CARDIO PULMONARY RESUSCITATION CPR has been known in theory, if not practice, for many hundreds or even thousands

of years; some claim it is described in the Bible, discerning a superficial similarity to CPR in a passage from the Books of Kings (II 4:34), wherein the Hebrew prophet Elisha warms a dead boy's body and "places his mouth over his". In the 19th century, Doctor H. R. Silvester described a method (The Silvester Method) of artificial respiration. A second technique, called the Holger Neilson technique, described in the first edition of the Boy Scout Handbook in the United States in 1911.

It was at Johns Hopkins University where the technique of CPR was originally developed. The first effort at testing the technique was performed on a dog. Soon afterwards, the technique was used to save the life of a child. Their combined findings were presented at annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, and gained rapid and widespread acceptance over the following decade, helped by the video and speaking tour they undertook Cardiopulmonary resuscitation is a set of assessments and skills you perform to save the life of an unresponsive person. Cardiopulmonary resuscitation maintains delivery of oxygen and blood to the heart and brain. CPR is a combination of two life support techniques: 1) artificial respiration and; 2) artificial circulation. INDICATION FOR CPR
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Respiratory Arrest Refers to the absence of breathing. When breathing stops first, the heart can continue to pump blood for several minutes. Opening the airway and providing rescue breathing may be all that is needed.

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Are you O.K?

If the victim is unresponsive, phone the emergency response number (or call 108) and get the AED.

If you are alone and find an unresponsive adult, leave the victim to phone 108 or other emergency response number and get the Automatic external defibrillator.

If you or someone else has called the emergency response number, kneel at the victims side near the head to start cardiopulmonary resuscitation. Carefully turn the victim onto the back if needed. If you think the victim is injured, turn the head, neck, and back as unit.

2. Airway: Open the airway. When a victim becomes unresponsive, the muscles of the jaw and neck relax. This allows the tongue to fall back against the throat and block the airway. You must open the airway.

There are two techniques for opening the airway:

o Head tilt- chin lift: place the palm of one hand on the victims forehead and

apply firm, backwards pressure, tilting the head back. Gently lift the chin with the other hand. This lifts the tongue away from the back of the throat.

o Jaw thrust: If you think the victims head or neck is injured, use the jaw thrust to

open the airway. Lift the angles of the jaw (the part of the jaw right below the earlobes). This moves the jaw and tongue forward and opens the airway without bending the neck.

3. Breathing. Hold the airway open and look, listen, and feel to determine if the victim is breathing adequately. If the victim is not breathing adequately give two slow rescue breaths. To check for breathing, look, listen, feel for breathing: a) Place your ear next to the victims mouth and nose and turn your head to look at the chest. b) Look for the chest to rise, listen for sounds of normal breathing, and feel for air movement on your cheek.

If the victim is not breathing adequately, give rescue breaths. Healthcare providers can give rescue breaths in 3 ways:
o Mouth-to-mouth or mouth-to-nose technique o Mouth-to-barrier device technique o Bag-mask technique

To use the mouth to mouth or mouth to nose technique: a) Place your mouth around the victims mouth and pinch the nose closed, or close the victims mouth and place your mouth around the victims nose.

b) Continue to tilt the head and lift the chin (or perform the jaw thrust). c) Give two slow breaths (1 second each). Deliver breath slowly. If you deliver breaths too quickly or too forcefully, you will force air into the stomach instead of lungs. d) Be sure the victims chest rises each time you give a rescue breath. If the chest does not rise, reopen the airway and give rescue breaths again. e) Health care providers must be able to provide rescue breathing with the, mouth to-mouth or mouth-to-nose technique, with a barrier device (face shield or face mask), and with a bagmask device. You are providing adequate ventilation if you see the chest rise and fall with each breath and you hear and feel the air escaping during exhalation.  When you give rescue breaths without supplemental oxygen, give them for 2 seconds. The chest rise should clearly rise with each breath.  When you give rescue breaths through a mask barrier device or a bag -mask device with supplemental oxygen, you can use a smaller volume for each breath. Deliver these smaller breaths over 1 to 2 seconds. These smaller breaths should still make the

chest rise does not need to be as pronounced as when you are delivering breaths without oxygen.

