Introduction
Performing Cardiopulmonary Resuscitation (CPR) is a critical, lifesaving skill used when someone’s heart or breathing has stopped.
Basic life support is that phase of emergency cardiac care that either (1) prevents circulatory or respiratory arrest or insufficiency through prompt recognition and intervention or (2) externally supports the circulation and ventilation of a victim of cardiac or respiratory arrest through cardiopulmonary resuscitation (CPR).
Objective of cardiopulmonary resuscitation
To provide oxygen to brain, heart, and other vital organs until appropriate or definitive medical treatment (advanced cardiac life support) can restore normal heart and ventilatory function.
Indications
- Respiratory arrest resulting from drowning, stroke, foreign body, airway obstruction, smoke inhalation, drug overdose, electrocution, suffocation, myocardial infarction, injury from lightening, and coma of any cause leading to airway obstruction.
- Cardiac arrest.
Sequence of cardiopulmonary resuscitation
The sequence of CPR includes circulation, airway, and breathing and begins with an assessment phase to determine the need for action which includes “determining unresponsiveness” and “determining pulselessness”.
Articles
- Arrest board/back board/flat surface.
- Oral airway.
- A piece of lint to place over victim’s mouth or oral barrier device for mouth-to-mouth respiration.
- Mask and Ambu bag.
Procedure
| S.No | Nursing Action | Rationale |
| 1 | Determine the unresponsiveness: 1.Tap or gently shake the patient while shouting “ARE YOU OK”? | This will prevent injury from attempted resuscitation of a person who has not suffered a cardiac or respiratory arrest. |
| 2 | Determine pulselessness: Check for carotid pulse on one side for not more than 5 seconds. | Carotid pulse may persist when peripheral pulses are not palpable. |
| 3 | Call for help in hospital setup. | Alerts other trained personnel. |
| 4 | Sequence of CPR: A. Circulation Position the arrest board underneath victim’s chest (when arrest board is not available, place victim on firm, flat surface). | The arrest board provides a firm surface allowing for compression of the heart. |
| 5 | Kneel at victim’s side. | Allows performance of chest compression and rescue breathing with efficiency. |
| 6 | Using index finger of the hand, locate the lower rib margin and move the fingers up to where the ribs connect to the sternum. Place the middle finger of this hand on the notch and index finger next to it. Place the heel of the opposite hand next to the index finger on the sternum. Ensure that the long-axis of the heel of hand is parallel to the long-axis of the sternum. Remove the first hand from the notch and place on top of the hand that is on the sternum. Extend or interlace the fingers, do not allow them to touch the chest. Keep the arm straight with shoulders directly over the hands on the sternum and lock elbows. | Proper hand positioning ensures maximum compression of the heart and prevents injury to liver and ribs. |
| 7 | Compress the adult chest at least 2 inches (5 cm) at the rate of at least 100 per minute. | |
| 8 | Release the chest compression completely and allow the chest to return to its normal position after each compression. The time allowed for release should be equal to the time required for compression. Do not lift hands off chest. | Release of external chest compression allows blood flow into the heart. Removing hands from the chest will result in more time required to locate the exact point for chest compressions. |
| 9 | Do 30 compressions and then perform two ventilations, re-evaluate the patient after four cycles (use the mnemonic “1,2, and 3″to keep rhythm and timing). | Rescue breathing and chest compressions should be combined. |
| 10 | For CPR performed by one or two rescuers, the compression rate is 100 per minute. The compression ventilation ratio is 30:2. | |
| 11 | B. Airway 1. Open the victim’s airway by using one of the following maneuvers: Head tilt chin lift maneuver: Place one hand on victim’s 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 to bring the jaw forward. | This supports the jaw and helps tilt the head back. This maneuver should not be performed for victims of suspected head and neck injuries. |
| 12 | Jaw thrust maneuver: Grasp the angles of the patient’s lower jaw and lift with both hands, one on each side, displacing the mandible forward. Place an airway if available. | Jaw thrust technique without head tilt is the safest method for opening the airway in the presence of suspected neck injury. Keeps airway patent. |
| 13 | C. Breathing Occlude nostrils with thumb and index finger of the hand on forehead that is tilting the head back. Form a tight seal over the patient’s mouth or place an appropriate respiratory arrest device (Ambu bag and mask) and give two full breaths of approximately 0.5 to 2 seconds allowing time for both inspiration and expiration. | Occluding the nostrils and forming a seal over the patient’s mouth will prevent air leakage and provide full inflation of the lungs. |
| 14 | Observe for rise and fall of the chest. | Excessive air volume and rapid respiratory flow rates can create pharyngeal pressure that is greater than oesophageal opening pressure. This will allow air into the stomach resulting in gastric distension and increased risk of vomiting. |
When to stop cardiopulmonary resuscitation (CPR)
Guidelines for the termination of resuscitation are as follows:
- Return of spontaneous circulation.
- Arrival of arrest team or medical help.
- If the rescuer becomes exhausted.
- When death is confirmed.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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