Cpr-1-Bls Basic Life Support PDF

CARDIOPULMONARY RESUSCITATION (CPR) PRESENTED BY Mr. Vinod Bhatt NPCC ANATOMY OF HEART The body's circulatory system is powered by the heart, a muscular organ the size of a closed fist. The thoracic cavity contains the heart, which is posterior to t...

CARDIOPULMONARY RESUSCITATION (CPR) PRESENTED BY Mr. Vinod Bhatt NPCC ANATOMY OF HEART The body's circulatory system is powered by the heart, a muscular organ the size of a closed fist. The thoracic cavity contains the heart, which is posterior to the sternum and medial to the lungs The anatomical position of human heart is slightly tilted left side of sternum. The heart points to the left, about 2/3 of the heart’s mass is found on the left side of the body and the other 1/3 is on the right. There are three layers that make up the heart wall: pericardium, myocardium, and endocardium. CONT.. Chambers of the Heart  The right atrium, left atrium, right ventricle, and left ventricle are the four chambers of the heart. Valves of the Heart  The heart valves can be broken down into two types: 1) Atrioventricular – Bicuspid valve and Tricuspid valve. 2) Semilunar valves – Pulmonary valve and aortic valve Conduction System of the Heart The heart's pacemaker, a small group of cells known as the sinoatrial (SA) node, is where the conduction system begins. The SA node is situated in the right atrium's wall, below the superior vena cava. 21648-heart-conduction-illustration.jpg The Cardiac Cycle The cardiac cycle includes all of the events that take place during one heartbeat. Normal heart rate is 60 to 100beat per minutes and the Cardiac cycle time period is 0.8 second.  The Electrocardiogram The electrocardiogram (also known as an EKG or ECG) is a non-invasive device that measures and monitors the electrical activity of the heart through the skin.  Cardiac Output Cardiac output (CO) is the volume of blood being pumped by the heart in one minute. The equation used to find cardiac output is:- CO = Stroke Volume x Heart Rate 70*72 CARDIAC ARREST A Sudden Cardiac Death (SCD) attack is when there is an abrupt loss of heart function and can be due to a variety of heart conditions.  CAUSES Coronary heart disease is the leading cause of sudden cardiac arrest. Many other cardiac and non-cardiac conditions also increase one's risk.  RISK FACTORS Smoking, Obesity Family history, lack of physical exercise.  IMMEDIATE MANAGEMENT Sudden cardiac arrest may be treated via attempts at resuscitation. This is usually carried out based upon Basic life support (BLS), Advanced cardiac life support (ACLS), Cardiopulmonary Resuscitation (CPR).  BASIC LIFE SUPPORT Basic life support refers to maintain the airway, support respiration and circulation without the use of equipment. The best chance of ensuring survival is to give them emergency treatment known as cardiopulmonary resuscitation (CPR). Definition of CPR Cardiopulmonary resuscitation, is an emergency procedure performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. Cardiopulmonary resuscitation is a technique of Basic Life Support. CONT.. Basic life support (BLS) refers to maintain the airway, support respiration and circulation without the use of equipment. Basic life support consists of cardiopulmonary resuscitation and, when available, defibrillation using automated external defibrillators (AED). CONT.. Adult CPR is a series of steps used to establish artificial ventilation and circulation in an adolescent person who is not breathing and has no pulse. CPR is performed according to the Basic Life Support guidelines given by American Heart Association. Latest guidelines are 2020 guidelines. CONT.. Age considerations for CPR are: Adult: Adolescent (after onset of puberty) and older Children: 1 year to puberty Infant: Less than 1 year  Pulse less Ventricular Activity Pulse less Electrical Activity Asystole Pulse less Bradycardia CONTRAINDICATION DNR (Do Not Resuscitate) Adult chain of survival The AHA has developed the concept of emergency cardiovascular care system for many years. They have introduced five links chain in adult in In-Hospital Cardiac Arrest: Immediate recognition of cardiac arrest and activation of