CARDIOPULMONARY

RESUSCITATION
by
ROSOS, Lucky Charm D.
SOLIS, Ken
SUCANO, Faith
TREMEDAL, Jorgette Mae A.
WENCESLAO, Dianne
YAP, Mary Aira


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OBJECTIVES

After 5 hours of varied learning activities, the Lecl II nursing
students will be able to:
1. define the terms such as:
1.1 Basic Life Support
1.2 Cadio-pulmonary rescuscitation
1.3 Airway
1.4 Ventilation
1.5 Artificial respiration
1.6 Respiratory arrest
1.7 Crackles
1.8 Rales
1.9 Ronchi
1.10 Cardiac arrest
1.11 Resusitation
1.12 Cardioversion
1.13 Defribrillation
1.14 External cardiac compress
1.15 Heimlich maneuver
1.16 Jaw thrust technique
2. State the general principles of breathing anf circulation
3. Discuss the ABCs of basic life support.
4. Enumerate nad explain the causes w/ respective signs
and symptoms of cardian and respiratory arrest.


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5. Explain the meaning and implication of artificial
respiration
6. Discuss the cardiopulmonary resuscitaiton and its
implication including the technique of external cardiac
compression.
7. Show a tabulated comparison in performing CPR in
adults, children and infant.
8. Delineate the guidelines in performing CPR. And ways to
gauge the effectiveness of its performance.
9. Cite the indication and steps in performing the ff.
techniques used in BLS:
9.1 Heimlich Maneuver
9.2 Jaw thrust technique
9.3 Back blows for infants
9.4 Chest thrust
9.5 Finger sweep
10. Demonstrate the beginning skills in perorming:
10.1 One-man recuer CPR
10.2 Tw0-man Rescuer CPR
10.3 Artificial Respiration





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1.1 Basic Life Support a phase of emergency cardiac case
that is intended to prevent circulatory and respiratory arrest.
1.2 Cardiopulmonary resuscitation involves the use of artificial
and external chest
compression.
1.3 Airway passageway through which air normally circulates.
1.4 Breathing act of inhaling and exhaling.
1.5 Circulation the movement of blood through the heart and
blood vessels.
1.6 Advanced Life Support emergency medical care for
sustaining life including defibrillation, airway management, and
drug management.
1.7 Artificial resuscitation method of forcing air into the lungs
in a person who still has a pulse but whose breathing has
stopped.
1. DEFINITION OF
TERMS


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1.8 Cardiac arrest condition wherein circulation stops, the
pulse disappears and breathing also stops at the same time.
1.9 Respiratory arrest condition wherein breathing stops but
pulse and circulation may continue for the same time.
1.10 Ronchi an abnormal sound heard upon auscultation of an
airway obstructed by thick secretions, muscular spasms,
neoplasm or external pressure.
1.11 Crackles coarse crackles are loud, bubbly sounds best
heard on inspiration.
1.12 Rales a discontinuous sound consisting of a series of
short, non-musical noises, heard primarily during inhalation.
1.13 External Cardiac Compression a rhythmic application of
pressure over the
lower portion of the sternum.
1.14 Ventilation movement of air in and out of airways.
1.15 Cardioversion The conversion of a cardiac rhythm or
electrical pattern to another, generally from an abnormal one to
a normal one. Cardioversion can be accomplished by using
medications or by electrical shock with a special defibrillator.
1.16 Defibrillation is a process in which an electronic device
sends an electric shock to the heart to stop an extremely rapid,
irregular heartbeat, and restore the normal heart rhythm.
1.17 Heimlich Maneuver An emergency treatment for
obstruction of the airway in adults. It may be needed when
someone chokes on a piece of food that has "gone down the
wrong way."
1.18 Jaw-thrust technique a maneuver for opening the airway
of an unconscious patient. The flats of the hands are
placed on the cheeks with the fingers hooked under the
angles of the jaw so that the jaw can be pulled upwards to
separate the tongue from the back of the pharynx. This method


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is particularly useful when spinal injury is suspected and
movement of the neck is undesirable.
1.19 Resuscitation - restoration to life of one apparently dead.







