CARDIO-

PULMONARY
RESUSCITATION
DEFINITION:
CPR is a basic emergency procedure for life support consisting of artificial respiration and manual external
cardiac massage.
Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for
an infant, child, or adolescent who has stopped breathing (respiratory arrest) and/or whose heart has
stopped (cardiac arrest)

PURPOSES:
 To establish effective ventilation and circulation.
 To prevent irreversible brain damage from anoxia.
 To decrease immature mortality rate of patient in hospital.

INDICATIONS :
1.Respiratory arrest resulting from :
 drowning
 stroke
 foreign body
 drug overdose
 smoke inhalation
 suffocation
 myocardial infraction
 coma; of any cause leading to airway obstruction.
2.Cardiac arrest
 Sudden and complete loss of cardiac function.
 Sudden collapse with loss of consciousness.
 Pulse absent(femoral and carotid).
 No respiration.
 NOTE: If CPR is not given within 4-6 minutes, death may occur.

TYPES :
A. Basic life support(BLS)
B. Advance life support(ALS)

BASIC LIFE SUPPORT:

 It is the sequences of procedures preformed to restore the circulation of oxygenated blood
after a sudden pulmonary and/or cardiac arrest.
 Chest compressions and pulmonary ventilation performed by anyone who knows How to do
it, anywhere, immediately, without any other equipment.
Aims:
 To ensure open airway and adequate ventilation.
  To maintain circulation until help comes and definite treatment with advanced life support
can be administered.

ADVANCE LIFE SUPPORT:

 Airway secured with advanced technology,
 Breathing is maintained with some means of breathing apparatus, and
 Circulation is maintained by BLS along with: - IV access - Defibrillator, and - Appropriate
drugs.

PROCEDURE:
 Check for responsiveness of victim. If you suspect that victim has sustained spinal or neck
injury , do not shake or move him. Otherwise shake victim gently and shout ‘Are you
okay?’ to see if there is any response. If there is no response no breathing quickly call for
emergency help and follow following steps:
 Circulation assessment - Establish presence or absence of carotid pulse by placing two
fingertips on his carotid artery for 5 to 10 secs. - Start chest compression immediately if the
carotid pulse is absent or questionable.
 Remember to spell C-A-B
The American Heart Association uses the letters C-A-B — compressions, airway, breathing — to
help people remember the order to perform the steps of CPR.
Here's advice from the American Heart Association:

 Untrained. If you're not trained in CPR, then provide hands-only CPR. That means
uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive (described
in more detail below). You don't need to try rescue breathing.
 Trained and ready to go. If you're well-trained and confident in your ability, check to see
if there is a pulse and breathing. If there is no breathing or a pulse within 10 seconds, begin
chest compressions. Start CPR with 30 chest compressions before giving two rescue breaths.
 Trained but rusty. If you've previously received CPR training but you're not confident in
your abilities, then just do chest compressions at a rate of 100 to 120 a minute.
1. Chest compression: Restore Blood Circulation
 The rhythmic application of pressure over the lower half of the sternum. Kneel as close to side of
the victim’s chest as possible.
 Place the heel of one hand in the center of victim’s chest between the nipples.
 Place the other hand on top of the first one and interlock the finger and the finger’s of both hands
directed away from rescuer.
 In children it is done with one hand where as in infants it is done with two fingers(index and
middle finger) Compression rate should be 100 compression/minute with a compression depth of
1.5-2” (approx. 4-5 cm)
 Allow the chest return to its normal position completely after each compression with equal
compression and relaxations
 Assess after 1 minute , if circulation present(heart beat returns back) stop compressions
immediately but continue rescue breathing and check circulation in each minute.
 If the victim remains unresponsive , check the airway.
2. Assess Airway: Open the Airway
 Assess for any visible obstructions in the airway.
  Clear airway by removing any loose obstruction, (mucus, blood, foreign body) from mouth and
pharynx.
 In case of unconscious victim, tongue is the most common cause of airway obstruction. f the
victim is still not breathing, then open airway by head tilt and chin lift or jaw thrust.
 Note : The jaw thrust is a technique used on patients with a suspected spinal injury and is used
on a supine patient.
 If the victim is still not breathing on in his own after the airway has been you will have to assist
him breathing.
3. Breathing: Breathe for the person
 Look, listen, feel. Place ear over the victim’s mouth and nose, looking toward the victim’s chest
and stomach. Watch to see if the victim’s chest is raising.
 Pinch the nostrils closed with the thumb and index fingers of the hand that is on the forehead.
 Take a deep breath, open mouth wide, place it outside of the victim’s mouth making a tight seal.
 Inflate the victim’s lung by 2 full breaths each breath over 1 sec allowing the victim’s lungs to
relax.
 If resistance is experienced, then recheck airways.
 Note: Avoid rapid or forceful breath. Rate:10-12 breaths/min.
 Continue the cycle of 30 chest compressions and 2 rescue breaths until spontaneous circulation is
returned or until the arrival of medical help.
To perform CPR on a child

