This document provides information on clinical teaching for cardiopulmonary resuscitation (CPR). It defines CPR as an emergency procedure performed when the heart stops beating. The importance of CPR is that it keeps blood flow active until medical staff can restore normal heart function. The objectives, indications, sequence, chain of survival, performing, guidelines for termination and nurses' responsibilities regarding CPR are described. Immediate CPR can double or triple chances of survival after cardiac arrest.

1. CLINICAL TEACHING ON
CARDIO PULMONARY
RESUSCITATION
PREPARED BY
GOPIKA S
1ST YEAR MSC NURSING
KIMS COLLEGE OF NURSING

2. DEFINITION
CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving
procedure performed when the heart stops beating. Immediate CPR can
double or triple the chances of survival after cardiac arrest.

3. NEED
Basic life support is that phase of emergency cardiac care that either :
(1) prevents circulatory or respiratory arrest or insufficiency through
prompt recognition and intervention
(2) Externally supports the circulation and ventilation of a victim of
cardiac or respiratory arrest through cardiopulmonary resuscitation
(CPR)

4. IMPORTANCE
• Keeping the blood flow active – even partially – extends the
opportunity for a successful resuscitation once trained medical staff
arrive on site.

5. OBJECTIVES
To provide oxygen to brain, heart and other vital organs until
appropriate or definitive medical treatment (advanced cardiac life
support) can restore normal heart and ventilatory function.

6. INDICATIONS
1. Respiratory arrest resulting
from
• drowning
• Stroke
• foreign body
• airway obstruction
• smoke inhalation
• drug overdose

7. • electrocution
• suffocation
• myocardial infarction
• injury from lightening
• coma of any cause leading
to airway obstruction.
2. Cardiac arrest.

8. SEQUENCE OF CPR
The sequence of CPR includes Circulation, airway and breathing
And it begins with an assessment phase to determine the need for action
which includes 'determining unresponsiveness' and 'determining
pulselessness

9. CHAIN OF SURVIVAL
• CPR is a critical step in the AHA’s Chain of Survival. The term Chain
of Survival provides a useful metaphor for the elements of the ECC
systems concept.
• Steps in chain of survival
1. Recognition of cardiac arrest and activation of the emergency
response system
2. Early CPR with an emphasis on chest compressions

10. 3. Rapid defibrillation
4. Advanced resuscitation by Emergency Medical Services and other
healthcare providers
5. Post-cardiac arrest care
• Recovery (including additional treatment, observation, rehabilitation,
and psychological support)
• A strong Chain of Survival can improve chances of survival and
recovery for victims of cardiac arrest

11. PERFORMING OF CPR
• There are two commonly known versions of CPR:
1. For healthcare providers and those trained: conventional CPR using
chest compressions and mouth-to-mouth breathing at a ratio of 30:2
compressions to-breaths. In adult victims of cardiac arrest, it is
reasonable for rescuers to perform chest compressions at a rate of 100 to
120/min and to a depth of at least 2 inches (5 cm) for an average adult,
while avoiding excessive chest compression depths (greater than 2.4
inches [6 cm])

12. 2. For the general public or bystanders who witness an adult suddenly
collapse: compression-only CPR, or Hands-Only CPR. Hands-Only
CPR is CPR without mouth-to-mouth breaths. It is recommended for
use by people who see a teen or adult suddenly collapse in an out-of-
hospital setting (such as at home, at work, or in a park).

13. ABOUT HIGH-QUALITY CPR
High-quality CPR should be performed by anyone - including
bystanders. There are five critical components:
1. Minimize interruptions in chest compressions
2. Provide compressions of adequate rate and depth
3. Avoid leaning on the victim between compressions
4. Ensure proper hand placement
5. Avoid excessive ventilation

14. ARTICLES
1. Arrest board/ back board/ flat surface.
2. Oral airway.
3. A piece of lint to place over victim's mouth or oral barrier device for
mouth-to mouth respiration.
4. Mask and Ambu bag.

