DEMONSTRATION

ON

CARDIOPULMONARY RESUSITATION

SUBMITTED TO SUBMITTED BY

Miss Mukti Rose Ekka Asha Lugun

Asst. Professor Msc Nursing 1 st yr

Holy Cross College Of Nursing Holy Cross College Of Nursing

Ambikapur Ambikapur

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Name of the supervisor : Miss Mukti Rose Ekka

Name of the student teacher : Asha Lugun

Subject : Nursing Advance

Topic : Cardiopulmonary resusitation

Place : Classroom

Date :

Time : 1 hr

No. of audience : 11

Method of teaching : Lecture cum discussion & demonstration

Medium of teaching : English

Teaching AIDS : Chart, flash card, manikin, power point

Previous knowledge : Students had some knowledge regarding CPR

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CENTRAL OBJECTIVE

Students will expand their knowledge regarding cardiopulmonary resuscitation thus able to manage the patients with cardiac arrest.

SPECIFIC OBJECTIVE

At the end of my demonstration students will be able to

1) Define cardiac arrest
2) List out the cause of cardiac arrest
3) Mention the clinical manifestation of cardiac arrest
4) Enlist emergency management of cardiac arrest
5) Define cardiopulmonary resuscitation.
6) List down the indications of CPR.
7) Describe the changes in CPR technique
8) Explain the CPR guidelines for health care providers
9) Explain the phases of CPR
10) Enumerate the basic life support.
11) Explain the procedure of CPR.
12) Describe advance cardiac life support.
13) Enlist the post resuscitation complications of CPR.
14) Enumerate the nursing considerations for CPR.
15) Discuss evidenced based practice for CPR.

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TIME SPECIFIC SUBJECT MATTER TEACHING LEARNING AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
Introduce the Listening
Introduction
1min Introduction to topic
Cardiopulmonary resuscitation (CPR) techniques are used to artificially
the topic
maintain both circulation and ventilation in persons suffering from cardiac
arrest. CPR can be life-saving first aid and increases the person’s chances
of survival if started soon after the heart has stopped beating. If no CPR is
performed, it only takes three to four minutes for the person to become
brain dead due to a lack of oxygen.

By performing CPR, you circulate the blood so it can provide oxygen to

the body, and the brain and other organs stay alive while you wait for the
ambulance. There is usually enough oxygen still in the blood to keep the
brain and other organs alive for a number of minutes, but it is not
circulating unless someone does CPR. CPR does not guarantee that the
person will survive, but it does give that person a chance when otherwise
there would have been none.

LEARNING

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 SPECIFIC SUBJECT MATTER ACTIVITY EVALUATION
TIME OBJECTIVE TEACHING Listening AV
Introduction of CARDIAC ARREST ACTIVITY AIDS
1min cardiac arrest. Discussion
INTRODUCTION
Cardiac arrest is a condition in which the heart has stopped beating or is
not beating efficiently enough to sustain life. Cardiac arrest is also known
as sudden cardiac arrest, is rapidly fatal within minutes if not immediately
treated with CPR, defibrillation and advanced life support. Cardiac arrest
can occur without any underlying cause. Cardiac arrest can happen in any
age group people but people most at risk include those who have a history
of coronary heart disease and or at a risk of previous heart attack. Other
risk factor includes smoking, diabetes, congenital heart defects,
electrolyte imbalance, obesity, cardiovascular disease.

Listening
DEFINITION
Define cardiac What is cardiac
5min arrest
Cardiac arrest occurs when the heart ceases to produce an effective pulse Explanation arrest?
and blood circulation.
It may be due to cardiac electrical event , as when the HR is too
fast(especially ventricular tachycardia or ventricular fibrillation) or too
slow (bradycardia AV block), or when there is no heart rate at
LEARNING

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 SUBJECT MATTER ACTIVITY
SPECIFIC EVALUATION
TIME OBJECTIVE all(asystole).Cardiac arrest may follow respiratory arrest;it may also occur TEACHING AV
ACTIVITY AIDS
when electrical activity is present but there is ineffective cardiac
contraction or circulating volume, which is called pulseless electrical
activity(PEA)
PEA can be caused by:
 Hypovolemia
 Cardiac tamponade
 Hypothermia
 Massive pulmonary embolism
 Drug overdoses(calcium channel blockers,betablockers,digitalis)
 Massive acute myocardial infarction

