First aid in cardiac arrest

Dr. Emanuel Kanga

TEL:15640948747email: [email protected]

FIRST AID IN CARDIAC ARREST

CPR and AED USE

Definition:•The immediate care given to a person who is injured or ill.

Principle goals:•Ensure the safety of rescuer and patient.•Identify the causes of injury.•Stabilize the neck and care for life threatening injuries.•Arrange for transportation.•Continue patient assessment

First Aid Review

Definition

CARDIAC ARREST: Abrupt cessation of

cardiac pump function which may be

reversible by a rapid intervention but

will lead to death in its absence.

DEATH: Irreversible cessation of all

biologic functions

At the end of this session participants should be able to demonstrate:

How to assess the collapsed victim

How to perform chest compression and rescue breathing (CPR)

How to operate an automated external defibrillator safely

How to place an unconscious breathing victim in the recovery position

Objectives

To remember

MECHANISMS OF CARDIAC

ARREST

50-80%: VF and PULSLESS VT

20-30%: Asystole, severe

bradycardia and pulseless electrical activity

Chain of Survival

Check response

Shake shoulders gently

Ask “Are you all right?”

If he responds

• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

Recovery position

A position used for unconscious,

breathing casualties.

Maintains an open airway so the

casualty can breathe.

Primary Survey: ABCD

Airway

Breathing

Circulation

Defibrillation

Always assess and manage before moving on to the next step!

Open airway – signs of life?

Head tilt / chin lift

Check breathing and

pulse for 10 sec

If no breathing & no

pulse or unsure of pulse

assume cardiac arrest

Caution of agonal

breathing

If signs of life present

Look

ListenFeel

Breathing

Keeping the airway open, look, listen, and feel for normal breathing.

• Look for chest movement.

• Listen at the victim's mouth for breath sounds.

• Feel for air on your cheek.

In the first few minutes after cardiac arrest, a victim may be barely

breathing, taking infrequent, noisy, gasps. Do not confuse this with

normal breathing.

Look, listen, and feel for no more than 10 sec to determine if the

victim is breathing normally. If you have any doubt whether

breathing is normal, act as if it is not normal.

Decision to start CPR

Decision to start CPR is made if a victim is

unresponsive and not breathing normally.

Pulse check is no longer required, and is NOT

recommended for lay persons.

Pulse check has been shown to be unreliable,

with unacceptably high rates of false positives

and negatives.

START CPR

If he is breathing normally:

Turn him into the recovery position.

Send or go for help, or call for an ambulance.

Check for continued breathing.

If he is not breathing normally:

• Ask someone to call for an ambulance or, if you are on your own, do this yourself; you may need to leave the victim.

Start chest compression as follows:

Kneel by the side of the victim.

Place the heel of one hand in the centre of the victim’s chest.

Chest Compressions

Place hands on the center of the chest, rather than the ‘rib

margin’ method.

100/min for all victims (except newborns).

Allow chest to recoil to normal position after each

compression.

Use equal compression and relaxation times.

Limit interruptions in chest compressions, even for rhythm

check, shock delivery, advanced airway, or vascular

access.

30 chest compressions

Heel of hand in centre

of chest

Interlock fingers

Keep arms straight

Compress 4-5 cm depth

Rate of 100 min-1

Allow chest to recoil

Cardio-pulmonary resuscitation (CPR)

is a means to provide temporary

support to the coronary and cerebral

circulation, till normal cardiac output is restored

PERSON COLLAPSES

Check if he is unresponsive

Call emergency number

Get AED ( Automated External

Difibrillator )

Beginning the ABCD’s and CPR

Combine chest compression with rescue breaths

► After 30 compressions open the airway again using head

tilt and chin lift.

► Pinch the soft part of the victim’s nose closed, using the

index finger and thumb of your hand on his forehead.

► Allow his mouth to open, but maintain chin lift.

► Take a normal breath and place your lips around his

mouth, making sure that you have a good seal.

