effective only if performed within 7minuites of the cardiac or respiratory
arrest.
 Nurses are the most important health care personnel who should effectively care
for more complex cases, including interventions for patients with
cardiopulmonary arrest, initiating basic life support (BLS) and a adding in
advanced life support (ALS).

DEFINITOION:-

 CPR is the artificial ventilation and maintains blood circulation accompanied by

cardiac massage to facilitate normal breathing and normal heart action in the
event of cardiac arrest or pulmonary arrest.

PURPOSE OF CPR:-

 To maintains blood circulation by external cardiac massages (C).

 To maintains an open and clear air way (A).
 To maintain breathing by external ventilation (B).
 To save life of the patient.
 To provide basic life support (BLS) till medical care and advanced life support
(ALS) arrives.

INDICATORS FOR CPR:-

 The major indicator for initiating CPR is the cardiac arrest or

respiratory arrest.
 Cardiac arrest indicators\sign and symptoms:-
 Ventricular fibrillation (VF)-a rapid heart rate
 Ventricular tachycardia (VT)-abnormal heart rate, faster than
normal heart rate.
 Asystole-absence of ventricular contraction or a cardiac flat line in
ECG
 Pulse less electrical activity-in which ECG shows a heart rhythm,
but no pulse.

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  Respiratory arrest indicators/sign and symptoms:-
 Drowning
 Shock
 Air way obstruction
 Acute respiratory failure
 Drug overdose
 Suffocation
 Poisoning
 Hypoxia
 choking

IMPORTANT POINTS TO START CPR:-

 It is important to start the CPR immediately after the cardiac arrest because brain
damage starts in 4-6 minutes.
 So no time should be wasted in checking blood pressure, peripheral pulse or
monitoring cardiac sound and tone.
 The first indicator of a cardiopulmonary arrest is absence carotid artery
pulsation. This is the main symptom to indicate initiation of CPR.
 Respiratory arrest this is the second indicator for the CPR to be initiated so a
quick check of the carotid pulse and respiratory movement indicate the need for
CPR.
 Any patient with sudden syncope or unconsciousness should be suspected for
cardiac or respiratory arrest and the carotid pulse and respiratory assessment
must be performed.

CPR PROCEDURE/HOW TO PERFORM CPR:-

 The standard method of CPR has been C-A-B, ‘C’ for compression, ‘A’ for air
way, ‘B’ for breathing.
 SEQUENCE OF EVENTS IN CPR:-
 STEP-1
 Before starting CPR, check:-
 If patient is unresponsive, check is the person conscious or unconscious?
 If the person appears unconscious, tap or shack his or her shoulder and ask
loudly, “are you ok?’’
 If the person does not respond, call the local emergency health care number for
help.

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 STEP-2
 Restore blood circulation and respiration with chest compression and
giving breathing:-
 Put the person on his or her back on a firm surface.
 Check carotid pulse within 5-10 seconds.
 If carotid pulse is absent start CPR, place the heel of one hand over the center
of the person’s chest between two nipples.
 Interlock fingers of the other hand.
 Lean forward so the shoulders are over the hands.
 Press straight down with elbows straight.
 Push at least 2 inches or 4-5 cm.
 Push hard and fast at a rate of about 100/120 compressions in a minute.
 Give 30 compression and 2 breath in one cycle (30:2=1 cycle) have to give 5
cycle in 2 minute.
 Allow complete chest recoil after each compression.
 Minimize interruption in chest compressions.
 If carotid pulse is present look for chest rise listen breathe sound and feel for
normal breathing and check if any foreign body in the mouth or air way.
 Then clean the mouth or air way.
 If the breathing is absent begin mouth to mouth or mouth to nose or use the
mask breathing, using head tilt, chin lift or jaw thrust position.
 Don’t allow air to leak while giving breath.
 Give 10-12 breath per minute one breath in every 5-6 seconds and recheck
the pulse in every 2 minute.
 STEP-3:-
 Use of automated external defibrillator (AED):-
 After 5 cycle and adequate breathing if the person has not begun moving or not
giving any response administer one shock by manual defibrillator or AED,
immediately again start CPR for 5 cycle.
 If that time defibrillator or AED is not available then continue the CPR till the
defibrillator or ambulance reached to the patient.

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COMPARISON OF COMPONENTS FOR ADULTS, CHILDREN AND INFANTS
CPR:-

COMPONENTS ADULTS CHILDREN INFANTS

Hand placement Place heal of one  Rescuer can  Here 2
hand in center of use one or fingers or 2
chest or between both hand for thumb
two nipple and compression. method is
interlock fingers of  Place heel of used.
the other hand one hand in  Place two
center of finger or two
chest thumbs on
between two the breast
nipples. bone just
 If one hand is below the
not enough two nipple
use both line.
hands.

Compression depth At least 2 inches or At least 1/3 anterior At least 1/3 anterior
5cm. posterior diameter posterior diameter
about 2 inches or 5 about 1.5 inches or 4
cm. cm.

