CARDIOPULMONARY RESUSCITATION (CPR).
– Cardiopulmonary resuscitation ( CPR ) is a lifesaving technique.
– This technique is used in many emergencies including the heart attack or near drowning where someone’s breathing or heart beat has stopped.
• ABC of CPR
✓ A – Airway
– To maintain an open and clear airway
✓ B – Breathing
– To maintain breathing by external ventilation
– To maintain blood circulation by external massage
* Cardiac arrest :
– Ventricular fibrillation
– Pulse less electrical activity
* Respiratory arrest
– Drug overdose
– Smoke inhalation.
• Principles of CPR
– To restore effective ventilation
– To restore effective circulation
– To prevent irreversible cerebral damage.
• CPR procedure
– Patient is relaxed lying with hands on sides
– Perform Chest compression and pulmonary ventilation
– It is important to approach safety
– Shake the shoulder gently to check the response
– Check breathing by listen and feel nrml breathing , donot confuse with agonal breathing with normal breathing.
• Agonal breathing
– It is a Barely, heavy , noisy or gasping breathing occurs shortly after heart stops in upto 40% of cardiac arrest.
– 30 chest compression is performed by placing heel of one hand in centre of chest and other hand on top of it , interlock the fingers.
– Compress the chest : Rate is 100/min,
Depth is 4 to 5 cm and then relaxation.
– Two rescue breaths
Pinch the nose
Taking normal breath
Placing lips over mouth
Blowing until the chest raises
Take about 1 second
Then allow chest to fall
Then repeat the procedure.
– Coronary vessel injury
– Diaphragm injury
– Rib fracture
– Sternal fracture.
• Medical management
CPR FOR INFANTS
– CPR should begin with chest compression .
– Victim should be in supine lying on hard and flat surface.
– Chest compression is given by pushing hard to a depth of 2 inches in children and 1 and half inches in infants .
– Compression rate : 100 per minute
(a) Chest compression in infants ( less than 1 year )
– With both hands child’s chest is encircled
– Fingers are spread around thorax and thumbs brought together at lower half of sternum and avoid xiphisternum.
– Sternum is compressed with thumbs and thorax with fingers for counter pressure.
– While the other person maintains the airway and perform ventilation at 15:2 ratio
(b) Two – finger technique
– If the rescuer is alone or unable to encircle the victim’s chest , compression can be done using 2 fingers.
– 2 fingers are placed vertically over the Sternum just below the intermammary line avoiding xiphoid process
• Chest compression in children ( 1-8 yrs )
– Heel of the hand is placed over the lower half of sternum and avoid xiphoid process.
– Rescuer position : vertically above the victim’s chest .
• Chest compression for larger Children’s and those abouve 8 yrs
– Two hand method is used by placing heel of one hand over lower half of sternum and heel of other hand over the first hand , interlocking the fingers of both hand and lifted above the chest wall .
– child is placed supine on hard surface
• Head tilt chin lift maneuver
– One hand is placed over the child’s forehead and the head is gently tilted backwards .
– At the same time fingers of other hand are place on the lower jaw to lift the chin to open the airway .
– This method should be avoided if there is a trauma to head or neck
• Jaw Thrust
– 2 or 3 fingers are placed under each side of lower jaw to lift the jaw upwards and outwards.
– If it is unsuccessful , head may be extended slightly .
• Checking for breathing
– One should check for breathing after opening the child’s airway
– Should not be confused with agonal breathing
• Bag and mask ventilation
– Prefered technique for emergency ventilation
– Self inflating bags are available in both pediatric and adult sizes.
– Flow inflating bags needs oxygen flow for inflation and can be used in hospital set up .
• Volume of ventilation bag
– Neonates , infants and children less than 8 yrs of age : 450 – 500 ml
– Preterm neonates : 250 ml