GENERAL PRINCIPLES OF BREATHING AND CIRCULATION
Air that enters the lungs contains about 21 percent oxygen
and only a trace of carbon dioxide. Air that is exhaled from the
lungs contains about 16 percent oxygen and 4 percent carbon
dioxide.
The right side of the heart pumps blood to the lungs, where
the blood picks up oxygen and releases carbon dioxide.
The oxygenated blood then returns to the left side of the
heart, from where it is pumped to the tissues of the body.
In the body tissues the blood releases oxygen and takes up
carbon dioxide, after which it flows back to the right side of the
heart.
All tissues of the body require oxygen, but the brain requires
more than any other tissue. It is generally estimated that if the brain
is totally deprived of oxygenated blood for a period of 4 to 6
minutes, it will suffer irreversible damage.
When breathing and circulation stop, this is called clinical
death.
When the brain has been deprived of oxygenated blood for a
period of 6 minutes or more and irreversible damage has probably
occurred, this is called biological death.
2. PRINCIPLES


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Both ventilation and circulation are required to maintain life.
When breathing stops, the pulse and circulation may
continue for some time, a condition known as respiratory arrest. In
this case only artificial respiration is required, since the heart action
continues to circulate blood to the brain and the rest of the body.
Common causes of respiratory arrest are drowning, electric shock
(usually high voltage), suffocation, strangulation, and drug
overdose.
When circulation stops, the pulse disappears and breathing
stops at the same time or soon thereafter. This is called cardiac
arrest. When cardiac arrest occurs, both artificial respiration and
artificial circulation are required to oxygenate the blood and
circulate it to the brain. Common causes of cardiac arrest are heart
attack, electric shock (usually low voltage), hemorrhage, and--as a
final phase of drowning--suffocation and other forms of respiratory
arrest.








ABCS OF LIFE SUPPORT
- Level of medical care which is use d for patients
with life threatening illness or injuries until the
patient can be given full medical care at a hospital.

Be provided by:
o Trained medical personnel
o Emergency medical technician
3. DISCUSS THE ABCS
of BLS


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o Paramedics
o Laypersons- received BLS training

- Is used in the pre-hospital setting and can be
provided without medical equipment.
- Provided in the field increases the time available
for higher medical responders to arrive and
provide ALS (Advance life support) care.

AIRWAY
o Protection and maintenance of a clear
passageway for gases (O
2
and CO
2
) to
pass between lungs
1. Head tilt- chin lift method
- manually open the patients airway.
Steps:
1. Position yourself at the persons
head.
2. Place your fingers behind the angle
of the jaw and lift upward and
forward.
3. Place the other hand on the persons
forehead and press downward o tilt
the head backward and lift the chin.
2. Head tilt-neck lift method
- open the patient's airway.
- tilt the head back by lifting behind the
neck with one hand while pushing down on
the forehead with the other.





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BREATHING
o Inflation and deflation of the lungs via
airway.
o Actual flow of air through respiration,
natural or artificial respiration, often
assisted by emergency oxygen
To check for breathing:
1. Look for the persons chest to rise
and fall.
2. Listen for sounds of inhaled or
exhaled air.
3. Feel for exhaled air by putting our
cheek near the persons mouth.

CIRCULATION
o Providing an adequate blood supply to tissue,
esp. critical organ such as deliver of O
2
to al
cells and remove metabolic waste via perfusion
of blood throughout the body.
o Include bleeding control or Cardiopulmonary
resuscitation (CPR) techniques to manually
stimulate the heart and assist its pumping
action.
To asses for circulation:
Feel for a pulse, by gently palpating the carotid
pulse. If a pulse is absent or questionable, start
external heart compression.






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Enumerate and explain the causes with respective signs and
symptoms of cardiac and respiratory arrests.

