Essential guide to Cardiopulmonary Resuscitation (CPR)

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Essential guide to Cardiopulmonary Resuscitation (CPR)

Introduction
• CPR is needed for patient whose breathing or heart has stopped
• Ventilations are given to oxygenated blood when breathing is inadequate or has stopped
• If heart has stopped, chest compressions are given to circulate blood to vital organs
• Ventilation combined with chest compressions is called cardiopulmonary resuscitation (CPR)
• CPR is commonly given to patients in cardiac arrest as a result of heart attack
Cardiac Arrest
• Heart may stop (cardiac arrest) as a result of heart attack
• Brain damage begins 4 - 6 minutes after cardiac arrest
• Brain damage becomes irreversible in 8 - 10 minutes
• Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness

CAUSES OF CARDIAC ARREST

There re two causes of cardiac arrest, Cardiac causes and Extracardiac causes.

Cardiac
• Ischemic heart disease (myocardial infarction)
• Arrhythmias of different origin and character
• Cardiac tamponade
• Pulmonary artery thromboembolism
• Ruptured aneurysm of aorta

Extracardiac/Non cardiac
• airway obstruction
• acute respiratory failure
• shock
• embolisms of different origin
• drug overdose
• poisoning

Cardiopulmonary Resuscitation (CPR)

• CPR helps keep patient alive by circulating some oxygenated blood to vital organs
• Ventilations move oxygen into lungs where it is picked up by blood
• Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues
• Blood circulation resulting from chest compressions not as strong as circulation from heartbeat
   –Can help keep brain/other tissues alive until normal heart rhythm restored
• Often electric shock from defibrillation is needed to restore a heartbeat—and CPR can keep patient viable until then
• CPR is effective only for a short time
• CPR should be started as soon as possible
• In some instances, the heart may start again spontaneously with CPR
 When Not to Perform CPR
• Patient obviously dead or clear signs of prolonged death, such as rigor mortis

How long to resuscitate ?
• CPR can be continued for 30 minutes if the time to onset of CPR is less than 6 minutes, but if there is a delay to onset of CPR longer than 6 minutes, CPR should be terminated after 15 minutes.
FACTS ABOUT CPR
• 75% of all cardiac arrests happen in people's homes.
• CPR doubles a person's chance of survival from sudden cardiac arrest.
• There has never been a case of HIV transmitted by mouth-to-mouth CPR.
• Approximately 15% of patients are discharged neurologically intact
• CPR provides a flow of oxygenated blood to the brain and heart and keeps these organs alive until defibrillation can shock the heart into a normal rhythm.
• If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minutes, a person has a 40% chance of survival.

Main stages of resuscitation

A (Airway) – ensure open airway by preventing the falling back of tongue, tracheal intubation…???.... if possible
B (Breathing) – start artificial ventilation of lungs
C (Circulation) – restore the circulation by external cardiac massage
D (Drugs, Defibrilation) –use different medication and electric defibrillation

  A (Airway)
Ensure an open airway


Open the airway using a head tilt lifting of chin. Do not tilt the head too far back

Check the pulse on carotid artery using fingers of the other hand


B (Breathing)
•Tilt the head back
•Look, listen, & feel  for breathing (5-10 seconds)
• If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise.
• Artificial breathing can be mouth-mouth, mouth-bag, bag-mask
CIRCULATION
• Check for carotid pulse by feeling for 5-10 seconds at side of patients’s neck
• If there is a pulse, but patient is not breathing, give Rescue Breathing at rate of 1 breath every 5 seconds
• Check for return of pulse every minute
C. Circulation
Restore the circulation, that is start external cardiac massage if there is no pulse

2 Mechanisms explaining the restoration of circulation by external cardiac massage



General technique of CPR
• Shake victim’s shoulders and shout "are you okay?"
• If unresponsive, not breathing, and no pulse, start chest compressions
• Place victim flat on his/her back on a hard surface.
• Find the correct hand position (at the lower half of the sternum)
   – Two hands for adults
   – One or 2 hands for child
   – Two fingers for infant
• Compress chest hard and fast at a rate of 100 compressions/minute
   – Adult = 1 1/2 to 2 inches deep
   – Infant/child = 1/3 to 1/2 chest depth
• Release completely between compressions
• If alone, alternate 30 chest compressions and 2 ventilations for any age patient
• In two-rescuer CPR for infant/child, alternate 15 compressions and 2 ventilations and 30:2 for adult
• Give each ventilation over 1 second
• Follow local protocol regarding oxygen
Single-Rescuer CPR
1. Check patient’s responsiveness, open airway, and determine that patient is not breathing adequately
2. Give 2 ventilations, each lasting 1 second
3. Determine victim has no pulse


Continue CPR until:
• Patient begins to move
You are too exhausted to continue
• If patient starts moving, check for
  adequate breathing
• If patient is breathing adequately,
  put patient in recovery position and
  monitor breathing



Problems with CPR Technique
• CPR often ineffective because of poor technique
• Compressions not delivered steadily and constantly during resuscitation efforts
• Often compressions are too shallow, resulting in ineffective blood flow
• Compressions may be given at too fast a rate
• Only good-quality CPR improves chances of survival
Chest Compressions
• Infant or child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion
• If pulse < 60 beats/minute and infant or child has signs of poor perfusion, provide CPR
Reasons to Stop CPR
• Patient revives.
• You are so exhausted you can not
  continue
.
Complications of Compressions
  • Fractured ribs
  • Fractured sternum
  • Lacerated lungs
  • Lacerated liver, blood vessels, etc.,,
Drugs used in CPR

  Atropine
• Can be injected bolus
• Plays significant role in some cases of cardiac arrest
• Increases heart rate 
Adrenaline
• Large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min
• Increases heart rate and blood pressure 58
Lidocaine
• Low doses as local anesthetics, high dose
  as anti-arrhythmic.

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