The procedure for giving CPR to a child age 1 through puberty is essentially the same as that for an adult.
The American Heart Association also recommends the following to perform CPR on a child:
1. Compressions: Restore blood circulation
 Put the child on his or her back on a firm surface.
 Kneel next to the child's neck and shoulders.
 Use two hands, or only one hand if the child is very small, to perform chest compressions. Press
straight down on (compress) the chest about 2 inches (approximately 5 centimeters). If the child
is an adolescent, push straight down on the chest at least 2 inches (approximately 5 centimeters)
but not greater than 2.4 inches (approximately 6 centimeters). Push hard at a rate of 100 to 120
compressions a minute.
 If you haven't been trained in CPR, continue chest compressions until there are signs of
movement or until emergency medical personnel take over. If you have been trained in CPR, go
on to opening the airway and rescue breathing.
2. Airway: Open the airway
  If you're trained in CPR and you've performed 30 chest compressions, open the child's airway
using the head-tilt, chin-lift maneuver. Put your palm on the child's forehead and gently tilt the
head back. Then with the other hand, gently lift the chin forward to open the airway.
3.Breathing: Breathe for the child
Use the same compression-breath rate that is used for adults: 30 compressions followed by two breaths.
This is one cycle.
 With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-
to-mouth breathing and cover the child's mouth with yours, making a seal.
 Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and
watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise,
repeat the head-tilt, chin-lift maneuver and then give the second breath. Be careful not to provide
too many breaths or to breathe with too much force.
 After the two breaths, immediately begin the next cycle of compressions and breaths. If there are
two people performing CPR, conduct 15 compressions followed by two breaths.
 As soon as an AED is available, apply it and follow the prompts. Use pediatric pads if available,
for children up to age 8. If pediatric pads aren't available, use adult pads. Administer one shock,
then resume CPR — starting with chest compressions — for two more minutes before
administering a second shock. If you're not trained to use an AED, a 112 or other emergency
medical operator may be able to guide you in its use.
 Continue until the child moves or help arrives.

To perform CPR on a baby

Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know
the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't
breathing, perform CPR.
To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't
shake the baby.
If there's no response, follow the C-A-B procedures below for a baby under age 1 (except newborns, which
includes babies up to 4 weeks old) and time the call for help as follows:
 If you're the only rescuer and you didn't see the baby collapse, do CPR for two minutes — about
five cycles — before calling 112 or your local emergency number and getting the AED. If you
did see the baby collapse, call 112 or your local emergency number and get the AED, if one is
available, before beginning CPR.
 If another person is available, have that person call for help immediately and get the AED while
you attend to the baby.

1. Compressions: Restore blood circulation

 Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also
will do.
 Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just
below this line, in the center of the chest.
 Gently compress the chest about 1.5 inches (about 4 centimeters).
 Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 to 120
compressions a minute.
2. Airway: Open the airway
 After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing
down on the forehead with the other hand.
3. Breathing: Breathe for the baby
 Cover the baby's mouth and nose with your mouth.
  Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air
(instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time,
taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second
rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the
second breath.
 If the baby's chest still doesn't rise, continue chest compressions.
 Give two breaths after every 30 chest compressions. If two people are conducting CPR, give two
breaths after every 15 chest compressions.
 Perform CPR for about two minutes before calling for help unless someone else can make the
call while you attend to the infant.
 Continue CPR until you see signs of life or until medical personnel arrive.

Guidelines for termination of resuscitation:

 Return of spontaneous circulation.
 Arrival of arrest team or medical help.
 If the rescuer becomes exhausted.
 When death is confirmed.
Points to remember:
 Assess the victim (look, listen, feel) and if not breathing call for help.
 Compression should be smooth, regular and uninterrupted.
 The pressure on the chest should be completely released after each compression, although the
palm of the hand remains in contact with the chest wall.
 Assess the victim (look, listen, feel) and if not breathing call for help.
 Compression should be smooth, regular and uninterrupted.
 The pressure on the chest should be completely released after each compression, although the
palm of the hand remains in contact with the chest wall.
 All CPR equipment is to be checked at the beginning of each shift.
 Ratio of cardiac compression to ventilation:30:2
 Compression rate =100 compression/minute
 Compression depth Adult =5cm Child =4cm Neonate =3cm

CONCLUSION:
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often
with artificial ventilation 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. It
is recommended in those who are unresponsive with no breathing or abnormal breathing, for
example, agonal respirations. 
CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at
least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into
the subject's mouth or nose (mouth-to-mouth resuscitation) or using a device that pushes air into the
subject's lungs (mechanical ventilation). Current recommendations place emphasis on early and high-
quality chest compressions over artificial ventilation; a simplified CPR method involving chest
compressions, is only recommended for untrained rescuers. In children, however, only doing compressions
may result in worse outcomes because, in children, the problem normally arises from a respiratory, rather
than cardiac, problem. Chest compression to breathing ratios is set at 30 to 2 in adults.
REFRENCES:
1. Giri M, Sharma P, Essentials of Fundamentals of Nursing, 1st edition, Pp:385-386. 
2.  Pathak S, Devkota R, A Text Book of Fundamentals of Nursing, 2010 edition, Pp:333- 337. 
3.  Kozier and Erb’s, Fundamentals of Nursing, 8th edition, Pp:1419-1420.
4.  Brunner & suddharth’s Textbook of MedicalSurgical Nursing, 12th edition, Pp: 843-845.
5. https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600