Three cardinal signs of a cardiac arrest are:

 Apnea
 Absence of a carotid or femoral pulse and dilated pupils
 Person’s skin appears pale or grayish and feels cool

LEARNING
ACTIVITY
SPECIFIC Listening

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 OBJECTIVE SUBJECT MATTER and asking EVALUATION
List out the TEACHING question
cause of cardiac ACTIVITY What are the
VARIOUS CAUSES OF CARDIO PULMONARY
TIME arrest. Explanation AV causes of cardiac
ARREST
AIDS arrest?
3min Cardiac arrest can result from : Flash
 Ventricular fibrillation- card
Ventricular fibrillation is a condition in which there is uncoordinated
contraction of the cardiac muscle of the ventricles in the heart, making
them quiver rather than contract properly.
 Ventricular tachycardia-
Ventricular tachycardia is a very fast heartbeat caused by a malfunction in
one of the heart's ventricles. It is a pulse of more than 100 beats per
minute with at least three irregular heartbeats in a row.
 Asystole-
A condition in which heart ceases to beat
 Electromechanical dissociation
Pulseless electrical activity or PEA (also known by the older term
electromechanical dissociation) refers to a clinical diagnosis of cardiac
arrest in which a heart rhythm is observed on the electrocardiogram that
LEARNING
should be producing a pulse, but is not.
ACTIVITY
SPECIFIC

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 OBJECTIVE SUBJECT MATTER Listening
Mention the EVALUATION
clinical TEACHING
manifestation of CLINICAL MANIFESTATIONS: ACTIVITY What are the
TIME cardiac arrest 1. Immediately loss of consciousness Discussion AV clinical
2. Loss of blood pressure and pulse AIDS manifestation of
3min 3. Gasping may occur cardiac arrest?

4. Pupils of eye begin dilating within 45 seconds

5. Seizures may or may not occur
6. Risk of irreversible brain damage or death increases with every minute
from the time that circulation ceases

Listening
Enlist
emergency EMERGENCY MANAGEMENT
management of What is the
 Cardio pulmonary Resuscitation
cardiac arrest Explaining emergency
 Maintaining Airway And Breathing management of
1min
 Restoring Circulation cardiac arrest?

 Follow-Up Monitoring

SPECIFIC LEARNING

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 OBJECTIVE ACTIVITY
Definecardio- SUBJECT MATTER Listening EVALUATION
pulmonary
resuscitation TEACHING What is
CARDIOPULMONARY RESUSCITATION
ACTIVITY cardiopulmonary
TIME Discussion AV resuscitation?
Definition
AIDS
1min Cardiopulmonary resuscitation (CPR) is a technique of basic life support
for the purpose of oxygenating the brain and heart until appropriate,
definitive medical treatment can restore normal heart and ventilatory
action. Listening
List out the
indications of Indications What are the
CPR. indications of
1. Cardiac arrest
Explanation CPR?
a. Ventricular fibrillation
b. Ventricular tachycardia

3min
c. Asystole
d. Pulseless electrical activity
2. Respiratory arrest
Respiratory arrest is the cessation of normal breathing due to failure
Of the lungs to function effectively.
a. Drowning
LEARNING

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 SPECIFIC b. Stroke ACTIVITY
OBJECTIVE SUBJECTIVE DATA
EVALUATION

c. Foreign body airway obstruction

TEACHING
d. Smoke inhalation
ACTIVITY
e. Drug overdose
TIME AV
f. Electrocution/injury by light
AIDS
g. Suffocation
h. Accident/Injury
i. Coma Listening
Describe the j. Epiglottitis
changes in CPR CHANGES IN CPR TECHNIQUE
technique  A-B-C-D TO C-A-B-D What are the
recent changes
In its latest CPR guidelines, AHA or American Heart association
Discussion in CPR
has re-arranged the A-B-C-D to C-A-B-D.. By updating the
technique?
sequence to C-A-B-D or Chest-Airway-Breathing-Difibrillation,
10min
compressions will be initiated earlier, increasing the chances of
survival for many patients.
 Untrained rescuers should take the Hands-Only approach

