TIME OBJECTIVE CONTENT TEACHING EVALUATION

LEARNING
ACTIVITIES
INTRODUCTION:

There are several kinds of heart conditions, among which heart

attacks, strokes, and cardiac arrests are quite common in the world’s
population. It is one of the leading causes of out-of-hospital deaths.
The condition is so quick and severe that only the presence of mind
saves the life. In 2010 the American Heart Association changed the
guidelines for cardiopulmonary Resustation including a compression
only for untrained people. To encourage many people to attempt
CPR.This law is called as “Good Samaritan” law. Previously
protocol for CPR was A – airway; B- Breathing; C – Circulation. But
now in most cases compression is done first.
Reviewed about
ANATOMY AND PHYSIOLOGY OF HEART anatomy and
7 min Review anatomy Project on
physiology of
and physiology A child's heart is the center of their cardiovascular system. A normal PowerPoint
cardio vascular
of cardiovascular heart is strong, about the size of an orange and weighs about one
system.
system pound. Although it is small in size, the heart is extremely powerful.
The heart continuously pumps oxygen and nutrient-rich blood
throughout the body. On average, the heart beats 100,000 times and

pumps about 2,000 gallons of blood (source: American Heart

Association) that is (7571 liters of blood). As the blood circulates it
collects waste products that will be excreted from the body. The wall
of the heart consists of three layers: the epicardium (external layer),
the myocardium (middle layer) and the endocardium (inner layer).
The epicardium is the thin, transparent outer layer of the wall and is
composed of delicate connective tissue.

The heart has four chambers. They are:

1. Upper right atrium

2. Upper left atrium

3. Lower right ventricle

4. Lower left ventricle

The heart pumps blood through the chambers. The flow of blood
through the heart is controlled by four heart valves. The valves open
and close as the blood is pumped through the heart. Each valve has a
set of flaps (also called leaflets or cusps). All valves have three flaps,
except for the mitral valve. Normally, it only has two. As the heart
beats it creates pressure that opens the valves which allows blood to
flow through the flaps. They make sure the blood only flows in one
direction.

1. Tricuspid valve (between the right atrium and right ventricle)

2. Pulmonary valve (between the right ventricle and pulmonary

artery)

3. Mitral valve (between the left atrium and left ventricle)

4. Aortic valve (between the left ventricle and the aorta)

The two sides of heart have distinct features. The right side receives
blood from the body and pumps it to the lungs. The left side receives
the blood from the lungs and is pumped out into the body. The heart
receives blood from veins and sends blood out through arteries.
The Conduction System

Electrical impulses from our heart muscle (the myocardium) cause

our heart to contract. This electrical signal begins in the sinoatrial
(SA) node, located at the top of the right atrium. The SA node is
sometimes called the heart’s “natural pacemaker.” An electrical
 impulse from this natural pacemaker travels through the muscle
fibers of the atria and ventricles, causing them to contract. Although
the SA node sends electrical impulses at a certain rate, your heart rate
may still change depending on physical demands, stress, or hormonal
factors.
Answered the
Meaning of Cardiac arrest. meaning of
1min Review meaning What is the
cardiac arrest.
of cardiac arrest The term cardiac arrest refers to sudden stoppage of heart function, meaning of
meaning it stops beating and the person goes unconscious due to lack Cardiac arrest?
of blood supply throughout the body. It is not the same as heart
attack that most people misinterpret. Heart attack is the condition in
which the blood supply is obstructed to the heart, thereby causing
mild to severe pain at the heart region and/or other surrounding
areas. It is possible that a heart attack may cause cardiac arrest but
these are two different terms. Cardiac arrest may also be caused due
to any other heart conditions, or no previously diagnosed signs and
symptoms at all.

Defined Cardio
2min Review Definition of Cardiopulmonary Resustation: CPR is a procedure pulmonary
Definition of to support and maintain breathing and circulation for an infant child Resustation.
To project the
or adolescent who has stopped breathing (respiratory arrest) and/ or
Cardiopulmonary definition on
whose heart has stopped (cardiac arrest).
Resustation. transparency
According to W.H.O

CPR or Cardiopulmonary Resuscitation is an emergency lifesaving

procedure performed when the heart stops beating. Immediate CPR
can double or triple chances of survival after cardiac arrest.

