Introduction:

Unexpected cardiopulmonary collapse is a medical emergency that requires immediate institution of the artificial measures to support life and to reverse the initiating pathophysiological event. Cerebral resuscitation is the most important goal of advanced cardiac life support. Resuscitation is a continuous process from basic life support (BLS) to advance cardiac life support (ACLS), where BLS initiates the process and ACLS aims to restore and maintain spontaneous respirations and circulations.

Definition:
cardio pulmonary resuscitation (CPR)is a technique of basic life support for the purpose of oxygenation to the heart, lungs and brain until and unless the appropriate medical treatment can come and restore the normal cardiopulmonary function. It is also called as cardio pulmonary cerebral resuscitation (CPCR) as oxygenation of brain is more important within 4 minutes otherwise irreversible brain damage can occur.

Causes
System CNS Pulmonary: Reasons Cerebro-vascular accidents. Shock. COPD. Airway obstruction. Cardio vascular: Atelectasis. Acute M I. CABG. Heart failure. Dysrhythmias.

Miscellaneous:

Heart block. Drowning, Fall, Poisoning. Emboli, Accident.

Phases of the cardio pulmonary resuscitation:

Phases Phase-1 Steps Basic life support Phase-2 advanced cardiac Phase-3 support prolonged support life life A= Airway B= Breathing C= circulation D= Drugs E= ECG

F= fibrillation
G= Gauging H= Human Mentation I= Intensive care

Typically the sequence of BLS consists of assessment and the ABCs of CPR. Assessment It is of crucial importance. It includes 1. 2. Assess responsiveness by calling the person; shouting and shaking. Assess breathing by look, listen and feel: Look for chest movements, listen for breath sounds and feel for the movements of the air flow.

Assess circulation- feel the carotid pulse.

Basic life support

1. Airway management
i. Open and clear the airway: This is achieved by head tilt and chin lift maneuver or if there is suspicion/evidence of head or neck trauma, the jaw thrust maneuver is used. HEAD TILT CHIN LIFT MANEUVER: Place one hand on the victims hair line and place the other hands index finger and the middle finger on the chin and apply firm backward pressure.

Head tilt and chin lift maneuver JAW THRUST MANEUVER:It is accomplished by placing one hand on each side of the victims head, grasping the angles of the victims lower jaw, lifting with both hands.

ii) Open and clear the airway by using finger sweep method. FINGER-SWEEP MANEUVER:a) With the victims head up, opens the victims mouth by grasping both tongue and the lower jaw between the thumb and fingers and lifting (tongue-jaw lift).

b)

This action draws the tongue from the back of the throat and away from the foreign body. The obstruction may be partially relieved by this maneuver.

c)

If the tongue-jaw lift fails to open the mouth the crossed finger technique may be used. This is accomplished by opening the mouth by crossing the index finger and the thumb and pushing the teeth apart. The index finger of the available hand is inserted along the inside of the cheek and deeply into the throat to the base of the tongue.

d)

A hooking motion is used to dislodge the foreign body and maneuver it into the mouth for removal.

Finger sweep maneuver

Breathing: After the airway management if the victim is still not breathing, then maintaining head tilt, chin lift positions pinch the nostrils and place the mouth around the victims mouth to make a tight seal, take two deep breaths and deliver two positive pressure ventilations; each at least of two seconds duration. When performing mouth to mouth ventilation always assess for chest wall movement.

Other advanced method to deliver breathing are bag and mask ventilation, tracheal intubations and the use of laryngeal mask airway.

The volume of air of each ventilation should be approximately 7001000ml, which can be determined by noting a rise of 1-2 inches in the victims chest.

Smaller volume (400-600ml) should be attempted during bag and mask ventilation.

Bag and mask ventilation Use a resuscitator bag and mask. Apply the mask to the victims mouth and create a seal by pressing the left thumb on the bridge of the nose and the index finger on the chin. Use rest of the fingers of the left hand to pull on the chin and the angle of the mandible to maintain the head in extension. Use the rest of the fingers of the left hand to pull on the chin and the angle of the mandible to maintain the head in extension.

Use the right hand to inflate the lungs by squeezing the bag to its full volume. Observe the chest wall for symmetric expansion.

CIRCULATION:
The carotid artery is used to determine the absence of pulse. While maintaining the head tilt position with one hand on the forehead, locate the victims trachea with two or three fingers of the other hand, then slides these fingers into the groove between the trachea and the muscles of the neck where the carotid pulse can be felt. The technique is more easily performed on the side nearest the rescuer. If on assessment, there are no signs of circulation start external cardiac compressions. External cardiac compressions technique consists of serial rhythmic application of pressure on the lower half of the sternum. The victim is on the horizontal supine position on a flat and hard surface. The rescuer should be positioned closed to the side of the victims chest.

