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ADMINISTERING CARDIOPULMONARY RESUSCITATION

Definition: is an emergency procedure which is performed in an effort to manually preserve

intact brain function until further measures are taken to restore spontaneous
blood circulation and breathing in a person in cardiac arrest. It is indicated in
those who are unresponsive with no breathing or abnormal breathing.
STEPS:
A. Primary Assessment:
1. Pause and check scene
2. Observe universal precaution
3. Check for response
4. Look for normal breathing
B. Activate EMS and get an AED/Call 117
C. Chest Compressions
D. Rescue Breaths

Planning:
 Maintain adequate cardiac output
Materials:
 Compression board
 Gloves
 Face shield
 Mask/CPR oral device
 AED

Implementation:

PROCEDURE Rationale 1 2 3

1. Check scene to ensure that safety is obtained

2. Apply appropriate body

substance isolation items to prevent crossing of microoganism
( gloves, face shield)

3. Assess responsiveness by confirms that client is unconscious as supposed

tapping or gently shaking client to intoxicated, sleep, or hearing empaired
while shouting, “Are you OK?”

4. If victim is unresponsive, assess

this is to identify if there is presence of breathing
for respiration. Quickly look at
face and chest movement.

5. If normal breathing is absent.

The majority of adult victims are in venticular
Activate EMS (117) immediately febrillation and need defibrillation and anti-
and get an AED. If bystander is dysrythmics aas soon as possible.
present send him or her to
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activate.

6. Position client in a supine position

on a hard, flat surface. Use this position helps maintain the airway and give
external cardiac compression.
caution when positioning a client
with a possible head or neck
injury.

7. Palpate the carotid pulse for no

The carotid is most accessible, reliable; and easily
more than 10 seconds. learned location for checking the pulse in adult
and children
PULSE IS ABSENT!

8. Start Chest compressions

 Maintain a position parallel to this is to identify the exact location in placing
the hand
sternum
 Position hands properly, with
the heel of one hand
approximately two careful attention to hand placement during cardiac
fingerbreadths above the compression to prevents fracture ribs and organ
trauma.
xyphoid process directly over
the sternum, and then place the
other hand directly on top of the
first’s hand, extend or interlace
fingers and do not allow them to
touch the chest.
 Keep arms straight with to maintain the pressure in
shoulders directly over hands compressing the chest
on sternum and keeping elbows
locked.

Compression rate for approximately

100 times/minute, interjecting 2
rescue breaths after every 30
compressions

9. Compress the chest at the rate of

27-33 in 10 seconds. Push fast, this depth is needed to compress the heart
between sternum and vertebrae to pump out of
hard at least 2 inches, allow full heart.
rebound,

10. The heel of the hand must Using the heel of the hand exerts pressure only
completely release the pressure on the sternum. Pressure else where can create
between compressions, but it with fracture
should remain in constant contact
with the client’s skin.

11. Give two rescue breaths in less

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than 2 seconds after each set of
30 compressions. Take a deep becareful not to provide too many breaths or to
breathe with too much force
breath after providing each
breath.

12. Reassess the client’s breathing

the rise and fall of the chest wall confirm ventilation
and pulse after each set of four
compressions/breathing cycles.

13. Continue CPR until patient

artificial cardio pulmonary function is maintained
resumes spontaneous breathing
and pulse, medical help arrives,
or you are too exhausted to
continue.

14. Document the time you for legal purposes and for continuity of care
discovered the patient
unresponsive and started CPR.
Continued intervention such as by
the code team will typically be
documented on a code form,
which identifies the actions and
drugs provided during the code.

PROCEDURE Rationale 1 2 3
A. Administering CPR on an
Adult (Two Rescuer)
1. One rescuer is positioned facing the
client parallel to the head while the to provide compressions
other rescuer is positioned on the
opposite side facing the client
parallel to the sternum next to the
trunk.

2. The rescuer 1, positioned at the

client’s trunk is responsible for
performing cardiac compressions
and maintaining the count. allows one rescuer to maintain breathing while
other maintain circulation without getting in each
other's way.
3. The rescuer 2, positioned at the
client’s head is responsible for
monitoring respirations, assessing
the carotid pulse, establishing an
open airway, and performing rescue
breathing.
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4. Maintain the compression rate for
approximately 100 times/min, to provide circulation and breathing to the patient
interjecting 2 ventilations after every
30 compressions.

5. Rescuer 2, palpates the carotid to assess if pulse is present with each compression
pulse with each chest compression
during the first full minute.

6. Rescuer 2, is responsible for calling Switching positions helps to ensure effective CPR
a change when fatigued. efforts

7. Rescuer 1, calls for a change and

completes the 30 compressions.

8. Rescuer 2 administers two breaths To provide victim with air and stimulate breathing.
and then moves to a position
parallel to the client’s sternum and
assumes the proper hand position.

