U'ASON PIAN

Subjed : Nursing Founda1ien..fin1 Aid. hfemJ

UDI,
! 11 _ __. · --..I . ~- : . . • fi _:..1
; pnJ~IDie ilWU. leeiondJU.C U1 lnl i1DU
Topic ~ CPR- M'Oldll to moul&, Sylvmster" Schafer:. E&llmal ,cardiac m1t1uge _
Oroup : GNM 1• Ycar IIUdml&.
Pllce ; Class mom and de -··. lion room
Tune : 60 minutes
Teaching method : LeclDfe cum demonsuation
AV aids / instructional aids : Black 'Baud and chalk. dw:t. LCD" Computer:.
Studenl Pre requisite· ~The studems should he able 10 identify Im eligible victim who need CPR,- M,mnh kl
1

mou~ Sylvester~Schafer,, &lema.l canfiac massage.. and would t,c lbllc Reognizc tbc
importance of CPR- Moulh 1D mouth. S)!lvester.,Schaf•~ &Janal camiac ma«aF.

General Objective : .A t die end of'ihe class the smdems ·will be·,abJe,to gain knowledge and demoosuate
regarding,rC PI,.- :Moulb ID
I~ Sylvestert Sdw'er. Exlaml cardiac massag•.

' ICo.bJ1elln1,;
At die end orme class the nudems will be able ·ro
l. Define CPR.~ Mouth to mo11~ Sylvester. Schafer,, EJUcmaJ cardiac masage~
2.. Enumerate,the purposes of CPR· Mouth lo. mouth, Sylv.estet, Schafer,, &temal cardiac ma.ssage'"
] . Explain indications for CPR- Moul& M mo~ Sytves1er,, Schafer. &lmlal cardiac ·~ g e..

4a Apply lhe pn£lll instruerion .l ot ef&diw CPR- Mouth lo moudt. ,SJflvesrer, Schafctr, Ex.temal canfiac mn;age.
S. Ptepare am articles for CPR.- Mouth lomoulh:, Sylv,C:lla"li Schaf~,, .E mmal canliac massigt".
6. Describe 1:e clmiqms and steps fm of CPL
7. Describe lbc pierautiom of Cmdio-·l\llt:Mnaey hmscitation
 2

Review of previous class: Ask questions regarding CPR- Mouth to mouth, Sylvester, Schafer, External cardiac massage.
Introduction:
Unexpected cardiopulmonary collapse is a medical emergency that requires immediate institution of the artificial
measures to support life and to reverse the initiating path physiological event

Ask the students if they know CPR.

Tell a story of accidents in which CPR saves life.
Brainstorm what they should use a1 the time of emergency
Also mention the objectives of the lesson to the students here.
S.N Time Spttillc Coatenl Tncblna Enl1111ion
0 objtttive lamina
actlwity
1. 2 Delinllioo :• Lcc1urc Q: Wri1e the
.
malllS •CARDI O-PULMONAR Y ~USCITATION is a series of cum dcfmilion of
first aid procedures. including recognition and treatment of discussion CPR.
circulatory and respiratory arrest. ca,pable of maintaining life
until advance life support is available."

Define the Scluller mdhod-

8 cardio- lt is prone pressure method of artificial respiration in which Ilic
Min pulmonary victim is placed face downward pressure then being rhythmically
rcsu!l<:11auon appl ied with hands to the lower pan of thonut.
the first aider kn.eels on both knee ju.sl below victims hip joint
then place his band of the loin causality. one on each side then
the backbone with wrist almost touching and thumb ■pan. "Now
the first aider has to lean slowly forwarded without banding
elbow and knee for allow the weigh! 10 communicaled loin of the
patient. This results compress abdomci:n against the ground and
up againh1 diaphragm. Air is thus forced oul of lungs and
expira1ion. Now I.he first aider will release the: pressure by doing
so abdominal organs will fall baclc and diaphragm will drop and
induce inspiration. This two faces ween S seconds 12 limes in
min1ncs.