Locate landmark notch hands in the centre of the chest, right between the nipples and four fingers above the xiphoid process.

Position hands, arms and shoulders.

Elbows should be locked and arms are straight. Rescuers shoulders position directly over hands. Begin compression. Pressure should come from the shoulders. Compression should depress victims sternum

approximately 1.5- 2 inches. Dont allow the fingers to touch the chest wall. Allow chest to rebound to normal position after each compression. Perform compression at the rate of 100/min. Maintain correct position at all times. Check for signs of circulation every 3-5 min. Compression: ventilation ratio is 30:2 irrespective of number of rescuer. Exhalation occurs between the two breaths and during the first chest compression of the next cycle. Perform four complete cycles and then reassess for signs of breathing and circulation.

Drugs: Name Action Dose Indications Ionized hypocalcimia in . Osteoporosis . a. Hypermagne samia. Ca blocker over dose. SideEffects Hypercalcimia Tingling sensation Hypotension Brady cardia Arrhythmia Nsg manageMent Avoid Extravasations of The iv injection. Do not

Essential element of Adult: Calcium gluconate: Electrolyte water agent. the body;helps to 10mg/kg with maintain nervous to the Iv

and functional integrity of 10mins. and Paed: muscular helps cardiac functions,blood coagulation. systems;

balance the

Administer oral drugs with In 1-2 hrs of Antacid Administration. Monitor the

20mg/kg maintain in1:1dilution iv.

Hyperkalaemi Cardiac arrest.

Cardiac response. Scalp vein

Should be avoided.

Name

action

Dose

Indica-

Side-

Nsg management

Adren-aline. Class: Adreno receptor agonists.

Increases of the heart.

the

force .5-1mg repeated Max.18

Tions iv Restoration rhythm arrest. Attacks block syncope seizures.

Effects Cns: tremors, Use extreme caution when calculating and preparing the doses. sun light. Maintain blockers. Maintain a - adrenergic blockers. -adrenergic in insomnia,head confusion. of Cv:

and rate of contraction bolus

of the cardiac anxity,

every 3-5mns. cardiac Mg(for adult) .01mg/kg body weight (for pead)

ache,dizziness, Protect drug solutions from

transitory av Palpitation,tac and hycardia, hypertension Nausea vomiting.

Name Lidocain Hydrochloride.

Action Local anaesthetic effects inhibiting sodium channels. Depress conduction velocity(phase-0) and phase. slope of

Dose Adult: by maintenance:

Indications In

Side effects

Nsg management Monitor ecg. Watch increased vetriculareeto pic beats. Check electrolytes. Monitor signs. vital for

prophylaxis Drowsiness, restlessness, confusion, euphoria.

1mg/kg.iv bolus on treatment of dizziness, ventricular arrythmias. intoxication.

binding to and 2-4mg/mn. dilution.

Paed:1mg/kg 1:1 Digitalis

Resp arrest and depression. Hypotension, bradycardia etc

CPR

ECG ECG is the graphical representation of the electrical activity of the cardiac muscles. During cpr the cariac muscles. During CPR the victims ecg should be continuously monitored for monitored for monitoring evaluating and recording. DEFIBRILLATION: It is asynchronous cardio-version that is used in emergency situation. Defibrillation completely depolarizes the all myocardial cells at once, allowing the sinus node to recapture its role as the pacemaker. KEY POINTS TO REMEMBER WHILE DEFIBRILLATING. Use a conducting agent between the skins the paddles such as saline pads or electrode paste. This decreases the electrical impedance and helps to prevent burns. The paddles are placed on the chest wall one the sternal paddle is placed to the right of the sternum, 2nd intercostals space just below the clavicle. The apex paddle is placed on the left 6Th intercostals space mid axillary line. Switch on the defibrillator. Move the knob of the defibrillator to the required amount of joules. Shock at 200,300,360 joules. Exert 20-25 pounds of pressure on each paddle to ensure good skin contact. Press the charge button.

Call stand clear to ensure that personal are not touching the patient or the bed at the time of discharge. The defibrillator is then discharged by depressing the buttons on the both paddles simultaneously.

GAUGING: Identify the cause of cardiac arrest by: 1. Cardiac monitoring, 2. Lab examination of the blood. Human mentation: Start CPR within 4 min as brain can only survive for four min with out oxygen. Do not interrupt the CPR more than 7min. Reassess for breathing and circulation every 23min. INTENSIVE CARE: If the victims condition is stable, send the victim to the ICU for close and continuous monitoring. CONCLUSION: CPR is the responsibility of a team of personnel and not one person in isolation. For cardiac arrest we strive to prevent when possible, treat effectively when challenged and support humanely when death is imminent.