4. CIRCULATION: After you give 2 rescue breaths, look for signs of circulation a. Look for adequate breathing, coughing, or movement in response to the 2 rescue breath and s, try to feel a carotid pulse. To check the carotid pulse, locate the victims windpipe (trachea) with your index and middle fingers and slide your fingers in the groove between the windpipe and the muscle at the side of the neck.

b. Dont take more than 10 seconds to check for signs of circulation. c. If you dont confidently feel a pulse or see other signs of circulation, start chest compression Note: if the victim has signs of circulation, chest compressions are not required. If the victim is not breathing adequately but has signs of circulation, the victims is in respiratory arrest and must continue to give rescue breaths (1 breath every 5 seconds) d. Chest compressions are performed on the lower half of the sternum (breast bone). To locate the correct position for chest compression, Place the heel of one hand in the centre of the victims chest between the victims nipple. Place the heel of your other hand on top of the first hand (rescuer should place their hands on the center of the chest, rather than to spend more time using the rib margin technique).

Lean forward so your shoulders are over the breast bone and your arms are straight. You should be looking at your hands.

You may extend or interlace fingers, but do not rest them on the chest. Keep the heel of your hand on the chest during and between compressions.

e. Provide 30 compressions at a rate of about 100 compressions per minute with a compres sion depth of 1 to 2 inches (approximately 4 to 5 cm). Allow the chest to recoil

completely after each compression, and allow approximately equal compression and relaxation times. Minimize interruptions in chest compressions. Provide 30 compressions, and then give 2 rescue breaths. 5. Continue to provide cycles of 30 chest compressions and 2 rescue breaths. After 1 minute of cardiopulmonary resuscitation (about 2 cycles of 30 compression and 2 breaths), check for signs for circulation, including a pulse. If signs of circulation returns, stop chest compression and continue providing rescue breathing if needed. If you do not detect signs of circulation, continue cycles of 30 compressions and 2 breaths. Check for sings of circulation every few minutes.

CPR PERFORMED BY 2 RESCUERS All professional rescuers should learn both 1-rescuer and 2 rescuer techniques. When you perform CPR in a health facility, use barrier devices such as bag mask device. In 2 rescuers CPR, 1 rescuer is positioned at the victims side and perform chest compressions. The other rescuer remains at the victims head, keeps the airway open, monitors the carotid pulse to assess the effectiveness of chest compressions, and provide rescue breathing

The compression rate for 2-rescuer CPR is 100comperssion per minute. The compression ventilation ratio for 2-rescuer adult CPR is 30:2. Provide cycles of 30 compression and 2 breaths in 1 cycle. Provide cycle of 30 compression and 2 breaths until a breathing tube is inserted. Take 1 second for each breath.

Performing chest compression is tiring. If one rescuer becomes tired, change positions. Change quickly. Interrupting chest compressions interrupts circulation.

REASSESSMENT DURING 2-RESCUER CPR During 2-rescuer CPR the rescuer giving breaths must assess the effectiveness of chest compressions and must periodically check for signs of circualation. To assess the effectiveness of chest compression, feel for a pulse during chest compressions. If you do not feel a pulse, the rescuer performing compressions will need to compress more deeply or forcefully. To determine if the victim has signs of circulation, stop chest compressions for 10 seconds after the first minute of CPR (or according to protocol at your facility). When chest compressions are stopped, the rescuer at the victims head open the airway and looks, listens, and feels for adequate breathing or coughing. Both rescuer look for movement. The rescuer at the victims head should also feel for a carotid pulse. If signs of circulation (including a pulse) return, chest compressions are no longer required. Rescue breathing may still be needed. If no signs of circulation are detected, continue chest compressions and check for signs of circulation every few minutes.

RECOVERY POSITION If signs of circulation return, chest compressions are unnecessary. Continue rescue breathing until the victim breaths adequately. If the victim starts to breath adequately and no signs of injury are present, place the victim in the recovery position. If the victim is injured, leave the victim on his back and hold the airway open using a jaw thrust as needed.

