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The ARC cardiopulmonary guide for resuscitation

Discuss about the Review of Code Blue Video.

After carrying out a review of the video, “Code Blue”, various areas displaying poor performance were realized. This assignment shall analyze the video scenario bringing out the negative and positive issues, discussing them based on the available evidence. The ARC cardiopulmonary guide for resuscitation applied to all unresponsive students. The procedure comprises techniques designed to minimize the effects of circulatory arrest and for the assistance of the patient to regain blood circulation along with the technique of rescue breathing together with the external health breathing. The nurses did the right thing in beginning the CPE process. According to the ARC guide, the first step entails beginning the CPS process in the event that the person is unresponsive and not breathing in a normal manner.

The level of compression to ventilate was too shallow. According to the guide, the nurses needed to compress-to-ventilate in a ratio of 30:2 for all ages. The procedure must be performed with Oxygen and airway adjuncts (Leturiondoa M. , et al., 2016). The fourth guide for the ARC guideline entails helping the person to the ground and positions them to their side. After the CPR ratio procedure, the nurses correctly apply the pads and attempt to defillbrate (Brown, Gallagher, Fowler, & Wales, 2014). According to the guide, the nurses needed to call for advanced life support in case the patient did not respond to their efforts. The nurses needed to check to see whether there was a risk for cervical spine injury and establish a clear upper airway by the use of a thrust of the jaw (Boyle, 2017). The guide recommends the combination with manual in-line stabilization or MILS for the head and neck using all the manpower available in the scene.

The ARC guide provides steps that ought to be followed in case obstruction of the airway persists despite the effective application of chin lift or the jaw thrust. The nurse ought to apply a head tilt, small amounts at a time (Lakea, et al., 2017). The nurses needed to ensure the airway is open. The nurses followed the procedure because they ensured that the patient was not sitting in a chair nor putting their head between their knees (Leturiondoa, et al., 2018). ARC guidelines recommend giving of breaths for the patient in case he remains unresponsive to chest compressions of any kind. According to Leturiondoa, et al.,(2018), peformance of Capnography is considered a method for monitoring the rate of ventilation in the event of cardiopulmonary resuscitation or CPS (McGonigle & Mastrian, 2012). Of all incidences requiring resuscitation, representing more than 70% of all the cases procedures distorted by the chest compression led to oscillations.

Inadequate compression-to-ventilation ratio

It was noted that the nurse lacked due professionalism and respect for nursing ethics on multiple occasions. For example, at the 3rd second, the nurse comes in and finds the patient, Mr. Smith, unresponsive on the bed (Leturiondoa M. , et al., 2016). She searches for his pulse and finds that he is not breathing. It can be noted that the level of compression remains inadequate on multiple occasions. For example, the nurse seeks for the help of another nurse and requests for a concord (Lakea, et al., 2017). The second nurse requests for code blue in the room. The first nurse tries to pump air into the chest of the unresponsive patient on the bed (Merrifield, 2016). A third nurse arrives pushing a table drawer and places a board below the back of the patient. A fourth nurse arrives and begins to pump air into the mouth of the patient. Three nurses work on the patient at the same time. Another team of nurses arrives rushing into the room (Cohen, 1996). The first nurse places plastic simulators on the breasts of the patient. A physician arrives and orders for concussions. The procedure measures 150 joules. The pressure of the patient is steadily falling.

Brown et al. (2014) posit that nurses have a responsibility to perform to the public for the provision of patient-centered, holistic, and safe care. I believe nurses should use the benefit of clinical judgment to meet the needs of the patients (Brown, Gallagher, Fowler, & Wales, 2014). Although she does not agree with the idea of Bacterial infection, she explores the concept of proper sanitation and abhors overcrowding (Boyle, 2017). I believe nurses should empower patients by encouraging them to become active partners in the engagement of mutual goal setting. So strong is her determination that it can almost be termed an obsession. One man proposed marriage to her and she says she prayed that God should cleanse her heart from being desired by men. Her commitment was only to her work and nothing more.