According to American Heart association

Purpose of CPR

2min Its main purpose is to restore partial flow of oxygenated blood to

What are the
the brain and heart. The objective is to delay tissue death and to
purposes of
Review purpose extend the opportunity for a successful resuscitation without
Cardiopulmonary
of permanent brain damage.
Resustation?
Cardiopulmonary
Indications for CPR:
Resustation
2min  Respiratory arrest

Enumerate  Cardiac arrest Prepare a chart on

indications for the indications of
 strokes (when the blood flow to a part of the brain suddenly
CPR Cardiopulmonary
stops)
Resustation
 Depression from anesthesia

 Coronary occlusion

 Acute myocardial infraction

 Ventricular fibrillation(VF)

 Ventricular tachycardia(VT)

 A systole

 Drowning

 Pulmonary embolism
 Warning signs of cardio pulmonary arrest:-

 Early signs: loss of consciousness & convulsions

 Late signs: Apnea .Dilated pupils .Absence of heart sound
1min
o Other signs
 Changes in respiratory rate Show flash cards
 A weak or irregular pulse for warning signs
List the warning  Bradycardia
signs  Cyanosis
 Hypothermia

Cardio Pulmonary Resustation: Equipment.

1.Ambu bag and masks with different size (0,1,2)

2. Oro pharyngeal airways.

1min
3. Endotracheal tubes of appropriate sizes and stillet. E T .tubes
Show live and on
Sizes (2, 2.5, 3, 3.5, 4 ,4.5 )
power point
Arrange the
4. Pediatric laryngoscope with straight (Miller) and curved projection.
equipment for
 CPR (McIntosh) blade – Appropriate sizes.( 0,1)

5. Suction apparatus with suction catheter size 10 or 12 F

6. NG tube. Size (5,6F )

7.equipments & fluids

8.Pulse-oxymetry

9.Oxygen sources

10. Automated external defibrillator

11.Emergency drugs (Adrenalin ,Normal

saline,Ringerlactate,Sodiumbicarbonate)

12.Cardiac monitor

Physiology: Blood moves during cardiopulmonary resuscitation

(CPR) as a result of direct compression of the heart between the
5min sternum and the vertebral column was originally proposed by
Kouwenhoven, Jude and Knickerbockers' in 1960. Pressure and Flow
 Pattern During CPR Each chest compression produced positive
pressure pulses of similar magnitude in the right atrium, When
Describe the
compression was released, there was significant retrograde carotid
Physiology
blood flow as well as ante grade jugular flow. There was negligible
retrograde jugular flow during chest compression despite a large
pressure gradient between the right atrium and the jugular vein
outside the chest. The mechanism of blood flow during
cardiopulmonary resuscitation remains controversial. Both
cardiac pump and thoracic pump models have been Power point
proposed. The "cardiac pump" theory postulates that projection.
forward blood flow during cardiopulmonary resuscitation is due to
compression of the heart between the
sternum and the spine. This theory requires that the
atrioventricular valves be closed during cardiac compression
(systole). The "thoracic pump" theory postulates that external chest
compression increases intrathoracic pressure, which forces blood to
flow from the
thoracic to the systemic circulation, with the heart
acting as a passive conduit without having a pump function.
5min BAG and MASK VENTILATION: Return
demonstration.
• This is the most important airway skill.

Demonstrate bag • A basic airway management technique that allows for oxygenation Demonstration
and mask and ventilation of patients until a more definitive airway can be
ventalitation established.

• Also used in cases where Endotracheal intubation or other

definitive control of the airway is not possible.

. • In the pediatric population, BMV may be the best option for

prehospital airway support. BMV ventilation is also appropriate for
elective ventilation in the operation theatre when intubation is not
required, but it is now often substituted by the laryngeal mask airway

EQUIPMENT & PARTS OF BMV

PARTS OF BMV The BMV consists of

1. The bag : a flexible air chamber , attached to a face mask via a
shutter valve which is squeezed to expel air to the patient.