Sylvester mdhod ·
it is a method of anificial respiration in which the subjccl is laid
 OD 1115 JMr DICK and ur lS lllpillied nm nmp oy pR!SSmJ lDC
11J1D over the chat 111d ftab air' dawn, in by puniq lhe am1
above lhc head.
pba·cuuall)' on rum surface 1c leu die moolh IJenadl shoulders
lo ni&1: lhan saff"icimlly rm .b ad lo be tilled back in OfASl!a
ainny posilimL Knee~ It 1c uually held 11mp lhl· \Wiat ad 1c rou
lhcm over an the lower chat kecpiq diem lower clear of
abdomen. Evm pns.sum with tb1: holdtr nelson IDllhod for 2
lllCondl..
Rclmsc I.he praswe. ■ftcr 4 1«fUC11£C1 check. rmhean beat if
normal 1oominu1· IINlhod unlil bn@bing restore.

5 Em.uncnte the Pupale ar mrdlD -p9'nm-, r1n~t11daa :

Min purposes of
canio- • Yo uw. die life of lh• patient~
pulmonary ♦ To pro-vidl: haste liife •pport li1~ medical and ~ife 111ppm1
resuscitation. .services arc nol available,
♦ To 1n1io11in bJoad circuwion by extaml cardiac
massap.
♦ CPR Pmvides Ulificial vcn1ilalion and Recin:ulal.mn la a,
person eq,eriencing cardiK and R:Spinlnry am:st
♦ Temaiatainanapen udclarmnny.,
S..N Thar Specill£ Caalcld
10 objectiR

Mm [NDICATIO'N llESUCITATION
OF CARDI~ ~ CARDIAC AR.RE.n
PULMONARY ~ VENTRICULAR. FIBR1LATION {VF)
RESCUSSITAT -J VENTRICULAR TACHY C.A RDIA (Vf)
ION -t CABCi.
➔ HEART FAILURE.
➔ DYS'RHYTHMI.AS,
~ I BEA.RT 81.()CI(
♦ Ral'IRATOKY AllKEST
➔ DKOWNIN'Ci
➔ STROKE
➔ FOREIGN BODY IN THROAT
1

-91 SMOKE INHALATJON

➔ DRUG OVER DOSE
,-+, :INIUR.Y B,Y LIGHTING
~ SUFFOCA.I lON
➔I ACCIDENT
-+COMA
➔ co,o
➔ AIJlWAY OBSTR.U ClJON.
➔ ATELECTASIS

CONTBAINDICADON' :•
• ·1:x1i NOT RESUSCITATE WHEN THE DECISION
5.N Time Spa lie Cantmt T...-,.ing Emn■tie11
a olljedlw

NOT TO 'R ESUSCITATE HAS BEEN NOTED IN

......,
IMndq

THE CHAJtT.

Q :What are
4 PREPARE THE EQl11PMEiP-flfS: .. 'J: la.:ture the articles
EQUIP'M ENTS • NO EQU'IPMENTS lS ABSOLlITELY REQUIRED cum recommend
fOR CPR. FO.R EFF.ECTIVE PERfOR.ANCE Of CPR. discussion ed for ·CPR?
HOWEVE~ CPR POCKET .M ASKS AND AMBU
BAG ARE RECOMMENEDTO DECREASE TIIE
TRANSMISSI.ON OF PATHOGENS WHEN
1

CARRYING OUT THE MOUTH TO MOUTH

.BREATHINCi1PROCEDURE.
• IF TilE ARRES,T OCCURS. WHILE TIIE CUB« IS
IN IllE BED~A HARD11 BROADLIKE OBJECT
(MEAL TRA.Y ) SHOULD BE P'LACED UNDER THE
1

CUENT,S CHES'f IF SUCH AN OBJECT' IS

READLY AVAIL.ABLE.

s. .
Apply the GENERAL .INST■U(7)10N po·■ EFFEC..'TIVE C~P..R.. 1": lcctuR Q : What is
min genanl cum tbe
instruction fol' discussion prelimimuy
• CPR used in pcrsom whose ,apiraliom ,&
effective .,. . asse&!tDcnt
LN Time Spedfk 1udti111 8-luadoa
a Gbjertiw lnnlnl
atlnlJ
CRP.. une:1·pec1edly stopped. before
• Tbae. is no need of anempting CPR 1cchnique iu ,applying
pal ienlS in lhe last s1age D'f ,an incurabte ii Inns & CPR?
1

in pawns whose hcm1 bal. ,& respiration have

bcm abscnl. ror more lhu six minutes,.
• Tite immcdiale rcspousibilitics of dlc resuscitator