9. Rescuer 1, moves to the rescue CPR should be performed until client regains
breathing position and check the unconsciousness
carotid pulse for 5 seconds. If
cardiac arrest persists, rescuer 1
says “continue CPR “and delivers 1
breath. Rescuer 2 resumes cardiac
compressions after the breath.

10. Continue CPR until patient resumes

CPR should be performed continually to prevent
spontaneous breathing and pulse, complications such as irreversible brain damage
medical help arrives, or when the
rescuers are too tired to continue.

PROCEDURE Rationale 1 2 3
B. Administering CPR on a child:

The procedure for giving CPR to a child

age 1 through 8 is essentially the same
as that for an adult. The differences are
as follows:

 If you're alone, perform five cycles

Proper number of compressions/ minute should
of compressions and breaths on the be delivered to ensure adequate cardio output

child — this should take about two

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minutes — before calling the local
emergency number or using an
AED.

 Use only one hand to perform chest

compressions.

 Breathe more gently.

to maintained an airway
 Use the same compression-breath Proper placement off the hands prevent rib fracture
rate as is used for adults: 30 and proper number of compressions per minute
should be delivered to ensure adequate cardio
compressions followed by two output.

breaths. This is one cycle.

Following the two breaths,
immediately begin the next cycle of
compressions and breaths.

 After five cycles (about two to deliver shock

minutes) of CPR, if there is no
response and an AED is available,
apply it and follow the prompts. Use
pediatric pads if available. If
pediatric pads aren't available, use
adult pads.

Continue until the child moves or help Repeats 5 cycles until the victims recovers
arrives.

PROCEDURE Rationale 1 2 3
C. Administering CPR on an
infant:

Most cardiac arrests in babies occur obstruction is removed first before starting CPR
from lack of oxygen, such as from to clear the airway and to allow air to get into the
lungs
drowning or choking. If you know the
baby has an airway obstruction, perform
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first aid for choking. If you don't know
why the baby isn't breathing, perform
CPR.

To begin, examine the situation. Stroke

to determine if CPR is needed
the baby and watch for a response,
such as movement, but don't shake the
baby.

If there's no response, follow the CAB

procedures below and time the call for
help as follows:

 If you're the only rescuer and CPR

To inform medical team of emergency and to aid
is needed, do CPR for two minutes the victim as soon as possible

— about five cycles — before

calling the local emergency
number.

 If another person is available, have

that person call for help immediately
while you attend to the baby.

Circulation: Restore blood

circulation

1. Place the baby on his or her back This position helps maintain the airway and give
external cardiac compression
on a firm, flat surface, such as a
table. The floor or ground also will
do.

2. Imagine a horizontal line drawn

Using both hands will injure the victims chest
between the baby's nipples. Place
two fingers of one hand just
below this line, in the center of
the chest.

3. Gently compress the chest about

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1.5 inches (about 4 cm). 1.5 inches is enough to penetrate the heart and
prevent injury of the chest
4. Count aloud as you pump in a
fairly rapid rhythm. You should To effectively resuscitate the infant
pump at a rate of 100
compressions a minute.

Airway: Clear the airway

1. After 30 compressions, gently tip

to prevent injury to the neck
the head back by lifting the chin
with one hand and pushing down
on the forehead with the other
hand.

2. In no more than 10 seconds, put

to access for breathing after cycles
your ear near the baby's mouth
and check for breathing: Look for
chest motion, listen for breath
sounds, and feel for breath on
your cheek and ear.

Breathing: Breathe for the infant

1. Cover the baby's mouth and nose

mouth to mouth and nose method is used in infant
with your mouth. CPR

2. Prepare to give two rescue To establish on effective open airway

breaths. Use the strength of your
cheeks to deliver gentle puffs of
air (instead of deep breaths from
your lungs) to slowly breathe into
the baby's mouth one time, taking
one second for the breath. Watch
to see if the baby's chest rises. If
it does, give a second rescue
breath. If the chest does not rise,
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repeat the head-tilt, chin-lift
maneuver and then give the
second breath.

3. If the baby's chest still doesn't

an obstruction in the airway impedes breathing.
rise, examine the mouth to make If not removed immediately cause aspiration
and obstruction may lodge in the lungs thereby
sure no foreign material is inside. creating serious complication.
If the object is seen, sweep it out
with your finger. If the airway
seems blocked, perform first aid
for a choking baby.

4. Give two breaths after every 30 to maintain airway

chest compressions.

5. Perform CPR for about two

minutes before calling for help
unless someone else can make
the call while you attend to the
baby.

6. Continue CPR until you see signs to continue pumping blood manually to reach
of life or until medical personnel organs and tissues of blood supply

arrive.

Points to Remember:
CPR should be started for any situation in which either breathing alone or breathing
and heart beat are absent. The brain is sensitive to hypoxia and will sustain irreversible
damage after 4 to 6 minutes of no oxygen. The faster CPR is initiated, the greater the
chance of survival.

Evaluation:
1. Outcome measures for the goal of maintaining adequate cardiac output
2. Balance between factors that affect cardiac output
3. Evaluate for the stability of the vital signs