02.01 Brief CPR (Cardiopulmonary Resuscitation) Overview

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Outline

Overview

  1. This is based on actions IN a healthcare facility – as if you are the nurse and find an unconscious patient.
    1. In the community, the algorithm is slightly different, refer to the American Heart Association for details.

Nursing Points

General

  1. Patient found unconscious:
    1. Always assess first
    2. Determine responsiveness (sternal pressure, yelling)
    3. Check for carotid pulse (MAX 10 seconds)
    4. Know/ask if a neck injury is suspected
  2. If no pulse
    1. Call for help (Code Button, yell, call light)
    2. Send someone for AED
    3. Begin chest compressions at a rate of 100-120 beats/min
    4. Do NOT delay chest compressions
    5. During chest compression, do not stop unless instructed
      1. Minimizing chest compression interruptions is ESSENTIAL
      2. Push hard and fast
      3. Must allow for recoil
  3. Help arrives
    1. Another health care provider will open airway
    2. Use BVM to administer breaths after 30 compressions
      1. 30 : 2 ratio until secured airway
    3. Other health care providers should be attaching the defibrillator pads, ensuring IV access
    4. Do not use the pediatric/child defibrillator pads on an adult
  4. 2-minute cycle finishes
    1. Check carotid pulse
    2. Analyze rhythm (AED mode if no ACLS providers present)
  5. If shock advised
    1. Resume compressions while defibrillator charges
    2. Clear patient to administer appropriate shock
    3. Immediately resume compressions
  6. If pulseless and no shock indicated, immediately resume CPR
  7. Begin ACLS algorithms when advanced practitioners available

Nursing Concepts

  1. Clinical Judgment
  2. Perfusion
  3. Oxygenation
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Transcript

Hey guys, my name is Brad and welcome to nursing.com. And in today’s video, what we’re going to be doing is we’re going to have a little brief CPR overview, cardiopulmonary resuscitation.  Let’s dive in. 

So, in instances where CPR is warranted, you can imagine that the heart is the pump of the body. And when CPR is warranted is whenever the pump is broken. And instances where the heart has stopped, in cardiac arrest, the heart is stunned. The ventricles are not contracting and the pump is broken and therefore blood is not moving. It’s stagnant and it’s just sitting there. And I like to think about this, a little water pump. As an example, the heart is a pump, right? Imagine you have this water pump. Every single time that you pull the handle of that water pump water gets ejected.  Every time with consistency. But what would happen if that handle were to break and you went to try and pump water out of that water pump? Water is not going to come out at all. You’re just going to have a loose handle, a broken pump. And because the pump is broken, water can not be ejected. 

So that begs the question, right? What is CPR? This is essentially a last ditch, emergent effort to try and resuscitate somebody. To try and restart a patient’s heart who has stopped working. So imagine here that we have a patient, right? This is the way that I like to conceptualize what CPR is actually doing. Okay. If we take essentially a closeup view of a patient’s sternum, right? We have a patient’s sternum. Imagine that this is the breast bone. And underneath that breast bone, you know, it’s there to protect our heart from any kind of injury. So what we’re going to do is, in CPR, we’re going to compress, high quality compressions, pushing down on the sternum and then attempt to squish the heart, to squeeze the heart dry of blood, eject blood out of the heart so that the rest of the tissues of the body can be perfused. Think about it like ringing the sponge dry. That’s the entire idea. We’re going to mechanically, physically push down on a patient’s sternum to squeeze the heart, compress the heart, to eject blood and achieve perfusion, right? That’s the biggest thing. We need to perfuse these tissues to achieve profusion to the rest of the body. 

So when is CPR warranted?  What are some of the assessment findings that you’re going to come across? Whenever you come across an individual actively in cardiac arrest, right? Well, first of all, they’re going to be unresponsive. You’re going to call their name. You’re going to be tapping on them, trying to shake them to wake up and they’re not going to be responsive. The second thing is they are not going to have any respirations. They’re not going to be breathing at all. What you’re going to do is you’re going to get down, you’re gonna look at their chest, see if you see any chest rise, any actual respirations occurring.  In cardiac arrest, you’re not going to see this. And the third thing that you’re going to see or assessment finding is no respirations. Also no pulse, right? The entire idea is we don’t have a pulse. Pulse is generated from a contracting heart. The pump is broken. The pump is broken, blood is not moving. There’s no pulse. They’re in cardiac arrest. There’s no respirations. They’re unresponsive. Going to try and shake them, wake them up. See if they’re responsive.  You’re going to be looking for chest rise and fall seeing if they have any respirations. Make sure that you understand that, right? We’re not going to feel for a radial pulse. We are going to feel for a carotid pulse. That’s the gold standard whenever we’re talking about CPR.

