Cpr ppt

58
SEMINAR ON CARDIO PULMONARY RESUSCITATION Diana Joseph

Transcript of Cpr ppt

Page 1: Cpr ppt

SEMINAR

ON CARDIO PULMONARY

RESUSCITATION

Diana Joseph

Page 2: Cpr ppt

DEFINITION: Cardio pulmonary resuscitation (CPR) is a

technique of basic life support for the purpose of oxygenation to the heart, lungs and brain until and unless the appropriate medical treatment can come and restore the normal cardiopulmonary function.

Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and circulation in the patient who is not breathing and has no pulse.

Page 3: Cpr ppt

DEFINITION Cardiopulmonary resuscitation is the

process of artificially supporting a patient’s breathing and heart beat when respirations and pulse have ceased.

CPR is the process of externally supporting the circulation and respiration of a person of who has a cardiac arrest.

Page 4: Cpr ppt

CPR- INDICATIONS Cardiopulmonary arrest Pulseless VT VF Asystole Electro Mechanical Dissociation Unresponsive person with no breathing

Page 5: Cpr ppt

OBJECTIVES Delay tissue death Extend the brief window of opportunity

for a successful resuscitation without permanent brain damage.

Induce a heart rhythm which may be shockable.

CPR is generally continued until the subject regain return of spontaneous circulation (ROSC) or is declared dead.

Page 6: Cpr ppt

Historical review: 5000- First artificial mouth to mouth respiration.

3000 BC- Ventilation.

1780-First attempt of newborn resuscitation by blowing.

874- First experimental cardiac massage.

1901- First successful direct cardiac massage in man.

1946- First experimental indirect cardiac massage and defibrillation.

1960- Indirect cardiac massage.

1980- Development of cardio pulmonary resuscitation due to works of peter safar.

Page 7: Cpr ppt

PRINCIPLES1. Define the team leader2. Establish effective artificial circulation3. Effective oxygenation and ventilation4. Establish a route for medication

administration5. Create an effective cardiac rhythm6. Evacuate the patient to the ICU as soon

as practical7. Re-evaluate and stabilize8. Preserve the brain

Page 8: Cpr ppt

8

CHAIN OF SURVIVAL

Page 9: Cpr ppt

9

1) EARLY RECOGNITION Assessment is of crucial importance. It

includes :1) Unresponsiveness

Check the victim for a response. Shake shoulders gently Ask “Are you all right?’’

Page 10: Cpr ppt

10

2) No breathing or no normal breathing (i.e, only gasping)

Page 11: Cpr ppt

11

3) No pulse felt within 10 seconds.

Page 12: Cpr ppt

12

2) CPR SequenceA Change From A-B-C to C-A-B

Page 13: Cpr ppt

13

PHASES OF THE CARDIO PULMONARY RESUSCITATION:

Phases Steps

Phase-1 Basic life support C= circulation

A= Airway

B= Breathing

Phase-2 Advance cardiac life

support

D= Drugs

E= ECG

F= fibrillation

Phase-3 Prolonged life

support

Post resuscitation care

Page 14: Cpr ppt

BLS(Basic Life Support)

BLS is used for patients with life threatening illnesses or injury until the person can be given full medical care at hospital.BLS is provided in a pre hospital set up and can be provided without medical group

Page 15: Cpr ppt

○BLS is defined as a life saving procedure which involves the external support of circulation and ventilation for patient with cardiac or respiratory arrest

Page 16: Cpr ppt

BLS Consists of CHEST COMPRESSIONS AIRWAY BREATHING DEFIBRILLATION

Page 17: Cpr ppt
Page 18: Cpr ppt

MAIN STAGES OF RESUSCITATION:

A (Airway)- ensure open airway by prevention the falling back of tongue, tracheal intubation if possible.

B (Breathing) – start artificial ventilation of lung.

C (Circulation) – restore the circulation by external cardiac massage.

D (Differentiation, drug, defibrillation) – quickly perform differential diagnosis of cardiac arrest; use different medication and electric defibrillation in case of ventricular fibrillation.