The Assumption made in ALS is that tasks like administration of a bag of Oxygen and compression of the chest are administered (Leturiondoa M. , et al., 2018). The main algorithm of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation is applied, and medication is administered (McGonigle & Mastrian, 2012). Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effect of the treatment on the heart rhythm, as well as the presence of cardiac output, is assessed (Leturiondoa M. , et al., 2018). Medication that may be administered may include adrenaline, amiodarone, atropine, bicarbonate, calcium, potassium and magnesium. Saline or colloids may be administered to increase the circulating volume.

Correct application of pads and defibrillation

I would recommend the video to another student for various reasons. Not only is it informative and entertaining but it also gives an accurate account of historical events (Pruneta, et al., 2018). The video offers socio-cultural perspectives about the lives of the people of the 1800s and the role of education in shaping their beliefs. When she returns to London 3 years after her expedition, she is a hero. She slides into sickness at the age of 40, suffering from what may have been chronic fatigue syndrome (Boyle, 2017). Although she lives in recluse for the remaining 50 years of her life, she continues to impose substantial influence on the course of  nursing and public health (Brown, Gallagher, Fowler, & Wales, 2014). She makes conference presentations, personal persuasions, writes books, and letters.

The overall quality of the analyzed study in the video was poor. In all the instances demonstrated in the video, only a few instances represented a case of proper emergency response and behavior. Therefore, effective conclusions cannot be drawn concerning in-hospital care in the selected patient cohorts (Merrifield, 2016). In the hospital care of sudden cardiac arrest, cardiopulmonary and early defibrillation is essential. Further, interventions using ALS have not managed to show an increase in the rate of survival (Leturiondoa M. , et al., 2016). Hypothermia initiated before arriving in the healthcare facility is a promising kind of treatment even though it is not an intervention based on evidence (Leturiondoa M. , et al., 2016). Thrombolysis of myocardial procedure initiated before arrival to the healthcare facility increased the chances of survival when it is compared to the same procedure initiated in the health care facility. Scientific evidence points to the benefits of ALS to epileptic patients together with patients that have respiratory distress.

Because of multiple methodological issues found in studies of trauma, comparing BLS and ALS care before arrival to the hospital is hard and in some cases, impossible. Various cases lead to painful episodes when the procedure is performed to patients who have intracranial pressure (Virginia Saba & McCormick, 2015). Too much pressure in the head cavity is not healthy for the patient because it might lead to gradual breakdown and work out. In case the help is offered by a qualified physician and by a HEMS organization, the ALS intervention may prove beneficial for patients that have multiple blunt injuries. In many other kinds of patients like patients with cases of drowning or those with cerebrovascular problems there lacks research on the level of effectiveness of levels of ALS and BLS before arrival to the hospital (Leturiondoa M. , et al., 2018). There is need for high quality controlled studies in clinical emergency actions and solutions. Besides study, there ought to be development of in-hospital care for uniform and complete documentation and follow up of all the patients by the use of a register founded on real life data.

Lack of due professionalism and respect for nursing ethics

Pre-hospital care is an essential part of the process of treatment in many of the acute diseases and trauma. The treatment is normally aligned into Advanced Life Support (ALS) and Basic Life Support (BLS) levels of treatment according to the methods used (Leturiondoa M. , et al., 2018). Advanced Life Support refers to complex pre-hospital care that employs the use of methods like intubation, medication and use of intravenous fluids. The vehicle used for such procedures has been either an ambulance or a helicopter (Leturiondoa M. , et al., 2016). The primary purpose of Basic Life Support is to assist the body of the patient to assume basic functions until the patient reaches the necessary center for health care and checkup. On the one hand, ALS has traditionally been implemented by paramedics or physicians (Takahiro Kamada, Masahiro Kaneko, & Tomioka, 2017). On the other hand, BLS level care is given by emergency medical technicians or paramedics. In many of the cases, the nurses performing the ALS units are normally the same as the nurses performing the BLS units.

Concepts connected with ALS and BLS differs and is diverse between countries and regions around the world. Both types have developed and changed into greater levels of complexity (Brown, Gallagher, Fowler, & Wales, 2014). Some procedures that were previously found in ALS are now found in BLS as well. In spite of all the research that has been conducted, the effectiveness of ALS over BLS has remained questioned over time (Takahiro Kamada, Masahiro Kaneko, & Tomioka, 2017). Several reports on research about the area of nursing study have been published and conclusions have been drawn. Research methods have employed the use of different target groups and methods leading to controversial results (Leturiondoa M. , et al., 2016). The implementation of care before arrival to the hospital depends largely to the economic, geographical, political, and social factors connected to the systems and health care facilities. Proper execution of the procedures of resuscitation is essential for patient survival.

