Cardiac Emergencies

1. Cardiac Emergencies List the signals of a heart attack for both men and women. Describe the care for a person having a heart attack. Identify the links in the Cardiac Chain of Survival. Describe the role of CPR in cardiac arrest. Describe defibrillation and how it works. Describe the general steps for the use of an automated external defibrillator (AED). List the precautions for the use of an AED. Demonstrate how to perform CPR and use an aed

2. Introduction • Cardiovascular disease is the leading cause of death for men and women in the United States. • Coronary heart disease is the most common type of cardiovascular disease. (fig 6-1) • The two most common cardiac emergencies are heart attack (also known as myocardial infarction) and cardiac arrest. • A heart attack refers to a condition in which the blood flow to the heart muscle is compromised and the heart begins to die. • The term cardiac arrest refers to a condition in which the heart stops beating.

4. Recognizing Signals of a Heart Attack Heart attacks are caused by an obstruction in the coronary arteries. This blockage leads to death of the heart muscle. Any severe chest pain, pain lasting longer than 3 to 5 minutes or chest pain accompanied by other signals of a heart attack should receive emergency medical care immediately.

5. Recognizing Signals of a Heart Attack(continued) Pain is described as— • Uncomfortable pressure. • Squeezing. • Crushing. • Tightness. • Aching. • Constricting. • Heavy sensation in the chest. Other signals include— • Trouble breathing. • Paleness. • Ashen skin or bluish skin, particularly around the face. • Skin may also be moist.

6. Recognizing Signals of a Heart Attack(continued) • As with men, women’s most common heart attack signal is chest pain or discomfort. • Women are somewhat more likely to experience other warning signals, particularly— • Shortness of breath. • Nausea or vomiting. • Back or jaw pain. • Unexplained fatigue or malaise

7. Care for a Heart Attack Follow CHECK—CALL—CARE. Call 9-1-1 or the local emergency number. Have the victim stop all physical activity. Loosen any restrictive clothing and have the victim rest. Monitor the victim closely. Be prepared to perform CPR or use an AED. Talk to bystanders to find out what happened. Assist the victim to take prescribed medication. Do not try to drive the victim to the hospital yourself. Aspirin may be given under certain circumstances, after 9-1-1 has been called. Demonstrate a calm, reassuring manner.

8. Angina Pectoris • Angina pectoris develops when the heart needs more oxygen than it gets. • When the coronary arteries are narrow and the heart needs more oxygen, heart muscle tissues may not get enough oxygen. • Pain associated with angina seldom lasts longer than 3 to 5 minutes. • Nitroglycerin temporarily widens the arteries and therefore helps relieve the pain. • Usually 3 doses over a 10-minute period • If there is no relief after 10 minutes, call for help.

9. Cardiac Arrest Cardiac arrest occurs when the heart stops beating or beats too ineffectively to generate a pulse and blood cannot be circulated to the brain and other vital organs. A victim in cardiac arrest is unconscious and shows no signs of life.

10. Cardiac Arrest(continued) • Signs of life include— • Normal breathing. • Movement. • A pulse (for children and infants). • The victim’s skin may be pale, ashen or bluish, particularly around the face. • The face may also be moist from perspiration. • In some cases, a victim of cardiac arrest may not have shown any warning signals. This condition is called sudden death.

11. Care for a Heart Attack • Cardiac Chain of Survival: • Early recognition and early access • Early CPR • Early defibrillation • Early advanced medical care

12. CPR An adult victim who is in cardiac arrest is unconscious and shows no signs of life. CPR can help circulate blood containing oxygen by a combination of chest compressions and rescue breaths. • Each minute that CPR and defibrillation are delayed reduces the chance of survival by about 10 %.

13. CPR - Adult CHECK the scene and the injured or ill person. If the person is unconscious, CALL 9-1-1 or the local emergency number or send someone to call. CHECK for breathing for no more than 10 seconds. Quickly CHECK for severe bleeding. If the person is not breathing, give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths.

14. CPR - Adult • If necessary, move the person so he or she is lying on his or her back on a firm, flat surface before beginning CPR. • CPR is not effective if the person is on a soft surface, such as a bed or sofa, or is sitting up. • Do not stop CPR unless: • The adult shows obvious signs of life, such as breathing. • An AED becomes available and is ready to use. • Another trained rescuer or EMS personnel arrive and take over. • You are too exhausted to continue. • The scene becomes unsafe. • Video Segment

15. CPR - Child • Children seldom initially suffer a cardiac emergency. • Instead, they suffer a respiratory emergency that results in a cardiac emergency. • Most cardiac arrest in children are not sudden. • A child is in cardiac arrest if he or she is unconscious, shows no signs of life (movement or breathing) including no pulse. • When you perform CPR, give cycles of 30 compressions and 2 rescue breaths for a child.