Causes of Cardiac arrest
RESPIRATORY CAUSES CIRCULATORY CAUSES
Upper airway obstruction
(croup, epiglottitis, foreign body)

Lower airway disease
(asthma, bronchiolitis,
pneumonia)

Respiratory depression
(drugs, convulsions, raised ICP)
Fluid loss
(hemorrhagic shock and blunt
trauma, gastroenteritis)

Fluid maldistribution
(sepsis, anaphylaxis, spinal
injury)

Cardiac disease
(cardiac failure, arrhythmias)
RESPIRATORY FAILURE CIRCULATORY FAILURE





4. ENUMERATE AND
EXPLAIN
CARDIAC ARREST


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Signs and symptoms of cardiac arrest
Loss of consciousness
Absence of pulse rate and respiration
No measurable blood pressure
Pallor/cyanosis
Darkening of blood

Causes of respiratory arrest
Aspiration of foreign objects (such as part of a hotdog,
peanuts, candy or small toys in the airway )
Airway infections (such as croup and epiglottitis)
Poisoning and drug overdose
Near drowning accidents and electrocution
Sudden infant death syndrome (death of a child or infant that
remains unexplained after a complete autopsy)

Signs and symptoms of respiratory arrest
Bradycardia or slowed heart rate
Episodes of apnea
Gasping
Agonal or uncoordinated respirations
Hypotension
Absence of breath sounds
No response to painful stimuli








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Explain the meaning and implications of artificial respiration
a. Mouth-to-mouth
Artificial ventilation with the mouth-to-mouth
technique is quick, effective way to provide oxygen to
the patient
The exhaled air contains enough oxygen to supply
the patients needs

b. Mouth-to-nose
It is effective when the patients mouth cannot be
opened (lock jaw), extensive facial or dental injuries
occur, or an air tight seal of the mouth cannot be
achieved.

5. EXPLAIN


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c. Mouth-to-stoma
A stoma is a permanent opening in the neck through
which the person breathes following the removal of
the larynx
When a person with a laryngectomy requires rescue
breathing, direct mouth-to-stoma ventilation should be
performed



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d. Mouth-to-mask
The mouth-to-mask breathing device includes a
transparent mask with a one-way valve mouthpiece.
The one-way valve directs the rescuers breathe into
the patients airway while directing the patients
exhaled air away from the rescuer.

e. Mouth-to-mouth and nose
It is usually done for infants and children whose
mouths are very small for effective mouth-to-mouth
resuscitation
Artificial respiration is inflated and maintained in
essentially the same manner.
















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d. Bag valve mask
This is a simple device, manually operated by the
rescuer, which involves squeezing a bag in order to
expel air into the patient









Cardiopulmonary resuscitation (CPR) is an emergency
procedure which is 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 in cardiac
arrest. It is indicated in those who are unresponsive with no
breathing or abnormal breathing, for example agonal respirations. It
6. DISCUSS THE CPR


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may be performed both in and outside of a hospital.

CPR involves chest compressions at least 5 cm deep and at
a rate of at least 100 per minute in an effort to create artificial
circulation by manually pumping blood through the heart. In
addition, the rescuer may provide breaths by either exhaling into
the subject's mouth or nose or utilizing a device that pushes air into
the subject's lungs. This process of externally providing ventilation
is termed artificial respiration. Current recommendations place
emphasis on high-quality chest compressions over artificial
respiration; a simplified CPR method involving chest compressions
only is recommended for untrained rescuers.

CPR alone is unlikely to restart the heart; its main purpose is
to restore partial flow of oxygenated blood to the brain and heart.
The objective is to delay tissue death and to extend the brief
window of opportunity for a successful resuscitation without
permanent brain damage. Administration of an electric shock to the
subject's heart, termed Defibrillation, is usually needed in order to
restore a viable or "perfusing" heart rhythm. Defibrillation is only
effective for certain heart rhythms, namely ventricular fibrillation or
pulseless ventricular tachycardia, rather than asystole or pulseless
electrical activity. CPR may succeed in inducing a heart rhythm
which may be shockable. CPR is generally continued until the
subject regains return of spontaneous circulation (ROSC) or is
declared .dead





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Adult and Children/ Infant Compression Characteristics
ARTIFICIAL
RESPIRATION
ADULT CHILD INFANT
Opening of the
Airway
Maximum tilt of
the head and
Chin Lift
Maximum tilt of
the head and chin
lift
Neutral position.
Dont hyperextend
the infants neck
Method Mouth to mouth Mouth to mouth Mouth to mouth
and nose
Breaths Full slow ( 1-2
sec/ breath)
Full slow ( 1-15
sec/breath)
Gentle slow( 1- 15
sec/ breath)

