STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING CARDIOPULMONARY RESUSCITATION

Name of presenter : Mrs Pravati Pradhan

Topic : Cardiopulmonary Resuscitation

Group : Biju Pattnaik Degree College of Science

& Education, Bhubaneswar

Duration : 45 Minutes

Medium of Instruction : English

Method of teaching : Power point presentation

General Objective : The students will gain knowledge, attitude and skill regarding

CPR.
 TEACHING
OBJECTIVES CONTENTS LEARNING
ACTIVITY WITH AV
AIDS
HEART
INTRODUCTION:
The heart is a muscular organ about the size of a closed fist that functions as
the body’s circulatory pump. It takes in deoxygenated blood through the veins and
Introduce the topic delivers it to the lungs for oxygenation before pumping it into the various arteries
(which provide oxygen and nutrients to body tissues by transporting the blood Introducing the topic with
throughout the body). The heart is located in the thoracic cavity medial to the lungs help of Power point
and posterior to the sternum. presentation
On its superior end, the base of the heart is attached to the aorta,
pulmonary arteries and veins, and the vena cava. The inferior tip of the heart,
known as the apex, rests just superior to the diaphragm. The base of the heart is
located along the body’s midline with the apex pointing toward the left side.
Because the heart points to the left, about 2/3 of the heart’s mass is found on the
left side of the body and the other 1/3 is on the right.

ANATOMY OF HEART:
Pericardium
The heart sits within a fluid-filled cavity called the pericardial cavity.
Pericardium is a type of serous membrane that produces serous fluid to lubricate
the heart and prevent friction between the ever beating heart and its surrounding
organs.
 Structure of the Heart Wall
The heart wall is made of 3 layers: pericardium, myocardium and endocardium.
• Epicardium. The epicardium is the outermost layer of the heart wall .
• Myocardium. The myocardium is the muscular middle layer of the
heart wall that contains the cardiac muscle tissue.
• Endocardium. Endocardium is the simple squamous endothelium layer
that lines the inside of the heart. lungs.
Describe the Lecturing about the topic
anatomy and Chambers of the Heart with the help of Power
physiology. The heart contains 4 chambers: the right atrium, left atrium, right ventricle, point presentation.
and left ventricle
Valves of the Heart
The heart functions by pumping blood both to the lungs and to the systems of the
body. The heart valves can be broken down into two types:
 atrioventricular and
 semilunar valves.
Conduction System of the Heart
The conduction system starts with the pacemaker of the heart—a small bundle
of cells known as the sinoatrial (SA) node. The SA node is located in the wall of
the right atrium inferior to the superior vena cava. The SA node is responsible for
setting the pace of the heart as a whole and directly signals the atria to contract.
The signal from the SA node is picked up by another mass of conductive tissue
known as the atrioventricular (AV) node.
 CARDIAC ARREST: Explaining about the
cardiac arrest and its
DEFINITION:A Sudden Cardiac Death (SCD) attack is when there is an abrupt management with the
loss of heart function and can be due to a variety of heart conditions. help of powerpoint
presentation.
CAUSES:

Coronary heart disease is the leading cause of sudden cardiac arrest. Many
other cardiac and non-cardiac conditions also increase one's risk.

RISK FACTORS:

Smoking, Obesity,Family history, lack of physical exercise.

DIAGNOSTIC STUDIES:

A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In

many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest,
but lack of a pulse (particularly in the peripheral pulses) may result from other
conditions (e.g.shock), or simply an error on the part of the rescuer

IMMEDIATE MANAGEMENT:

Sudden cardiac arrest may be treated via attempts at resuscitation. This is

usually carried out based upon Basic life support (BLS), Advanced cardiac life
support (ACLS), Cardiopulmonary Resuscitation (CPR).

Define CPR and

BLS.
CARDIO PULMONARY RESUSCITATION:
Describing about CPR
INTRODUCTION: and BLS with the help
Cardiopulmonary resuscitation, commonly known as CPR, is an emergency of Powerpoint
procedure performed in an effort to manually preserve intact brain function until presentation.
further measures are taken to restore spontaneous blood circulation and breathing in
a person who is in cardiac arrest.