15. PROCEDURE
First of all, determine whether is the environment safe for the person.
• DETERMINE THE UNRESPONSIVENESS
1. Tap or gently shake the patient while shouting "ARE YOU OK"?
• DETERMINE PULSELESSNESS
Check carotid pulse for not more than 5 secs. If the person doesn't respond
call emergency or if there is another person who can help, have one person to
call local emergency number and get the AED, if one is available. Have the
other person begin CPR.

16. • The American Heart Association uses the letters C-A-B to help people
remember the order to perform the steps of CPR.
• C: compression
• A: airway
• B: breathing

17. Compressions aim is to Restore blood flow
• Use hands to push down hard and fast in a specific way on the person's
chest. Compressions are the most important step in CPR. Follow these
steps for performing CPR compressions:
1. Position the arrest board underneath victim’s chest(when arrest board
is not available place victim on firm flat surface)
2. Kneel next to the person's neck and shoulders.

18. 3. Using index finger of the hand, locate the lower rib margin and move
the fingers up to where the ribs connect to the sternum. Place the middle
finger of this hand on the notch and index finger next to it. Place the
heel of the opposite hand next to the index finger on the sternum.
Ensure that the long-axis of the heel of hand is parallel to the long-axis
of the sternum. Remove the first hand from the notch and place on top
of the hand that is on the sternum. Extend or interlace the fingers, do not
allow them to touch the chest. Keep the arm straight with shoulders
directly over the hands on the sternum and lock elbows.

21. 4. In case of children Place two hands (or only one hand if the child is
very small) on the lower half of the child's breastbone (sternum).
Imagine a horizontal line drawn between the baby's nipples. Place two
fingers of one hand just below this line, in the center of the chest.
5. Push straight down on (compress) the chest at least 2 inches (5 cm)
but no more than 2.4 inches (6 cm). Use entire body weight (not just
arms) when doing compression count 1, 2 3 for ensuring compressions.

22. 6. For babies compress Gently compress the chest about 1.5 inches
(about 4 cm).
7. Push hard at a rate of 100 to 120 compressions a minute. The
American Heart Association suggests performing compressions to the
beat of the song "Stayin' Alive." Allow the chest to spring back (recoil)
after each push.
8. Compression ventilation ratio is 30:2 and for infants 15:2

23. Airway aim is to Open the airway
1. Open the victim's airway by using one of the following maneuvers:
a. Head tilt chin lift maneuver: Place one hand on victim's forehead
apply firm backward pressure with the palm to tilt the head back. Then
place the fingers of the other hand under the bony part of the lower jaw
near the chin and lift up to bring the jaw forward.

24. b. Jaw thrust maneuver: Grasp the angles of the patient's lower jaw and
lift with both hands ,one on each side, displacing the mandible forward.
Place an airway if available. Breathing aim Breathe for the person

26. Breathing aim Breathe for the person
1. Occlude nostrils with thumb and index finger of the hand on forehead
that is tilting the head back. Form a tight seal over the patient's mouth or
place an appropriate respiratory arrest device (ambubag and mask) and
give two full breaths of approximately 0.5 to 2 seconds allowing time
for both inspiration and expiration. Observe for rise and fall of the chest.
2. Resume chest compressions to restore blood flow.
3. Continue CPR until there are signs of movement or emergency
medical personnel take over.

27. GUIDELINES FOR TERMINATION OF RESUSCITATION
• Return of spontaneous circulation.
• Arrival of arrest team or medical help.
• If the rescuer becomes exhausted.
• When death is confirmed

28. NURSES RESPONSIBILITY
• Identifies self as Nursing Team Leader, responsible for co-
coordinating and directing emergent nursing care of the patient.
• Checks appropriate emergency call has been placed
• Starts timer as soon as the Emergency trolley arrives.

29. • Delegates available staff to roles appropriate to their level of practice:
Airway, Compression, Monitor & Medications and Runner to collect
or remove extra equipment, supplies, labs etc.
• Establishes the patient’s weight and delegates someone to print out an
Emergency Drug Worksheet (Icon on desktop of clinical computers)