1. LESSON 8
CARDIAC EMERGENCIES
AND CPR

2. Introduction
Basic cardiac life support needed for patient whose breathing or heart has stopped
Ventilations are given to oxygenate blood when breathing is inadequate or has stopped
If heart has stopped, chest compressions are given to circulate blood to vital organs
Ventilation combined with chest compressions is called CPR
CPR is commonly given to patients in cardiac arrest as a result of heart attack

3. Review of Circulatory System
Circulatory system consists of:
Heart
Blood
Blood vessels

4. Cardiovascular System: Primary Functions
Transports blood to lungs
Delivers carbon dioxide and picks up oxygen
Transports oxygen and nutrients to all parts of body
Helps regulate body temperature
Helps maintain body’s fluid balance

5. Anatomy and Physiology of the Heart
Ventricles pump blood through two loops or cycles in body
Right ventricle pumps blood to lungs to pick up oxygen and release carbon dioxide
Blood returns to left atrium and then flows into left ventricle
Left ventricle pumps oxygenated blood through arteries to all areas of body, and to pick up carbon dioxide
Blood returns through veins to right atrium, to be pumped again to lungs
Within heart, valves prevent back flow of blood so that it moves only in one direction through these cycles

6. Heart Muscle
Heart is composed of a unique type of muscle (myocardium) that contracts to make pumping action

7. Heart Muscle (continued)
Contractions are controlled by electrical signals under nervous system control

8. Arteries Carotid arteries: major arteries passing through neck to head
Femoral arteries: major arteries to legs passing through thigh
Brachial arteries: in upper arm
Radial arteries: major arteries of lower arm
Arteries are generally deeper in body than veins and more protected
Arterial blood is oxygenated, bright red and under pressure

9. Pulse
When left ventricle contracts, wave of blood is sent through arteries causing pulsing blood pressure changes in arteries that can be palpated in certain body locations
A pulse can be felt anywhere an artery passes near skin surface and over a bone
Palpate carotid pulse on either side of neck

10. Pulse (continued)
Palpate femoral pulse in crease between abdomen and thigh
Palpate radial pulse on the palm side of wrist proximal to base of thumb
Palpate brachial pulse on the inside of arm between elbow and shoulder

11. Capillaries
Arteries progressively branch into smaller vessels that eventually reach capillaries
Capillaries are very small blood vessels connecting arteries with veins throughout body
Capillaries have thin walls through which oxygen and carbon dioxide are exchanged with body cells

12. Veins
From capillaries, blood drains back to heart through extensive system of veins
Venous blood is dark red, deoxygenated and under less pressure than arterial blood
Blood flows more evenly through veins, which don’t have a pulse
Veins have valves that prevent blood backflow

13. Heart Rate Heart rate, measured as pulse, is affected by many factors
With exercise, fever or emotional excitement, heart rate increases to meet body’s greater need for oxygen
Various injuries and illnesses may either increase or decrease heart rate

14. Circulatory System: Emergencies
Any condition that affects respiration – reduces ability to deliver oxygen
Severe bleeding – shock
Stroke – reduces blood flow to brain
Heart conditions – reduce tissue oxygenation

15. Circulatory System: Emergencies (continued)
Heart attack – can lead to cardiac arrest
Ventricular fibrillation – heart muscle flutters rather than pumping blood

16. Cardiac Arrest
Heart may stop (cardiac arrest) as a result of heart attack
Brain damage begins 4-6 minutes after cardiac arrest
Brain damage becomes irreversible in 8-10 minutes
Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness

17. Causes of Cardiac Arrest
Heart attack
Drowning
Suffocation
Stroke
Allergic reaction
Any condition causing respiratory arrest
Diabetic emergency
Prolonged seizures
Drug overdose
Electric shock
Certain injuries

18. Cardiac Chain of Survival

19. Call First vs. Call Fast Call First (to get AED on the way) Call Fast
If alone with adult found unresponsive and not breathing normally
If alone with patient of any age seen to collapse suddenly
Call Fast
If alone with child found unresponsive and not breathing normally
If alone with patient in cardiac arrest because of asphyxial arrest

20. CPR
CPR helps keep patient alive by circulating some oxygenated blood to vital organs
Artificial ventilation moves oxygen into lungs where it is picked up by blood
External compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues

21. CPR (continued)
Blood circulation resulting from chest compressions not as strong as circulation from heartbeat
Can help keep brain and other tissues alive until normal heart rhythm restored

22. CPR (continued)
Often electric shock from AED is needed to restore a heartbeat  and CPR can keep patient viable until then
CPR effective only for a short time
CPR should be started as soon as possible
In some instances, the heart may start again spontaneously with CPR

23. CPR Saves Lives
CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest patients
CPR followed by AED saves thousands of lives each year
In most cases CPR helps keep patient alive until EMS or AED arrives

24. General Technique of CPR
If unresponsive, not breathing normally and no pulse, start chest compressions
Find the correct hand position
2 hands for adults
1 or 2 hands for child
2 fingers for infant

25. General Technique of CPR (continued)
Compress chest hard and fast at a rate of at least 100 compressions/minute
Adult = at least two inches deep
Infant/child = at least one-third chest depth
Let chest return to normal height between compressions

