Chapter 6 Cardiac Emergencies. Cardiovascular Disease Abnormal conditions that affect the heart and blood vessels Leading cause of death in US (male/female)

Chapter 6Chapter 6Cardiac EmergenciesCardiac Emergencies

Cardiovascular DiseaseCardiovascular Disease

Abnormal conditions that affect the heart and blood Abnormal conditions that affect the heart and blood vesselsvessels

Leading cause of death in US (male/female)Leading cause of death in US (male/female) 61 million suffer; 950,000 die each year (2005)61 million suffer; 950,000 die each year (2005) Principle componentsPrinciple components::

Coronary heart diseaseCoronary heart disease: arteries that carry oxygen-: arteries that carry oxygen-rich blood to heart harden or narrow from build up of rich blood to heart harden or narrow from build up of fatty depositsfatty deposits

StrokeStroke: disruption of blood flow to part of brain which : disruption of blood flow to part of brain which causes permanent damage to brain tissue causes permanent damage to brain tissue (cerebrovascular accident or CVA)(cerebrovascular accident or CVA)

Cardiovascular EmergenciesCardiovascular Emergencies

2 common emergencies:2 common emergencies:

A) heart attack- (myocardial infarction) bloodA) heart attack- (myocardial infarction) blood flow to some part of heart muscle isflow to some part of heart muscle is comprised and heart beginscomprised and heart begins to die; if enough of heart dies, heart cannotto die; if enough of heart dies, heart cannot circulate blood effectivelycirculate blood effectively -B) cardiac arrest – heart stops beating-B) cardiac arrest – heart stops beating

Cardiovascular EmergenciesCardiovascular Emergencies

Clinically dead = no signs of life (no pulse Clinically dead = no signs of life (no pulse or breathing)or breathing) Cells of brain and other vital organs continue to Cells of brain and other vital organs continue to

live until oxygen is depletedlive until oxygen is depleted CPRCPR: : cardiopulmonary resuscitationcardiopulmonary resuscitation is is

needed; combination of chest compressions and needed; combination of chest compressions and rescue breathingrescue breathing

Together take over functions of heart/lungs until Together take over functions of heart/lungs until advanced medical care givenadvanced medical care given

Only generates 1/3 of normal blood flow to brainOnly generates 1/3 of normal blood flow to brain

Cardiovascular EmergenciesCardiovascular Emergencies Cardiac Chain of SurvivalCardiac Chain of Survival: give victim of : give victim of

cardiac arrest the best chance of survivalcardiac arrest the best chance of survival

1. 1. Early recognition and early accessEarly recognition and early access::

sooner 9-1-1 called; sooner early sooner 9-1-1 called; sooner early

advanced medical care arrivesadvanced medical care arrives

2. 2. Early CPREarly CPR: : helps circulate oxygen-rich helps circulate oxygen-rich

blood to vital organs until AED is ready blood to vital organs until AED is ready

to be used or advanced medical help arrivesto be used or advanced medical help arrives

Cardiovascular EmergenciesCardiovascular Emergencies

3.3. Early DefibrillationEarly Defibrillation: : electric shock electric shock called defibrillation that can restore an called defibrillation that can restore an effective heart rhythm to cardiac arrest effective heart rhythm to cardiac arrest victim; each minute delayed reduces victim; each minute delayed reduces chance of survival by 10%chance of survival by 10%

4.4. Early Advanced Medical CareEarly Advanced Medical Care: given : given by trained medical personnel, who by trained medical personnel, who provide further care and transport to provide further care and transport to hospitalhospital

Signals of Signals of Heart AttackHeart Attack

Chest pain spreadingChest pain spreading * * shortness of breath shortness of breath shoulders/neck/jaw/arms shoulders/neck/jaw/arms * sweating* sweating Nausea or vomitingNausea or vomiting * denial* denial Dizziness, light headedDizziness, light headed *pale, ashen (gray) or bluish *pale, ashen (gray) or bluish

or faintingor fainting skin skin

Additional Signs felt by WomenAdditional Signs felt by Women Shortness of breathShortness of breath Nausea or vomitingNausea or vomiting Back or jaw painBack or jaw pain

Nearly ½ of all deaths from heart attacks are WomenNearly ½ of all deaths from heart attacks are Women

Heart AttackHeart Attack

Most important first aid measure is to be Most important first aid measure is to be able to recognize signals of heart attack able to recognize signals of heart attack and take action.and take action.

Most victim’s will deny the seriousness of Most victim’s will deny the seriousness of the signals he/she is experiencing.the signals he/she is experiencing.