,. / lo rccopi.2e lhe si ps o·fcardiac anest

1

✓ Pm.teem the pa1ienf'1 brain £mm ano1.i,1 by immediately

.sla.d·in,g arti fie isl venl ila1ion 1o f lhe I ungs & cx.1anal
cardia'C massage~
~ CaH for help~
. , The carotmd utay is used ·10 ddeml'ine ·tlx: absence of pulse.
• llf on ,alHCSsmcnt. •lhcfe arrc no signs o(,ci:ttulation S'tart ,c-1tcmal
,cudliac: com1ncss1om~
• The vic-1im is on dx horimn1al 111;pinc position 011 a Dai and
bud surface.
• Locale llandmark notch hands in die center of lhc chcs1 •. right
be'w.,rcn the nippla ,and four rmgcrs above b x.iphoid 1

proeca.

GQIBAL INSTRtlt'IQN EOLPOSffiQN HANDS, Whal.are

ARMS AND SBDULDIIIS the
s.N ITimt Spedlk Contml
o ab.Jee.Urn

• Elbows should be lack.a l ,and urnw arc ,mrai,ghl.

• Resc111er"s shoulders posi1ion diroctJy ov,cr bands,
Bqin
com;pressto
n Pressure
should
come· [rom
the
·shoulders.
• Compn:ssi
1

on ahould
deprns,
victiirn's
!IUDUDl
approlimatcly I .S-- 2 inches.
• Don,' I .allow thc fin1en eo touc'lll lhc cbcsl wait
1

• Allow chest lo mMJUnd lo normal posnion after

1

mchoomp~an.
1
• Pmor:m ·CO~p7tMion at tile talc or 1OOhnin.
• Maimaio oonea position at all tiines..
• Check for s1gns of circulation every ]-.
5min.
.
¥entilarion ratio 1S 15:2
s.N 11at I 5pffft: Caalall ·•twWna I J
o lllljecllft lmnlilll
acd'rity
irrespective of inum'bcr of reSCUG".
• Exbalalion occurs bftw:cm lhe tv.ro1 breams .and
during ·the flfsl ches1 oompresston of lbe. ncxl
cycle.

I;ECHNlOUES FOR APPLYING CPR

ASSESSMENT :-
11 ll,ol' m&dal.imponJllltL II indndes
1

I. Assess r.espomiveoess by calling i'.h-e person;

shouting allid sbaking
2~ A&SCSS brcaabiog by look. lislm and £eel: Look for
6. 30 Desaibc chest. ·movements., listed [or breath .sounds and fee1
min 1e.cbniq,u a1ud for lhc mova1KUts o:r lhe air Dow.
steps for of C"PR~
 Caallld

lldlrit)'
ur
inapet:ti,~c of .number f!CKUC'f'~
•
1
Exhalalion occurs between lhe two breaths. and
dullJII 'l b£• rnt. c:hdl. WmpRSSio.11 of the nexl
1

cycle..

, TECHNJQUES EOR.AffLYING CPR

II .i s '6. crndal impo~ U indni&:51

I. Assess .respOD.Sivene.ss by calling die pnson;
shoutms and shakin&
2.. Assess. bnalhmg by look. lisbm and feel: .L oot for
chcst movements. lislm ror brealh sounds and feel
1

foJ the mo~emenls of lhe air fte'II'.