Page 19: Cpr ppt

ASSESSMENT

Determine that the client is unconscious. Shake the client and shout at him or her to confirm if unconscious rather than being asleep, intoxication or hearing impairment.

Assess for the presence of respirations.

Assess carotid artery for pulse.

Page 20: Cpr ppt

EQUIPMENTS A hard flat surface.

No additional equipment is necessary but in hospital setting, an emergency (crash) cart with defibrillator and cardiac monitor should be brought to the bedside. A crash cart contains:

Airway equipment.

Suction equipment.

Intravenous equipment.

Laboratory tubes and syringes.

Pre packed medication for advanced life support.

Page 21: Cpr ppt

CAUSES

System Reasons CNS Cerebro-vascular accidents.

Shock.

Pulmonary: COPD. Airway obstruction. Atelectasis.

Cardio vascular: Acute M I. CABG. Heart failure. Dysrhythmias. Heart block.

Miscellaneous: Drowning, Fall, Poisoning. Emboli, Accident.

Page 22: Cpr ppt

PHASES OF THE CARDIO PULMONARY RESUSCITATION:

Phases Steps

Phase-1 Basic life support A= Airway

B= Breathing

C= circulation

Phase-2 Advance cardiac life

support

D= Drugs

E= ECG

F= fibrillation

Phase-3 Prolonged life

support

G= Gauging

H= Human Mentation

I= Intensive care

Page 23: Cpr ppt

TYPICALLY THE SEQUENCE OF BLS CONSISTS OF ASSESSMENT AND THE ABCS OF CPR.

AssessmentIt is of crucial importance. It

includes

Assess responsiveness by calling the person; shouting and shaking.

Assess breathing by look, listen and feel: Look for chest movements, listen for breath sounds and feel for the movements of the air flow.

Page 24: Cpr ppt

Assess circulation- feel the carotid pulse.

Page 25: Cpr ppt

BASIC LIFE SUPPORT

Airway management Open and clear the airway: This is

achieved by head tilt and chin lift maneuver or if there is suspicion/ evidence of head or neck trauma, the jaw thrust maneuver is used.

Page 26: Cpr ppt

HEAD TILT CHIN LIFT MANEUVER: 

Place one hand on the victim’s hairline and place the other hand’s index finger and the middle finger on the chin and apply firm backward pressure.

Page 27: Cpr ppt

JAW THRUST MANEUVER: -

It is accomplished by placing one hand on each side of the victim’s head, grasping the angles of the victim’s lower jaw, lifting with both hands.

 

Page 28: Cpr ppt

FINGER-SWEEP MANEUVER: -

With the victim’s head up, opens the victim’s mouth by grasping both tongue and the lower jaw between the thumb and fingers and lifting (tongue-jaw lift).

  This action draws the tongue from the

back of the throat and away from the foreign body. The obstruction may be partially relieved by this maneuver.

Page 29: Cpr ppt

If the tongue-jaw lift fails to open the mouth then crossed finger technique may be used. This is accomplished by opening the mouth by crossing the index finger and the thumb and pushing the teeth apart. The index finger of the available hand is inserted along the inside of the cheek and deeply into the throat to the base of the tongue.

A hooking motion is used to dislodge the foreign body and maneuver it into the mouth for removal.

Page 30: Cpr ppt

If the tongue-jaw lift fails to open the mouth the crossed finger technique may be used. This is accomplished by opening the mouth by crossing the index finger and the thumb and pushing the teeth apart. The index finger of the available hand is inserted along the inside of the cheek and deeply into the throat to the base of the tongue.

A hooking motion is used to dislodge the foreign body and maneuver it into the mouth for removal.

Page 31: Cpr ppt

BREATHING: -

After the airway management if the victim is still not breathing, then maintaining head tilt, chin lift positions pinch the nostrils and place the mouth around the victim’s mouth to make a tight seal, take two deep breaths and deliver two positive pressure ventilations; each at least of two seconds duration. When performing mouth-to-mouth ventilation always assess for chest wall movement.

Page 32: Cpr ppt

BAG AND MASK VENTILATION Use a resuscitator bag

and mask.

Apply the mask to the victim’s mouth and create a seal by pressing the left thumb on the bridge of the nose and the index finger on the chin.

