NURSING SERVICE STILL ON CARDIO RESPIRATORY

By: Enf ª. Ana Paula S. Cross

Respiratory arrest
• It's the sudden withdrawal of respiration, may be with or without heart failur
e.
RESPIRATORY FREQUENCY Adult - 15-20 Child WPRM - 20-25 WPRM Babies - 30-40 WPRM
FACTORS allowing proper BREATHING Proper concentration of oxygen in inspired air
, unobstructed air passages; Action muscular rhythmically active respiratory mus
cles, circulation adequate blood.
Diagnosis
• Absence of respiratory movements; • Cyanosis (purplish blue lips, nails, not m
andatory) • Dilation of pupils (not mandatory) • Unconsciousness.
Causes of respiratory arrest
• • • • • • Drowning burial Shock Trauma Poisoning Choking (foreign body)
Objectives of respiratory care
• Ensure a patent airway, provide supplemental oxygen and establish positive pre
ssure ventilation, when spontaneous breathing is inadequate or absent.
METHODS TO RESTORE BREATHING
Mouth / mask
Word of Mouth
Using the Ambu
The OB STRUC WAYS TO OCCURS RESPIR ACTOR IA
Muscle relaxation (Language); Presence of Foreign Body.
PROCEDURES FOR RELEASE For muscle relaxation;
In the presence of foreign body;
Sequence of care
• Chin lift - The fingers of one hand are placed under the chin, which is slight
ly drawn up, raising it earlier. The thumb of that hand depresses the lower lip
to open the mouth. The thumb can also be placed behind the incisors, while simul
taneously and gently lifted her chin. If mouth to mouth resuscitation is require
d, the nostrils are closed with the thumb and forefinger of his other hand;
• Draw the jaw - Find the angles of the jaw and pulls up the lower jaw forward.
If the lips close the bottom can be retracted with the thumb. If mouth to mouth
resuscitation is required, we must close the nostrils by placing your cheek agai
nst them, blocking them.
• Breath of mouth - Taken the previous measures put his mouth firmly over the mo
uth of the victim. Blow into the mouth of the victim until you notice that your
chest is moving. Next, let the victim exhale freely. We repeat this procedure 15
-20 times per minute.
• mouth-nose breathing - place your mouth over the nose and close the mouth of t
he victim. In children we can put your mouth on the nose and taking care not exp
ire with excessive pressure.
Cardiac Arrest
• The heart stops pumping blood to the body which thus ceases to carry oxygen to
tissues.
Diagnosis
• No wrist (radial, femoral and carotid); • Cold, pale or bluish; • Respiratory
arrest (frequent but not compulsory) • Unconsciousness; • Dilation of pupils (of
ten, but not required) • In doubt, proceed as if it were.
Sequence of care
1 - Place the victim lying on her back on a hard surface, 2 - Put your hands sup
erimposed on the lower third of the sternum; 3 - Make compression on the sternum
to the spine;
The location of external cardiac massage is found by placing your hand two finge
rs above the xiphoid process.
CHEST
Sternum xiphoid process ribs Borders
Hands should be overlapping, interlocking fingers and only one hand in contact w
ith the sternum. The compression causes the blood to circulate, thus replacing t
he work would be done by the heart.
• Position the hands of the rescuer.
Treatment
• We do 30 compressions to 2 breaths lung at a rate of 100 compressions per minu
te, counting aloud, "and one and two, three, four and five and six, and ..., fan
s! , fans! "so if the team working properly, at least 04 cycles must be complete
d out of each minute of CPR.
Cardiopulmonary resuscitation
• The maneuvers aim to maintain the flow of oxygenated blood to vital organs, es
pecially the brain. • Intervention in respiratory arrest should be aggressive to
prevent the occurrence of cardiac arrest.
• The CPR is divided into primary and support ALS (advanced life support). • The
basic life support includes opening the airway, artificial respiration (ventila
tion) and artificial circulation (chest compressions), this procedure does not r
equire sophisticated equipment, but, dexterity and speed of execution of the man
euvers.
• The VAS requires the improvement of techniques used in basic support in obtain
ing vascular access route in the administration of fluids and drugs in cardiac m
onitoring and the use of defibrillation.
Necessary material in a PCR
• Ambu mask;
• Cannula guedell of different sizes;
• Laryngoscope with blades of different sizes; • Laryngoscope unconventional; •
Laryngoscope with articulated tip
• Laryngoscope cable articulated
• Optical Laryngoscopes;
• Magill forceps; • Wire guide;
• endotracheal tube with cuff and without cuff, different numbering.
Special material
• Chest Compressor (rigid board) • Fan;
• Cardiac monitor; • Defibrillator.
• Ventilation with Ambu
• • • • • • •
AMOUNT OF OXYGEN SUPPLIED IN MOUTH-MOUTH-A-16% OPEN AIRWAYS - FILL YOUR LUNGS PI
NCE Nostrils - SELECTION WITH THE MOUTH inflated for 2 SECONDS (10 A 12-MINUTE B
Y EVERY 1 4-5 SEC) TO OBSERVE THE chest elevated-SE (700 A 1000 ML) RISK: gastri
c distension IN FIRST TIME, GIVE TWO BLOWERS O2 INCREASE USE IF POSSIBLE IF POSS
IBLE AMBU
• • • • •
THE POINT IS IN COMPRESSION, brisket, LEAVING FREE TWO FINGERS UP THE JUNCTION O
F LATEST RIBS Compress the chest 4-5 CM (60-80mmHg) THEN, LIGHTEN THE HAND COMPL
ETELY WITHOUT LOSING TOUCH REPEAT X 100 PER MINUTE interspersed with BREATH: 15
X 2 (1 OR 2 rescuers)
COMPRESSION THORACIC
PRIMARY ASSESSMENT AND CPR
CHECKING THE CONSCIOUSNESS
OPENING AIRWAY
CHECKING THE BREATHING SEE-HEAR-SENT
CHECKING THE BREATHING SEE-HEAR-SENT
INFLATION 2 X
NOTING SIGNS OF CIRCULATION: RESPIRAÇÃOPULSO-COUGH-MOV
15 X 2
2 FINGERS UP THE AP. Xiphoid 2 breaths 15 compressions S
AFTER 4 CYCLES
NOTING SIGNS OF CIRCULATION: RESPIRAÇÃOPULSO-COUGH-MOV
Complications
rib fracture. rarely fractured sternum. Pneumothorax Hemothorax pulm
onary contusions of the liver and spleen lacerations Fat embolism
Situations that allow the interruption of resuscitation:
• When there is no restoring circulatory, usually after 30 minutes of CPR, excep
t for hypothermia;
•
Other factors must be considered and / or circumstances for this decision, predi
ctive of successful CPR, ie: • Background and history provided, • Cause of arres
t, arrest mechanism, • Place of occurrence, duration of symptoms, duration of re
suscitation pre and hospital.
Situations where there is no indication to start CPR maneuvers:
• Under conditions of irreversible diseases; • In the condition where there are
obvious signs of deterioration of organs, characterizing biological death.
Care after cardiac arrest
• After resuscitation, the patient needs a continuous observation and rigorous,
especially in relation to heart function, kidney and brain. • These patients sho
uld preferably be kept in ICU.
Questions? Questions?