1. Chapter 34 Emergency Cardiovascular Life Support

2. Objectives List the causes of sudden cardiac arrest (SCA).
List the signs of SCA, heart attack, stroke, and foreign-body airway obstruction (FBAO).
Describe how to perform cardiopulmonary resuscitation (CPR) on adults, children, and infants.
Describe how to defibrillate with automated external defibrillators (AEDs) and manual defibrillators.
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3. Objectives (cont.) State how to administer synchronized cardioversion.
Describe how to evaluate quality and effectiveness of CPR.
List the complications that can occur as a result of resuscitation of SCA.
State when not to initiate CPR.
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4. Objectives (cont.)
Describe how to apply key adjunct equipment during advanced cardiovascular life support (ACLS).
State common drugs and drug routes are used during ACLS.
Describe how to monitor patients prearrest, during CPR, and postarrest.
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5. Causes and Prevention of Sudden Death
Sudden cardiac arrest (SCA) is a leading cause of death in North America.
Approximately 250,000 people die annually from coronary artery disease.
About 40% of SCA victims are in ventricular fibrillation upon collapse.
Immediate CPR with defibrillation can save many lives.
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6. Basic Life Support Check for movement or response.
Activate the EMS system and get automated external defibrillator.
Open airway and check breathing.
If no breathing, give two breaths.
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7. Basic Life Support (cont.)
If no response, check pulse within 10 seconds.
If no pulse, give cycles of 30 compressions and two breaths until AED arrives.
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8. Basic Life Support (cont.)
Determining unresponsiveness
BLS begins when a victim is found unresponsive and not moving.
If head or neck injuries are apparent, rescuer needs to careful with subsequent moving of the head or neck.
The rescuer should call for help and activate the EMS system if the victim is unresponsive.
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9. Basic Life Support (cont.)
Restoring the airway
After calling for help, the rescuer should open the victim’s airway.
Use the head-tilt/chin-lift method in most cases.
Use the jaw-thrust method when neck injury may be present.
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10. Basic Life Support (cont.)
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11. Basic Life Support (cont.)
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12. Basic Life Support (cont.)
Restoring ventilation
Before attempting to provide artificial ventilation, the rescuer should assess for the presence of breathing.
The rescuer should place his ear over the victim’s mouth and nose to listen for breathing while looking at the chest wall for movement for 3 to 5 seconds.
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13. Basic Life Support (cont.)
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14. Basic Life Support (cont.)
Mouth-to-mouth ventilation
The rescuer should take a deep breath and exhale directly into the victim’s mouth over 1 second to produce visible chest rise.
Exhaled air has 16% oxygen.
Children should be given smaller volumes.
Excessive volumes can cause gastric distention.
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15. Basic Life Support (cont.)
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16. Basic Life Support (cont.)
Restoring circulation
After two rescue breaths, the rescuer should check to see if a pulse is present.
Palpate the carotid artery in adults and children older than 1 year.
If no pulse is present, external cardiac compressions must be interposed with ventilatory support.
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17. Basic Life Support (cont.)
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18. Basic Life Support (cont.)
Providing chest compressions
The rescuer should compress the lower half of the sternum at a rate of 100/min.
Good compressions can produce a cardiac output that is one-fourth of normal with a blood pressure of 60 to 80 mm Hg.
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19. Basic Life Support (cont.)
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20. Basic Life Support (cont.)
Chest compressions under special circumstances
Near drowning: victims need to be moved to a firm surface; compressions in the water not likely to be effective.
Electrical shock: victim still in contact with source of electricity should not be touched; the power must be turned off first.
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21. Basic Life Support (cont.)
One- versus two-rescuer adult CPR
Single rescuer gives 30 compressions to two breaths for adults, children, and infants until help arrives.
When two rescuers are present, one provides ventilation while the other provides compressions (30:2 for adults; 15:2 for children and infants).
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22. Basic Life Support (cont.)
One- versus two-rescuer adult CPR (cont.)
Rescue attempts should continue until
Advanced life support is available,
The rescuers note spontaneous pulse and breathing,
Or a physician pronounces the victim dead.
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23. Basic Life Support (cont.)
Automated external defibrillation
Defibrillation is to be done after the airway has been established and CPR initiated.