 10

5.N 1lw ~ ... Coe..... '"°ffll Eat■,..-..,.

o (lbjecdft ltarDlna
acdvlly

v~
I
\
•

3. Assess cin:ulation- feel the carotid pulse.

CHECK CAROTID PULSE

SJII n. Spnlllr Calllml --•• E..i...,._
0 al,Jedwe leandq
adbilJ
L ,tlRWA'YMANAGEtffiNI;
OPEN AND Cl.EAII THE; A.DIWAY:
ThJis is achieved by had 1iU and min lift maneu1ver or
,or
it l.bere is, 1u.spir1on/evtdenc-e bead or neck cnuma,
die jaw dtrust maneuver is UK4
• ll&ID T~T CHIN UFr MANElJ'V.ER:
1

Placc DOC' band on the victim ~s hairline and place the odwr
1
1

hand Ill .fadc:c .finger and the middle r.gcr ,om the chm and apply
1

finn backw1rd prasun: I

 ' pn3 JP-4.i 4 ~'~

Ir I ,- - - - . ,., _ , /
... ·sf'""~

. ·...,~ ,,. . f1!»- - /

':Ji,M "',i ~~
_,.,,.___..· ~ ,

~- -~ ·?j . ~ ~~ ' 1'

·~
T-'" 11
' ,- '
'.
-
-~
.
~ -~ -·
~---
... , ·,_~.....-.
__

· ~
~-
■

Bend IHI ud rhi• BA mcn1a,re,

• J'A W 1BII.IJST . "
l I is sco1up1idted 'by placifts one band an each
1

side of the vidim•a had. grasping lhc qlm of the

vie1un 1 lower j■w~ liftina wirtlm bolh banclsi,
1
s.N C•lm l Ttadd!II E,,.luaHOR
0 abjed lft laanalaa
lldlrily

• flNGE ll-swE EP MANE UVER ; -

'With lbe viC"1im't5 head up? opens 11.: v.icliru. s moulh What are
1
a)
by gruspi:ag the loop and the lower jaw betwee n llx·general
die thumb and fingers and lifting (rongu ~jow lift). pn:-caution
b) This action draws die 'IODgUe .&om lbc back of tht should l,c
duoat and a\\'•Y Jrom the forcip body. The used foe
ohsuuc1ion may be part i.ally reline d by this effective
maneuver.. CP.R..
,c}, Jf lhe toogue -j•w lift fails to open lhe mouth lhe
crossed rfflgff technique: may be used. This is
accornp,Lisbed by openin g the. mouth by crossing I.be:·
index linger and the tburoh and pushing lbe teeth
,apart.
d) The indc:x finger of the av,ailahlc hand, is in.setted
'oatent 'Teadd.na Ewloldioa
lnmlq
MIIYHJ

· ~ .,

... ~~.{)
,.__, ~
-,.;...a-~ •
MOUTH TO MOUTH BREATHING

B) AM1VIMi AND MASK YINDJ~ADON

1 1

• Other ,advanced methods. la deliva breathing are ambu

ba1 and mask rvcn1ilation..
• The volllf'Jileor a1ror eKb Ycntilation should be
,1pp11oxin1atcly· 700-U)OOmt which can be detennined b_y
s.N 11lllf ]Sped& Cmalall
o objccdw

ncnine,a rise ,o f I -2 inches in die '\'ictiim•s ,chest..

• SmaHcr volume (400-600ml) should be attmnpted during
'1mg md mask ·v «iti l.a tinn.
• Use a resuscitator bas and mask~
1

10
• ~ly the muk to thr victim s mouth and 1crea1e a seal by
pnssi ng, the left thumb on lhe bridge of die nose and lhe
index fm1,e r on lhe· chin~
1

• Use rest o,f 1he fingcm or lhc left hand IO pun 0D the chin
1

,and lhe ,anafc 1G 'f the' mandible lO mainlam lhe head in

,extension.
• 1u·- I.he l'CSI of' the fingers of ch.re le:n hand lO pull Oi1 the,
thin and the ang·lc of the mandible lo mainbUn the head in
1

,extension.
s.N Time Sa,o lie C•IMI nacblna Eviol!M11on
0 oLjedi-... leanlq
lldlwity
• Use: the right band 10 inflalc the lungs by squeezing lhc
bag to its full volume.
• Observe the chcsl wall for symmelric expansion.