the emergency response system  Steps of CPR FIRST STEP: Assessment and Scene Safety Make sure that the surrounding area is safe for rescuer and victim. Identify if victim has any physical injury Check if the victim is responding. Tap on the shoulder and shout “Are you all right”. Second step Activate Emergency Response System (ERS) If victim has collapsed, call for medical emergency services immediately. If others are around, instruct them to call 108 and if rescuer alone, he should call himself. Lay down the victim on a firm and flat surface. Third step Check for pulse Check the carotid pulse (for less than 10 seconds). Locate trachea by sliding 2 fingers into the groove between the trachea muscles at the side of the neck, where you can feel the carotid pulse. Check for breathing by placing hand to feel if air is coming out of victim’s nose or mouth. Feel pulse for at least 5seconds but no more than 10 seconds. Fourth step Start CPR (CAB) C stands for circulation A stands for Airway B stands for Breathing  Fifth step Re-assess Reassessment is done after 5 cycles of CPR High Quality CPR Cardiopulmonary resuscitation involves three series of steps: C A B Compression Lay patient on their back and kneel next to their neck and shoulder. If victim is having spinal injury than roll or moving him as a single unit. Put him in flat and firm surface. Place heel of your one hand on the midline lower 1/3 of the sternum  Place the second hand on top of your one hand. Keep your elbows straight and align your shoulders directly over your hands. Keep the compressions hard and fast. Push down at least 2.4 inches. Allow the chest to rise fully and recoil completely CONT.. Begin compressions: 30 compressions in one cycle at the rate of 100-120 compressions/minute While giving compressions, count loudly. Maintain 30:2 cycle, where 2 breaths are delivered after 30 compressions. 5 cycles should be completed in 2 minutes.  Minimize interruptions After completing 5 cycles check for pulse and breath for less than 10 seconds. If the patient has recovered put him in recovery position else continue CPR until medical help arrives. Another method to place hand is given below: Airway Second step is to open the airway of the victim. Airway can be opened with two methods: 1) Head tilt chin lift 2) Jaw thrust (use in case of spinal injury) CONT.. The proper method to open airway is head tilt chin lift. Place one hand on victim’s forehead and push with your palm to tilt head back. Push chin only by two fingers and thumb. Do not close the victim’s mouth during head tilt chin lift, it can cause obstructed airway. Breathing Third step is to deliver breaths: If the victim is not breathing, give two rescue breaths after 30 compressions. Breaths can be given by two methods: Mouth to mouth breathing Open victim’s airway with head tilt chin lift. CONT.. Pinch the nose with thumb and index finger. Take a regular breath and make a complete airtight seal over victim’s mouth Blow air for 1 second, check for chest rise A handkerchief can be used to prevent infection Air should be blown with force for at least 500ml air at a time.  Mask Position yourself directly above victim’s head. Place mask on face, using bridge of nose as guide for correct position. Ensure a tight seal between the mask and mouth by using C and E technique along with head tilt chin lift. CONT.. Use thumb and index finger of one hand to make a ‘C’ on side of the mask, pressing the edges of mask to the face. Use remaining fingers to lift the angles of the jaw (3 fingers form an ‘E’). Squeeze the bag for 1 second and deliver breath. Watch for chest rise. CONT.. Two rescuer CPR This action repeats the cycle with the deviation of the rescuer work Rescuer 1: perform 30 chest compressions Rescuer 2: deliver 2 breaths, also call for help. CONT.. Steps for two rescuer CPR One rescuer will check the person response and response and start CPR with 30 compressions. Second rescuer will call 108 for help and complete the first cycle by providing 2 breath after 30 compressions given by first rescuer. CONT.. After completing five cycles both rescuers can change their position and exchange their work. Who was giving