Now, what is this usually caused from? Right? This is usually a disruption in the electrical system of the heart, right? And I have to reiterate and remind you guys, remember, so here we have the heart: two atrium, two ventricles. Also remember up here in the myocardial tissue itself, we have the SA node going down to the AV node, the electrical A and P of the heart. Remember that going down into these bundle branches and terminating in these Purkinje fibers, right? What we have is a disruption in the electrical conduction system itself. It could be from something such as a myocardial infarction, for instance.  Whenever we have a vessel in the heart that has gotten blocked off and no profusion is actually occurring to this heart muscle itself. Think about it, if you don’t have perfusion to the heart muscle and the electrical conduction system lives inside of the heart muscle, then you can think that the electrical conduction system is not going to be getting blood. And if that fails to start to get blood, you’re going to start to see electrical abnormalities, usually in cardiac arrest situations in the form of v-tach or v-fib. If myocardial infarctions or v-tach or v-fib, or the electrical A and P of the heart is not familiar to you, we have a lot of resources down below. I recommend you check out. But the overall idea here is to understand that if you don’t have perfusion to the heart, then your electrical conduction system is impaired. So, you don’t have conduction. And if you don’t have conduction, you don’t have contraction.  No contraction, the pump is broken, blood is not moving. 

So, the actual hallmark of cardiopulmonary resuscitation are effective quality compressions. So how are we going to actually perform quality CPR? Okay. The first thing is we’re going to be doing this at a rate of 100 to 120 compressions per minute. There are several different songs out there that you can use to keep in your head to try and help you stay on rhythm, to stay doing 100 to 120 compressions per minute. Like “Another One Bites the Dust”, right? That’s another one. Okay. Anyway, you know, that song. Just different kinds of things that you can keep in your head to make sure that you’re maintaining a rate of at least 100 to 120 compressions per minute. 

Also, want to understand and make sure that your compression depth is at least two inches in adults, right? Remember that sternum, remember the heart underneath there. We’re actually compressing the sternum down and we’re squeezing the blood out of the heart, like ringing the sponge dry. So we want to make sure that we’re actually compressing at least a depth of two inches. 

And it’s also important to remember in between every compression to allow for full chest recoil, which means you’ve squished the sternum down to compress the heart, allow that sternum to fully, fully recoil, back up to try and allow as much blood to return to the heart so that you have a full heart again, before you do your next compression. I hope that made sense. 

And you’re going to be doing this on your own fully, just relying on compressions, no respirations, whenever it’s just you arriving on scene. But once you have a friend that arrives to help, we’re going to get the AED in action and start to implement a few other steps. 

So once you have a friend arrive and you have a little bit of help, we’re going to begin implementing this AED, which again is that defibrillator. So essentially what’s going to happen while compressions are still occurring, because high quality compressions are the most important thing with CPR, we’re going to get these pads attached, right? We’ll have a pad here, a little pad over on this side, and these are going to be hooked up to a defibrillator machine, right? And we’re going to have our second friend, our helper now, begin starting respirations. So we’re going to make sure that we do these at a ratio of 30 compressions to two respirations. Again, maintaining high-quality compressions. As we have our patient hooked up to the AED, we’re going to then push, analyze, right? This is going to cause the AED to analyze our rhythm. Now, if, as we’re analyzing, we want to stop all compressions. Now this is an actual instance where you’re going to stop all compressions, that we’re going to allow the AED to actually analyze, to see if a patient has any kind of intrinsic electrical activity, cardiac activity. While you’re analyzing, we’re not doing anything other than letting the machine do the work, we can also take the opportunity to check a carotid pulse. If the AED, after analyzing, says that the patient is in a rhythm that is shockable. This is where it is very important. You now have friends on the scene who are helping you. People who are healthcare providers trying to help this person. But what we’re about to do, if this thing, if this AED says, we need to deliver a shock, we have to keep our coworkers safe as well. So what we’re going to say is “ALL CLEAR”. We want to make sure that everybody is clear of the bed. The last thing that you want to do is defibrillate your coworker who’s over there bagging the patient and send them into cardiac arrest themselves. So we’re going to make sure that we yell “ALL CLEAR”. We’re going to ensure visually that our patient is indeed all clear. And then we’re going to press the shock button. And if the AED says that the patient is still in a lethal rhythm, we still need to resume compressions, that we’re going to do. So we’re going to, after delivering the shock, we would then go on from there continuing to code. 

And so to summarize a few of our key points surrounding CPR or cardiopulmonary resuscitation, remember that it is warranted in instances during cardiac arrest whenever the pump, the heart itself has broken and blood is not moving. We want to mechanically, physically compress the patient, sternum, squeezing and ringing that heart dry of blood, like a sponge, and then overall attempt to try and perfuse those end organs of the patient. Remember that it all begins with high-quality compressions. Remember how many compressions per minute. Remember those songs that would help you stay on track. Also remember that we want to compress at least a depth of two inches in adults and make sure that we allow for full chest recoil and whatever you do, do not stop. Right. And also don’t forget whenever you have a friend arrive, this is when we’re going to begin to implement respirations, at least a ratio of 30 to two, and we’re going to get the AED on the patient so that we can begin to analyze what kind of electrical activity we have in an overall attempt should shocks be needed to try and shock that heart out of a lethal rhythm and restore a normal sinus rhythm. 

So guys, I really hope that this video helped you understand CPR a little bit better. I know that it was a quick, condensed, little lesson on CPR, but I hope that what you learned here today, you will take forward with you not only for your tests, but also in clinical practice. I hope that you guys go out there and be your best selves today. And as always, happy nursing.

 

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