CPR and Airway Mgt.

7/31/2019 CPR and Airway Mgt.

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CARDIOPULMONARY

RESUSCITATION AND AIRWAYMANGEMENT


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INDICATIONS

1. Cardiac arrest

a. Ventricular fibrillationb. Ventricular tachycardia

c. Asystoled. Pulseless electrical activity


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2. Respiratory arrest

a. Drowningb. Strokec. Foreign-body airway

obstruction

d. Smoke inhalatione. Drug overdose


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f. Electrocution/injury bylightning

g. Suffocationh. Accident/injuryi. Comaj. Epiglottitis


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ASSESSMENT

1. Immediate loss of consciousness

2. Absence of breath sounds or air

movement through nose ormouth

3. Absence of palpable carotid or

femoral pulse; pulselessness inlarge arteries


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COMPLICATIONS

1.Postresuscitation distresssyndrome (secondary

derangements in multipleorgans)

2.Neurologic impairment, braindamage


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NURSING ALERT

The patient who has beenresuscitated is at risk foranother episode of cardiacarrest.


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EQUIPMENT Trained personnel

Arrest board

Oral airway


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Bag and mask deviceIntravenous (IV) set up

DefibrillatorEmergency cardiac drugs

Electrocardiograph machine


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PROCEDURE

NURSING ACTION RATIONALE

RESPONSIVENESS/AIRWAY1. Determine

unresponsiveness: tap orgently shake patient while

shouting, Are you OK?.

1. This will prevent injury from

attempted resuscitation ona person who is not

unconscious.

2. Activate emergencymedical service (EMS).


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3. Place patient supine

on a firm, flat surface.Kneel at the level of the

patients shoulders. If

the patient has

suspected head or neck

trauma, the rescuer

should move the

patient only ifabsolutely necessary.

3. This enables the

rescuer to performrescue breathing and

chest compression

without moving the

knees.


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4. Open the airway.a. Head-tilt/Chin-lift Maneuver:

Place one hand on the

patients forehead and apply

firm backward pressure with

the palm to tilt the head

back. Then, place the fingers

of the other hand under the

bony part of the lower jaw

near the chin and lift up tobring the jaw forward and the

teeth almost to occlusion.

a. In the absence of sufficient

muscle tone, the tongue

and/or epiglottis will

obstruct the pharynx and

larynx.

This supports the jaw and

helps till the head back.


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b. Jaw-thrust

Maneuver:

Grasp the angles of

the patients lower

jaw and, lifting with

both hands, one oneach side; displace

the mandible

forward, while tiltingthe head backward.

b. The jaw-thrust

technique without head

tilt is the safest method

for opening the airway

in the presence of

suspected neck injury


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BREATHING

Determine presence or

absence of spontaneousbreathing.


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1. Place ear over

patients mouth and

nose while

observing the chest,

look for

the chest to rise andfall, listen for air

escaping during

exhalation, andfeel for the flow of

air.

1. Keep maintaining an

open airway.


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2. Perform rescue breathing

mouth-mouth: while keeping the

airway open, pinch the nostrils

closed using the thumb and indexfinger of the hand that is on the

forehead. Take a deep breath, open

mouth wide, and place it outside of

the patients mouth, creating an

airtight seal.

Ventilate the patient with two full

breaths (1-1 seconds each

breath), taking a breath after each

ventilation. If the initial ventilationattempt is unsuccessful, reposition

the patients head and repeat

rescue breathing.

2. This prevents air from

escaping from the patients

nose.

Adequate ventilation is

indicated by seeing the

chest rise and fall, feelingthe air escape during

ventilation and hearing the

air escape during

exhalation.


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CIRCULATION

1. While maintaining head

tilt with one hand on

the forehead, palpatethe carotid or femoral

pulse. If pulse is not

palpable, start external

chest compressions.

1. Cardiac arrest is recognized by

pulselessness in the large

arteries of the unconscious,

breathless patient. If there is a

palpable pulse, but no breathing

present, initiate rescue

breathing at rate of 12 times per

minute (once every 5 seconds)after initial two breaths.

Determine pulselessness.


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External Chest Compressions

Consist of serial, rhythmic applications

of pressure over the lower half of the

sternum.


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1. Kneel as close to the

side of patients chest

as possible. Place the

heel of one hand on

the lower half of the

sternum, 3.8 cm (1 inches) from the tip of

the xiphoid. The

fingers may either be

extended or interlaced

but must be kept off

the chest.

1. The long axis of the

heel of the rescuers

hand should be placed

on the long axis of the

sternum; thus the

main force of thecompression will be

on the sternum and

decrease the chance

of rib fracture.


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2. While keeping your

arms straight,

elbows locked, and

shoulders positioned

directly over your

hands, quickly andforcefully depress the

lower half of the

patients sternumstraight down, 3.8-5

cm (1-2 inches).


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3. Release the external

chest compression

completely and allow thechest to return to its

normal position after

each compression. The

time allowed for releaseshould equal the time

required for

compression. Do not lift

the hands off the chest or

change position.

3. Release of the external

chest compression

allows blood flow intothe heart.


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4.Use 80

compressions per

minute(100 if possible).

For one rescuer, do

15 compressions ata rate of 80-100 per

minute and then

perform two

ventilations;re-evaluate the

patient.

4. Rescue breathing and

external chest

compressions must becombined. Check for

return of carotid pulse. If

absent, resume CPR

with two ventilations

followed bycompressions. For CPR

performed by health

professionals,

mouth-to-mask ventilationis an acceptable

alternative for rescue

breathing.


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5. For CPR performed

by two rescuers, the

compression rate is

80-100 per minute.

The compression-

ventilation ratio is

15:1 with a pause for

ventilation(1-1 seconds)


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6. While resuscitation

proceeds,

simultaneous efforts

are made to obtain

and use special

resuscitationequipment to manage

breathing and

circulation andprovide definitive

care.

6. Definitive care

includes

defibrillation,

pharmacotherapy for

dysrhythmias and

acid-basedisturbances, and

ongoing monitoring

and skilled care in anintensive care unit.


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THE END

THANK YOU

Evelyn E. Torres, RN-MAN

CPR and Airway Mgt.

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