Many delay seeking care – usually 2 hours Many delay seeking care – usually 2 hours or more before going to hospitalor more before going to hospital

Some mistake signals for indigestionSome mistake signals for indigestion

Care for Heart AttackCare for Heart Attack

Check, Call, CareCheck, Call, Care Recognize signals of heart attackRecognize signals of heart attack Call 9-1-1Call 9-1-1 Help victim rest comfortablyHelp victim rest comfortably Loosen any restrictive clothingLoosen any restrictive clothing Assist the victim w/any prescribed medicationAssist the victim w/any prescribed medication Monitor breathing and other signs of lifeMonitor breathing and other signs of life Be prepared to perform CPR or use an AED if Be prepared to perform CPR or use an AED if

victim’s heart stops beatingvictim’s heart stops beating

Heart AttackHeart Attack

Angina Pectoris: chest pain or pressure Angina Pectoris: chest pain or pressure that comes and goes at different timesthat comes and goes at different times Heart needs more oxygen than it getsHeart needs more oxygen than it gets Lack of oxygen causes constricting chest pain Lack of oxygen causes constricting chest pain

that spreads to neck, jaw, and armsthat spreads to neck, jaw, and arms Seldom lasts longer than 3 to 5 minutesSeldom lasts longer than 3 to 5 minutes Nitroglycerin – medication that dilates blood Nitroglycerin – medication that dilates blood

vessels to make it easier for blood to reach vessels to make it easier for blood to reach heart; relieves painheart; relieves pain

If does not go away after 10 min; call 9-1-1If does not go away after 10 min; call 9-1-1

Cardiac ArrestCardiac Arrest

Heart stops beating or beats to ineffectively to Heart stops beating or beats to ineffectively to generate a pulse and blood is not circulated to generate a pulse and blood is not circulated to brain and other vital organsbrain and other vital organs

CausesCauses Cardiovascular diseaseCardiovascular disease DrowningDrowning *certain drugs*certain drugs Severe injuries to chestSevere injuries to chest *suffocation*suffocation Severe blood lossSevere blood loss *electrocution*electrocution Stroke or other brain damageStroke or other brain damage Sudden Death- no warning signals at allSudden Death- no warning signals at all

Signals:Signals: no signs of life no signs of life

CPR for AdultCPR for Adult Check the scene and victimCheck the scene and victim If victim is unconscious, send someone to call 9-1-1If victim is unconscious, send someone to call 9-1-1 Check for breathing for no more than 10 seconds (Look, Check for breathing for no more than 10 seconds (Look,

listen, and feel)listen, and feel) Check for bleedingCheck for bleeding 30 chest compressions30 chest compressions Head tilt/chin liftHead tilt/chin lift 2 slow breaths2 slow breaths Repeat Repeat

CPRCPR

Chest compressions- victim needs to be on a Chest compressions- victim needs to be on a hard surface to be effectivehard surface to be effective

Hand position: Hand position: 2 hands in center of chest2 hands in center of chest kneel down beside victimkneel down beside victim Place heel of hand on the center of victim’s sternum Place heel of hand on the center of victim’s sternum

(breastbone)(breastbone) Place other hand directly on top of firstPlace other hand directly on top of first Use heel of hand to apply pressureUse heel of hand to apply pressure Keep fingers off chestKeep fingers off chest Shoulders directly over handsShoulders directly over hands Arms straight and elbows locked Arms straight and elbows locked

CPRCPR

Compressions: push sternum down 2 inches Compressions: push sternum down 2 inches Each movement should be smooth not jerkyEach movement should be smooth not jerky Do not pause between compressionsDo not pause between compressions Hands never leave chest during compressionsHands never leave chest during compressions 100 per minute100 per minute (30 compressions – 18 seconds) (30 compressions – 18 seconds) Count: one and two and three and four and five Count: one and two and three and four and five

….. Up to 30….. Up to 30 Push down saying #, up say “and”Push down saying #, up say “and”

CPRCPR

Cycles of 30 compressions and 2 rescue Cycles of 30 compressions and 2 rescue breathsbreaths

Use head tilt/chin lift technique to open Use head tilt/chin lift technique to open airway after compressionsairway after compressions

Breath until see the chest rise (1 second); Breath until see the chest rise (1 second); pinch nose during breath and releasepinch nose during breath and release

If two responders, send one to call 9-1-1 If two responders, send one to call 9-1-1 and get an AEDand get an AED

When to stop CPRWhen to stop CPR

Scene becomes unsafeScene becomes unsafe Victim shows signs of lifeVictim shows signs of life An AED becomes available and is ready to An AED becomes available and is ready to

useuse Another trained rescuer arrives and takes Another trained rescuer arrives and takes

overover You are too exhausted to continueYou are too exhausted to continue

Child and Infant CPRChild and Infant CPR

Children do not often initially suffer a cardiac Children do not often initially suffer a cardiac emergencyemergency

Generally, they suffer a respiratory emergency Generally, they suffer a respiratory emergency that can develop into a cardiac emergencythat can develop into a cardiac emergency

Infant in need of CPR: no breathing and no Infant in need of CPR: no breathing and no signs of lifesigns of life