This recommendation is based on the fact that ventricular fibrillation is very common in victims of sudden cardiac arrest.
It should be done has soon as possible following a witnessed cardiac arrest.
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24. Basic Life Support (cont.)
Evaluating the effectiveness of CPR
Observe the chest wall rise and fall.
Compressions at a rate of 100/min with a depth of 1½ to 2 inches (for adults) are most effective.
Allow the chest to recoil completely after each compression.
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25. Basic Life Support (cont.)
Hazards and complications
Neck injuries can be aggravated.
Gastric inflation
Vomiting
Internal trauma
Advancement of foreign objects in the upper airway
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26. Basic Life Support (cont.)
Health concerns of CPR
Risk of disease transmission during mouth-to-mouth resuscitation is small.
Use of an appropriate barrier device (e.g., pocket mask) will reduce the risk of disease transmission.
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27. Basic Life Support (cont.)
Dealing with an obstructed airway
Conscious victim with obstructed upper airway will usually clutch his or her throat (universal distress signal).
Abdominal thrusts should be used to clear the obstruction.
Back blows and chest thrusts can be used with infants and pregnant women.
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28. Basic Life Support (cont.)
Evaluating the effectiveness of foreign body removal
Confirmed expulsion of the foreign body
Clear breathing and the ability to speak
Return of consciousness
Return of normal color
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29. Advanced Cardiovascular Life Support (ACLS)
ACLS includes
Using accessory equipment to support ventilation and oxygenation
Monitoring the ECG
Establishing an intravenous route for drugs
Applying selected pharmacological agents and electrical therapies
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30. Advanced Cardiovascular Life Support (ACLS) (cont.)
Support for oxygenation
The highest concentration of oxygen should be administered as soon as possible.
Concerns about oxygen toxicity are not valid.
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31. Advanced Cardiovascular Life Support (ACLS) (cont.)
Airway management
Pharyngeal airways can help restore airway patency and improve ventilation, especially when using a bag-valve-mask.
Two types exist
Nasopharyngeal
Oropharyngeal
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32. Advanced Cardiovascular Life Support (ACLS) (cont.)
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33. Advanced Cardiovascular Life Support (ACLS) (cont.)
Endotracheal intubation
Allows the delivery of ventilations that are nonsynchronous with chest compression
Restores airway patency
Maintains adequate ventilation
Reduce the risk of aspiration
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34. Advanced Cardiovascular Life Support (ACLS) (cont.)
Endotracheal intubation (cont.)
Provides access for clearance of secretions
Provides an alternate route for drug administration
It is the preferred method for securing the airway during CPR.
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35. Advanced Cardiovascular Life Support (ACLS) (cont.)
Ventilation
Health care providers who respond to cardiac arrests should be trained in the use of bag-valve-masks.
The rescuer should deliver tidal volumes adequate to produce visible chest rise over 1 second.
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36. Advanced Cardiovascular Life Support (ACLS) (cont.)
Restoring cardiac function
ECG monitoring during CPR should be started as soon as possible.
Rescuers may see
Ventricular tachycardia
Ventricular fibrillation
Supraventricular tachycardia
Pulseless electrical activity
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37. Advanced Cardiovascular Life Support (ACLS) (cont.)
Pharmacological intervention
Unless and central vein is already cannulated, the ideal route for drug administration during CPR is the peripheral IV line.
Drugs are given by rapid bolus injection.
Selected drugs such as epinephrine, lidocaine, and atropine also may be given through the endotracheal tube.
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38. Advanced Cardiovascular Life Support (ACLS) (cont.)
Electrical therapy
Defibrillation is an unsynchronized shock used to simultaneously depolarize the myocardial fibers.
It is the definitive treatment for ventricular tachycardia and pulseless ventricular tachycardia.
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39. Advanced Cardiovascular Life Support (ACLS) (cont.)
Electrical therapy (cont.)
Cardioversion is slightly different than defibrillation.
The shock is synchronized.
The shock uses less energy.
Electrical pacing: intermittently timed, low-energy discharges to pace the heart
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40. Advanced Cardiovascular Life Support (ACLS) (cont.)
Monitoring during ACLS
Usually limited to ECG, pulse, blood pressure, and intermittent arterial blood gas sampling
The ECG provides the basis for selecting various drugs and electrical therapies during CPR.
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