2. Mask: a flexible mask to seal over the patients face,

3. Filter and valve : a filter & valve prevent backflow into the bag
itself (prevents patient deprivation and bag contamination)

4. Oxygen Reservoir:

5. Pressure Gauge

6. Oxygen Connecting tube

7. Provide a volume of 6-7 mL/kg per breath Paediatric size:500 ml

.Self inflating bag (AMBU Bag) • Fill spontaneously after they are
squeezed, pulling oxygen or air into the bag

• Remain inflated at all times

• Can deliver positive-pressure ventilation without a compressed gas

source.

• Require attachment of an oxygen reservoir to deliver 100% oxygen

PROCUDURE • One hand to • maintain face seal • position head •

maintain patency • Other hand for ventilation

BMV TECHNIQUE

• “Sniffing” position C-spine

• Thumb + index finger to maintain face seal

• Middle finger under mandibular symphysis

• Ring and little finger under the angle of mandible AMBU Bag Fill
spontaneously after they are squeezed, pulling oxygen or air into the
bag.

BAG and MASK VENTILATION:

• This is the most important airway skill.

• A basic airway management technique that allows for oxygenation
and ventilation of patients until a more definitive airway can be
established.

• Also used in cases where endotracheal intubation or other

definitive control of the airway is not possible.

. • In the pediatric population, BMV may be the best option for

prehospital airway support. BMV ventilation is also appropriate for
elective ventilation in the operation theatre when intubation is not
required, but it is now often substituted by the laryngeal mask airway

EQUIPMENT & PARTS OF BMV

PARTS OF BMV The BMV consists of

1. The bag : a flexible air chamber , attached to a face mask via a

shutter valve which is squeezed to expel air to the patient.

2. Mask: a flexible mask to seal over the patients face,

3. Filter and valve : a filter & valve prevent backflow into the bag
itself (prevents patient deprivation and bag contamination)

4. Oxygen Reservoir:

5. Pressure Gauge

6. Oxygen Connecting tube

7. Provide a volume of 6-7 mL/kg per breath Paediatric size:500 ml

.Self inflating bag (AMBU Bag) • Fill spontaneously after they are
squeezed, pulling oxygen or air into the bag

• Remain inflated at all times

• Can deliver positive-pressure ventilation without a compressed gas

source.

• Require attachment of an oxygen reservoir to deliver 100% oxygen

PROCUDURE • One hand to • maintain face seal • position head

•maintain patency • Other hand for ventilation
BMV TECHNIQUE

• “Sniffing”position C-spine

• Thumb + index finger to maintain face seal

• Middle finger under mandibular symphysis

• Ring and little finger under the angle of mandible AMBU Bag Fill
spontaneously after they are squeezed, pulling oxygen or air into the
bag.
 Aftercare
Emergency medical care is always necessary after CPR. Once a
1min How do perform
person's breathing and heartbeat have been is coming and talk
after care of the
positively until professionals arrive restored, the rescuer should make
child?
the person comfortable and stay there until emergency medical
Perform after personnel arrive. The rescuer can continue to reassure the person that
care of the child help and take over.

Risks
CPR can cause injury to a person's ribs, liver, lungs, and heart.
2min
However, these risks must be accepted if CPR is necessary to save What are the risks
the person's life. related?

Discuss about
Risks, normal Normal results
results, abnormal In many cases, successful CPR results in restoration of consciousness
results and and life. Barring other injuries, a revived person usually returns to
parents concern normal functions within a few hours of being revived.
Abnormal results include injuries incurred during CPR and lack of
success with CPR. Possible sites for injuries include a person's ribs,
liver, lungs, and heart. Partially successful CPR may result in brain
damage. Unsuccessful CPR results in death.

Parental concerns
Because most cardiopulmonary arrest in infants and children occurs
in or around the home and results from Sudden Infant Death
Syndrome ( SIDS), trauma, drowning, choking, or poisoning , all
parents and child caregivers should consider becoming trained in
CPR. Training is available at local schools and community center