compressions now, he will give breaths. While changing position do not cross each other. Position will be change always from victim’s head side in ‘C’ shape. Re-Assessment Assess the victim for pulse (less than 10 seconds), after every 5 cycles of CPR. If pulse is absent, continue CPR with 30:2 ratio. If pulse is present, check for breathing. If breathing is absent, perform rescue breaths at rate of 10-12 breaths per minute (1 breath every 5-6 seconds) by counting ‘one two three four’ after each breath. CONT.. If both the pulse and breathing is present, position the victim in recovery position. Continue to monitor victim’s pulse and breathing after every few minutes. Wait for the medical help. Post CPR Recovery Position: The recovery position is used in the management of victim who are unresponsive but have breathing, pulse and signs of circulation. When an unresponsive victim is lying supine, the airway may become obstructed by the tongue or mucus and vomit. These problems may be prevented when the victim is placed in the recovery position, because fluid can drain easily from the mouth. CONT. Final recovery position: Ensure that the victim’s head is lying on the back of his palm Check that the victim’s other hand is lying free along side his body with palm facing upwards. The former far leg should preferably bend at the knee at about 90°. Continue to monitor the victim’s pulse, signs of circulation and breathing every few minutes as these can stop suddenly. ASSESS THE VICTIM:-  Tap the victim’s shoulder and shout, “Are you all right”  Check for response  Check breathing Activate emergency system :-  Shouts for help Circulation – 1. Check for pulse :-  Checks carotid pulse  Time should be less than 10 sec 5. Airway–  Place one hand on the victim’s forehead and push your palm to tilt the head back.  Place the finger of the other hand under the bony part of the lower jaw near the chin.  Lift the jaw to bring the chin forward.  Check for any secretion and foreign body Breathing -  Observe for the visible chest rise & fall  Pinch the nostril closed with thumb and index finger.  Open the mouth and maintain the mouth seal tight.  Deliver each breath over 1 second Start CPR :- Chest compression - 1. Make sure that victim is lying face up on a hard & flat surface. 2. Check the victim has a head or neck injury. 3. Two handed (Heel of one hand, other hand on the top) 4. Correct placement of hands in center of the nipple on chest 5. Straighten your arms and position your shoulder directly over your hands. 6. Compression rate of at least 100-120/min (deliver 30 compression in 18 seconds or less) 7. Compression depth- 5 cm (2.5 inches) 8. Check for complete chest recoil after each compression 6. Adequate rate :-  Compression and ventilation ratio – 30:2 7. Minimize interruptions 8. Complete 5 cycles in 2 minutes 9. Correct sequence https://journalspub.com/? publication=a-study-to-assess-the-effectiveness-of-a-cardio-pulmon ary-resuscitation-cpr-training-program-on-the-life-saving-knowledge- and-skills-of-the-high-school-students-regarding-cpr-in-a-selected-sc hool-of  Summary In the presentation we have discussed about CPR, definition of CPR, indications of CPR, contraindications, warning signs, adult chain of survival, steps of BLS, sequence of CPR, two rescuer CPR, re-assessment and recovery position after CPR. Conclusion Cardiopulmonary Resuscitation that can save life of victim with no pulse and breath. CPR is not end, it’s a beginning of reviving a person under arrest. As soon as resuscitation is started after ventilation or circulatory arrest the better chances of survival by CPR.  References Brunner & Suddarth’s, Textbook of Medical Surgical Nursing,10th Edition(2004), Lippincott Williams & Wilkins ,Pg. No:250-251. Davidson; Davidsons Principle and Practice of Medicine; 19th Edition; Churchill Living Stone publishers; pp no: 403- 405. Joyce. Black, Medical Surgical Nursing;7th Edition. Elsevier publication, Pg. 472-474. Lewis, Medical and Surgical Nursing, 6th edition, Philadelphia, Mosby publication 2004, Pg.879-884. American Heart Association Guidelines for CPR &Emergency Cardiovascular care circulation 2015; 112:1V1-203. Thank you