LESSON PLAN

ON CPR – Basic
Life Support

Libin Palluppettayil Jose

BSN
Dr. Panjabrao CPR is a basic life saving skill that all HCP must know as,
Deshmukh Nursing in the clinical areas there are more chances for cardio or
Institute pulmonary or a combined arrest. Assessing the cardio
pulmonary arrest in minimum time can increase the life
Shivaji Nagar
expectancy after the CPR.
Amravati

+91721 2551164

+918055225486

11/26/2009
 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
AMRAVATI

SUBJECT : Foundations of Nursing

TOPIC : CPR – Basic Life Support

GROUP : Basic BSc (N) First Year

DATE : 27th November 2009

METHOD : Lecture, Discussion followed by Demonstration

AIM : Students understand the Cardio Pulmonary Resuscitation and its techniques, to
provide basic life support in the emergency situations in their clinical practice.

OBJECTIVE : at the end of the class the students will be able to

1. Identify the cardio pulmonary emergency situations

2. Demonstrate the need based care

3. Demonstrate CPR Procedure

INTRODUCTION : CPR is a basic life saving skill that all HCP must know as, in the clinical
areas there are more chances for cardio or pulmonary or a combined arrest. Assessing the cardio
pulmonary arrest in minimum time can increase the life expectancy after the CPR.

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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CONTENT :

1. Introduction to CPR

2. Understanding the ABCDs of CPR

3. Chest compression and its technique

4. Opening the Airway and giving Breaths

a. Head tilt – chin lift

b. Mouth to mouth breathing

c. Mouth to barrier device breathing

d. Mouth to mask breathing

5. 1 Rescuer Adult CPR sequence

6. Adult bag and mask technique and Rescue Breathing

7. 2 Rescuer CPR for Adult

8. Special situations

a. Scene safety

b. Rescuer safety

c. Standard precautions

d. Head, Neck And Spine Injuries

e. Agonal gasps

f. Recovery position

9. Automated External Defibrillator

a. Principles of early defibrillation

b. Structure and functions of AED

c. AED Operation

d. Integrating AED and CPR

e. 2 Rescuer CPR Sequence with AED

f. Special situations and its Precautions

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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i. Hairy chest

ii. Water

iii. Implanted defibrillator and Pace makers

iv. Transdermal Medication Patches

ADULT BLS ALGORITM (CPR)

No movement or response

Phone 101 or emergency number and Get AED or send second rescuer (if available to do this)

Open AIRWAY , check BREATHING

If not breathing , give 2 BREATHS that make chest rise

Definite

Pulse

If no response, check pulse: Do you DEFINITELY feel Pulse within 10 Give 1 breath every5 to 6 seconds
seconds? No

→ Recheck pulse every 2 minutes

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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Give cycles of 30 COMPRESSIONS and 2 BREATHS Until AED/defibrillator arrives, ALS providers take over, or Victim starts to move

Push hard and fast (100/min) in compressions

AED/defibrillator ARRIVES

Check Rhythm (Shockable rhythm or not)

Shockable Not Shockable

Give 1 shock and Resume CPR immediately for 5 Resume CPR immediately For 5 cycles
cycles
Check rhythm after every 5 cycles ; continue until over ALS

Providers take over or Victim starts to move

Positioning The Victim : The victim should be in a face up (supine) position and on a hard
surface before you begin CPR. If an unresponsive victim is not face up, roll the victim to a face up position

If a victim is not on a hard surface for Example, (if the victim is in bed) place a board or other
rigid surface between the victim and the bed. If one is not available, move the victim to the floor.

1 or 2 -Rescuer Adult CPR Practice Sheet

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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Performance Guidelines

Check for response

• If there is no response, shout for help. If no help is available,

active the emergency response system and get the AED

Open the airway

• Head tilt-chin lift Check for adequate breathing (take at

Least 5 and no more than 10 seconds)

• Look, listen, and feel If no adequate breathing , give 2 Breaths

• Make the chest rise

Check pulse

• Take at least 5 and no more than

10 seconds

If no pulse start cycles of 30 compressions and 2 breaths:

• 30 compression (push hard, push fast)

• Rate of 100 per minute
• 2 breaths

Minimize interruptions in chest compressions; try to keep interruptions to10 seconds or less

2-Rescuer Adult CPR Sequence Technique

All professional rescuers should learn both the 1-rescuer and 2-rescuer techniques. When possible, use
devices for month-to mask and bag-mask ventilation. In 2-rescuer CPR, each rescuer has specific roles:

Rescuer Location Actions

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Rescuer 1 At the victim’s side • Performs chest compressions

• Counts out loud
• Switches duties with rescuer 2 every
5 cycles or 2 minutes, king taking less than

5 seconds to switch

Rescuer 2 At the victim’s head • Maintains an open airway

• Gives breaths , watching for chest rise
and avoiding hyperventilation
• Encourages rescuer 1 to perform
compressions that are fast and deep
enough and to allow full chest recoil
between compressions

• Switches duties with rescuer 1 every 5

cycles or 2 minutes , taking less than 5
seconds to switch

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UNIVERSAL AED OPERATING STEPS

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Step Action

1 POWER ON the AED (this activates voice prompts for guidance in al subsequent steps.).

• Open the carrying case or the top of the AED.

• Turn the power on(some devices will “power on” automatically when you open the lid or case)
2. ATTACH electrode pads to the victim’s bare chest.