BASIC LIFE SUPPORT:

Basic life support refers to maintain the airway, support respiration and
circulation without the use of equipment. Each year, a number of babies and
children will suffer with an accident or illness severe enough to stop their
breathing and leads to respiratory arrest. In a small number of these cases, it will
even stop their heart beating and leads to cardiac arrest. The best chance of
ensuring their survival is to give them emergency treatment known as
cardiopulmonary resuscitation (CPR). CPR can consist of many different things,
but the initial, vital part is Basic Life Support (BLS).
Basic life support is a type of medical care used on someone with a life-
threatening injury or condition until full medical care can be given. An emergency
responder or someone trained in BLS can provide this critical care. Basic life
support consists of cardiopulmonary resuscitation and, when available, defibrillation
using automated external defibrillators (AED). The keys to survival from sudden
cardiac arrest (SCA) are early recognition and treatment, specifically, immediate
initiation of excellent CPR and early defibrillation.
The ability to deliver Basic Life Support, and apply basic aspects of first
aid, are important community skills that have been shown to save lives.BLS
includes maintaining airway and supporting breathing and circulation without the
help of any equipment .It comprises of repagination of signs of sudden cardiac
arrest, heart
attack ,stroke, obstruction of airway by a foreign body
steps performed in
CPR. PURPOSES:
Its main purpose is to restore partial flow of oxygenated blood to the brain Explained about CPR
and with the help of
heart. Powerpoint presentation.

MOST INDICATIONS:
 Cardiac arrest(trauma)
 Respiratory arrest(drowning)
.
Indications :
 CPR should be performed immediately on any person who has become
unconscious and is found to be pulseless.
 Loss of effective cardiac activity is generally due to the spontaneous
initiation of a nonperfusing arrhythmia, sometimes referred to as a
malignant arrhythmia. The most common nonperfusing arrhythmias
include the following:

 Ventricular fibrillation (VF)

 Pulseless Ventricular activity
 Pulseless electrical activity
 Asystole
 Pulseless bradycardia

Contraindications:

The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order

or other advanced directive indicating a person’s desire to not be resuscitated in
the event of cardiac arrest. A relative contraindication to performing CPR is if a
clinician justifiably feels that the intervention would be medically futile. Emergency
cardiac treatments no longer recommended include the following:

 Routine atropine for pulseless electrical activity (PEA)/asystole

 Cricoid pressure (with CPR)
 Airway suctioning for all newborns (except those with obvious obstruction)

Chance of receiving CPR in time:

CPR is likely to be effective only if commenced within 6 minutes after the

blood flow stop because permanent brain cell damage occurs when fresh blood
infuses the cells after that time, since the cells of the brain become dormant in
as little as 4–6 minutes in an oxygen deprived environment and, therefore,
cannot survive the reintroduction of oxygen in a traditional resuscitation.

EQUIPMENT:

CPR, in its most basic form, can be performed anywhere without the need for
specialized equipment. Universal precautions (ie, gloves, mask, gown) should be
taken. However, CPR is delivered without such protections in the vast majority of
patients who are resuscitated in the out-of-hospital setting, and no cases of disease
transmission via CPR delivery have been reported. Some hospitals and EMS
systems employ devices to provide mechanical chest compressions. A cardiac
defibrillator provides an electrical shock to the heart via 2 electrodes placed on the
patient’s torso and may restore the heart into a normal perfusing rhythm.

American Heart Association CPR guidelines:

In 2010, the Emergency Cardiovascular Care Committee (ECC) of the AHA

released the Association’s newest set of guideness for CPR. Changes for 2010
include the following :

• The initial sequence of steps is changed from ABC (airway, breathing,

chest compressions) to
• CAB (chest compressions, airway, breathing), except for newborns
• “Look, listen, and feel” is no longer

recommended TECHNIQUE:

In its full, standard form, CPR comprises the following 3 steps, performed in order:

 Chest compressions
 Airway
 Breathing
For lay rescuers, compression-only CPR (COCPR) is recommended.

