CARDIOPULMONARY RESUSCITATION AND AIRWAY MANGEMENT

Cardiopulmonary resuscitation (CPR) is a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilatory action. Management of foreign-body airway obstruction or cricothyroidotomy may be necessary to open the airway before CPR can be performed.

INDICATIONS
1. Cardiac arrest a. Ventricular fibrillation b. Ventricular tachycardia c. Asystole d. Pulseless electrical activity

2. Respiratory arrest
a. Drowning b. Stroke c. Foreign-body airway obstruction d. Smoke inhalation e. Drug overdose

f. Electrocution/injury by lightning g. Suffocation h. Accident/injury i. Coma j. Epiglottitis

ASSESSMENT
1. Immediate loss of consciousness 2. Absence of breath sounds or air movement through nose or mouth 3. Absence of palpable carotid or femoral pulse; pulselessness in large arteries

COMPLICATIONS
1.Postresuscitation distress syndrome (secondary derangements in multiple organs) 2.Neurologic impairment, brain damage

NURSING ALERT
The patient who has been resuscitated is at risk for another episode of cardiac arrest.

EQUIPMENT
Trained personnel Arrest board Oral airway

Bag and mask device Intravenous (IV) set up Defibrillator Emergency cardiac drugs Electrocardiograph machine

PROCEDURE
NURSING ACTION RESPONSIVENESS/AIRWAY RATIONALE

1. Determine unresponsiveness: tap or gently shake patient while shouting, Are you OK?. 2. Activate emergency medical service (EMS).

1. This will prevent injury from attempted resuscitation on a person who is not unconscious.

3. Place patient supine 3. This enables the on a firm, flat surface. rescuer to perform Kneel at the level of the rescue breathing and patients shoulders. If chest compression the patient has without moving the suspected head or neck knees. trauma, the rescuer should move the patient only if absolutely necessary.

4. Open the airway.

a. Head-tilt/Chin-lift Maneuver: a. In the absence of sufficient Place one hand on the muscle tone, the tongue patients forehead and apply and/or epiglottis will firm backward pressure with obstruct the pharynx and the palm to tilt the head larynx. back. Then, place the fingers of the other hand under the This supports the jaw and bony part of the lower jaw helps till the head back. near the chin and lift up to bring the jaw forward and the teeth almost to occlusion.

b. Jaw-thrust Maneuver: Grasp the angles of the patients lower jaw and, lifting with both hands, one on each side; displace the mandible forward, while tilting the head backward.

b. The jaw-thrust technique without head tilt is the safest method for opening the airway in the presence of suspected neck injury

BREATHING
Determine presence or absence of spontaneous breathing.

1. Place ear over 1. Keep maintaining an patients mouth and open airway. nose while observing the chest, look for the chest to rise and fall, listen for air escaping during exhalation, and feel for the flow of air.

2. Perform rescue breathing mouth-mouth: while keeping the airway open, pinch the nostrils closed using the thumb and index finger of the hand that is on the forehead. Take a deep breath, open mouth wide, and place it outside of the patients mouth, creating an airtight seal. Ventilate the patient with two full breaths (1-1 seconds each breath), taking a breath after each ventilation. If the initial ventilation attempt is unsuccessful, reposition the patients head and repeat rescue breathing.

2. This prevents air from escaping from the patients nose.

Adequate ventilation is indicated by seeing the chest rise and fall, feeling the air escape during ventilation and hearing the air escape during exhalation.

CIRCULATION

Determine pulselessness.
1. While maintaining head 1. Cardiac arrest is recognized by pulselessness in the large tilt with one hand on arteries of the unconscious, the forehead, palpate breathless patient. If there is a the carotid or femoral palpable pulse, but no breathing pulse. If pulse is not present, initiate rescue palpable, start external breathing at rate of 12 times per chest compressions. minute (once every 5 seconds)
after initial two breaths.

External Chest Compressions Consist of serial, rhythmic applications of pressure over the lower half of the sternum.

1. Kneel as close to the 1. The long axis of the side of patients chest heel of the rescuers as possible. Place the hand should be placed heel of one hand on on the long axis of the the lower half of the sternum; thus the sternum, 3.8 cm (1 main force of the inches) from the tip of compression will be the xiphoid. The on the sternum and fingers may either be decrease the chance extended or interlaced of rib fracture. but must be kept off the chest.

2. While keeping your arms straight, elbows locked, and shoulders positioned directly over your hands, quickly and forcefully depress the lower half of the patients sternum straight down, 3.8-5 cm (1-2 inches).

3. Release the external 3. Release of the external chest compression chest compression completely and allow the allows blood flow into chest to return to its the heart. normal position after each compression. The time allowed for release should equal the time required for compression. Do not lift the hands off the chest or change position.

4. Rescue breathing and 4. Use 80 external chest compressions per compressions must be minute combined. Check for (100 if possible). return of carotid pulse. If absent, resume CPR For one rescuer, do with two ventilations 15 compressions at followed by a rate of 80-100 per compressions. For CPR minute and then performed by health professionals, perform two mouth-to-mask ventilation ventilations; is an acceptable re-evaluate the alternative for rescue patient. breathing.

5. For CPR performed by two rescuers, the compression rate is 80-100 per minute. The compressionventilation ratio is 15:1 with a pause for ventilation (1-1 seconds)

6. While resuscitation 6. Definitive care proceeds, includes simultaneous efforts defibrillation, are made to obtain pharmacotherapy for and use special dysrhythmias and resuscitation acid-base equipment to manage disturbances, and breathing and ongoing monitoring circulation and and skilled care in an provide definitive intensive care unit. care.

THE END

THANK YOU
Evelyn E. Torres, RN-MAN