Chapter 7 Cardiac Emergencies - firstresponders.cafirstresponders.ca/.../09/7-Cardiac-Emergencies.pdf · Cardiac Emergencies ♦ KNOWLEDGE OBJECTIVES 1. List four signs and symptoms

Chapter 7

Cardiac Emergencies ♦ KNOWLEDGE OBJECTIVES

1. List four signs and symptoms of a heart attack.

2. Describe how to care for a heart attack casualty.

3. Identify the primary sign of cardiac arrest.

4. Identify five early signs that an infant or child may develop a cardiac emergency.

5. Describe the purpose of CPR.

6. Describe how to perform one-rescuer CPR for an adult, a child, and an infant.

7. Describe how to perform two-rescuer CPR.

8. List five conditions under which a rescuer may stop CPR.

9. Identify three risk factors for cardiovascular disease that can be controlled.

10. Describe the importance of early defibrillation.

11. Define the key terms for this chapter.

♦ SKILL OBJECTIVES

After reading this chapter and completing the class activities, you should be able to

1. Demonstrate how to give CPR to an adult, a child, and an infant.

2. Make appropriate decisions about care when given an example of an emergency in which a person has persistent chest pain.

3. Make appropriate decisions about care when given an example of an emergency in which a person is in cardiac arrest.

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♦ OUTLINE

Introduction 125

Heart Attack 125

Common Causes of Heart Attack 126

Preventing Cardiovascular Disease. 126

Risk Factors of Hear t Disease 128

Signs and Symptoms of a Heart Attack 129

Care for a Heart At tack 130

Cardiac Arrest 132

What Is Cardiac Arrest? 132

Common Causes of Cardiac Arrest 132

Signs of Cardiac Arrest 132

Care for Cardiac Arrest 132

CPR for Adults 133

Chest Compressions . 133

Compression/Breathing Cycles 137

When to Stop CPR 138

Automated External Defibrillators 138

What Makes the Heart Work 139

Cardiac Emergencies in AduIts and Children 141

CPR for Infants and Children 141

CPR for Children 141

CPR for Infants 144

Two-Rescuer CPR 146

Two-Rescuer Techniques 146

When Two Rescuers Arrive on the Scene at the Same Time 147

Two-Rescuers Beginning CPR Together 147

When CPR Is in Progress by One Rescuer 147

Changing Positions 147

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♦ KEY POINTS

Signs and Symptoms of Heart Attack

♦ Persistent chest pain or discomfort.

♦ Breathing difficulty.

♦ Changes in pulse rate.

♦ Pale, bluish, or moist skin.

Care for a Heart Attack

♦ Stop the casualty's activity.

♦ Have the casualty rest in a comfortable position.

♦ Summon more advanced medical personnel.

♦ Be calm and reassuring.

♦ Monitor casualty's vital signs, look for changes in casualty's appearance and/or behaviour.

♦ Administer supplemental oxygen, if available.

Controllable Risk Factors for Cardiovascular Disease

♦ Smoking.

♦

Common Causes of Cardiac Arrest

♦ Cardiovascular disease.

♦ Drowning.

♦ Electrocution.

♦ Poisoning.

♦ Respiratory arrest.

♦ Severe blood loss.

When to Stop CPR

♦ Another trained rescuer takes over.

♦ Advanced medical personnel take over.

♦ Too exhausted to continue.

♦ Scene becomes unsafe.

♦ Casualty's heart starts beating.

Ways to Prevent Cardiac Emergencies in Children

♦ Prevent injuries leading to cardiac emergencies.

Diet high in fat.

♦ High blood pressure.

♦ Obesity.

♦ Lack of routine exercise.

♦ Provide proper medical care.

♦ rly signs of respiratory emergency.

•

sed heart and breathing

rates.

Recognize ea

They are: Agitation. Drowsiness. Change in skin colour. Increased difficulty breathing.

Increa

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♦ LEARNING ACTIVITIES

Matching

Match each term with its definition. Write its letter on the line in front of the definition.

