CPR

Heart Attack and Cardiac Arrest A heart attack occurs when heart muscle tissue dies. Cardiac arrest results when the heart stops beating.

Caring for Cardiac Arrest Chain of survival –Recognition and action –CPR –Defibrillation –Advanced care –Post-arrest care

Performing CPR Check for responsiveness. Check for breathing. Call CPR if unresponsive and not breathing –Chest compressions –Rescue breaths © Berta A. Daniels, 2010

Chest Compressions (1 of 3) 2 hands for adults 1 or 2 hands for a child 2 fingers for an infant Compression depth –Adult and child: 2 inches –Infant: 1½ inches (1/3 depth of the chest) Compression rate –At least 100 per minute –30 compressions in 18 seconds © Berta A. Daniels, 2010

Chest Compressions (2 of 3) Location –Adult and child: center of chest between nipples –Infants: just below nipple line Cycles of 30 compressions and 2 breaths until: –AED becomes available. –Victim shows signs of life. –EMS takes over. –You are too tired to continue.

Chest Compressions (3 of 3) Chest compressions alone are an acceptable alternative. Provide continuous chest compressions. © Berta A. Daniels, 2010

Rescue Breaths After every 30 compressions: –Tilt the head and lift the chin. –Close the nose. –Give 2 breaths. –See the chest rise. © Berta A. Daniels, 2010

Airway Obstruction Mild blockage –Coughing forcefully Severe/complete blockage –Weak, ineffective cough –Unable to breathe or speak Common causes of obstruction –Tongue, vomit, foreign body, swelling, spasm

Caring for Airway Obstruction (1 of 5) Responsive adult or child: Heimlich maneuver –Abdominal thrusts just above navel –Perform thrusts until object is removed or victim is unresponsive. –Chest thrusts for larger or pregnant victims

Caring for Airway Obstruction (2 of 5) Responsive infant –Support infant’s head and lay infant’s face down over your forearm and thigh. –Give 5 back blows. –Roll infant face-up. –Give 5 chest thrusts.

Caring for Airway Obstruction (3 of 5) Chest ThrustsBack Blows

Caring for Airway Obstruction (4 of 5) Unresponsive adult or child, if breath fails to go in: –Retilt the head. –Reattempt breath. –Give 30 chest compressions. –Check airway. –Remove object if visible. © Berta A. Daniels, 2010

Caring for Airway Obstruction (5 of 5) Unresponsive infant, if breath fails to go in: –Retilt the head. –Reattempt breath. –Give 30 compressions. –Check the airway. –Remove the object if visible.

Automated External Defibrillation

Public Access Defibrillation CPR and defibrillation improve chance for survival from sudden cardiac death. Defibrillation can be provided by rescuers through the use of automated external defibrillators (AEDs). Public access defibrillation (PAD) laws promote the use of AEDs in public places. Food and Drug Administration (FDA) approved devices for the home.

How the Heart Works Heart is a muscle. Four chambers store blood. Pacemaker cells send electrical impulses; heart muscle contracts. Normal sinus rhythm

When Normal Electrical Activity Is Interrupted (1 of 2) Ventricular fibrillation (V-fib) –A common abnormal heart rhythm in cases of sudden cardiac arrest in adults –Chaotic electrical activity that causes loss of circulation From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.

When Normal Electrical Activity Is Interrupted (2 of 2) Ventricular tachycardia (V-tach) –A common abnormal heart rhythm in cases of sudden cardiac arrest in adults –Very rapid electrical activity –Heart may be unable to pump blood effectively. From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.

Care for Cardiac Arrest CPR is the initial care until defibrillator is available. V-fib and V-tach can be corrected with defibrillation, but time is critical. For every minute that defibrillation is delayed, victim’s chance for survival decreases by 7% to 10%. Provide CPR until defibrillator is available.

About AEDs (1 of 2) Analyzes the heart rhythm Determines and advises need to shock Delivers electrical shock to the victim in cardiac arrest Can reestablish heart rhythm that will generate a pulse

About AEDs (2 of 2) Common elements –On/off button –Cable and pads (electrodes) –Analysis capability –Defibrillation capability –Prompts to guide user –Battery operation for portability

Using an AED (1 of 2) Turn the unit on. Apply AED pads to bare, dry chest. Make sure cable is attached to the AED.

Using an AED (2 of 2) Stand clear and analyze the heart rhythm. Deliver a shock if indicated. Perform CPR for 2 minutes. Repeat analysis. Repeat shock and CPR as needed.

Special Considerations (1 of 2) Water –Remove victim from water. –Dry victim’s chest. Children/infants –Use pediatric pads if available. Medication patches –Remove patches and wipe skin.

Special Considerations (2 of 2) Implanted devices –Pacemakers and defibrillators –Avoid placing electrode pads over devices if possible.

AED Maintenance Preventive maintenance checks are recommended. AED automatically performs periodic self-tests. Check supplies, such as expiration dates on electrode pads and batteries.

AED Manufacturers Devices and supplies are available from different manufacturers. All devices function similarly.

Cardiovascular Emergencies

Heart Attack Blood supply to part of the heart muscle is reduced or stopped. Recognizing a heart attack –Chest pressure, squeezing, or pain that lasts longer than a few minutes or goes away and comes back –Pain spreading to shoulders, neck, jaw, or arms –Dizziness, sweating, nausea –Shortness of breath

Care for a Heart Attack Call Help victim into comfortable position. Assist with prescribed medications. –Nitroglycerin Provide aspirin. –Regular or chewable

Angina Heart muscle does not get enough blood. Brought on by physical activity. Recognizing angina –Signs are similar to heart attack. –Usually does not last longer than 10 minutes. –Almost always relieved by nitroglycerin.

Care for Angina Have the victim rest. If the victim has nitroglycerin, help the victim use it. If pain lasts longer than 10 minutes, suspect a heart attack and call

Risk Factors of Cardiovascular Disease Cannot be changed –Heredity –Gender –Age Can be changed –Smoking –High blood pressure –High cholesterol –Diabetes –Obesity –Inactivity –Stress

Stroke (Brain Attack) (1 of 2) Blood flow to brain disrupted Blocked or ruptured blood vessel

Stroke (Brain Attack) (2 of 2) Recognizing stroke –Weakness, numbness, partial paralysis –Blurred or decreased vision –Problems speaking –Dizziness or loss of balance –Sudden, severe headache

Care for Stroke Seek medical care. If responsive, lay patient on back with head and shoulders slightly elevated. If vomiting, place in recovery position.