The latest AHA guidelines distinguish between an untrained bystander

and a trained professional and provide steps for each type of rescuer. LEARNING

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 ACTIVITY
SPECIFIC SUBJECTIVE DATA
OBJECTIVE
The previous version of the AHA guidelines (2005) only recommended
EVALUATION
that dispatchers should provide compressions-only CPR instructions to
bystanders, but did not provide a different set of instructions. TEACHING
ACTIVITY
According to the new recommendations if a bystander does not have any
TIME AV
training in providing CPR for the patient, the bystander should initiate AIDS
compression-only CPR also referred to as Hands-Only CPR. The AHA
instructs the untrained bystander to “push hard and fast” or follow the
instructions provided by the EMS dispatcher. The rescuer should continue
the compressions until other responders take over or trained professionals
arrive at the scene. The reason for the focus on Hands-Only CPR is
because it is easier for dispatchers to provide instructions on the phone
and untrained responders find it easier to perform it.

 Depth of compression set at 2 inches for adults

The latest AHA guidelines instruct responders that the “adult sternum
should be depressed at least 2 inches.” This is a shift from the previous
version of the guidelines which defined the depth of compression to be
approximately 1½ to 2 inches.
LEARNING

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 ACTIVITY
SUBJECTIVE DATA 
SPECIFIC
OBJECTIVE
EVALUATION
 Removal of “Look, listen and feel”

Previously the AHA recommended that the responder “Look, listen, and TEACHING

feel” after the airway was opened to make sure that the patient is ACTIVITY
TIME AV
breathing. Now, in the latest AHA guidelines, the rescuer has to open the
AIDS
patient’s airway and deliver two breaths after conducting 30 compressions
on the patient’s chest

 Routine use of Cricoid pressure discontinued

The previous edition of the AHA guidelines used to suggest the use of
Cricoid pressure if the victim was “deeply unconscious.” However, a
number of recent studies found that use of this technique can actually
impede ventilation. Therefore, the latest set of instructions coming from
the AHA say that the routine use of Cricoid pressure is not recommended.
Learning

CPR GUIDELINES FOR HEALTH CARE PROVIDERS.

Explain the CPR

guidelines for LEARNING

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 health care  Immediate recognition of Sudden Cardiac Arrest based on ACTIVITY
providers assessing unresponsiveness and absence of normal breathing What are the
SPECIFIC SUBJECT MATTER CPR guidelines
OBJECTIVE Discussion for health care
providers?
(victim is no breathing or only gasping).
10min EVALUATION
 Look, Listen, and Feel removed from the BLS algorithm.
 Encouraging Hands-Only (chest compression only) CPR for
TEACHING
untrained-rescuer (continuous chest compression over of the
ACTIVITY
TIME
middle of the chest).‘ AV
 Sequence change to chest compression before rescue breaths AIDS
(CAB rather than ABC)
 Health care providers continue effective chest compression/CPR
until return of spontaneous circulation (ROSC) or termination of
resuscitative efforts.
 Increase focus on methods to ensure that high quality CPR
(compression of adequate rate and depth, allowing full chest recoil
 Between compressions, minimizing interruptions in chest
compression and avoiding excessive ventilation) is performed.
 Continued de-emphasis on pulse check for health care providers.
 A simplified adult BLS algorithm is introduced with the revised
traditional algorithm.
 choreographed approach for chest compression, airway manage- LEARNING

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 ment, rescue breathing, rhythm detection, and shocks by an ACTIVITY
integrated team of highly-trained rescuers in appropriate settings. Listening

SUBJECT MATTER
SPECIFIC
OBJECTIVE
PHASES OF CPR
Explain the
phases of CPR EVALUATION
The Electrical Phase

The first phase of CPR is called the electrical phase and extends from the TEACHING What are the

beginning of cardiac arrest to approximately 5 minutes following the ACTIVITY phases of CPR?
TIME Explanation AV
arrest. Defibrillation is most effective during the electrical phase. If an
AIDS
AED is available when a cardiac arrest is witnessed, it is imperative that
5min Chart
defibrillation pads are applied promptly and the device is allowed to
analyze the victim. Approximately 70% of cardiac arrest occurs in the
home. For this reason, it is recommended that one person in every
household receives CPR/AED training, as this can help increase the
number of survivors of cardiac arrest. AED's are now available for home
use and can be purchased without a prescription.