Terms

a. Cardiac arrest

b. Cardiovascular disease

c. Heart attack

d. Atherosclerosis

e. Cholesterol

f. Stroke

g. Sudden death

h. Coronary arteries

Definitions

1. A sudden illness involving death of heart muscle tissue because of insufficient oxygen-rich blood reaching the cells

2. A substance involved in coronary artery disease and found in certain foods, including egg yolks, shrimp, and lobster

3. A chronic illness affecting the heart and blood vessels

4. A condition in which the heart has stopped, or beats too irregularly or weakly to pump blood

5. The vessels that supply the heart muscles with oxygen-rich blood

6. A buildup of fatty acids on the inner walls of the arteries

7. A medical condition caused by diseased arteries in the brain

Match each compression/ventilation cycle with the correct type of CPR. Write its letter on the line in front of the type of CPR.

Compression/Ventilation Cycle

a. 5 compressions followed by 1 slow puff; 100 or more compressions per minute

b. 15 compressions followed by 2 slow breaths; 80-100 compressions per minute

c. 15 compressions followed by 2 slow breaths; 80-100 compressions per minute

Type of CPR

1. One-rescuer adult CPR

2. Two-rescuer adult CPR

3. Infant CPR

Short Answer

Read each statement or question and write the correct answer or answers in the space provided.

1. What five key questions should you ask a casualty about his or her chest pain?

1.

2.

3.

4.

5.

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2. `What are five circumstances in which it is appropriate to stop CPR after you have started?

1.

2.

3.

4.

5.

3. Describe the three steps to locate the correct hand position to deliver chest compressions to an adult.

1.

2.

3.

4. List five early signs and symptoms of a respiratory emergency in infants and children that could lead to a cardiac emergency.

1.

2.

3.

4.

5.

5. In what three situations should you be able to perform two-rescuer CPR?

1.

2.

3.

CASE STUDIES

Read the case studies and answer the questions that follow.

Case 7.1

You are called to the scene of a drowning. A child, probably between 8 and 10 years of age, has just been removed from the water after being submerged for several minutes. The child is not breathing, and you feel no carotid pulse.

1. T F To avoid injuring the child, you should only perform rescue breathing.

2. To deliver chest compressions to this child, you would use the

a. Heel of one hand.

b. Heel of two hands.

c. Pads of two fingers.

d. Pads of three fingers.

3. T F You should push the sternum of the child down from 2.5 to 3.8 cm (1 to 1 1/2 inches) with each chest compression.

4. T F Chest compressions should be delivered at a rate of 80-100 times per minute.

5. After you have started chest compres-sions, how often should you recheck this child's pulse?

1.

6. T F During CPR, you should remove your hand from the child's chest to deliver breaths, and relocate your hand position when you return to the chest to deliver compressions.

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Case 7.2

You are attending an office meeting at which a co-worker is giving a presentation. Midway through the presentation, she stops and complains of chest pain and shortness of breath. She looks pale and is sweating, even though the office is air conditioned.

1. Which step would you take first in caring for this casualty?

a. Have her stop her presentation and sit down.

b. Call for an ambulance.

c. Turn off the air conditioning.

d. Have her lie on the floor, and cover her with a blanket to prevent chilling.

2. T F With these signs and symptoms, it is unlikely that this individual is experiencing a heart attack.

3. Describe five actions you would take for this casualty while waiting for advanced medical personnel to arrive.

1.

2.

3.

4.

5.

4. If the casualty is experiencing a heart attack, why is it very important for advanced medical personnel to arrive quickly?

Case 7.3

You rescue a six-month-old from an apart-ment fire. When you look, listen, and feel for breathing, you find that her breathing has stopped.

1. What will you do next in providing emergency care?

a. Check for a pulse.

b. Deliver two slow puffs.

c. Do a finger sweep.

d. Turn the infant over and deliver 5 back blows.

2. Where will you check this infant's pulse?

a. At the carotid artery in the neck

b. At the heart at the left nipple

c. At the brachial artery in the arm

d. At the radial artery in the wrist

3. Describe the four steps for finding the correct hand position to give chest compressions to this infant.

1.

2.

3.

4.

4. T F When you provide CPR to an infant or child, you should always keep one hand on the casualty's forehead to keep the airway open by tilting the head.

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5. Describe the cycle of chest compressions and breathing for giving CPR to an infant.

♦ SELF-ASSESSMENT

Circle the letter of the best answer.