► Blow steadily into his mouth whilst watching for his chest to

rise; take about one second to make his chest rise as in

normal breathing; this is an effective rescue breath.

► Maintaining head tilt and chin lift, take your mouth away

from the victim and watch for his chest to fall as air comes

out.

►If your rescue breaths do not make the chest rise as in

normal breathing, then before your next attempt:

► Check the victim's mouth and remove any visible

obstruction.

► Recheck that there is adequate head tilt and chin lift.

► Do not attempt more than two breaths each time before

returning to chest compressions.

► If there is more than one rescuer present, another should

take over CPR about every 2 min to prevent fatigue.

► Ensure the minimum of delay during the changeover of

rescuers.

Automated External

Defibrillator

AED

While there are many styles of AEDs they all work the same. The first

step is to turn the unit on and follow the voice prompts.

CPR/AED

What is an AED?

Automated external defibrillator – is an computerized defibrillator

it can analyze heart rhythm

recognize shockable rhythm

advise the operator whether the rhythm should be shocked

very easy to use

AED’s computer chips analyze the rate, size and wave shape of human cardiac rhythm.

will not shock a properly functioning heart

will not shock a heart that has stopped – VF is not present

Defibrillation

Most frequent initial rhythm in witnessed sudden cardiac

arrest is ventricular fibrillation (VF) or pulseless ventricular

tachycardia (VT) which rapidly deteriorates into VF

The only effective treatment for VF is electrical defibrillation

Probability of successful defibrillation diminishes rapidly

over time

VF rapidly converts to asystole if not treated

Universal steps of AED use

Place AED parallel to patients left ear Power on the AED first

Some automatically turn on when opened

Attach the AED to the patients chest with electrode pads Remove clothing – to bear chest

Be kind to females

Dry patient or shave chest in area of electrode placement if needed

Place one pad above right nipple and one to the side and below the left nipple. (CPR is continued up to the point of placing the pads on)

Analyze rhythm Make sure everyone is clear (must say “stand clear of the victim”).

No contact

Push analyze

Charge AED if shock is required (some machine charge automatically)

Universal steps of AED use

Shock if indicated – (after checking everyone is clear

again)

Begin CPR for five cycles then analyze again

If shock is advisable again you clear everyone and

shock

If shock is not advisable – continue with CPR

If victim has pulse and is breathing put into recovery

position.

DO NOT take off pads or turn off AED until prompted by EMS

Special Considerations

Water Must remove victim from water or wet surface

Dry before attaching pads

Metal surfaces Is victim lying on metal surface? – if so move victim

The metal surface may cause the shock form the AED to hit you.

Children Children 8 and older use as soon as possible

Children 1-8 – CPR for two minutes before using AED

Transdermal medications Remove patch and wipe clean before attaching AED pads

Implanted pacemakers and defibrillators Do not place an AED electrode directly over implanted device.

Move at least one inch to the side of device

Defibrillation

Know your AED

Universal steps:

1. Power ON

2. Attach electrode pads

3. Analyze the rhythm

4. Shock (if advised)

Keep clear

5H’s and 5T’s

The H’s and T’s of ACLS is a mnemonic used to

help recall the major contributing factors to

pulseless arrest including PEA, Asystole,

Ventricular Fibrillation, and Ventricular

Tachycardia. These H’s and T’s will most

commonly be associated with PEA, but they will

help direct your search for underlying causes to

any of arrhythmias associated with ACLS

4H’s and 4T’s

The H’s include:

Hypovolemia,

Hypoxia,

Hyper/hypokalemia,

Hypothermia.

The T’s include:

Toxins,

Tamponade(cardiac),

Tension pneumothorax,

Thrombosis (coronary and

pulmonary),

Take Home Points

Assess and manage at every step before moving on to

the next step

Rapid defibrillation is the ONLY effective treatment for

VF/VT

Search for and treat the cause

Treat the patient not the monitor

Reassess frequently

Minimize interruptions to chest compressions