The Circulatory Phase

The second phase is the circulatory phase, also known as the

hemodynamic phase. This phase last between 5-15 minutes after cardiac LEARNING

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 ACTIVITY
arrest and CPR is the most critical intervention during this time. Adequate
myocardial blood flow is related to adequate coronary and cerebral (CPP)

SPECIFIC SUBJECTIVE DATA

OBJECTIVE
perfusion pressure which is the major factor in successful resuscitation
efforts and neurologically normal outcomes. Not all resuscitations are
EVALUATION
successful, and those with poor CPP inevitably result in brain death. CPP
is generated during chest compressions and takes time to develop or TEACHING
"build up". When chest compressions are stopped CPP decreases. This is ACTIVITY
TIME the reason standards for CPR have changed to include more chest AV
compressions than in the past. When caring for a victim in cardiac arrest it AIDS

is important that interruptions in chest compressions be kept to minimum.

The Metabolic Phase

The metabolic phase extends beyond 10-15 minute after cardiac arrest. At
this point the effectiveness of CPR and defibrillation are minimal and the
prognosis for a positive outcome is poor.

LEARNING

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 ACTIVITY
Listening

SPECIFIC
PHASES OF CPR
OBJECTIVE
SUBJECTIVE DATA
Enumerate the
basic life EVALUATION
BASIC LIFE SUPPORT(BLS)
support
Basic life support is an emergency procedure that consists of recognising TEACHING What is Basic
an arrest and initiating proper CPR techniques to maintain life until the ACTIVITY life support?
TIME victim either or is transported to a medical facility where advanced life- Describing AV
support measures are available. Basic life support is a level of medical AIDS
3min care which is used for patients with life-threatening illness or injury until
the patient can be given full medical care. It can be provided by trained
medical personnel, including emergency medical technicians and by
laypersons who have received BLS training. BLS is generally used in the
pre-hospital setting, and can be provided without medical equipment.
SIMPLIFIED ADULT BLS

LEARNING

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 ACTIVITY
Learning

SPECIFIC
OBJECTIVE
Explain the
procedure for EVALUATION
SUBJECTIVE DATA
CPR
TEACHING What are the
PROCEDURE
ACTIVITY steps of CPR?
TIME Explaination AV
1. Attempt to wake victim.
AIDS
10min  If the victim is not breathing (or is just gasping for breath), call
help immediately and go to step 2.
 If someone else is there to help, one of you call help while the
other moves on to step 2.

2. Begin chest compressions.

 Place the victim on his or her back on a firm, flat surface.

LEARNING

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  If the victim is not breathing, place the heel of your hand in the ACTIVITY
middle of his chest.
 Locate the lower part of the victim’s sternum by placing your
hands between the nipples on the centre of the chest.
 Another method is to slide your middle and index finger along the
margin of the victim’ rib cage until you locate the notch in the

SPECIFIC centre of the lower chest where the ribs and the sternum meets.
OBJECTIVE

SUBJECT MATTER EVALUATION

TEACHING
 Keep the middle finger on the centre of the notch and place
ACTIVITY
your index finger on the lower end of the victim’s sternum, next
TIME AV
to your middle finger AIDS
 Place the heel of the other hand on the back of the first hand.
Your finger should be pointing away from you.
 Interlace or extend your fingers but keep them off the victim’s
chest wall to avoid rib fractures and other internal injuries.
 The heel of the hand that is in direct contact with the sternum
must remain in contact with the chest during both the
compression and the release to prevent bouncing and jerking LEARNING

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 movements. ACTIVITY

 Lean forward so your shoulders are directly over your hands.