2. CIRCULATION:
It is the main key of basic life support, because here 1hc
rescuer makes his efforts 10 save the life of ('II. There arc lwo
methods for rcgula1m of circulation
• The pericardia! thump
• Cardiac comprcssJon ( cardio pulmonary
resuscitation)

1. The perkanllal thump :

• Use of "Pericardia! lhurnp" is clTcctive in case of
witnessed cardiac arrest. Pcricaniial !hump IS a
below. which is delivered to lhc half of lhc pa1icnl's
sternum wilh the flashy pan of of lhc fis1 from 8-12
inches above lhe patients chest. This blow gcncratcs
a . nll cum,nl o f dcc1 ·cilv . which shocks I
,z; 11me Spedllc 1C alltm1

...,..,
Tadliag
I abjecdft leandq

myocanbum & s1imula1cs. cardiac bc-ating &

circuJarlion♦ To be cdfa:tive ii mu1 Ix done ·wilh.m a
m·inule of cardiac am,si.

2 . Canllac nmp,r apnn (cardio pulmonary nsaldtaliDn)

• F.irst of all l.hei Id rib IO the ·noleh where the :ribs
meet me: sternum.. Thtn place I.he .heel of the
,other hand on the lo·wer ·par:1 of lhc sternum
abou1 1-1 .:5 mcb above the palpating band.. The
' r -- ---e hand
_-,,Nltitu,
t . 15 'lb-ti
__ - ..........~
p ___ tJOPI or.
-1 O n, the _ un;
d .. -:

had,. ·which is reswlifl,g oa 1k sternum. Both

hands should be pualle,1.
✓- Kep fing,a s off lhe chsl or interloeked.
·✓ l''f fingien are ra&ing on the chat., forice
will be dmipalcd.
✓ The artificial brtalbing 1& the cardiac
- a_ s.hould
m:a,~uoe•
· __ ___ be
__ c-:. - ~~d+
1ng- 1~o
· - th c-

normaJ respirario-n a pub1e nre.

✓ The ratio o:r cardiac compriessum 10
ventilation id S; I Le. S, ,cardiac
oomp,ess10111 'lo one vcn1ilaiion. Cardiac
compression 1s given between ithc cardiac
compression without or solvin.1 lhc rate of
 compression. lhus, 60 cardiac
compression cl 12 Vffllilalion/ min arc
achieved.
✓ The ratio I sonly one n:scucr, inlfflUpl
compccss1on to the ventilation ratio of
IS:2.

CQMPLJCAJIQN Of CAllDIQ PULMQN6BX

RESUSCITATION

7. 10 Enlisl !he
.
min complic:a1ioo of
• Hypoxia
lecture Q : What arc
• Apnca
CPR cum lhc
• Pncumothoru
discussion complicatio
• Local trauma
nof CPR.
• Fractuttofribs
• Fractutt of clavicle bone

NJJBSING BfMPONSgg,[[)'. IN QBPJQ

PULMONARY RESUSCITATION
&. 20 Describe the
. I. The nurse should know lhc skills of pcrfonning CPR.
mm role of nurse 2. The nurse should have critical lhinking. lecture Q:Whatarc
 20

5.N Time Sp Pk c-,~-, Tr N191

after care of 3. The: nurse should lo know about the anatomy & cum
cardio- physiology of Cardiac & Rcspira1ory system. discussion
pulmonary 4. The nurse: should follow 1hc protocol of B.L.S.
rcscussitatioo S. The nurse: should know bow 10 handle the complica1ioo.
6. The nurse should have lcnowlcdge about the drug
administration.
7. Rccortling & rcpotting of !he procedure
8. Monitor ECG.
10. Watch for increased ventricular beats.
11 . Check elcctrolytcs.
ll. Monitor vital signs.
13. Blood investigation to be done
14. X-ray c.hcst to be done
• IS. Use extreme caution when calculating and
preparing !he doses.

Steps lo Pm-'ng CPR:

