RUFAIDA COLLEGE OF

NURSING JAMIA HAMDARD

Assignment on advanced nursing

procedures

SUBMITTED TO: SUBMITTED BY:

Mrs. Fareha Khan Ms. Umme Ruman
Assistant professor MSc. Nursing 1st year
Rufaida college of Nursing Rufaida college of Nursing
Jamia Hamdard Jamia Hamda
 CARDIOPULMONARY RESUSCITATION (CPR)

INTRODUCTION:
o Approximately 50% of all deaths are due to cardiovascular disease
o CPR is basic life support
o To maintain tissue oxygenation
o In clinical death first 4 to 6 mints, at this time someone can recovered completely by CPR
Meaning of CPR
 Cardio means of the heart and pulmonary means of the lungs
 Resuscitation is medical word to revive to bring back to life
 The person giving CPR is called rescuer

DEFINITON:
Cardio-pulmonary resuscitation includes those techniques which are used to revive
circulation and breathing in patients whose respiration and circulation of blood has suddenly
and unexpectedly stopped.
Purpose
 To maintain sufficient Perfusion of the brain
 To maintain the Sufficient perfusion other vital organs until and adequate
spontaneous Cardiac output can be established
 To prevent brain damage
What is BLS?

• BLS stands for Basic Life Support.

• BLS involves a variety of life-saving skills and techniques, like CPR , a combination of
chest compressions and rescue breaths and pulse checks.
• BLS also involves using specialized equipment like AEDs (Automatic External
Defibrillators) and bag valve masks.
• BLS is performed mostly by healthcare professionals, like doctors, physicians, nurses,
EMTs (Emergency Medical Technicians), paramedics, but also first responders like police
 officers and firefighters.
• BLS is performed when patients are in cardiac arrest, respiratory arrest or distress, or when
there is an obstructed airway.
What is ACLS?
• ACLS stands for Advanced Cardiovascular Life Support.
• In ACLS, healthcare professionals use a set of algorithms to treat conditions ranging from
cardiac arrest and myocardial infarctions (heart attacks) to stroke and other life-threatening
emergencies.
• Part of ACLS involves healthcare professionals interpreting a patient’s heart rhythm using an
electrocardiogram. Based on this heart rhythm, decisions are made regarding treatment
options.
• ACLS providers must have the skills and knowledge to place advanced airways and insert
an IV (Intravenous) or IO (Intraosseous) line for the administration of fluids and
medications.
• And they must have a thorough understanding of all the medications available to them that
are used to treat for the variety of heart rhythms and conditions they will encounter.

BLS

Basic life support (BLS) is the foundation for saving lives following cardiac arrest.
Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA)
and activation of the emergency response system, early cardiopulmonary resuscitation (CPR),
and rapid defibrillation with an automated external defibrillator (AED)

INDICATIONS:
CARDIAC ARREST:
• Cardiac arrest refers to a sudden state of apnea and circulatory failure; it means the victim's
heartbeat; circulation of blood and respiration has suddenly and unexpectedly stopped.
• Only the victims of sudden death are generally resuscitated. For e.g. - Young healthy
individual dying immediately
CARDIO-RESPIRATORY FAILURE

■ The respiratory and cardio-vascular systems are interdependent.

■ Consequently, when the lungs stop working, the heart-fall occurs. Conversely, the
ventilation of the lungs fail soon after the heart stops. This is because the respiratory center
in the medulla oblongata cannot function without the continuous supply of oxygen that is
normally transported to it by the cardiovascular system.
■ The cardio-respiratory failure is marked by hypoxia.
■ When the heart fails to get an adequate supply of oxygen, arrhythmias occur.
■ Angina pectoris is the chest pain produced by the heart tissues that are hypoxic.

Causes of Cardiac Arrest

5 H's and 5 T's:

• Hypoxia,
• Hypovolemia,
• Hydrogen ions (acidosis),
• Hyper/Hypo-kalemia,
• Hypothermia;

• Tension pneumothorax,
• Tamponade-cardiac,
• Toxins,
• Thrombosis-coronary (MI),
• Thrombosis-pulmonary (PE).

Signs and Symptoms of Cardiac Arrest

• Apnea
• Absence of Carotid and Femoral Pulse
• Dilated Pupils
• Cyanosis
• Unconsciousness
• Fit (grand mal seizure
CONTRA - INDICATIONS:
➢ The patient has a valid DNAR order
➢ The patients have signs of irreversible death: rigor mortis, decapitation, or
dependent lividity
➢ No physiological benefit can be expected because the vital functions have
deteriorated despite maximal therapy for such conditions as progressive septic or
cardiogenic shock
➢ Withholding attempts to resuscitate in the delivery room is appropriate for newly
born infants with confirmed gestation <23 weeks or birth weight <400g,
anencephaly, confirmed trisomy 13 or 18
OBJECTIVE OF CPR

To provide oxygen to the brain, heart and other vital organs until appropriate definite medical
treatment (advanced cardiac life support) can restore normal heart and ventilatory action.