Keeping your arms straight, press straight downward on the
sternum 2 inches (4-5cm), using the weight of the upper part of
your body, then relax pressure on the sternum completely.
 Allow the chest to completely recoil before the next compression.
Compress the chest at a rate of at least 100 pushes per minute. Perform
SPECIFIC 30 compressions at this rate (should take you about 18 seconds).
OBJECTIVE
SUBJECT MATTER
EVALUATION
 If you are not trained in CPR, continue to do chest compressions until
help arrives or the victim wakes up. TEACHING
ACTIVITY
3. Begin rescue breathing.
TIME AV
AIDS
 If you have been trained in CPR, after 30 compressions, open the
victim's airway using the head-tilt, chin-lift method.
 Pinch the victim's nose and make a seal over the victim's mouth with
yours
 Use a CPR mask if available. Give the victim a breath big enough to
make the chest rise.
 Let the chest fall, then repeat the rescue breath once more.
LEARNING

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  If the chest doesn't rise on the first breath, reposition the head and try ACTIVITY
again.
 Whether it works on the second try or not, go to step 4.
 If you don't feel comfortable with this step, just continue chest
compressions at a rate of at least 100/minute.

4. Repeat chest compressions.

 Do 30 more chest compressions just like you did the first time.

SPECIFIC
OBJECTIVE
SUBJECT MATTER
EVALUATION
5. Repeat rescue breaths.
 Give 2 more breaths just like you did in step 3 (unless you're skipping TEACHING
the rescue breaths). ACTIVITY
TIME AV
6. Keep going.
AIDS

 Repeat steps 4 and 5 for about two minutes (about 5 cycles of 30

compressions and 2 rescue breaths).

 If you have access to an automated external defibrillator (AED),

continue to do CPR until you can attach it to the victim and turn it
LEARNING

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 ACTIVITY
on.
 If you saw the victim collapse, put the AED on right away.
 If not, attach it after approximately one minute of CPR (chest
compressions and rescue breaths).
 After 2 minutes of chest compressions and rescue breaths, stop
compressions and recheck victim for breathing. If the victim is
still not breathing, continue CPR starting with chest compressions.
 Repeat the process, checking for breathing every 2 minutes (5
cycles or so), until help arrives. If the victim wakes up, you can
SPECIFIC
OBJECTIVE stop CPR.

EVALUATION
SUBJECT MATTER

TEACHING
FOLLOW-UP MONITORING: ACTIVITY
TIME If the patient is monitored or is immediately placed on the monitor using AV

defibrillation and the ECG shows ventricular tachycardia or ventricular AIDS

fibrillation defibrillation rather than CPR is the treatment of choice. I fthe

patient has not defibrillated within 10 minutes,the chance of survival is
LEARNING
close to zero.Once successfully resuscitated, the patient is transferred to
ACTIVITY
an intensive care unit for close monitoring. Continuous ECG monitoring Listening

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 and frequent blood pressure assessments are essential until the patient is
hemodynamic stable. Etiologic factors that precipitated the arrest, such as
metabolic or rhythm abnormalities, must be identified and treated

SPECIFIC
OBJECTVE EVALUATION
SUBJECT MATTER TEACHING
Describe ACTIVITY
Advance What is Advance
Cardiac Life ADVANCED CARDIAC LIFE SUPPORT: Discussion Listening
Cardiac Life
Support Support?
TIME ACLS involves a systematic approach to treatment of cardiac emergencies AV
AIDS
with knowledge and skills necessary to provide early treatment.Most
10min LEARNING
hospitals have trained teams of personnel, including physicians, nurses,
ACTIVITY
anaesthesiologists, and technicians, who provide immediate care in the
event of a cardiac arrest. ACLS includes ( 1.) basic life support (2). The

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 use of adjunctive equipment and special techniques for establishing and
maintaining effective ventilation and circulation (e.g.ECG machine,
suction device, oxygen, defibrillator, breathing bag, laryngoscope, a
variety of endotracheal tubes, intravenous fluids, and a tracheostomy set).
Medications administered during a cardiac arrest are usually stored on a
emergency cart. American Heart Association office can provide the most Listening
and learning
current practice guidelines and information about available training

Enlist the post sessions for advanced cardiac life support.

