First aid - CPR

Undertaking cardiopulmonary resuscitation

The ability to undertake cardiopulmonary resuscitation (CPR) is a fundamental skill which all nurses should possess at the point of registration (Nursing and Midwifery Council, 2018).  While some nurses will undertake additional skills training to be able to provide advanced forms of life support, all nurses should have an understanding of basic life support methods which can be used to maintain life both internal and external to the hospital.

Establish the need for CPR

The nurse should always be aware whether the people for whom they are caring have a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) in place, in which case they should not undertake CPR. Where there is doubt, CPR should be commenced. In the absence of a DNACPR order, the nurse should ensure they undertake a rapid assessment taking into account their own continuing safety and that of the patient. 

Once the nurse is assured the environment is safe, they should undertake a rapid assessment of the status of the patient. Assessing the apparently unresponsive patient means establishing if they are breathing or whether their breathing is slow and laboured (Resuscitation Council, 2021). (See: First aid - assessing a casualty)

Call for help

• it is always better to call for help immediately, this may mean pressing the emergency bell in hospital or shouting or phoning (using handsfree calling if possible) for help in the community.
• calling for help takes priority over starting CPR if the nurse is alone.

Make ready

• if the patient is on a bed, the nurse should lay the bed flat and it may be wise to raise the bed to a working height.
• if the patient is on an air mattress the nurse should pull out the CPR plug to deflate the mattress rapidly.
• if the patient is on a chair or sat upright, it may be best to get them quickly and safely on to the floor.
• it is imperative that chest compressions start as soon as possible, but in a position which maximises their effectiveness.

Delivering chest compressions

• chest compressions are delivered to the

References

Davison L, McSporran W, Brady G et al. Respiratory care, CPR and Blood Transfusion in Lister S, Hofland J, Grafton H and Wilson C (eds.). The Royal Marsden Manual of Clinical Nursing Procedures (10th edn). Chichester: Wiley Blackwell; 2021 pp. 539-655.

Morgan S. Emergency Care, In: Delves-Yates (ed.) Essentials of Nursing Practice. (3^rd edn).  Sage; 2015 pp. 509-530.

Nursing and Midwifery Council.  Future nurse: Standards of proficiency for registered nurse. 2018.  https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 12 April 2022)

Resuscitation Council. Adult basic life support Guidelines. 2021.  https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines (accessed 12 April 2022)

St John’s Ambulance. How to do CPR on an adult: COVID-19 update. 2021. https://www.sja.org.uk/get-advice/first-aid-advice/unresponsive-casualty/how-to-do-cpr-on-an-adult/  (accessed 12 April 2022)