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Al Ameed University College of Nursing Subject: critical care nursing Stage: Fourth Lecture: 1 CardioPulmonary Resuscitation ‫م علي عالء الهاشمي‬.‫اعداد م‬  CardioPulmonary Resuscitation Definition: CPR is an emergen...

Al Ameed University College of Nursing Subject: critical care nursing Stage: Fourth Lecture: 1 CardioPulmonary Resuscitation ‫م علي عالء الهاشمي‬.‫اعداد م‬  CardioPulmonary Resuscitation Definition: CPR is an emergency first-aid procedure that is used to maintain respiration and blood circulation in a person, whose breathing and heartbeats have suddenly stopped, (one or more vital functions failed ).  all cases accompanied with hypoxia Extracardiac Causes of cardiac arrest cardiac The primary lesion of cardiac muscle leading to the progressive decline of contractility, conductivity disorders, mechanical factors 4  Causes of circulation arrest Cardiac Extracardiac Ischemic heart disease airway obstruction (myocardial infarction) Arrhythmias acute respiratory failure Electrolytic disorders shock Valvular disease reflector cardiac arrest Cardiac tamponade embolisms of different Pulmonary artery origin thromboembolism Ruptured aneurysm of drug overdose aorta electrocution poisoning 5  Diagnosis of cardiac arrest Blood pressure measurement  Taking the pulse on peripheral arteries  Auscultation of cardiac tones Loss of time !!! Symptoms of cardiac arrest  absence of pulse on carotid arteries – a pathognomonic symptom  Respiration arrest – may be in 30 seconds after cardiac arrest  enlargement of pupils – may be in 90 seconds after 6 cardiac arrest  Main stages of resuscitation C (Circulation) – restore the circulation by external cardiac massag B (Breathing) – start artificial ventilation of lungs A (Airway) – ensure open airway by preventing the falling back of the tongue, tracheal intubation if possible D (Differentiation, Drugs, Fibrillation) quickly perform differential diagnosis of cardiac arrest, use different medication and electric defibrillation in case of ventricular Fibrillation 7  Cardio Pulmonary Resuscitation Three basic vital functions: The three C’s!! Breathing Circulation Consciousness Is the location safe?  Check for anything unsafe, such as spilled chemicals, traffic, fire, and other hazardous items.  Check a conscious person by: getting their approval, ask them about what happened, and do not touch or move painful areas  If no approval is given, DO NOT give care but do call 122  Check an unconscious person by: shouting  Signs of cardiac arrest 1. Unconsciousness in several seconds 2. Respiratory arrest ( apnea) 3. Pulse-less 4. Changed general appearance (color changes, face changes…) 5. Pupils dilation (mydriasis) miosis Chain of Survival Early Early Early Early Access CPR Defibrillation Advanced Care Early CPR is important because it helps circulate the blood that contains oxygen to vital organs. Basic Life Support, BLS sequence Kneel by the side of the victim BLS sequence Shake shoulders Ask “Are you fine?” If he responds Leave as you find him Find out what is wrong Reassess regularly  BLS sequence Unresponsive Shout for help Unresponsive Shout for help Open airway  BLS sequence Unresponsive Shout for help Open airway Check breathing Look, listen and feel for NORMAL breathing Eupnea No breathing – apnea  To perform chest compression inchildren over 1 year of age, Position yourself vertically above the victim’s chest place the heel of one hand over the lower third of the sternum with your arm straight, compress the lower third of the sternum. (avoid compressing the upperabdomen), Normal position of comprtion 33 BLS sequence Unresponsive Shout for help Open airway Check breathing Call for help 30 chest compressions Chest compression Unresponsive Shout for help Open airway Check breathing Call 112 30 chest compressions 2 rescue breaths 2 rescue breaths Pinch nose Place and seal your lips over the victim´s mouth Blow until the chest rises Takes about 1 second Allow chest to fall Repeat (10 – 12 times per minute)  Continue CPR Continue CPR 30 : 2  Defibrillation Analyse rhythm – do not touch victim Shock indicated – stand clear  Need new picture If victim starts to breathe normally place him in recovery position  Drugs used in CPR Atropine – can be injected bolus, max 3 mg , which plays significant role in some cases of cardiac arrest Adrenaline – large doses have been with. The recommended dose is 1 mg in each 3-5 min. Vasopressin – in some cases can replace adrenaline Amiodarone - Lidocaine – should be used only in ventricular Fibrillation 47 Were you paying attention? I hope so! Here are some Key point you NEED to remember!  Check the person for consciousness  Call for help!  Open the airway and look, listen, and feel for signs of life for no more than 10 seconds.  Give 30 chest compressions with both hands then open the airway and give 2 rescue breaths each lasting 1 second.  Continue the 30/2 ratio (5 cycles in 2 minutes) until EMT arrives or you are too exhausted to continue.  Do NOT stop CPR to check for signs of life until an AED is ready, a trained responder arrives or the victim breathes on their own. Here are some key points to Child CPR in case you missed them!  The same first 3 steps apply for children as adults when giving CPR. (check for consciousness, call for help, care, open airway check for signs of life)  After opening the airway, give 2 rescue breaths (1 every 3 seconds)  Check for signs of life  If there are no signs of life, follow with 30 chest compressions with only one hand.  Check for signs of life every 2 minutes  Continue 30 to 2 ratio until EMT arrives.  15\2 Compress the sternum straight down. Put one hand on the forehead and two fingers..  Infant CPR Check the position safety open the infant’s airway by tilting the head back ( do not hyperextend the neck ) Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC) If the infant is not breathing Give two initial relief breaths (1 breath every 3 seconds) The redactor should provide 5 cycles (a cycle is 15 compressions and 2 breaths) of CPR (about 2 minutes) CALL for help and start chest compressions Stop and check for signs of life every 2 minutes Important things you need to know about Infant CPR!  Checking for consciousness on a baby is different from an adult or child, you must tap their foot.  Check for consciousness, call for help, open airway check for signs of life.  An infant needs CPR if there is no breathing and no pulse.  Give 2 rescue breaths then listen for signs of life. Follow with 30 chest compressions with only 2 fingers and not as much force.  Continue 30 to 2 ratio.  Complications during CPR  Gastric distension –often in children Prevention: avoid overinflating the lungs appropriate volum making the chest rise  Rib fractures Prevention: correct hand´s position do not remove hands from the chest wall prevent “dancing on the chest“) Mechanical CPR?