Positioning for CPR is as follows:

 CPR is most easily and effectively performed by laying the patient supine on
a relatively hard surface, which allows effective compression of the sternum
 Delivery of CPR on a mattress or other soft material is generally less
effective
 The person giving compressions should be positioned high enough above the
patient to achieve sufficient leverage, so that he or she can use body weight
to adequately compress the chest

For an unconscious adult, CPR is initiated as follows:

  Give 30 chest compressions
 Perform the head-tilt chin-lift maneuver to open the airway and determine
if the patient is breathing
 Before beginning ventilations, look in the patient’s mouth for a foreign body
blocking the airway

Chest compression

The provider should do the following:

 Place the heel of one hand on the patient’s sternum and the other hand on
top of the first, fingers interlaced
 Extend the elbows and the provider leans directly over the patient (see
the image below)
 Press down, compressing the chest at least 2 in (5 cm)
 Release the chest and allow it to recoil completely
 The compression depth for adults should be at least 2 inches (instead of up
to 2 inches, as in the past)
  The compression rate should be at least 100/min
 The key phrase for chest compression is, “Push hard and fast”
 Untrained bystanders should perform chest compression–only CPR
(COCPR)
 After 30 compressions, 2 breaths are given; however, an intubated
patient should receive continuous compressions while ventilations are
given 8-10 times per minute
 This entire process is repeated until a pulse returns or the patient
is transferred to definitive care
 To prevent provider fatigue or injury, new providers should intervene
every 2-3 minutes (ie, providers should swap out, giving the chest
compressor a rest while another rescuer continues CPR

Ventilation

If the patient is not breathing, 2 ventilations are given via the provider’s
mouth or a bag-valve-mask (BVM). If available, a barrier device (pocket mask or
face shield) should be used.

To perform the BVM or invasive airway technique, the provider does the following:

 Ensure a tight seal between the mask and the patient’s face
 Squeeze the bag with one hand for approximately 1 second, forcing at
least 500 mL of air into the patient’s lungs

To perform the mouth-to-mouth technique, the provider does the following:

 Pinch the patient’s nostrils closed to assist with an airtight seal

 Put the mouth completely over the patient’s mouth

 After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
 Give each breath for approximately 1 second with enough force to make the
patient’s chest rise
 Failure to observe chest rise indicates an inadequate mouth seal or airway
Occlusion
 After giving the 2 breaths, resume the CPR cycle
 ACLS(Advanced Cardiac Life Support)

In the in-hospital setting or when a paramedic or other advanced provider is

present, ACLS guidelines call for a more robust approach to treatment of cardiac
arrest, including the following:

 Drug intervention
 ECG monitoring
 Defibrillation
 Invasive airway procedures

ADJUNCT DEVICES:

While several adjunctive devices are available, none other than defibrillation. as of 2010,
have consistently been found to be better than standard CPR for out-of- hospital cardiac
arrest. These devices can be split into three broad groups: timing devices' those that
assist the rescuer to achieve the correct technique, especially depth and speed of
compressions; and those that take over the process completely.

DEFIBRILLATOR:
Defibrillation is a common treatment for life-threatening cardiac dysrhythmias,
ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of
delivering a therapeutic dose of electrical energy to the heart with a device called a
defibrillator. This depolarizes a critical mass of the heart muscle, terminates the
dysrhythmia and allows normal sinus rhythm to be reestablished by the body's natural
pacemaker, in the sinoatrial node of the heart.
Complications:
 Fractures of ribs or the sternum from chest compression (widely considered
uncommon)
 Gastric insufflation from artificial respiration using noninvasive ventilation
methods (eg, mouth-to-mouth, BVM); this can lead to vomiting, with further
airway compromise or aspiration; insertion of an invasive airway prevents this
problem .

 Fractures of ribs or the sternum from chest compression (widely considered uncommon)
Gastric insufflation from artificial respiration using noninvasive ventilation methods (eg, mouth-to-mouth, BVM); this can lead to vomiting,