1. The purpose of cardiopulmonary resuscitation (CPR) is to

a. Keep the brain supplied with oxygen until the heart can be restarted.

b. Prevent clinical death from occurring in a casualty of cardiac arrest.

c. Restart heartbeat and breathing in a casualty of cardiac arrest.

d. All of the above.

2. The most common cause of cardiac emergencies in children is

a. Poisoning.

b. Near-drowning.

c. Respiratory arrest.

d. Motor vehicle injury.

3. What should you do if a casualty's breathing and heartbeat return while you are giving CPR?

a. Have a bystander transport you and the casualty to the nearest hospital.

b. Continue rescue breathing while waiting for advanced medical personnel to arrive.

c. Complete a secondary survey before calling advanced medical personnel for assistance.

d. Keep the airway open and monitor vital signs until advanced medical personnel arrive.

4. During two-rescuer CPR, the person giving the breaths should

a. Count aloud to keep the person giving the compressions at the proper rate.

b. Periodically check the effectiveness of the compressions by checking the carotid pulse during CPR.

c. Call for a stop in the compressions after every minute to check for a return of pulse.


5. The most prominent sign of a heart attack is

a. Difficulty breathing.

b. Jaw and left arm pain.

c. Nausea and sweating.

d. Persistent chest pain.

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6. In what position should you place a casualty who may be experiencing a heart attack?

a. The most comfortable position for the casualty

b. Sitting or semisitting

c. Lying on the left side

d. Lying on the back with legs elevated

7. High blood pressure can be controlled by

a. Losing excess weight.

b. Changing dietary habits.

c. Taking prescribed medication.


8. Where should you place your hands to deliver effective chest compressions?

a. Over the xiphoid process

b. Over the lower half of the sternum

c. On the middle of the sternum

d. Just below the notch at the top of the sternum

9. Which is the primary sign of cardiac arrest?

a. No breathing

b. Absence of blood pressure

c. Absence of a carotid pulse

d. Dilation of the pupils

10. To deliver chest compressions on a child, you would use the

a. Heel of one hand.

b. Pads of two fingers.

c. Heel of two hands.

d. Pads of three fingers. .

11. Which of the following is a major factor in determining the success of defibrillation?

a. Time

b. Patient gender

c. Type of defibrillator

d. Patient's age

12. During ventricular fibrillation the heart is

a. Able to pump 50 percent of normal capacity.

b. Able to pump 75 percent of normal capacity.

c. Quivering and unable to pump blood.

d. Not affected in its pumping action.

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13. The cycle of compressions to breaths in two-rescuer CPR for an adult victim is

a. 15 compressions for every 2 breaths.

b. 5 compressions for every 2 breaths.

c. 15 compressions for every 1 breath.

d. 5 compressions for every 1 breath.

14. Which of the following must occur for a casualty of cardiac arrest to have the best chance of survival?

a. CPR must be started promptly.

b. Defibrillation must occur rapidly.

c. Advanced medical personnel must be summoned immediately.


15. When should you stop providing CPR?

I. When you hear the ambulance coming.

II. When a neighbour tells you to stop.

III. If you become exhausted.

IV. If the scene becomes unsafe.

V. If the casualty vomits.

a. I and III

b. II and IV

c. III and IV

d. V

16. Which of the following is a risk factor for heart disease that cannot be controlled?

a. High blood pressure.

b. Heredity.

c. Smoking.

d. Diet high in saturated fat.

17. Which is the key signal of a heart attack?

a. Difficulty breathing.

b. Pain in the jaw.

c. Nausea and sweating.

d. Persistent chest pain.

18. In which position should you place a casualty who may be experiencing a heart attack?

a. Lying on the left side.

b. Standing.

c. The most comfortable position for the casualty.

d. Lying on the back.

19. Which is the most common cause of cardiac arrest?

a. Electrocution.

b. Drowning/suffocation.

c. Cardiovascular disease.

d. Drug overdose/poisoning.

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20. A casualty is described as being clinically dead. What happened?

a. Breathing has stopped.

b. Blood pressure is too low to measure.

c. Breathing and heartbeat have stopped.

d. has sustained brain damage.

21. Which is the purpose of cardiopulmonary resuscitation (CPR)?

a. To restart heartbeat and breathing in a casualty of cardiac arrest.

b. To keep the brain supplied with oxygen until the heart can be restarted.

c. To prevent clinical death from occurring in a casualty of cardiac arrest.