• Step I : Try to awaken the person. tr the pcoon is

unresponsive. immediately call 91 1 and gel back to the
victim.
• Step 2: Open the Airway. To do this, gently lift lhe chin
with ooe hand. This will till the head bac.k, allowing a
SJl'lime Spmfic Contml 'feacldna
D olJjemff lanllq
adldy
palh ror ai·r 10 travel, 10 the· lun_gs from lhe ·moumb and
1

nose·.
,. Step 3: Oted for breaihing. You can eilhn· look l'or 'tbe
1ches1ror mov.eman or.· listm to I.he breathing sound ,or- ,
else £a:1 the warm air of lbeir hreath oo your cbed If
them is a sign of bra.thing CPR may not be n:quin:d.
Hov,fcvet~ irthere is, DD1 sign of breathing, men n:scue
breathing needs 10 be provided.
• Step 4: Provide RSCue breathing. lac best way llo, do
dus is hy mouth to mouth ta:hniq,uc. The head is
properly posibODed by ulling llte head hack hy liliins
IIM:·chm. The nomi1s are lhen pinched and Ille· person is
given two qu.ick 'breadis. However,, for tW:b math lhe
rnovemffll. of the chest is cbeckat Movement suggesa
thal the a:inva,y is clear and air is reaching lh-e lung,s'" If
·001., Repeat Step 2 1(clearing I.he· airw,ay) and ·provide
rescue bralhing again.
• S,tcp S: Check (or pullsc and bn:udlin.s ~ If pulse is felt,
but no 'breathing dten n:seue lxealh1ag :needs lo be
etnUinued ttntil I.he 'ndim. begm.Si ·1111breath. Howc\l,e r it.
1

lhC'Je.· is, .oo puke and :ao hrealJ,ing Ihm anifieia1l

circuJalion needs rube pro,1tided.
• Step 6: Provide anificial ciKulation lhmugh chat
,comprcwioas.. This rcaores blood circulation or lhe
SJf Time Spa Hie Ccalllll "lntbi!DJ!
0 abjcdlft 1mn11D1
atdni)'
"'
person. Y:0 do I.bis,. kneel 'besirdc the person and flace
1

dte .heel of yoor hand in the micklle or dlC chcsl

1(betweeo I.be wpplcs)t. Platt· rme oth« hud on lhc lop
or
lbc band placed on tbe diest. tr lhe· victim1 is an
1

Bihllt ~dy eomprem I.he chest of lhe v1idi01 lo abo1.u

1

2 inches_. Then n:movc me pn:ssure wilhoul l'CIDD,\fing

your ham, &am die vi~lim's chesl. Chat compricssions
1

should he given al ·I.he rate ,mf aboul. 2 per· HCDnd. .l:r

rescue breathing md rchesm c~pressi,oms are given
simul1aneomly, lbcn idaJlyt aboul 15 ,e hal
compFnSiom should be given afta two breaths"
1

• Stap 7; Tha above process of l\VO bfca1'hs and 15 ebes1

1

cumpressiom should be repealed unnl die wc'lim,

bcBins 10, hreath or until cmcrpncy medical help
arrives on ihe. spot
SUMMARY & DA.LUATIO.N ( I I ~ )

I,~ De·fine CPR· M.aulh to,:moudL ,Sylrvata1 Schafcr,

2. Eawnerm 'lhe purposes of CPR- Moulb 10 mouth~ SJIYCller, Schaf«

3. E~pllin indications ror cPR,.. Mouth Ill moulh. Sylves11r. Schafer

4.. Explain the 5lcpS ar CPR- Mouth lo mouth,. Sylvatcr, Sc.hafts

5. Dacribc 'b role or nurse after care or CDdiO-Pullmonary Rc.usc111tioa

A...pmeal: 'Describe 1hc indication, and dcps. of CPR

l ,'l'..Ullaa : unil 'm at al the: md oF unif

I. BRUNNER 5 ,& SUDDARTiiS'"' TEXT BOOK OF MEDICAL SUROICAL NURSlNG" 10th. EDITION
11

2004 LIPPrNCOTI WILLIAMS A WlLKJiNS PHILADEI.PHIA

2. 2. Dr.Bimll kapoor .,. FUNDAMENTAL 0f NURSINO" I 11 alili1a 2007 TNAJ NEW D£UD ~ 475-
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48,9

l. l~KOZIER. E.R.B. HFUNDAMENTALS1OF NURSCNG~ , EDmON 2003 PEARSON EDUCATION

 SIOA'P ORE Pp l282-

4,. 4. DR. RDAHA IC.RJSHNAN ..NATIONAL CRITICAL CARE CONGREsr Dini EDITION 1998

U'.S ..V'. LIMITED PUNE Pp 1- 12.44 4S, 117- l21.