26. General Technique of CPR (continued)
If alone, alternate 30 chest compressions and two ventilations for any age patient
In two-rescuer CPR for infant or child, alternate 15 compressions and two ventilations
Use chest-encircling method in infant
Give each ventilation over one second
Follow local protocol regarding oxygen

27. Factors That Decrease Effectiveness of Chest Compressions
Compressions that are too shallow
A compression rate that is too slow
Not allowing the chest to recoil fully
Frequent interruptions of compressions

28. Skill: 1-Rescuer CPR
Determine that the patient is not breathing normally and has no pulse

29. Put hand(s) in correct position for chest compressions

30. Give 30 chest compressions at rate of at least 100 per minute
Then give two ventilations
Continue cycles of compressions and ventilations

31. Continue CPR until:
Patient is breathing normally and has a pulse
AED brought to scene and ready to use
Personnel with more training arrive and take over

32. If patient starts breathing normally and has a pulse but is unresponsive, put patient in recovery position and monitor breathing and pulse
When an AED arrives, start AED sequence for patient who is not breathing normally and has no pulse

33. Chest Compressions Alert
Be careful with your hand position
For adults and children, keep your fingers off patient’s chest
Do not give compressions over bottom tip of breastbone

34. Chest Compressions Alert (continued)
When compressing, keep elbows straight and hands in contact with patient’s chest at all times

35. Chest Compressions Alert (continued)
Compress chest hard and fast, but let chest recoil completely between compressions
Minimize amount of time used giving ventilations between sets of compressions

36. Problems with CPR Technique
CPR often ineffective because of poor technique
Compressions not delivered steadily and constantly during resuscitation efforts
Often compressions are too shallow, resulting in ineffective blood flow
Only good-quality CPR improves chances of survival

37. Chest Compressions for Bradycardia in Child
Infant or child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion
If pulse <60 beats/minute and infant or child has signs of poor perfusion, provide CPR

38. 2-Rescuer CPR for Adults and Children
Minimizes time between rescue breaths and compressions
CPR becomes more effective
Can more quickly set up AED
Reduces rescuer fatigue

39. 2-Rescuer CPR
Performed in cycles of 30:2 for adult (15:2 for infant or child)
One rescuer provides breaths, second rescuer gives chest compressions
Rescuers switch positions every two minutes
Change done after full CPR cycle
Accomplish change in <5 seconds

40. 2-Rescuer CPR (continued)
If AED present, one rescuer gives CPR while the other sets up unit
If unit advises CPR, rescuers resume CPR together

41. 2-Rescuer CPR (continued)
If you are assisting another trained rescuer who places an advanced airway:
Chest compressions given continually at rate of at least 100 per minute
No pauses for ventilations
Give ventilations with bag mask at rate of 8-10 breaths/minute

42. Transitioning from 1-Rescuer CPR to 2-Rescuer CPR
Second rescuer moves into position on other side to prepare to take over chest compressions
First rescuer completes a cycle of compressions and ventilations
While first rescuer gives ventilations, second rescuer finds correct hand position and begins compressions after second ventilation

43. Differences in 2-Rescuer Training
If EMR started CPR, arriving second rescuer may have a higher level of training
Rescuer with greater training determines how CPR should best be continued

44. Skill: CPR FOR ADULT OR CHILD (TWO-RESCUERS)

45. Rescuer 1 checks for unresponsiveness, normal breathing, and pulse
Rescuer 2 locates site for chest compressions

46. If no pulse, rescuer 2 gives 30 compressions for adult (15 for child) at rate of at least 100/minute

47. Rescuer 1 gives two breaths

48. Continue cycles of 30:2 for adults (15:2 for child)
After 5 cycles (~2 minutes), quickly switch positions

49. If AED brought to scene, start AED sequence
Continue CPR until:
Patient is breathing normally and has a pulse
AED brought to scene and ready to use
Help arrives and takes over
If patient starts breathing normally and has pulse but is unresponsive, put in HAINES recovery position and monitor breathing and pulse
If AED brought to scene, start AED sequence

50. Infant Two-Rescuer CPR
Uses different hand position
Place thumbs of both hands on sternum just below the nipple line while fingers encircle chest
Compress breastbone with both thumbs
Same rate and depth as usual

51. Skill: CPR FOR INFANTS (TWO-RESCUERS)

52. Rescuer 1 checks for normal breathing and pulse
Rescuer 2 locates site for chest compressions

53. If no pulse, rescuer 2 gives 15 chest compressions

54. Rescuer 1 gives 2 breaths

55. Continue cycles of 15:2 for ~ 2 minutes, then quickly switch roles
Continue CPR until:
Infant is breathing normally and has a pulse
AED is ready to use
Advanced help arrives and takes over
If infant starts breathing normally but is unresponsive, hold in recovery position and monitor breathing and pulse

56. When Not to Perform CPR A DNR order is present
Patient obviously irreversibly dead (decapitation; incineration; or clear signs of prolonged death, such as rigor mortis and dependent lividity)
Not safe to be on the scene and the patient cannot be moved somewhere safe
A physician pronounces the patient dead