Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 42 views

    Cardiopulmonary Resuscitation: By: Dr. Mohita Singh

    Uploaded by

    khanfayiq11
    Yem chi laghbag same to you dear so no need for a long term y a d e f g h I guess it was the issue 6

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Cardiopulmonary Resuscitation: By: Dr. Mohita Singh

    Uploaded by

    khanfayiq11
    42 views19 pages
    Yem chi laghbag same to you dear so no need for a long term y a d e f g h I guess it was the issue 6

    Original Title

    CPR

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Yem chi laghbag same to you dear so no need for a long term y a d e f g h I guess it was the issue 6

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views19 pages

    Cardiopulmonary Resuscitation: By: Dr. Mohita Singh

    Uploaded by

    khanfayiq11
    Yem chi laghbag same to you dear so no need for a long term y a d e f g h I guess it was the issue 6

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 19

    CARDIOPULMONARY

    RESUSCITATION

    By: Dr. Mohita Singh


    CPR is first aid, life saving emergency procedure and must be started
    without losing a second. It is given to patients with cardiac arrest.

    Cardiopulmonary arrest is said to have occurred when there is sudden


    stoppage of heart or respiration or both. It is an extreme emergency that
    threatens life. Consciousness is lost within 10-15 seconds of stoppage of
    oxygen supply to the brain and some brain damage occurs in 5-6 minutes.
    Circulatory arrest for more than 10-15 minutes causes permanent damage
    to brain.
    Causes of cardiopulmonary arrest
    Acute conditions
    i. Drowning
    ii. Hanging
    iii. Electric shock
    iv. Massive, acute myocardial infarction leading to cardiac asystole or
    fibrillation
    v. Inhalation of poisonous gases e.g. CO
    vi. Overdose or sensitivity to an anaesthetic agent, poisoning with narcotics
    and drugs, acid, other chemicals
    vii. Head injuries
    viii. Anaphylactic shock
    Signs and symptoms for CPR
    1. The victim is unconscious, the lips, face, ear lobes, fingers and toes are
    blue and there is death like appearance
    2. The skin is pale, cold and moist, and the pupils are dilated
    3. Absent or weak arterial pulse. The carotid artery must be palpated
    because radial pulse maybe too weak to be felt.
    4. Absence of heart sounds. Put your ears on the chest of the victim and try
    to confirm presence or absence of heart sounds
    5. Breathing is absent. There is no movement of the chest or nostrils. There
    is no air coming out of the nose or mouth
    6. Blood pressure is not recordable
    What to do immediately
    Confirm the diagnosis. Unconsciousness, absent carotid artery pulse. Note
    what time is it. One person should be in charge.
    1. Assess
    * Thump the chest if there is no carotid pulse. This may stop fibrillation.
    Recheck pulse. If absent, start CPR.
    * Make sure you are in a safe place. Trying CPR on the road may risk your life
    as well.
    First establish unresponsiveness
    * Determine the responsiveness of the victim by tapping him or her on the
    shoulder and asking "Are you all right?"
    * Check carotid pulse and breathing to make sure that heart and breathing
    have really stopped. Because if heart is still beating, there will be enough
    muscle tone so that external cardiac massage may cause fracture of the ribs.
    2. Start CPR routine after confirming CP arrest and find out if a bystander can
    help.
    3. Ask a bystander to phone the hospital emergency for an ambulance
    because you do not have time to do so yourself. If no one is available, continue
    CPR till the victim is revived.
    What not to do
    1. Do not delay resuscitation, immediate intervention is required after
    establishing unresponsiveness.
    2. The victim must not be made to sit or stand. No pillow should be placed
    under the head or neck, as this will bend the head and close the trachea.
    3. The feet and legs should be raised by placing the pillow etc. under the hips/
    legs. This will help promote venous return to the heart.
    4. Nothing should be given by mouth to a semi- conscious or unconscious
    individual for fear of aspiration of the fluid into the lungs.
    5. There should be no crowding around the victim.
    General plan for CPR
    Management of CP arrest involves 2 phases:
    Phase 1: Emergency measures
    If unconscious but breathing and pulse are present:
    A- airway: Tilt the head back with a hand under the neck to maintain an open
    airway.
    If not breathing
    B- Breathe: Give mouth-to-mouth respiration. Inflate lungs 14 to 16 times per
    minute to provide adequate oxygen supply. Maintain head tilt to avoid
    flaccid tongue from falling back into pharynx.
    * Feel carotid pulse. If pulse is present, continue lung inflation.
    If pulse absent (death like appearance, fixed dilated pupil)
    C- Circulate: Give external cardiac massage.
    *One operator:[2:15] Alternate 2 quick lung inflation with 15 cardiac
    compression
    *Two operators:[1:5]Interpose1 lung inflation after every 5th sternal
    compression.

    Phase II: Definitive treatment


    This phase of treatment is carried out in the hospital and includes:
    D- drugs (adrenaline, intravenous sodium bicarbonate for acidosis etc.)
    E- ECG monitoring
    F- Fibrillation treatment with a defibrillator, lidocaine or procaine
    G- Gauging and restoration of normal breathing and circulation
    H- Hospitalized
    Artificial respiration
    It may be given by manual methods, mouth to mouth method or by
    mechanical method.
    A. Manual method
    The method described below is used when mouth-to-mouth respiration is not
    possible.
    Holger Nielson method (back pressure arm lift, BPAL method)
    1. Place the victim face downwards on a hard surface with the arms bent and
    head turned to one side and resting on the hands.
    2. Kneel down on one knee at the victim's head with the opposite foot placed
    near the elbow.
    3. Place your hands with the fingers widespread on the victim's back just
    below the scapulae. Now rock forward with the arms held straight at the elbow
    until your arms are vertical and pressing down on the back. This compresses
    the chest and produces expiration.
    B. Mouth to mouth respiration
    It has proved to be superior to all the manual methods in all age groups.