In case, the person handling an unresponsive patient he or she must check for breathing and assess the pulse at the carotid at the same time. The assessment ought to take less than 10 seconds whether the nurse performs a check or the pulse or not. Agonal breathing in the form of irregular and occasional gasps is typical in the initial stages of cardiac arrest and signifies the possibility of a cardiac arrest. The same must not be mistaken for a sign of life. Movement of the limbs and breathing can take place in the course of compression of the chest because of the improvement of cerebral perfusion. However, the same does not indicate return of spontaneous circulation. Changes in the color of the skin otherwise referred to, as ‘pallor or cyanosis in isolation does not pass for diagnosis of cardiac arrest. In the event that the patient is already attached to monitoring in a critical area, it adds to rather than replaces the assessment for life signs.

Recommendation of the video


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Brown, N., Gallagher, R., Fowler, C., & Wales, S. (2014). Asthma Management Self Efficacy in Parents of Primary School Age Children. Journal of Child Healthcare, 18(2), 133-144.

Cohen, J. J. (1996). Monster Culture . New York : University of Minnesota Press.

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Lakea, D., K.Engelke, M., A.Koskoa, D., Roberson, D. W., Fany, J., Feliciana, J., et al. (2017). Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan Curricula and Teaching Modalities Using the Community Engagement Model. Nurse Education Today, 51(1), 34-40.

Leturiondoa, M., Gaunaa, S. R., Ruiza, J., Gutiérreza, J., Leturiondoa, L., González-OteroaJames, D., et al. (2018). Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation. Resuscitation, 98(3), 63-68.

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Pruneta, B., Cordier, P.-Y., Pratd, N., Bourmonte, S. D., Courete, D., Lamberte, D., et al. (2018, April 11). Short-term effects of low-volume resuscitation with hypertonic saline and hydroxyethylstarch in an experimental model of lung contusion and haemorrhagic shock. Anaesthesia Critical Care & Pain Medicine, 98(3), 135-140.

Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2013). Nurse Staffing and NICU Infection Rates. Journal of American Medical Association Pediatrics, 167(5), 444–450.

Saba, V., & McCormick, K. A. (2015). Essentials of Nursing Informatics, 6th Edition. New York: McGraw-Hill Education.

Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review. Annals of Internal Medicine, 158(5), 404-410.

Soones, T. N., Lin, J. L., Wolf, M. S., O'Conor, R., Martynenko, M., & Wisnivesky, J. P. (2017). Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma. Journal of Allergy and Clinical Immunology, 139(3), 804-809.

Souverein, P. C., Koster, E. S., Colice, G., Ganse, E. v., Chisholm, A., Price, D., et al. (2017). Inhaled Corticosteroid Adherence Patterns in a Longitudinal Asthma Cohort. The Journal of Allergy and Clinical Immunology: In Practice, 5(2), 448-456.

Takahiro Kamada, Masahiro Kaneko, M., & Tomioka, H. (2017). The relationship between respiratory system impedance and lung function in asthmatics: A prospective observational study. Respiratory Physiology & Neurobiology, 239(1), 41-45.

VanDerWerff, T. (2014, October 24). 13 classic scenes that explain how horror movies work. Retrieved April 4, 2018, from

Virginia Saba, & McCormick, K. A. (2015). Essentials of Nursing Informatics, 6th Edition. New York : McGraw-Hill Education.

Wallace, B. (2013). Nurse staffing and patient safety: What’s your perspective? Nursing Management, 44(6), 49-51.

West, E., Barron, D., Harrison, D., Rafferty, A., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in Intensive Care: An observational study. International Journal of Nursing Studies, 51(5), 781–794.

Younga, H. N., Len-Riosb, M. E., Brownc, R., Morenod, M. M., & Coxe, E. (2017). How does patient-provider communication influence adherence to asthma medications? Patient Education and Counseling, 100(4), 696-702.

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