Causes:Causes: car crashes, drowning, smoke car crashes, drowning, smoke inhalation, poisoning, choking, firearm injury, inhalation, poisoning, choking, firearm injury, falls, and also from acute respiratory conditions falls, and also from acute respiratory conditions such as asthma attacksuch as asthma attack

Child CPRChild CPR

Same as for the adult except forSame as for the adult except for Give 2 minutes of CPR then call 9-1-1 if you are alone Give 2 minutes of CPR then call 9-1-1 if you are alone

otherwise ask someone to call for you otherwise ask someone to call for you Use heel of only two handsUse heel of only two hands for compressions for compressions

Shoulders over handsShoulders over hands Compress chest 2 inches smoothlyCompress chest 2 inches smoothly 30 compressions in 18 seconds (100 per min)30 compressions in 18 seconds (100 per min) 2 slow rescue breaths (until see chest rise); pinch 2 slow rescue breaths (until see chest rise); pinch

nose and release after breathnose and release after breath Repeat cycle (30 compressions and 2 breaths)Repeat cycle (30 compressions and 2 breaths)

Infant CPRInfant CPR

Same as for the adult except forSame as for the adult except for Use only pads of 2 fingers for compressionsUse only pads of 2 fingers for compressions and the and the

other on the infant’s forehead to maintain open airwayother on the infant’s forehead to maintain open airway Shoulders over handsShoulders over hands Compress chest 11/2 inches smoothlyCompress chest 11/2 inches smoothly 30 compressions in 18 seconds (100 per min)30 compressions in 18 seconds (100 per min) 2 slow rescue breaths (until see chest rise); cover 2 slow rescue breaths (until see chest rise); cover

infant’s nose and mouth with your mouthinfant’s nose and mouth with your mouth Repeat cycle (Repeat cycle (30 compressions and 2 breaths30 compressions and 2 breaths))

Automated ExternalAutomated ExternalDefibrillator (AED)Defibrillator (AED)

Abnormal rhythms of the heartAbnormal rhythms of the heart Ventricular FibrillationVentricular Fibrillation (V-fib): (V-fib): totally disorganized electrical activity totally disorganized electrical activity

in the heart in the heart Results in fibrillation or quivering of the ventriclesResults in fibrillation or quivering of the ventricles Heart cannot pump blood and no signs of life (including no pulse)Heart cannot pump blood and no signs of life (including no pulse)

Ventricular TachycardiaVentricular Tachycardia (V-tach): (V-tach): very rapid contraction of very rapid contraction of ventriclesventricles Regular rhythm, rate is so fast heart unable to pump blood Regular rhythm, rate is so fast heart unable to pump blood

properlyproperly No signs of life including no pulseNo signs of life including no pulse

Fibrillation can be corrected by early defibrillation Fibrillation can be corrected by early defibrillation (85% of people)(85% of people) If not corrected, all electrical activity will ceaseIf not corrected, all electrical activity will cease – – asystole asystole

(flatline)(flatline)…… cannot be corrected or reversed cannot be corrected or reversed

AED PrecautionsAED Precautions Do not touch victim while AED is analyzing Do not touch victim while AED is analyzing (disrupts analysis)(disrupts analysis) Do not touch victim during defibrillation Do not touch victim during defibrillation (you could be injured)(you could be injured) Do not use alcohol to wipe victim’s chest (flammable)Do not use alcohol to wipe victim’s chest (flammable) Do notDo not use AED in a use AED in a moving vehiclemoving vehicle Do notDo not use AED on use AED on victim in contact with watervictim in contact with water Use proper pads for adults and children (under 8 yrs and Use proper pads for adults and children (under 8 yrs and

less than 55 lbs)less than 55 lbs) Do notDo not use AED on victim with a use AED on victim with a nitroglycerin patchnitroglycerin patch Do notDo not use use cell phonescell phones or radio transmissions or radio transmissions w/in 6 ftw/in 6 ft of of

AED- interrupts analysisAED- interrupts analysis

AEDAED

How to use an AED: How to use an AED: As soon as it is available and safe to do so, CPR is stoppedAs soon as it is available and safe to do so, CPR is stopped Turn on AEDTurn on AED Open victim’s shirt and wipe chest dryOpen victim’s shirt and wipe chest dry Attach AED pads (Attach AED pads (upper right chest, lower left sideupper right chest, lower left side)) Plug in connector to AEDPlug in connector to AED AED analyze heart rhythmAED analyze heart rhythm Say: “Say: “everyone stand cleareveryone stand clear” (do not touch victim)” (do not touch victim) Deliver shock by pushing button when told to do soDeliver shock by pushing button when told to do so Say: “everyone stand clear, shocking”Say: “everyone stand clear, shocking” AED analyze againAED analyze again Recheck for pulse, provide additional shock if advised to do soRecheck for pulse, provide additional shock if advised to do so No shock advised, continue CPR, No shock advised, continue CPR, leave AED attachedleave AED attached