Discussion
resuscitation Enlist the post
complications resuscitation
POST RESUSCITATION COMPLICATIONS: complications
1. Trauma fractured ribs and sternum
SPECIFIC 2. Pneumothorax
TEACHING
OBJECTIVE 3. Ruptured spleen
2min EVALUATION
ACTIVITY
SUBJECT MATTER

4.Skin burns
5.Cervical neck injury
TIME 6.Oral, tracheal and laryngeal damage AV

7.Congestive heart failure AIDS

LEARNING

Enumerate the
8.Anoxic encephalopathy ACTIVITY
nursing Explanation
What are the
considerations

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 for CPR NURSING CONSIDERATIONS: nursing
consideration of
1. After the client regains consciousness, profound anxiety often CPR?
appears.
2. The nurse should remember that clients need psychological Listening
and learning
support when they have undergone such as catastrophic
2min
physiologic event. Many clients have a very clear recall of the
events surrounding resuscitation, including the verbal commu-
nication that occurred.
3. The nurse should take time to assess the client’s coping
mechanisms.
4. The nurse should encourage expression of the clients feelings and
concerns not only by the client but by significant others who are
SPECIFIC
TEACHING
equally stressed by sudden, serious nature of disorder EVALUATION
OBJECTIVE
ACTIVITY
SUBJECT MATTER

Clear clarifications and explanations of misconceptions about

what has happened help move the client forward to optimal
physiologic and psychological recovery .
Discuss the
Discussing
TIME evidenced based LEARNING AV What is
practice for CPR ACTIVITY evidenced based
EVIDENCED BASED PRACTICE FOR CPR PRACTICE AIDS
practice for CPR
Alice Jones, phd, facp, from the Hong Kong Polytechnic University in

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 Hong Kong, served as lead author of this EBR article. Because of
anecdotal information she’d been provided by students during and after
CPR training courses, she saw physical exhaustion during administration
of chest compressions as a fundamental issue that affected a significant
2min
number of critical care professionals. But when she searched the
literature, she found no reports on either energy consumption or spinal
kinetics associated with CPR.
In the study that followed, it was found that female rescuers delivered
fewer effective compressions and consumed more oxygen than did male
Listening
rescuers in the standing position. “We believe this is due to the small and writing.
female stature,” said Dr Jones.
When the CPR administrator is on the floor in the kneeling position, the
SPECIFIC TEACHING
OBJECTIVE downward compression force is assisted by gravity and the weight of the ACTIVITY EVALUATION
SUBJECT MATTER

clinician’s trunk. “In the standing or erect posture, however, even though
the trunk could be ‘thrown’ forward, the resultant downward compressive
force is found to be less. In order to maintain the same compression depth,
female nurses must generate more force by actively bending their trunk to
AV
TIME supplement the compression force, thereby consuming more oxygen AIDS
during the process. Male subjects were larger and their forward
momentum was able to provide a sufficient compressive downward force

25
 to overcome the resistive forces of the victim’s chest, resulting in less
energy expenditure,” said Dr Jones.
To conclude the discussion
topic. CONCLUSION:
Cardiopulmonary Resuscitation (CPR) is a relatively a new medical
procedure. CPR is an organized approach to maintaining the vital
functions of a person who has been rendered incapable of continuing
those functions on their own. BLS and ACLS is an emergency procedure
that consists of recognising an arrest and initiating proper CPR techniques
to maintain life of the victim.

10 sec

BIBLIOGRAPHY
1. Luckmann& Sorensen, “Medical Surgical nursing” 2003, 2nd Edition,W. B. Saunder’s Company, Page no. 830-838

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 2. Lippincott “The Lippincott Manual of Nursing Practice”2008, Sixth Edition, Lippincott Publishers, , Page no. 942-946
3. Jacob Annamma, R. Rekha ,” Clinical Nursing Procedures”2010, Fifth Edition, J.P. Publishers, Page no. 387-391
4. Black. M. Joyce, “Text Book Of Medical Surgical Nursing”,2003,Fourth Edition, W. B. Saunder’s Company, Page no. 1208- 1203

Net Reference
1. www.cprguidelinesforhealthcareproviders2014.com
2. www.bclsforcpr.com
3. www.ablsforcpr.com

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