Compression rate At least 100/120 At least 100/120 At least 100/120

compression per compression per compression per
minute. minute. minute.

Compression- 30:2 for single or 30:2 for single 30:2 for single
ventilation ratio 2- rescuers rescuer and 15:2 for rescuer and 15:2 for
two rescuers. two rescuers.

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CHOKING:-
DEFINITION:-

Choking (also known as foreign body air way obstruction) is a life-threatening medical
emergency characterized by the blockage of air passage in to the lungs.

SIGN AND SYMPTOMES OF CHOKING:-

 Difficulty or inability to speak or cry out.

 Difficulty or inability to breathing, labored breathing, includes gasping or
wheezing may be present.
 Violent and largely involuntary coughing.
 The person’s face may turns blue from lack of oxygen.
 The person may become unconscious, if breathing is not restored.

TREATMENT OF CHOKING:-

 Adult (age 18-35) chocking treatment:-

 If chocking victim is conscious and responsive encourage the victim to cough and
give hard back slaps, if none of these things work abdominal thrusts (Heimlich
maneuver) or chest thrusts.
 If choking victim loses consciousness initiating CPR is recommended.

Procedure for abdominal thrusts (Heimlich maneuver):-

 Stand behind the person and wrap your arms around the person’s waist.
 Make a fist with one hand place the thumb side of your fist just above the
person’s navel, well below the breast bone.
 Grasp the fist with the other hand.
 Make quick, upward and inward thrusts with your fists.
 Continue thrust until the object is dislodged or the person loses consciousness.
 If the person becomes unconscious begin CPR.

 Child (age 6-11) chocking treatment same as adult treatment.

 Infant (age 0-1year) chocking treatment:-

 Place the infant stomach down across your fore arm and give five quick force full
blows on the infant’s back with heel of your hand.
 Place two fingers on the middle of the breast bone just below the nipples. Give up
to 5 quick thrusts down, compressing the chest one third to one half the depth of
the chest. This is called chest thrust. Continue 5 back blows followed by 5 chest
thrusts until the object is dislodged or the infant becomes unconscious.
 If the infant becomes unconscious begin CPR.

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POSSIBLE COMPLICATIONS OF CPR PROCEDURE:-

 Coronary vessel injury

 Diaphragum injury
 Hemopericardium
 Hemothorax
 Liver injury
 Pneumothotax
 Rib fracture
 Spleen injury
 Sternal fracture

EQUIPMENTS NEEDED FOR CPR IN HOSPITAL SETUP:-

 Suction apparatus
 Oxygen supply
 Ambu bag and mask
 Endotracheal tube (ETT)
 Laryngoscope
 Oro pharyngeal airway
 Defibrillator
 Ventilator
 Iv equipments and fluids
 Pulse oxymeter
 Emergency drugs
 Cardiac monitor

MEDICATION USED IN CPR:-

 Adrenaline-reduce heart rate,dose-1mg/1ml

 Atropine-increase heart rate,dose-0.5mg/1ml
 Amiodorone-maintain normal heart rate,dose-50mg/1ml
 Dopamine-improve pumping strength of heart,dose-1.6mg/ml
 Dobutamine-used in heart failure, increase heart rate,dose-12.5mg/ml

NURSING MANAGEMENT:-

 Maintains airway patency with use of air way adjunct.

 Assist with intubation and securing of endotracheal tube (ETT).
 Inserts nagogastric tube.
 If shakable rhythm is present (VT/VF) ensure manual defibrillator pads are
applied and connected.
 Prepare and administered iv fluids.

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  Document medications administered with time.

SUMMARY:-

This topic CPR summarized by introduction, definition, purpose, indication for CPR,
important points to start CPR, CPR procedure, comparison components for adults
children and infants, chocking, possible complications, equipment needed in hospital
setup, medical managements, nursing managements.

CONCLUSION:-

CPR is a life saving skill. We don’t know when we will need the skill. This topic gives a
brief knowledge about CPR technique. We should up to date the knowledge about CPR
techniques. This knowledge will help to save a life.

BIBLIOGRAPHY:-

 Brunner and Suddarth’s.(2016), Text book of medical surgical nursing; 12th

edition: publish by. Lippincott Williums and wilkins, page no-843-845
 Dr. Auradha. S.(2018), a text book of fundamentals of nursing; 1 st edition: publish
by. Vijayam publication, prakasam road, tirupati-517501; page no-
 Javed Ansari and Davinden kaur.(2011), Text book of medical surgical nursing
volume-ii; 1st edition: publish by pee vee, page no-2033-2039
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017), Roberts medical surgical
nursing, assessment and management of clinical problems; 3rd south asia
edition: publish by RELX India pvt.ltd , new delhi; page no-110-111
 https://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation
 https://www.mayoclinic.org/first-aid/first-aid-chokin
 https://www.webmd.com/first-aid/cardiopulmonary-resuscitation-cpr-treatment

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