PRINCIPLES OF CPR

• To restore effective circulation and ventilation.

• To prevent irreversible cerebral damage due to anoxia. When the heart fails to
maintain the cerebral circulation for approximately four minutes the brain may
suffer irreversible damage.

CHAIN OF SURVIVAL

Sequence of Cardio-pulmonary Resuscitation

C Circulation
A-Airway
B-Breathing
 STEPS
1. Ensure the safety of patient and self. Move the patient only if necessary.
2. Assess the response of the person by tapping his/her shoulder and asking
loudly,” are you okay?”

THE SEQUENCE OF BLS

ABCS of CPR are Airway, Breathing and circulation and begins with an assessment
phase to determine the need for action which include ‘determine unresponsiveness’,
‘determine breathlessness’ and ‘determine pulselessness respectively.

ARTICLES

1. Arrest board/ back board/ flat surface

2. Oral airway
3. A piece of lint to place over victim’s mouth or oral barrier device for mouth-to-
mouth respiration or a mask and ambubag.

PROCEDURE

1. Tap or gently shake patient while shouting “Are you ok”

This will prevent injury from attempted resuscitation of a person who has not suffered a cardiac or
respiratory arrest
2. Check for breathing by keeping your cheek against the victim’s nose and look at the chest for
rise and fall and simultaneously listen and feel for exhaled breath against your cheek

3. CPR should not be administered to a patient with spontaneous respiration because of potential risk of
injury. Carotid pulse may persist when peripheral pulses are not palpable.

4. Call for help in hospital set up.

5. Position the arrest board underneath the victim’s chest (when arrest board is not available, place victim
on firm, flat surface. The arrest board provides a firm surface allowing for compression of the heart

6. Open victim’s airway by using one of the following manoeuvres.

a) Head tilt chin lift manoeuvre- place one hand on victim’s forehead and apply firm backward
pressure with the palm to tilt the head back. Then place the fingers of the hand under the bony
part of the lower jaw near the chin and tilt up to bring the jaw forward
b) Jaw thrust manoeuvre- grasp the angles of the patient’s lower jaw and lift with both hands, one
on each side, displacing mandible forward
 This supports the jaw and helps tilt the head back.
 This maneuver should not be performed for victims with suspected head and neck
injuries.
 Jaw thrust techniques without head-tilt is the safest method for opening the airway in
the presence of suspected neck injury.
7. Place an airway if available
 8. Occlude nostrils with thumb and index finger of the hand on forehead that is tilting the head back. Form
a seal over the patient’s mouth using either your mouth or appropriate respiratory arrest device
(ambubag and mask) and give two full breaths of approximately 0.5 to 2 seconds allowing time for both
inspiration and expiration
Occluding the nostrils and forming a seal over the patient’s mouth will prevent air leakage and provide
full inflation of the lungs. Excessive air volume and rapid respiratory flow rates can create pharyngeal
pressure that is greater than esophageal opening pressure. This will allow air into the stomach
resulting
in gastric

9. Using the index finger of hand nearest to legs of patient locate the lower rib margin and move the
fingers up to where the ribs connect to the sternum.
Place the middle finger of this hand on the notch and index finger next to it. Place the heel of the
opposite hand next to the index finger on the sternum. Ensure that the long axis of the heel of hand is
parallel to the long axis of the sternum. Remove the first hand from the notch and place on top of the
hand that is on the sternum. Extend or interlace fingers. Do not allow them to touch the chest. Keep
arms straight with shoulders directly over the hands-on sternum and lock elbow

10. Compress the adult chest 1 ½ to 2 inches at the rate of approximately 100 per minute

11. Release the external chest compression completely and allow the chest to return to its normal position
after each compression. The time allowed for release should be equal to the time required for
compression. Do not lift hands off chest.

12. Do 30 compression and then perform two ventilations, re- evaluate the patient after four cycles for
CPR performed by one or two rescuers, the compression rate is 100 per minute. The compression:
ventilation ratio is 30:2

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

WHEN TO STOP CPR

Guidelines for termination of resuscitation are:

1. Return of spontaneous circulation
2. Arrival of arrest team or medical help 3. If the
rescuer becomes exhausted
4. When death is confirmed.

NURSING MANAGEMENT

• Maintains airway patency with use of airway adjuncts as required (suction,

high flow oxygen with o2 or bag valve mask ventilation).
• Assist with intubation and securing of ETT
• Inserts gastric tube and/or facilitates gastric decompression post intubation as required.
• Assists with ongoing management of airway patency and adequate ventilation
• Supports less experienced staff by coaching/ guidance e.g. drug preparation
• If a shockable rhythm is present ensure manual defibrillator pads are applied and connected.
• If CPR is in progress, prepare and independently double check and label 3 doses of adrenaline
• Prepare and administer IV fluids
• Document medications administered