Cardiac Emergencies and CPR

1. Cardiac Emergencies and CPR Lesson 9

2. Introduction Basic 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 cardiopulmonary resuscitation (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, and 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 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 is composed of a unique type of muscle (myocardium) that contracts to make pumping action. Heart Muscle

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

8. Arteries Arterial blood is oxygenated, bright red, and under pressure 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 artery of lower arm Arteries are generally deeper in body than veins and more protected

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 Diabetic emergency Prolonged seizures Drug overdose Electric shock Certain injuries

18. Cardiac Chain of Survival

19. Call First vs. Call Fast Call First If alone with adult victim Any victim of any age seen to collapse suddenly Call Fast If alone with child victim Unresponsive victim in cardiac arrest because of respiratory arrest

20. Cardiopulmonary Resuscitation (CPR) CPR helps keep patient alive by circulating some oxygenated blood to vital organs Ventilations move oxygen into lungs where it is picked up by blood Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues

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

22. Cardiopulmonary Resuscitation (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 victims CPR followed by AED saves thousands of lives each year In most cases CPR helps keep victim alive until EMS or AED arrives

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

25. General Technique of CPR continued Compress chest hard and fast at a rate of 100 compressions/minute Adult = 1 1/2 to 2 inches deep Infant/child = 1/3 to 1/2 chest depth Release completely between compressions

26. General Technique of CPR continued If alone, alternate 30 chest compressions and 2 ventilations for any age patient In two-rescuer CPR for infant/child, alternate 15 compressions and 2 ventilations Chest-encircling method in infant Give each ventilation over 1 second Follow local protocol regarding oxygen

27. Single-Rescuer CPR 1. Check patient�s responsiveness, open airway, and determine that patient is not breathing adequately 2. Give 2 ventilations, each lasting 1 second 3. Determine victim has no pulse 

28. Single-Rescuer CPR 2. Give 2 ventilations, each lasting 1 second 3. Determine victim has no pulse 

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

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

35. Chest Compressions Alert 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 Compressions may be given at too fast a rate Only good-quality CPR improves chances of survival

37. Chest Compressions: 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. Two-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. Two-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 2 minutes Change done after full CPR cycle Accomplish change in < 5 seconds

40. Two-Rescuer CPR continued If AED present, one rescuer gives CPR while the other sets up unit If unit advises CPR, rescuers give CPR together Third rescuer can apply cricoid pressure

41. Two-Rescuer CPR continued If you are assisting another trained rescuer who places an advanced airway: Chest compressions given continually No pauses for ventilations Give ventilations at rate of 8 � 10 breaths/ minute

42. Transitioning from One-Rescuer CPR to Two-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 pauses to check for a pulse, second rescuer finds correct hand position for compressions

43. Transitioning from One-Rescuer CPR to Two-Rescuer CPR When first rescuer says, �No pulse, continue CPR,� second rescuer begins chest compressions and first rescuer then gives only ventilations

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

45. Skill: CPR For Adult or Child (Two Rescuers)

46. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.

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

48. Rescuer 1 gives 2 breaths.

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

50. Adult or Child Two-Rescuer CPR Continued Continue CPR until: Patient moves AED brought to scene and ready to use Advanced help arrives and takes over If patient starts breathing and has pulse, put in recovery position and monitor ABCs If AED brought to scene, start AED sequence

51. Uses different hand position Place thumbs of both hands on sternum while fingers encircle chest Compress breastbone with both thumbs while squeezing chest with fingers Same rate and depth as usual Two-Rescuer CPR: Infants

52. Skill: CPR: Infants Two Rescuers

53. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.

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

55. Rescuer 1 gives 2 breaths.

56. Infant Two-Rescuer CPR Continued Continue cycles of 15:2 for ~ 2 minutes then switch roles Continue CPR until: Infant moves Advanced help arrives and takes over If infant starts breathing, hold in recovery position and monitor ABCs

57. When Not to Perform CPR Presence of a Do-Not-Resuscitate (DNR) order Patient obviously 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