• Choose correct pads (adult vs child) for size /age of victim. Use child pads or child system for children
less than 8 years of age if available. Do not use child pads or child system for Victim 8 years and
older.
• Peel the backing away from the electrode pads.
• Quickly wipe the victim’s chest if it is covered with water or sweet.
• Attach the adhesive electrode pads to the victim’s bare chest.
- Place one electrode pad on the upper-right side of the bare chest to the right of the
breastbone, directly below the collarbone.

- Place the other pad to the left of the nipple, a few inches below the Left arm pit

• Attach the AED connecting cables to the AED box (some are Pre connected.)
3 “Clear” the victim and ANALYZE the rhythm.

• Always clear the victim during analysis. Be sure that no one is touching the victim, not even the
person in change of given breaths.
• Some AEDs will tell you to push a button to allow the AED to begin analyzing – the heart; others will
do that automatically. The AED may take about 5 to 15 seconds.
• The AED then tells you if a shock is needed.
4 If the AED advises a shock, it well tell you to be sure to clear the victim.

• Clear the victim before delivering the shock: be sure no one is touching the victim to avoid injury to
rescuers.
- Loudly state a “ clear the patient: message such as”I’m clear, you’re
- Clear, everybody’s clear “ or simply “Clear”
- Perform a visual check to ensure that no one is in contact with the victim.
• Press the SHOCK button
• The shock will produce a sudden contraction of the victim’s muscles
5 As soon as the AED gives the shock , begin CPR starting with chest compressions

6 After 2 minutes of CPR, the will prompt you to repeat steps 3 and 4.

2-Rescuer CPR Sequence with AED

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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Step Action

Check for response : if the victim does not respond:

• The first rescuer stays with the victim and performs CPR until the AED Arrives.

The second rescuer activates the emergency response system and gets the AED.(Either rescuer may
operate the AED once it Arrives.)
2. Open airway : head tilt-chin lift.

3 Check for breathing : provide breathing if needed:

- Look, listen and feel for breaths.

- If not breathing, give 2 breaths using appropriate barrier device:
4 Check for pulse : if pulse not definitely felt in 5 to 10 seconds:

• Perform chest compressions and prepare to attach the AED:

- The first rescuer starts chest compression while the second rescuer
- Prepares to use the AED:
- Remove or move clothing covering the victim’s chest to allow
- Rescuers to provide chest compression and apply the AED electrode pads.
5 Attempt defibrillation with the AED:

- When the AED arrives , place it at the victim’s side near the rescuer who will be operating it. The AED is usually placed on the side of
the victim opposite the rescuer who is performing CPR
There are 2 exceptions:

1. For a child who suffered an unwitnessed, out-of-hospital cardiac arrest, Complete 5 cycles (or about 2 minutes) of CPR before
attaching and using the AED.

2. For an adult who suffered an unwitnessed, out-of-hospital cardiac arrest and with EMS call-to-arrival interval greater than 4 to 5
minutes , EMS Personnel may complete 5 cycles of CPR before attaching AED

6 • POWER ON the AED and follow voice prompts. Some devices will turn on when the AED lid or carrying case is Opened.

• Attach the AED:

- Select the correct pads for the victim’s size and age (Adult vs child),
- And/or turn a key or switch to deliver a child shock dose if appropriate.
- Peel the backing from the pads.
- ATTACH the adhesive pads to the bare skin of the victim’s chest
- Attach the electrode cable to the AED (if not preconnected).

• Allow the AED to ANALYZE the victim’s rhythm (clear the Victim before analysis)

• Deliver a SHOCK if needed (clear the victim before shock)

• If no shock is needed and after any shock delivery, resume CPR beginning with chest compression

SUMMARY : Healthcare Provide Summary of CPR for Adults, Children, and Infants.

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 DR.PANJABRAO DESHMUKH NURSING INSTITUTE,
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CPR Adult and Child Infant
Older Child ( 1 year old to ( Less than
Puberty) 1 year old
Establish that the Activate your Activate your emergency response
Victim does not emergency System after giving of CPR
Respond response system
as soon as the
victim found
Activate your emergency
response system
Open the airway
Head tilt-chin lift ( Suspected trauma: jaw thrust)
Used head tilt-chin lift
Check breathing
Open the airway, look, listen, and feel.
If the victim is not
Breathing, give 2 breaths Take at least 5 seconds and no more than 10 seconds.
That make the chest rise.
First 2 breaths Give 2 breaths
( 1 second each)
Check pulse Carotid pulse Carotid pulse Brachial pulse ( if no
(if no pulse, (if no pulses or pulse is <60 bpm Pulse or pulse is
At least 5 seconds Start CPR) with signs of poor perfusion, ,60 bpm with sings
and no more than start CPR Of poor perfusion,
10 seconds Start CPR)
Start CPR

Compression Centre of breast bone between nipples Just below nipple

Location Line on breast-
bone

Compression Heel of 1 hand on top 2 fingers

Method (or 1 hand for small victims) ( thumb-encircling
hands for
2-rescuer CPR
Compression 1 ½ to 2 inches 1/3 to ½ depth of chest
depth
Compression rate 100 per minute

Compression
Ventilation ratio 30:2 30:2 for 1-rescuer CPR
(1-or 2-rescuer (15:2 for 2-rescuer CPR)
CPR)

HOME WORK : Prepare a Journal on Cardio Pulmonary Resuscitation

REFERANCE : BLS for Health Care Providers (Students Manual), American Heart
Association, 2006. ISBN 0-87493-461-3

SIGNATURE

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