Unit 5 Cardiac Emergencies

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Unit 5Cardiac Emergencies

• PE 216 Emergency Response

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Relevant Clinical Anatomy

• Heart is the central organ of the cardiovascular
  system
• Predominantly on the left side of the chest
• Divided into four chambers
• Right Atrium
• Right Ventricle
• Left Atrium
• Left Ventricle

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Relevant Clinical Anatomy

• Chambers are separated by a septum
• Valves ensure no backwards flow of blood
• Pulmonary arteries carry blood away from the
  heart to the lungs
• Pulmonary veins carry blood from the lungs back
  to the heart
• Blood exits the heart through the aorta

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Cardiac Chain of Survival

• Sequence of events which must occur for patient
  to have a favorable prognosis
• Early recognition and early access to Emergency
  Medical Services (EMS)
• Time from collapse to arrival on scene
• Early CPR
• Helps supply oxygen to the brain and other vital
  organs to keep the victims tissues alive

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Cardiac Chain of Survival

• Early Defibrillation
• May restore to a normal heart rhythm if initiated
  soon enough after collapse
• Chance of survival decreases by 10 for each
  minute defibrillation is delayed

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Cardiac Chain of Survival

• Early advanced medical care
• Paramedics can administer drugs which can help
  start the heart
• Intubation provides direct airway

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Heart AttackMyocardial Infarction

• Pathology An absence or decrease in oxygenated
  blood flow to heart muscle
• Cause Typically a blood clot in one or multiple
  coronary arteries
• Definitions
• Angina- chest pain
• Coronary Arteries- delivers oxygen rich blood
  from the lungs to the heart muscle

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Signs and Symptoms of MI

• Persistent chest discomfort, pain, or pressure
  that lasts gt3-5 min, or goes away and comes back
• Pain in arm, back, stomach, shoulder, neck, jaw
• Shortness of breath

• Nausea or vomiting
• Dizziness, fainting, loss of consciousness
• Pale, ashen, grayish, or bluish skin
• Profuse sweating at rest
• Denial of signs or symptoms

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Treatment of an MI

• Activate EMS
• Have victim rest comfortably
• Loosen restrictive clothing
• Monitor the victim until EMS arrives
• Assist the patient with heart related medications
  (Aspirin, Nitroglycerin)
• Be prepared to give CPR or use AED

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Sudden Cardiac Arrest (SCA)

• Pathology Heart can no longer circulate blood
  effectively to the body
• Indicated by unconsciousness, no breathing, no
  pulse
• Can occur suddenly in healthy individuals
• Child/Infant most common cause is respiratory
  distress

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Caring for a Cardiac Arrest Victim

• Activate EMS
• Begin CPR
• Use an AED as soon as possible

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Purpose of CPR

• Combination of rescue breathing and chest
  compressions
• Circulates oxygenated blood to the body
• Increases the chance of survival
• Keeps vital organs alive

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Adult and Child CPR

• Check Scene
• Check for Consciousness
• Activate EMS
• Open the Airway
• Check for Breathing
• Check for Circulation
• Scan for Severe Bleeding

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Adult and Child CPR

• If no breathing and no pulse, then begin CPR
• Place heel of hand on center of chest
• Inter-lock fingers with other hand, placing it on
  top of the first

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Adult and Child CPR

• Compress the chest 30 times
• Let the chest fully recoil between compressions
• Compress at a rate of 100 per minute
• Give 2 rescue breaths

-Continue cycles of 30 compressions and 2
breaths -Use AED as soon as possible
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Adult/Child CPRTechnique Notes

• Keep fingers off the chest
• Keep arms/elbows locked
• Position shoulders over hands
• Use body weight, not arms
• Take weight off chest between compressions, but
  maintain hand contact
• Count out loud to keep an even pace
• Compressions may be done with 1 hand on a small
  child

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Infant CPR

• Check Scene
• Check for Consciousness
• Activate EMS
• Open the Airway
• Check for Breathing
• Check for Circulation
• Scan for Severe Bleeding

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Infant CPR

• Keep one hand on the infants forehead to keep the
  airway open
• Place 2-3 fingers on the center of the chest,
  just below the nipple line

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Infant CPR

• Give 30 chest compressions
• Allow for recoil
• Rate of 100 per minute Give 2 rescue breaths
• Continue cycles of 30 and 2
• Discontinue for same reasons as in adult/child

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Infant CPRTechnique Notes

• Airway does not need tilted as far to open in an
  infant
• Keep fingers in contact with chest at all times
• CPR should be done on a firm, flat surface
• Count out loud

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2 Rescuer CPR Technique

• Compressions and breaths techniques are the same
• Rescuer 1 begins compressions
• Rescuer 2 begins with breaths after first cycle
  of compressions
• Ratios
• Adult- 302
• Child/Infant- 152
• Rate
• 100 compression per minute

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Positioning

• Rescuer 1 is positioned at the side of the
  victim, the same as regular CPR
• Rescuer 2 kneels at the head of the victim and
  gives breaths from above the head
• Or on opposite side

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Changing Positions

• Rescuers should switch positions every 2 minutes
  to reduce fatigue (5 cycles)
• Rescuer giving compressions indicates the switch
  by replacing 30 with change
• Rescuer giving breaths completes the two breaths,
  then proceeds to the chest to begin compressions
• Change should take lt5 seconds

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Advantages of Technique

• Allows rest from compressions
• Able to continue for longer period
• More efficient oxygen supply to patient because
  rescuers are not as out of breath/exhausted

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AED Use

• AED use does not change with Two-rescuer CPR
• If there are only two rescuers present,
  two-rescuer CPR should not be initiated until the
  AED is attached and ready to use and EMS has been
  activated

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Considerations

• CPR must be performed on a firm, flat surface
• CPR techniques must be modified for children and
  infants
• Compressing the Chest
• Adult 1.5-2
• Child 1-1.5
• Infant .5-1

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Complications

• Ribs will most likely break if CPR is done
  effectively
• Victim may vomit
• Scene may be chaotic
• Victim may not survive
• Do not expect cardiac arrest victims to suddenly
  wake up

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When to stop CPR

• Another trained rescuer arrives and takes over
• AED arrives and is ready to use
• You are too exhausted to continue
• The scene becomes unsafe
• You notice an obvious sign of life
• Movement, breathing, spurting blood, consciousness