Cardiopulmonary resuscitation

www.drjayeshpatidar.blogspot.in
CARDIOPULMONARY RESUSCITATION
( CPR
)
18/05/20181

Anatomy And Physiology Of
Heart And Lungs
Heart
Heart is responsible for the circulation of the
blood.Heart is actually two pumps in one
(1) Propels blood through the pulmonary
circulation
(2) Propels blood through the systemic
circulation
Healthy heart pumps approximately 5L
per min 18/05/2018www.drjayeshpatidar.blogspot.in

Size And Location
18/05/2018www.drjayeshpatidar.blogspot.in3
Shape of a blunt cone
measures
About12 x 9cm
and weighs
300gms in male
,250gms in
female.
Obliquely behind body
of sternum.

Heart chambers And valves
Heart has 4 chambers
(1)Right atrium
(2)Right ventricle
(3)Left atrium
(4)Left ventricles
Valves are
(1)Atrioventricular valve
(2)Semilunar valves

Conducting system
It is made by myocardium that is specialized
for initiation and conduction of cardiac
impulses.They are
(1)Sinuatrial node
(2)Atrioventricular node
(3)Bundle of his
Right And Left
(4)Purkinje fiber

Blood supply to the heart
Arteries;
(1)Right coronary artery
Branches,
(A)Marginal
(b)Posterior
interventricular
(c)Nodal
(d)Rt atrial

Cont……………..
(e) Infundibular
(f) Terminal
Areas of distribution
(1)Rt atrium
(2)Greater part of Rt ventricle & small part
of Lt ventricle
(3)Posterior part of interventricular septum
(4)Whole conducting system except Lt
branch of AV Bundle 18/05/2018www.drjayeshpatidar.blogspot.in7

Cont…………..
(2)Lt coronary artery
Branches,
(a)Anterior interventricular
(b)Br to the diaphragmatic surface of the
Lt ventricle
(c)Lt atrial
(d)Pulmonary
(e)Terminal

Cont……….
Area of distribution
(1)Lt atrium
(2)Great part of Lt ventricle and small part
of Rt ventricle
(3)Part of Lt branch of AV bundle
(4)Anterior part of interventricular septum

Cont………….
Veins;
(1)coronary sinus
(2)Anterior cardiac
vein
(3)Venae cordis
minimi

Heart sounds
1st heart sound
-in the Lt 5th inter costal space near the
sternal boarder
-prolonged and loud sound like “Lub”
-produced by closure of mitral and tricuspid
valves
2nd heart sound
-in the 2nd intercostal space close to sternum

Cont……….
-it is short and sharp sound like “Dupp”
-sound marks the clinical end of the systole
and clinical beginning of the diastole
3rd heart sound
-sound is produced by vibration of the
ventricular wall produced in the first rapid
filling phase of the ventricle

Cont…………
4th heart sound
-called atrial sound
-produced by last rapid filling phase
-not audiable by stethoscope
Adventitious heart sound
(1)Snaps and clicks
-stenosis of the mitral valve
-caused by high pressure in the Lt atrium
with mitral valve displacement 18/05/2018www.drjayeshpatidar.blogspot.in13

Cont……………
(2)Murmers
-caused by narrowing of the
valves ,malfunctioning of
valves ,congenital defect of the
ventricular defect,defect b/w aorta
pulmonary artery
(3)Friction rub
- a harsh,grating sound that can be heard
both systole &diastole 18/05/2018www.drjayeshpatidar.blogspot.in14

Lungs
Lungs are pair of respiratory organs in the
pleural cavity.They are brown or grey in
colour.Rt lung weights about 700gms it is
heavier than Lt lung.Each lung is conical in
shape.
FISSURES AND LOBES OF LUNGS
Rt lungs
3 lobes by 2 fissures

Cont………………
Fissures
(1) oblique fissure
(2) horizontal fissure
Lobes
(1) upper lobe
(2) middle lobe
(3) lower lobe

Cont…………….
Lt lung
Fissure oblique fissure
Lobes
(1) upper lobe
(2) lower lobe

Lung sounds
Normal sounds
1 bronchial breath sounds
2 vesicular breath sounds
Abnormal sounds
1 Crackles
a) coarse crackles
b) fine crackles

