Introduction:

Unexpected cardiopulmonary collapse is a medical emergency

that requires immediate institution of the artificial measures to support life

and to reverse the initiating pathophysiological event.

Cerebral resuscitation is the most important goal of advanced

cardiac life support. Resuscitation is a continuous process from basic life

support (BLS) to advance cardiac life support (ACLS), where BLS initiates

the process and ACLS aims to restore and maintain spontaneous

respirations and circulations.

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.

It is also called as cardio pulmonary cerebral resuscitation (CPCR) as

oxygenation of brain is more important within 4 minutes otherwise

irreversible brain damage can occur.

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.

Phases of the cardio pulmonary resuscitation:

Phases Steps

Phase-1 Basic life

support

A= Airway

B= Breathing

C= circulation

Phase-2 advanced

cardiac life

support

D= Drugs

E= ECG

F= fibrillation

Phase-3 prolonged life

support

G= Gauging

H= Human Mentation

I= Intensive care

Typically the sequence of BLS consists of assessment and the ABCs of

CPR.

Assessment

It is of crucial importance. It includes

1. Assess responsiveness by calling the person; shouting and

shaking.

2. Assess breathing by look, listen and feel: Look for chest

movements, listen for breath sounds and feel for the

movements of the air flow.

3 Assess circulation- feel the carotid pulse.

Basic life support

1. Airway management

i. 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.

HEAD TILT CHIN LIFT MANEUVER:

Place one hand on the victim’s hair line and place the other hand’s index

finger and the middle finger on the chin and apply firm backward pressure.

Head tilt and chin lift maneuver

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.

ii) Open and clear the airway by using finger sweep method.

FINGER-SWEEP MANEUVER:-

a) 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).

b) 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.

c) 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.

d) A hooking motion is used to dislodge the foreign body

and maneuver it into the mouth for removal.

Finger sweep maneuver

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.

Other advanced method to deliver breathing are bag and mask

ventilation, tracheal intubations and the use of laryngeal mask

airway.

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.

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.

Use the 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.

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

volume.

Observe the chest wall for symmetric expansion.

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.

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 centre of the chest,

right between the nipples and four fingers above the

xiphoid process.

Position hands, arms and shoulders.

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.

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.

Drugs:

Name Action Dose Indica-

tions

Side-

Effects

Nsg manage-

Ment

Calcium

gluconate:

Electrolyte and

water balance

agent.

Essential element of

the body;helps to

maintain the

functional integrity of

the nervous and

muscular systems;

helps to maintain

cardiac

functions,blood

coagulation.

Adult:

10mg/kg

Iv with in

10mins.

Paed:

20mg/kg

in1:1dilution

iv.

Ionized

hypocalcimia

.

Osteoporosis

.

Hyperkalaemi

a.

Hypermagne

samia.

Ca blocker

over dose.

Hypercalcimia

Tingling sensation

Hypotension

Brady cardia

Arrhythmia

Cardiac arrest.

Avoid

Extravasations of

The iv injection.

Do not

Administer oral

drugs with

In 1-2 hrs of

Antacid

Administration.

Monitor the

Cardiac response.

Scalp vein

Should be avoided.

Name action Dose Indica- Side- Nsg management

Tions Effects

Adren-aline.

Class:

Adreno

receptor

agonists.

Increases the force

and rate of contraction

of the heart.

.5-1mg iv

bolus

repeated

every 3-5mns.

Max.18

Mg(for adult)

.01mg/kg

body weight

(for pead)

Restoration

of the cardiac

rhythm in

cardiac

arrest.

Attacks of

transitory av

block and

syncope

seizures.

Cns: tremors,

anxity,

insomnia,head

ache,dizziness,

confusion.

Cv:

Palpitation,tac

hycardia,

hypertension

Nausea

vomiting.

Use extreme caution when

calculating and preparing

the doses.

Protect drug solutions from

sun light.

Maintain -adrenergic

blockers.

Maintain a - adrenergic

blockers.

Name Action Dose Indications Side effects Nsg

management

Lidocain

Hydrochloride.

Local

anaesthetic

effects by

binding to and

inhibiting

sodium

channels.

Depress

conduction

velocity(phase-0)

and slope of

phase.

Adult:

1mg/kg.iv bolus

maintenance:

2-4mg/mn.

Paed:1mg/kg 1:1

dilution.

In prophylaxis

on treatment of

ventricular

arrythmias.

Digitalis

intoxication.

Drowsiness,

dizziness,

restlessness,

confusion,

euphoria.

Resp arrest and

depression.

Hypotension,

bradycardia etc

Monitor ecg.

Watch for

increased

vetriculareeto

pic beats.

Check

electrolytes.

Monitor vital

signs.

CPR

ECG

ECG is the graphical representation of the electrical

activity of the cardiac muscles. During cpr the cariac muscles.

During CPR the victim’s ecg should be continuously monitored

for monitored for monitoring evaluating and recording.

DEFIBRILLATION:

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.

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.

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.

GAUGING:

Identify the cause of cardiac arrest by:

1. Cardiac monitoring,

2. Lab examination of the blood.

Human mentation:

Start CPR within 4 min as brain can only survive

for four min with out oxygen.

Do not interrupt the CPR more than 7min.

Reassess for breathing and circulation every 2-

3min.

INTENSIVE CARE:

If the victim’s condition is stable, send the victim to the ICU

for close and continuous monitoring.

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.