Use rest of the fingers of the left hand to pull on the chin and the angle of the mandible to maintain the head in extension.

Page 33: Cpr ppt

Use the right hand to inflate the lungs by squeezing the bag to its full volume.

Observe the chest wall for symmetric expansion.

The volume of air of each ventilation should be approximately 700-1000ml, which can be determined by noting a rise of 1-2 inches in the victim’s chest.

Smaller volume (400-600ml) should be attempted during bag and mask ventilation.

Page 34: Cpr ppt

CIRCULATION: The carotid artery is used to

determine the absence of pulse.

While maintaining the head tilt position with one hand on the forehead, locate the victim’s trachea with two or three fingers of the other hand, then slides these fingers into the groove between the trachea and the muscles of the neck where the carotid pulse can be felt.

The technique is more easily performed on the side nearest the rescuer.

If on assessment, there are no signs of circulation start external cardiac compressions.

Position hands, arms and shoulders

Page 35: Cpr ppt

External cardiac compressions technique consists of serial rhythmic application of pressure on the lower half of the sternum.

The victim is on the horizontal supine position on a flat and hard surface.

The rescuer should be positioned closed to the side of the victim’s chest.

Locate landmark notch hands in the center of the chest, right between the nipples and four fingers above the xiphoid process.

Page 36: Cpr ppt

Elbows should be locked and arms are straight.

Rescuer’s shoulders position directly over hands.

Begin compression.

Pressure should come from the shoulders.

Compression should depress victim’s sternum approximately 1.5- 2 inches.

Don’t allow the fingers to touch the chest wall.

Allow chest to rebound to normal position after each compression.

Page 37: Cpr ppt

Perform compression at the rate of 100/min.

Maintain correct position at all times.

Check for signs of circulation every 3-5 min.

Compression: ventilation ratio is 30:2 irrespective of number of rescuer.

Exhalation occurs between the two breaths and during the first chest compression of the next cycle.

Perform four complete cycles and then reassess for signs of breathing and circulation.

Page 38: Cpr ppt

Five keys aspects to great CPR

Rate Depth Release Ventilation Uninterrupted

Page 39: Cpr ppt

DEFINETION

It is asynchronous cardio-version that is used in emergency situation. Defibrillation completely depolarizes the all myocardial cells at once, allowing the sinus node to recapture its role as the pacemaker.

Page 40: Cpr ppt

IMPORTANCE OF EARLY DEFIBRILLATIONS

Most frequent arrest frequent arrest rhythm VF/VT

Treatment is defibrillation. Successful conversion

diminished over time. VF tends to deteriorate to A

systole.

Page 41: Cpr ppt

NOT USED FOR

Sinus rhythm

Page 42: Cpr ppt

Bradycardia

Page 43: Cpr ppt

A systole

Page 44: Cpr ppt

DEFIBRILLATION: GENERAL CONCEPT

Immediate defibrillation if

witnessed arrest and automated external defibrillation available compressions before defibrillation if unwitnessed or arrival at the scene >4-5 minutes. One shock followed by immediate CPR ( beginning with chest compression)

Page 45: Cpr ppt

KEY POINTS TO REMEMBER WHILE DEFIBRILLATING

Use a conducting agent between the skins the paddles such as saline pads or electrode paste. This decreases the electrical impedance and helps to prevent burns.

The paddles are placed on the chest wall one the sternal paddle is placed to the right of the sternum, 2’nd intercostals space just below the clavicle. The apex paddle is placed on the left 6’Th intercostals space mid axillary line.

Switch on the defibrillator.

Page 46: Cpr ppt

Move the knob of the defibrillator to the required amount of joules. Shock at 200,300,360 joules.

Exert 20-25 pounds of pressure on each paddle to ensure good skin contact.

Press the charge button.

Call “stand clear” to ensure that personal are not touching the patient or the bed at the time of discharge.

The defibrillator is then discharged by depressing the buttons on the both paddles simultaneously.

Page 47: Cpr ppt

GAUGING:  Identify the cause of cardiac arrest by: Cardiac monitoring. Lab examination of the blood.