Rate
10- 12 breath/
min. breathing
every 4 to 5
seconds
20 breaths/ min.
or breath every
second
20 breaths/min. or
1 breath every 30
seconds
Cycles 3 5 5
Compression
Area
Measure up to 2
fingers from the
sudsternal
notch; 1-2 cm
above xyphoid
process
(sternum)
Measure up to 1
finger from the
substernal notch
1 finger width
below imaginary
nipple line
Depth 1 - 2 inches 1 - 2 inches inches
Compress 2 heels of the
hand over the
sternum
1 heel of the hand
over the sternum
2 fingers over the
sternum
7. SHOW A TABULATED
COMPARISON


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Compression
ventilation Ratio
One- rescuer(
30:2)
Two- rescuer
(30:2)
One- rescuer
(30:2)
Two-rescuer
(15:2)
15:2









Prompt action is vitally important to the success of CPR.
When a person stops breathing spontaneously and his heart
stops beating, clinical death has occurred. Within 4 to 6
minutes, the cells of the brain begin to deteriorate due to
lack of oxygen. If the oxygen supply is not restored
immediately, the patient will suffer irreversible brain damage
and biologic death occurs.




It is only used when absolutely necessary since it also poses
some danger to the patient.
o Indicated during:
Absence of carotid pulse,
Absence of response to stimuli,
Slow, absent, or gurgling respirations, and
A deathlike appearance to the face.



8. DELINEATE THE
GUIDELINES


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Remember the ABCs of CPR. (Airway, Breathing,
Circulation)

Before performing CPR, make sure that the airway is open
and can allow for the passage of air into the bronchi.

If the patient is an infant or a small child, less force is used,
and small puffs of air are sufficient to inflate the lungs.

Make sure that your client is lying in a hard steady surface
before starting cardiac compression.

An effective squeezing of the heart is extremely difficult, if
not impossible, when the patient is lying on a soft surface
that will move downward each time the chest is compressed.

Position your hands properly in the lower half sternum. Do
not let your fingers touch the chest wall.

This is very important because improper positioning of the
hands for pressure on the heart will not circulate blood and
may damage ribs and external organs.

Position yourself directly over the patient so that you can
apply pressure downward vertically, thus using the weight of
your upper body to compress the heart.

Apply firm, heavy pressure, keeping the arms straight.

The amount of the pressure varies with the anatomy of the
victim, but the goal is to push the sternum down 1 to 2
inches in order to squeeze the heart against the spinal
column.

Never interrupt the rhythm of the chest compressions. (60
times per minute for adults and 80 to 100 times a minute for
children and infants) This happens in a two-man CPR.




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Indications and steps in performing the following:
Heimlich Maneuver

Indications:
The person cannot speak or cry out.
The face turns blue from lack of oxygen.
The person desperately grabs at his or her throat.
The person has a weak cough, and labored breathing
produces a high-pitched noise.
The person does all of the above, then becomes
unconscious.

Steps:
Heimlich Maneuver for Choking Adults (Conscious)
1. From behind, wrap your arms around the victim's waist.
2. Make a fist and place the thumb side of your fist against the
victim's upper abdomen, below the ribcage and above the
navel.
3. Grasp your fist with your other hand and press into their
upper abdomen with a quick upward thrust. Do not squeeze
the ribcage; confine the force of the thrust to your hands.
4. Repeat until object is expelled.

9. CITE THE INDICATION


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Heimlich Maneuver for Choking Adults (Unconscious)
1. Place the victim on back.
2. Facing the victim, kneel between the victim's shoulder. With
one of your hands on top of the other, place the heel of your
bottom hand on the upper abdomen below the rib cage and
above the navel. Use your body weight to press into the
victim's upper abdomen with a quick upward thrust.
3. Repeat until object is expelled. If the Victim has not
recovered, proceed with CPR.
4. The Victim should see a physician immediately after rescue.
5. Don't slap the victim's back. (This could make matters
worse.)