ONCE I START CPR, WHEN SHOULD I STOP?

Once started, CPR should only be stopped when: 1. The patient has a pulse and is breathing; 2. Another trained reducer take over; 3. The doctor stop CPR and pronounce the victim dead; OR 4. You are too exhausted to continue.

Note: Encircle the correct answer 1) What does CPR stand for? a) Call, Plan, Respond b) Cardio-Pulmonary Resuscitation c) Coronary Pathogen Revival d) Capillary Process Review 2) When a persons breathing and heart beat stop, the______cell begin to die after 4 to 6 minutes. a) Heart b) brain c) Liver d) Kidney 3. A client experiences a cardiac arrest. What would be the first nursing action in this situation a) Call the physician on duty b) Establish an airway c) Start closed-chest massage d) Give a bolus of sodium bicarbonate 4. In the ABC method of cardiopulmonary resuscitation, the C stand for a) Cardiac b) Compression c) Circulation d) Carotid 5. In the ABC method of cardiopulmonary resuscitation, the C stand for a) Air flow b) Arterial pulse c) Airway d) Aorta 6. The proper way to determine unresponsiveness is? a) Pinch the earlobe b) Pour cold water on the person c) Use smelling salts rubbed in the nose d) Tap the victim and shout Are you OK? 7. The preferred way to check for breathing is: a) Place your hand on the chest and see if it moves with respiration b) Hold a candle to the nose and see if the flame moves with breathing

c) Look at the chest to see if it rises and listen and feel for air coming from the persons nose or mouth d) Tickle them and see if they laugh 8. To determine pulselessness in an adult, the nurse should check for a pulse at the__________artery a) Femoral b) Brachial c) Radial d) Carotid 9. When an unconscious patients head flexes forward, the________ could cause an airway obstruction. a) Hypophyarynx b) Uvula c) Tongue d) Larynx 10. One of the best method to relieve an airway obstruction due to the positioning of the patient is a) Jaw-thrust maneuver b) Abdominal-thrust maneuver c) Head-tilt, chin lift maneuver d) Jaw-lift maneuver 11. What is the step just before you look, listen and feel for respirations in the ABC's a) Check for responsiveness b) Open the airway c) Ventilate two times d) Check for a pulse 12. After opening the airway in a patient who requires rescue breathing, the nurse should inflate the patients lung with a) One quick, full breath b) Two slow breath c) One-half breath d) Four slow breaths 13. Adult rescue breathing should be provided at a rate of _______ breaths per minute. a) 5-7 b) 10-12 c) 15-20 d) 21-25

14. The nurse is about to give mouth to mouth respiration, she notice dentures what is next a) Remove them, wash them in cold water and place them back in b) Brush and floss them c) Take them out d) Leave them in if they are positioned properly

15. When delivering chest compressions during CPR, which of the following is not correct a) Keep your elbow straight b) Keep your hands on the sternum c) Deliver compressions with a stabbing motion d) Move from your hips 16. The CPR compression point is located on the lower half of the _______cantered between the nipples a) Clavicle b) Substernal notch c) Ribs d) Sternum 17. How would you describe hand placement on the chest to perform a compression on an Adult a. Two fingers, one finger width below the nipple line b. Heal of one hand placed on the lower third of the sternum with the other hand placed on top of the first hand c. Heal of one hand placed on the lower half of the sternum with the other hand placed on top of the first hand d. Heal of one hand placed on the lower third of the sternum 18. For an adult, the one-rescuer compressions-to-ventilations ratio is a) 10 b) 15 c) 20 d) 30

19. When performing CPR on an adult, the sternum is depressed a) to inch b) to 1 inch c) 1 to 2 inches d) 2 to 3 inches 20. Why is the recovery position used a) It protects the airway and allows for drainage from the mouth b) It forces the mouth to remain open at all times c) It protects the patients head during a seizure d) It makes oxygen administration possible in the unconscious patient.