HUMAN MENTATION:

Start CPR within 4 min as brain can only survive for four min without oxygen.

Do not interrupt the CPR more than 7min. Reassess for breathing and circulation every 2-

3min.

Page 48: Cpr ppt

ECG

ECG is the graphical representation of the electrical activity of the cardiac muscles. During CPR the victim’s ECG should be continuously monitored for monitored for monitoring evaluating and recording.

Page 49: Cpr ppt

INTENSIVE CARE If the victim’s condition is stable, send the

victim to the ICU for close and continuous monitoring.

DRUGS THAT CAN BE USED DURING CPR  INJ EPINEPHRIN INJ ATROPINE INJ LIDNOCAINE INJ MAGNESIUM SULPHATE INJ DOPAMINE INJ DOBUTAMINE INJ SODA BI CARB INJ CALCIUM GLUCONATE

Page 50: Cpr ppt

TERMINATION OF BASIC LIFE SUPPORT:

CPR is stopped as a result of a number of circumstances; these are typically restoration of spontaneous respiration and circulation, complete rescuer exhaustion, or medical decision. Signs of restored ventilation and circulation include:

Struggling movements Improved color Return of or strong pulse Return of systemic blood pressure

Page 51: Cpr ppt

NURSING TEAM LEADER (USUALLY SENIOR WARD NURSE)  Identifies self as Nursing Team Leader, responsible for co-

coordinating and directing emergent nursing care of the patient.

Checks appropriate emergency call has been placed

Starts timer as soon as the Emergency trolley arrives.

Delegates available staff to roles appropriate to their level of practice: Airway, Compression, Monitor & Medications and Runner to collect or remove extra equipment, supplies, labs etc.

Establishes the patient’s weight and delegates someone to print out an Emergency Drug Worksheet (Icon on desktop of clinical computers).

Page 52: Cpr ppt

Cont ……. Ensures that the patient is placed on CPR back board.

Reassigns nursing staff once the PICU nurse and additional staff arrive as required.

Ensure someone is assigned to support family members.

Documents initial and ongoing vital signs and cardiac rhythm, medication administration, procedures and patient’s response to interventions on the ACH/Starship Resuscitation record (CR8545).

Monitors the time interval between adrenaline administration and prompts the Team Leader when 4 minutes has passed since last dose administered.

Completes, including a brief summation of presenting events and signs the ACH/Starship Resuscitation record (CR8545).

Ensures the outside copy of the CR8545 form is placed on the Charge Nurse desk and the inside copy is placed in the clinical record.

 

Page 53: Cpr ppt

AIRWAY NURSE(USUALLY THE PATIENTS NURSE OR THE

NURSE WHO FINDS THE PATIENT)

Summons help and initiates CPR as required until initial assistance arrives and then assumes responsibility for airway management.

Maintains airway patency with use of airway adjuncts as required (suction, high flow oxygen, via Hudson mask, blob mask with O2 or bag valve mask ventilation).

Page 54: Cpr ppt

Cont…….. This role becomes the responsibility of the

PICU nurse on their arrival. Assist with intubation and securing of ETT Inserts gastric tube and/or facilitates gastric

decompression post intubation as required. Assists with ongoing management of

airway patency and adequate ventilation Supports less experienced staff by

coaching/guidance e.g. drug preparation

Page 55: Cpr ppt

COMPRESSION NURSE

If CPR in progress, assume responsibility for cardiac compressions (this includes ensuring that staff doing compressions are changed at regular intervals (e.g. every 2 minutes) to avoid fatigue resulting in inadequate compressions being delivered)

Assess pulses (including pulse volume) and capillary refill as required

Page 56: Cpr ppt

SPECIAL CONSIDERATION:

Although aids isn’t known to be transmitted in saliva, some health care professionals may hesitate to give rescue breath, especially if the victim has AIDS. For these reason, it is recommended that all health care professional should how to use disposable air way equipments.

Page 57: Cpr ppt

CONCLUSION:

CPR is the responsibility of a team of personnel and not one person in isolation. For cardiac arrest we strive to prevent when possible, treat effectively when challenged and support humanely when death is imminent.

Page 58: Cpr ppt