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Heimlich Maneuver for Choking Infants
1. Lay the child down, face up, on a firm surface and kneel or
stand at the victim's feet, or hold infant on your lap facing
away from you. Place the middle and index fingers of both
your hands below his rib cage and above his navel. Press
into the victim's upper abdomen with a quick upward thrust;
do not squeeze the rib cage. Be very gentle. Repeat until
object is expelled.

2. If the Victim has not recovered, proceed with CPR. The
Victim should see a physician immediately after rescue.











The Heimlich Maneuver for Choking (Oneself)
1. Make a fist and place the thumb side of your fist against your
upper abdomen, below the ribcage and above the navel.
2. Grasp your fist with your other hand and press into your
upper abdomen with a quick upward thrust.
3. Repeat until object is expelled.


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4. Alternatively, you can lean over a fixed horizontal object
(table edge, chair, railing) and press your upper abdomen
against the edge to produce a quick upward thrust. Repeat
until object is expelled.
5. See a physician immediately after rescue.


Jaw thrust technique

Indications:
Possible cervical spine injury
Unresponsive patient
Patient is unable to protect his or her own airway
Patient is resistant to opening mouth

Steps:
1. Position yourself at the top of the victim head
2. Place the meaty portion of the base of your thumbs on the
arches of the jaw, and hook the tips of your index fingers
under the angle of the mandible, in the indent below the ear
3. While holding the victims head still, displace the jaw forward
and open the victims mouth with your thumb tips



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Baby Blows for Infants

Indications
Babies that are choking.
If a baby is suddenly unable to cry or cough.

Steps:
1. Carefully position him faceup on one forearm, cradling the
back of his head with that hand.
2. Place the other hand and forearm on his front. He is now
sandwiched between your forearms.
3. Use your thumb and fingers to hold his jaw and turn him over
so that he's facedown along the other forearm. Lower your
arm onto your thigh so that the baby's head is lower than his
chest.
4. Using the heel of your hand, deliver five firm and distinct
back blows between the baby's shoulder blades to try to
dislodge the object. Maintain support of his head and neck
by firmly holding his jaw between your thumb and forefinger.
5. Next, place your free hand (the one that had been delivering
the back blows) on the back of the baby's head with your
arm along his spine. Carefully turn him over while keeping
your other hand and forearm on his front.


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Chest Thrust
Indication:
For obese or pregnant victims.
Baby that are choking.

Chest thrust for choking babies
1. Use your thumb and fingers to hold his jaw while
sandwiching him between your forearms to support
his head and neck. Lower your arm that is supporting
his back onto your opposite thigh, still keeping the
baby's head lower than the rest of his body

2. Place the pads of two or three
fingers in the center of the
baby's chest, just below an
imaginary line running between
his nipples. To do a chest thrust,
push straight down on the chest
about 1 1/2 inches. Then allow
the chest to come back to its
normal position.

Chest Thrust for Conscious Patient Standing or Sitting
Stand behind the patient with your arms under
the patients axillae to encircle the patients
chest.
Place the thumb side of your fist on the middle
of the patients sternum, taking care to avoid
the xiphoid process and the margins of the rib
cage.
Grasp your fist with the other hand and perform
backward thrust until the foreign body is
expelled or the patient becomes unconscious.
Each thrust should be administered with the
intent of relieving the obstruction. All thrust


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should be in rapid sequence.

Chest Thrust for Conscious Patient Lying-
Unconsious
1. Place the patient on the back and kneel
close to the side of the patients body.
2. Place the heel of your hand on the lower
half of sternum.
3. Deliver each chest thrust slowly and
distinctly with the intent relieving the
obstruction.












FINGER SWEEP
Indication:
Finger sweeps should be used only in the
unconscious victim who does not have good
reflexes or the ability to bite the rescuers finger.
Steps:
1. Open the adult patients mouth by grasping both
tongue and lower jaw between the thumb and
fingers and lifting the mandible. This maneuver is
to be used only in unconscious patient. This action
draws the tongue way from the back of the throat


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and away from the foreign body that may be
lodged there.
2. If a foreign body is visible in the mouth, insert the
index finger of the other hands down along the
inside of the cheek and scrape across the back of
the throat.
3. Use a hooking action to dislodge the foreign body
and maneuver it into the mouth for removal.. Care
is used to avoid foreign the object deeper into the
throat.