CARDIOPULMONARY RESUSCITATION algorithm

CARDIOPULMONARY RESUSCITATION algorithm

Purpose

To provide artificial ventilation and circulation so as to provide oxygen to the brain, heart, and other vital organs until definitive medical treatment can be initiated

Indications

• Cardiopulmonary arrest

Contraindications

• None

Potential Complications

• Aspiration

• Gastric distention

• Laceration of internal organs

• Rib fractures

Equipment

Bag-valve-mask unit

Cardiopulmonary resuscitation record Supplemental oxygen

Procedure

1. Assess patient for unresponsiveness by gently shaking and calling loudly, "Are you OK?" Caution should be used in shaking any trauma victim.

2. If patient does not respond, assure adequate assistance is available

3. Open airway. Move lower jaw forward, using head-tilt-chin-lift maneuver or the jaw-thrust maneuver. This lifts the tongue away from the back of the throat and prevents obstruction.

4. Determine breathlessness. While maintaining an open airway, place your ear over patient's nose and mouth and observe patient's chest. Look for chest to rise and fall, listen for exhalation and feel for flow of air. If after 3-5 seconds none of the aforementioned are noted, prepare to initiate artificial respiration. A bag-valve-mask unit should be used whenever possible to ventilate the apneic patient. However, if one is not available, mouth-to-mouth rescue breathing should be started.

5. If bag-valve-mask unit is available:

a) The bag-valve-mask unit should be used only by well trained and experienced personnel as it is difficult to maintain an open airway while providing adequate ventilation volume

b) The head must be maintained in extension with the jaw elevated and the mask held tightly against the patient's face. Therefore, the nurse should be positioned at the head of the stretcher. One hand is used to hold the mask in place and the head in position. The other hand is used to squeeze bag.

If a bag-valve-mask is not available:

a) Pinch patient's nose closed using thumb and index finger of the hand placed on the forehead and used to maintain the head-tilt

b) Taking a deep breath, form an airtight seal with your mouth over patient's mouth

6. Deliver two full breaths—each lasting 1'/2 seconds/breath. Adequate time should be allowed to ensure good chest expansion and decrease likelihood of gastric distention. Supplemental oxygen should be added as soon as possible.

7. Determine pulselessness by locating carotid artery and checking for a pulse. This can be accomplished while maintaining the head-tilt with one hand on the forehead, locating the patient's larynx with two fingers of the other hand, and sliding the fingers into the groove between the trachea and the muscles at the side of the neck. To avoid compressing the artery, press gently for at least 5 seconds. Adequate time should be given to assure if a slow, irregular, or weak pulse would be identified.

8. If pulseless, perform external chest compressions with hands located on the lower half of sternum, arms straight, elbows locked, and shoulders over your hands. Perform compressions at rate of 80-100 per minute.

9. During two person CPR, deliver one breath during a pause after every fifteen chest compressions. Breath should last 1 to 1 '/2 seconds.

10. Assess patient frequently to assure that CPR is generating an artificial pulse

11. After every therapeutic intervention, stop CPR and assess patient to determine if a spontaneous pulse has returned

Follow-Up

1. If not yet done, place patient on monitor, initiate intravenous line and follow vital signs q 5-10min until stable

2. Determine cause for cardiac arrest, and assist in stabilizing

3. Provide information and support to family as appropriate

Documentation

Time of initiation and duration of CPR

Patient responses to therapy