Cont……..
2. Wheezes
a) Sonorus wheezes(rhonchi)
b) Sibilant wheezes

Cardiac Arrest ?
Sudden stopping of the pumping
action of the heart
Unconscious
Major pulse absent
MI
Asphyxia
drug overdose in
majority of children
Myocardial infarction
Stroke
Electrocution
Drowning
Choking
Trauma
Drug overdosage
Poisoning
In hospital SCA
Out of hospital SCA
Witnessed arrrest
Unwitnessed arrest

Gauging
Cardiac monitoring
a) ECG
b) Blood pressure
c) Pulse
d) Cardiac ausculation
Laboratory examination
a) Lipid profile
b) Creatine kinase
c) Serum electrolytes
d) Chest X-ray

Human mentation
a) CPR should start within 4mins.
b) should reassess circulation & breathing
in every 2-3 mins.
c) Don’t interrupt the CPR more than 7sec.

Intensive care
1) For close &
Continuous
monitoring.
2) Keep patient in
recovery position ie
left lateral position.

PHASES OF CPR
Phase--1 Basic
Life
Support
Airway
Breathing
Circulation
Phase--2
Phase--3
Advanced
Cardiac
Life
Support
Prolonged
Life
support
Drugs
ECG
Fibrillation
Gauging
Human mentation
Intensive care

Adult BLS -SAFE Approach

Chain of survival

Cardiopulmonary Resuscitation
CPR is a combination of rescue breathing
and chest compression delivered victims
through to be in cardiac arrest.
‘CPR’ the letters indicates,
C – Cardio
P – Pulmonary
R – Resuscitation
It means the reestablishment of heart and
lung action once it has stopped. 18/05/2018www.drjayeshpatidar.blogspot.in27

CPR
Restoration
Of
Spontaneous
Circulation
(ROSC)
Perform
Chest Compression
(CC)
Rescue Breathing
(RB)

SAFETY First
SHAKE on shoulders
and SHOUT
Hey ?Are You all right?
Sequence of
Action and (Re)/Assessment,
Response,
What is the response of the
victim to your action?
1
Your Actions
2
Victim’s Responses
3
Your assessments

Indications for CPR
(1) Absence of carotid pulse
(2) Absence of response to stimuli
(3) Absence of respiration
Steps in CPR
Steps in CPR AHA suggests using
“ABC” s the are
A – Airway
B – Breathing
C - Circulation

CPR for Adult
(1) Establish unresponsiveness
Gently shake and shout
“ Are you ok?”

Response of victim
No response
Shout for help
o turn the victim on to
his back and then
open the airway
o With your fingertips
under the point of the
victim's chin, lift the
chin to open the
airway.

(2) Check for airway and establish an airway
Turn the victim’s body on his back
and assess the airflow by keeping ear
close to victims nose and observe for raise
and fall of chest and feel the air flow by
placing cheek.if resp is absent,
maintain,
-Head tilt and chin lift with the hand on the
forehead
-Pinch the nose
-Deliver 2 full breaths lasting about 1.5 sec

Airway Assessment
Keeping the airway open,
look, listen, and feel for
normal breathing-
ten seconds
Look for chest movement
Listen at the victim's
mouth for breath sounds
Feel for air on your cheek

Rescue breathing
Ensure head tilt and chin
lift
Pinch the victim’s nose
closed with the index
finger and thumb of your
hand on his forehead
Open his mouth a little,
but maintain chin lift
Maintaining head tilt and
chin lift, take your
mouth away from the
victim and watch for his
chest to fall as air
comes out

Jaw thrust…

If no visible chest rise on RB….?
Check the victim's mouth and
remove any visible
obstruction.
Recheck that there is
adequate head tilt and chin
lift.
Do not attempt more than
two breaths each time before
returning to
chest compressions
If you see a foreign body, remove it.