22. CPR is needed

a. When the casualty is not breathing.

b. When the casualty's heart stops beating.

c. For every heart attack casualty.

d. When the heart attack casualty loses consciousness.

23. Once you have started CPR, when should you recheck to determine whether the casualty has a pulse?

a. After the first 2 minutes (8 cycles) and every 2 minutes thereafter,

b. After the first minute (4 cycles) and every few minutes thereafter.

c. After each minute (4 cycles) of continuous CPR.

d. Any of the above is acceptable.

24. High blood pressure can be controlled by

a. Losing excess weight.

b. Taking prescribed medication.

c. Changing dietary habits.


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Answers to Exercises Unit 7-Cardiac Emergencies

Matching: (Pg. 124) 1. c 2. e 3. b 4. a 5. h 6. d 7. f . Matching Cycle: (Pg. 137) 1. c 2. b 3. a . Short Answer: 1. When did the pain start?; What brought

it on?; Does anything lessen it?; What does it feel like?; Where does it hurt? (Pg. 131)

2. Another trained person takes over for you; advanced medical personnel arrive and take over; you are exhausted and unable to continue; the scene suddenly becomes unsafe; the casualty's heart starts beating. (Pg. 138)

3. Slide the middle finger and index finger up the edge of the ribs to the notch at the base of the sternum.; Place the middle finger in the notch with the index finger on the lower end of the sternum next to it.; Place the heel of the other hand on the sternum next to the index finger in line with the sternum. (Pg. 133)

4. Agitation; drowsiness; change in skin colour; increased difficulty breathing; increased heart and breathing rates. (Pg. 141)

5. When CPR is not being given, and 2 or more rescuers arrive at the same time; one rescuer is giving CPR, and a second is available to begin two-rescuer CPR; One rescuer tires and rescuers change positions. (Pg. 147)

6. Ventricular fibrillation, ventricular tachycardia. AED shocks the heart to restore a normal sinus rhythm. (Pg. 141)

Case Study 7.1: 1. F (Pg. 141) 2. a (Pg. 141) 3. T (Pg. 141) 4. F (Pg. 143) 5. After 1 minute of continuous CPR;

about 10 cycles of 5 to 1. (Pg. 144) 6. T. (Pg. 143) Case Study 7.2: 1. a (Pg. 130) 2. F (Pg. 129) 3. Inquire about chest pain.; Inquire about

any history of heart disease and about medications the casualty might be taking.; Administer oxygen if available.; Calm and reassure the casualty.; Monitor vital signs. (Pg. 130)

4. Most people who die from heart attacks do so within 1 to 2 hours of experiencing the first symptoms. (Pg. 130)

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Case Study 7.3: 1. b (Pg. 130) 2. c (Pg. 144) 3. Find the nipples.; Place index finger on

the sternum just below an imaginary line between the nipples.; Place pads of next two fingers on the sternum next to index finger.; Raise index finger off the chest-avoid pressure on the notch of the sternum. (Pg. 144)

4. T (Pg. 144) 5. 5 compressions followed by 1 breath.

(Pg. 144) Self Assessment: 1. a (Pg. 133) 2. c (Pg. 141) 3. d (Pg. 138) 4. b (Pg. 146) 5. d (Pg. 129) 6. a (Pg. 130) 7. d (Pg. 128) 8. b (Pg. 133) 9. c (Pg. 132) 10. a. (Pg. 141) 11. a (Pg. 138) 12. c (Pg. 140) 13. a. (Pg. 146) 14. d (Pg. 132) 15. c (Pg. 138) 16. b (Pg. 128) 17. d (Pg. ??) 18. c (Pg. ??) 19. c (Pg. ??) 20. c (Pg. ??) 21. b (Pg. ??) 22. b (Pg. ??) 23. b (Pg. ??) 24. d (Pg. ??)

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PRACTICE SESSION: CPR for an Adult □ Check for consciousness

♦ Tap and gently shake person.

♦ Shout, "Are you OK?"

If person does not respond...

□ Check for breathing

♦ Look, listen, and feel for about 10 seconds

If not breathing or you cannot tell...

♦ Position casualty on back. Roll person as a single unit while supporting the head and neck.

♦ Open the airway.

♦ Tilt head back and lift chin.