    Procedure
    1. Place the victim on his or her back on firm ground and loosen the clothing
    around the neck, chest and waist.
    2. Remove any mucus, food, saliva or any foreign material from the mouth
    and nose with your fingers wrapped in the handkerchief.
    3. Open the airway by tilting the head back. Kneel by right side of the victim.
    Place your right hand under the neck and lift it, while keeping the pressure
    on the forehead with the heel of other hand. Using your right thumb and
    fingers, lift the chin and angle of jaw upward and forward. This simple
    procedure keeps the airway open.
    4. Clamp the nostrils with your left thumb and fingers, take a deep breath,
    apply your mouth firmly on the victim's mouth, and blow a liter of air into
    victims lungs, watching the expansion of the chest at the same time.
    5. Remove your mouth, turn your head to one side and take another deep
    breath as the elastic recoil of the chest causes expiration.
    6. Repeat the cycle of blowing out- turning the head- breathing in- about 14
    to 16 times a minute, till spontaneous breathing returns or the victim is
    shifted to the hospital.
    7. Feel the carotid pulse. If after 6 to 8 lung inflations, there is no
    improvement in the color of the victim, suspect cardiac arrest and start
    external cardiac massage as well.
    Advantages
    1. The method is simple and safe.
    2. It is easy to perform even by lay man with minimum instructions.
    3. It does not require any apparatus.

    Disadvantage
    1. The victims flaccid tongue tends to fall back into the pharynx and
    obstructs the airway. This can be avoided by extending the neck and turning
    the head slightly to one side.
    C. Mechanical respiration

    It is employed when artificial respiration has to be given for long periods


    example during chronic respiratory failure. Airtight metallic/ plastic devices
    are placed around the chest and negative pressure is applied at intervals ,
    this draws air into the lungs. The elastic recoil of the lung and chest causes
    expiration. Alternate positive and negative pressures are also employed.

    1. Drinker tank respirator - It is an iron chamber in which the subject is


    placed with the head kept outside , an airtight collar sealing the body inside.
    The pressure is alternatively raised (2 to 3 cm of water) for expiration and
    lowered ( -10 to -14 cm of water) for inspiration by means of a pump.
    2. Sahlin's jacket model , Brag Paul Pulsator- and their modifications
    employ inelastic chest jacket in which pressure can be increased and
    decreased at intervals.

    3. Eve's rocking method- The victim is laid on a stretcher or a plank and the
    shoulders and ankles are fastened to it. A rhythmic rocking up and down like
    a seesaw causes the abdominal viscera to push up against the diaphragm (
    expiration) or pull it down ( inspiration).
    External cardiac massage
    The following reasons are believed to be responsible for partly maintaining
    cardiac output and coronary perfusion by this method.
    1. When the heart stops suddenly, the pulmonary vein, left heart and the arteries
    are full of oxygenated blood. Cardiac massage causes this blood to start flowing.
    2. Since the heart is situated between two rigid structures - sternum in front and
    vertebrae behind – pressure applied on the chest in front squeezes it, thus
    producing a mechanical systole. The right and left ventricle pressure exceeds the
    pulmonary and aortic pressure , which causes a forward flow of blood. When
    pressure is released, it causes diastolic filling of the ventricles due to pressure
    gradient between the large peripheral veins and intrathoracic structures –
    especially the thin walled right ventricle.
    Procedure
    1. Lay the victim on the firm surface. Kneel beside him and place the heel of
    your left hand (fingers extended and not touching the chest) on the junction
    of upper 2/3rd and lower 1/3rd of the sternum. Place the heel of the other
    hand over the first, parallel to it.
    2. Keeping the elbow straight, bend forward and depress the sternum
    towards the spine by 4-5 cm at a rate of 80-90/ minute. The movement
    should be at the shoulders so that the force can be transmitted through the
    hands to the chest.
    * CPR by one person (2:15). Alternate 2 quick lung inflations with 15
    cardiac compression.
    * CPR by two persons (1:5). Interpose 1lung inflation after every 5th cardiac
    compression.
    Internal or open cardiac massage
    This procedure is employed in hospitals. The chest is opened in the left
    intercostal space in the mid-clavicular line, a hand is inserted into the thorax
    and the heart is compressed against the chest wall. There is a trans-
    diaphragmatic approach as well.
    Reasons for failure of CPR
    It may be due to
    1. The injury to the heart is very severe.
    2. Acid- base disturbances (lactic acidemia) and electrolyte imbalance do not
    allow the heart rate and rhythm to be restored.
    Ventricular fibrillation

    It is the commonest cause of cardiac arrest because of fibrillating heart


    cannot act as an effective pump. It is most frequently caused by acute
    myocardial infarction as a result of which an ectopic irritable focus starts to
    discharge action potentials in a fast and irregular manner. The heart
    responds to these action potentials and goes into fibrillation. If ventricular
    fibrillation is not stopped within two to three minutes, it almost always leads
    to death.
    The specific treatment includes:

    1. Electroshock defibrillation (cardio version): While a weak AC current causes


    ventricular fibrillation and death, strong high voltage current applied to the
    chest via large flat electrodes can stop fibrillation. All AP stop and the heart
    remains quiescent for 4 to 5 seconds, after which it starts to beat at normal
    rate and rhythm. The shock may have to be repeated a couple of times.

    2. Intravenous injection of 100 ml of 8% sodium bicarbonate is used to


    neutralize lactic acidemia.

    3. Intravenous injection of 5 to 10 mL of 1% calcium chloride.

    4. Intravenous or intra-cardiac injection of 0.5 mL of 1:1000 adrenaline often


    revives the heart.

    You might also like