Cont…………..
General
Please do not Hyperventilate
Opening the airway priority for an unresponsive trauma
victim
Breaths in all age groups should be delivered over 1
second and should produce visible chest rise.
When the victim has an advanced airway
(eg, endotracheal tube) in place,
CPR is no longer performed as "cycles" of compressions
with pauses for breaths.
The compressor gives continuous compressions.
The rescuer giving breaths should give 1 breath every
6 to 8 seconds (about 8 to 10 breaths/minute)

Give 2 Rescue Breaths
Give 2 rescue breaths,
each over 1 second,
with enough volume
to produce
visible chest rise
to all forms
of ventilation during CPR,
including
mouth-to-mouth and
bag-mask ventilation and ventilation
through an advanced airway,
with and without supplementary
oxygen (Class IIa)

(3) Assess for presence of pulse
Assess thee carotid pulse .if there is no
pulse start compression.
(a)Location Of the compression site;
- locate xiphoid process,put the
index finger of the same hand on the lower
end of the patients sternum,
- place your hand alongside your
fingers

Hand Placement

Hand Placement…

(b) Position your hand
- position your free hand on the top of
the hand that placed on the hand.
- interlocate your finger.
- elbow of the hand should be stright and
shoulder is directly over hands.
(C)Perform chest compressions
- apply firm,heavy pressure depress the
sternum
- after each compression allow chest to
return normal position

- 30 compressions and 2 breaths in a
cycle.

Name of drug Action Indication
1.Epinephrine (adrenaline)
Adult: I V 0.1- 1mg/kg
5 mins as needed
Child: I V 0.01mg/kg
5 mins as needed
Increase the systemic
vascular resistance and
blood pressure,
strengthens myocardial
contractions, increase
cardiac output and cardiac
rate.
Cardiac arrest caused by
asystole, ventricular
tachycardia or ventricular
fibrillation.
2. Atropine
Adult : I V 0.5-1 mg q 1-2
hr
Child : I V 0.01-0.03mg/kg
for 1-2 doses
Blocks parasympathetic
action increase SA node
automaticity and AV
conduction
Sinus bradycardia or
asystole during CPR
18/05/2018www.drjayeshpatidar.blogspot.in

Name of drug Action Indication
3. Sodium bi carbonate
Adult IV 1meq/kg at 7.5
or 8.4% solution over 1-2
mins
Child IV 0.5-1meq/kg at
4.2% solution over 1-2
mins
4.Vasopressin
Restores buffering
capacity of the body and
neutralizes excess acid
Increase the permeability
of renal tubular
epithelium &promotes
reabsorption of water
Metabolic acidosis
Diabetic insipid us
Post operative
abdominal distention
5.Lindocaine
hydrochloride
Decrease depolarization
,automaticity ,and
excitability in ventricular
phase
Ventricular arrhythmias
Cardiac surgery
Cardiac catherization

Electrical current
may be on
delivered through
paddles or
conductor pads
both paddles
placed on the front
of the chest.

Points to be remember during
defibrillation
1)Maintain good contact between the pads
& the patient’s skin
2)Ensure that no one is in contact with
patient or anything that is touching the
patient
3)Use conducting agents between pads and
skin

4)Ensure that monitoring leads are attached
to patient
5)Don’t charge the device until ready to
shock
6)Before pressing the shock discharge
button call clear 3 times
7)Record delivery energy and the results
8)After the event inspect the skin under
pads for burns

Defibrillation
- Is a treatment for
the
tachydysrhythmias.
- They are usually
used to deliver an
external current to
depolarize a critical
mass of
myocardial cells 18/05/2018www.drjayeshpatidar.blogspot.in50

Signs of successful CPR
(1) You should feel the carotid pulse.
(2) Chest should raise and fall with all
ventilation.
(3) A heart beat may return.
(4) A spontaneous gasp of breathing may
occur.
(5) Skin colour may improve.

Complications of CPR
(1) Fracture of the sternum.
(2) Pneumothorax.
(3) Hemothorax.
(4) Lacerations to the lungs.

Future of CPR -- in You
most important
determinant of
survival from sudden
cardiac arrest
Presence of a trained
rescuer who is
Ready, able, willing and
equipped to act

BIBLIOGRAPHY
(1) www.americanheart.org
(2) Chaudhuri.coinise medical
physiology.central publishers.4th
edition.157-62
(3) BD Chaurasias’s .human anatomy.cbs
publishers.4th edition.181-92.
(4) J.David Bergaon,gloria Bizjak.First
responder.5th edition.812-14.

Cont………….
(5) Lehman ,Sands ,Phils.Medical-surgical
nursing.Mosby publishers.5th edition.812-
14.
(6) Brunner,Suddarth’s. Text book of
medical-surgical nursing.10th edition.480-
81,665-66,810-12.

Thank You

Cardiopulmonary resuscitation

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