♦ Recheck breathing.

♦ Look, listen, and feel for about 10 seconds.

If person is not breathing...

♦ Keep head tilted back.

♦ Pinch nose shut

♦ Seal your lips tightly around person's mouth.

♦ Give 2 slow breaths, each lasting about 1 1/2 seconds.

♦ Watch to see that the breaths go in.

107

□ Check for pulse

♦ Locate Adam's apple.

♦ Slide fingers down into groove of neck on side closer to you.

♦ Feel for pulse for 10 seconds.

□ Check for severe bleeding

♦ Look from head to toe for severe bleeding.

If person does not have a pulse...

♦ Begin CPR.

□ Find hand position

♦ Locate notch at lower end of sternum.

♦ Place heel of other hand on sternum next to fingers.

♦ Remove hand from notch and put it on top of other hand.

♦ Keep fingers off chest.

108

□ Give 15 compressions

♦ Position shoulders over hands.

♦ Compress sternum 3.8 to 5 cm (1 1/2 to 2 inches).

♦ Do 15 compressions in about 10 seconds.

♦ Compress down and up smoothly, keeping hand contact with chest at all times.

□ Give 2 slow breaths

♦ Open airway with head-tilt/chin-lift.

♦ Pinch nose shut and seal your lips tightly around person's mouth.


♦ Watch chest to see that your breaths go in.

□ Repeat compression/breathing cycles

♦ Repeat cycles of 15 compressions and 2 breaths.

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□ Recheck pulse and breathing

♦ After about 1 minute, feel for pulse for about 10 seconds.

If person has a pulse and is breathing...

♦ Keep airway open.

♦ Monitor breathing.

If person has a pulse but is still not breathing...

♦ Do rescue breathing.

If person does not have a pulse and is not breathing...

□ Continue compression/breathing cycles

♦ Locate correct hand position.

♦ Continue cycles of 15 compressions and 2 slow breaths.

♦ Recheck pulse and breathing every few minutes.

110

PRACTICE SESSION: CPR for a Child

□ Check for consciousness

♦ Tap and gently shake child's shoulder.

If child does not respond...




♦ Position child on back. Roll child onto back while supporting the head and neck.


♦ Tilt head back and lift chin.



If child is not breathing...


♦ Seal your lips tightly around child's mouth, pinch nose shut and...


♦ Watch to see that the breaths go in.

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□ Check for pulse

♦ Locate carotid pulse.

♦ Slide fingers down into groove of neck on side closer to you.

♦ Feel for pulse for 10 seconds.



If the child does not have a pulse...

♦ Begin CPR.


♦ Maintain head-tilt with hand on forehead.

♦ Locate notch at lower end of sternum with other hand.

112

♦ Place heel of same hand on sternum immediately above where fingers were placed.


♦ Position shoulders over hands.

♦ Compress sternum 2.5 to 3.8 cm (1 to 1 1/2 inches).


♦ Compress down and up smoothly, keeping hand contact with chest at all times.


□ Give 1 slow breath

♦ Open airway with head-tilt/chin-lift.

♦ Pinch nose shut and seal your lips tightly around child's mouth.

♦ Give 1 slow breath lasting about 1 1/2 seconds.

♦ Watch chest to see that your breath goes in.

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♦ Repeat cycles of 5 compressions and 1 breath.


♦ After about 1 minute, feel for pulse for about 10 seconds.

If child has a pulse and is breathing...



If child has a pulse but is still not breathing...


If child does not have a pulse and is not breathing...


♦ Locate correct hand position.

♦ Continue cycles of 5 compressions and 1 breath.


114

PRACTICE SESSION: CPR for an Infant

□ Check for consciousness

♦ Tap and gently shake infant's shoulder.

If infant does not respond...




♦ Position infant on back. Roll infant onto back while supporting the head and neck.


♦ Tilt head back and lift chin. Recheck breathing.


If infant is not breathing...


♦ Seal your lips tightly around infant's mouth and nose.

♦ Give 2 slow puffs, each lasting about 1 1/2 seconds.

♦ Watch to see that the puffs go in.

115

□ Check for pulse

♦ Locate brachial pulse.

♦ Place fingers on the inside of upper arm midway between elbow and shoulder.

♦ Feel for pulse for 5 to 10 seconds.



