Post on 05-Apr-2018
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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