LESSON 8 CARDIAC EMERGENCIES AND CPR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cardiac Chain of Survival

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

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

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

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

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

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

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

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

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

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

Put hand(s) in correct position for chest compressions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rescuer 1 gives two breaths

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

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

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

Skill: CPR FOR INFANTS (TWO-RESCUERS)

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

If no pulse, rescuer 2 gives 15 chest compressions

Rescuer 1 gives 2 breaths

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

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