If infant does not have a pulse...

♦ Begin CPR.



♦ Place pads of fingers next to imaginary line running across chest connecting nipples.

♦ Raise your index finger.

♦ Adjust finger position if necessary.

116


♦ Position hand over fingers.

♦ Compress sternum 1.2 to 2.5 cm (1/2 to 1 inch).


♦ Compress down and up smoothly, keeping fingers in contact with chest at all times.


□ Give 1 slow puff

♦ Maintain finger contact with chest.

♦ Seal your lips tightly around infant's mouth and nose.

♦ Give 1 slow puff lasting about 1 1/2 seconds.

♦ Watch chest to see that your puff goes in.


♦ Repeat cycles of 5 compressions and 1 puff.

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♦ After about 1 minute, feel for brachial pulse for about 10 seconds.

If infant has a pulse and is breathing...



♦ Wait for EMS personnel to arrive.

If infant has a pulse but is still not breathing...


If infant does not have a pulse and is not breathing...


♦ Locate correct compression position.

♦ Continue cycles of 5 compressions and 1 puff.


118

PRACTICE SESSION: Two Rescuer CPR Beginning CPR Together

□ Ventilator-Complete primary survey

♦ Check for consciousness.

♦ Position the person.

♦ Open airway and check for breathing.

♦ Give 2 slow breaths.

♦ Check for pulse. Say, "No pulse."

119

□ Compressor-Find hand position and give 15 compressions

♦ Locate hand position while ventilator checks pulse.

♦ Give 15 compressions in about 10 - 12 seconds, when ventilator tells you to "Begin CPR."

♦ Count out loud, "One-and, two-and, three-and, four-and, five."

♦ Stop compressions and allow partner to ventilate.

□ Ventilator-Give 2 slow breaths

♦ Give 2 slow breaths, each lasting about 1 ½ seconds.

120

□ Both rescuers-Continue CPR

♦ Repeat cycles of 15 compressions and 2 breaths.

♦ Ventilator-periodically check compression effectiveness by checking pulse while partner is giving compressions.


♦ At end of first minute, check pulse for about 10 seconds.

If person has a pulse...


♦ If person is not breathing, do rescue breathing.

♦ Recheck pulse every minute.

If person does not have a pulse...

♦ Say, "No pulse, continue CPR."

♦ Continue CPR.


121

PRACTICE SESSION: Two Rescuer CPR-Changing Positions

□ Compressor--Call for position change

♦ Say, "Change-and, two-and, three-and, four-and, five."

□ Both rescuers-Change positions

From Ventilator to Compressor-

♦ Complete 2 slow breaths at end of "change" cycle.

♦ Move quickly to person's chest.

♦ Find hand position. Wait for signal to begin compressions.

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From compressor to ventilator-

♦ Complete compression cycle.

♦ Move quickly to person's head and become ventilator.

♦ Check for pulse and breathing for about 10 seconds.

♦ Say, "No pulse, continue CPR."


♦ New compressor begins compressions.

♦ Both rescuers continue CPR with cycles of 15 compressions and 2 breaths.

♦ New ventilator periodically checks for effectiveness of compressions and rechecks pulse and breathing every few minutes.

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PRACTICE SESSION: Entry of a Second Rescuer When One Rescuer CPR is in Progress

□ Second rescuer--Identify yourself

♦ Identify yourself.

♦ Determine if more advanced medical personnel have been called.

□ Summon advanced medical personnel

□ Get into position to give compressions

• Position yourself by person's chest as first rescuer completes full cycle of 15 compressions and 2 breaths.

♦ Locate hand position.

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□ First rescuer--Check pulse

♦ Complete compression/ventilation cycle.

♦ Say, "Pulse check," and check for pulse and breathing for about 10 seconds.

♦ If no pulse, say, "No pulse, continue CPR."


♦ Second rescuer begins compressions.

♦ First rescuer gives 2 breaths after each set of 15 compressions.

♦ First rescuer periodically checks for effec-tiveness of compressions and rechecks pulse and breathing every few minutes.

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Chapter 7 Cardiac Emergencies - firstresponders.cafirstresponders.ca/.../09/7-Cardiac-Emergencies.pdf · Cardiac Emergencies ♦ KNOWLEDGE OBJECTIVES 1. List four signs and symptoms

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