16. CPR - Child CHECK the scene and the injured or ill child. If the child is unconscious, CALL 9-1-1 or the local emergency number (if you are alone and did not witness a collapse, wait to call until you have first given two minutes of care) or send someone to call. CHECK for breathing for no more than 10 seconds. If a child is not breathing, and a sudden collapse was not witnessed, give 2 rescue breaths. Quickly CHECK for severe bleeding. If the child is not breathing (and the rescue breaths, if given, make the child’s chest clearly rise), give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths. Video Segment

17. CPR - Infant • Unlike adults, infants seldom initially suffer a cardiac emergency. • Instead, they suffer a respiratory emergency that results in a cardiac emergency. • An infant is in cardiac arrest if he or she is unconscious, shows not signs of life (movement and breathing) including no pulse in an infant. • When you perform CPR, give cycles of 30 compressions and 2 breaths for an infant. • Use two or three fingers instead of palms when performing compressions

18. CPR - Infant CHECK the scene and the injured or ill infant. If the infant is unconscious, CALL 9-1-1 or the local emergency number (if you are alone and did not witness a collapse, wait to call until you have first given two minutes of care) or send someone to call. CHECK for breathing for no more than 10 seconds. If the infant is not breathing, and the sudden collapse was not witnessed, give 2 rescue breaths. Quickly CHECK for severe bleeding. If the infant is not breathing (and the rescue breaths, if given, make the infant’s chest clearly rise), give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths. Video Segment

19. CPR Skill Comparison

20. AED – Automated External Defibrillator

21. Automated External Defibrillation Disease or injury can disrupt the heart’s electrical system and damage the heart. An automated external defibrillator (AED) is a machine that analyzes the heart’s rhythm and, if necessary, tells you to deliver a shock to a victim of a sudden cardiac arrest.

22. Automated External Defibrillation Defibrillation is an electric shock that interrupts the heart’s chaotic electrical activity during sudden cardiac arrest, which is most commonly caused by an abnormal rhythms. • Each minute that defibrillation is delayed reduces the victim’s chances of survival by about 10 percent. • The sooner the shock is administered, the greater the likelihood of the victim’s survival. • If defibrillation is not administered when needed, all electrical activity will cease (asystole).

23. Sinoatrial Node • Impulse point of origin • Atrioventricular Node • Convergence of impulse after it spreads through the atria. • Purkinje Fibers • Spreads impulse along the septum and through the ventricles • Measured by an EKG

24. Automated External Defibrillation The two most common abnormal rhythms leading to cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). • V-fibis a state of totally disorganized electrical activity in the heart, resulting in fibrillation, or quivering, of the ventricles. • In V-fib, electrical impulses fire at random, creating chaos and preventing the heart from pumping and circulating blood. • V-tachrefers to a very rapid contraction of the ventricles. Electrical activity is present and results in a regular rhythm, but the rate is often so fast that the heart is unable to pump blood properly. With either abnormal rhythm, the person may collapse, become unconscious and stop breathing. Video Segment

25. Safety Precautions When Using an AED When using an AED, follow these precautions: • Do not touch the victim while the AED is analyzing. • Do not touch the victim while defibrillating. • Do not use alcohol to wipe the victim’s chest dry. • Do not defibrillate someone around flammable materials. • Do not use an AED in a moving vehicle. • Do not use an AED and/or electrode pads designed for adult victims on a child under age 8 or weighing less than 55 pounds. • However, if pediatric pads specific to the device are not available, use may use one designed for an adult.

26. Safety Precautions When Using an AED(continued) • Do not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest. • Remove patch first • Do not use a mobile phone or conduct radio transmission within 6 feet of the AED. • Do not place the pads directly over a pacemaker or other imp • Do not place the pads directly over metallic jewlery. • Do not use an AED on a victim in contact with water. • Remove wet clothing and dry chest

27. AED – Child and Infant • AEDs equipped with pediatric AED pads are capable of delivering lower levels of energy to a victim between up to age 8 or weighing less than 55 pounds. • Pediatric pads should not be used on adult victims. • Sudden cardiac arrest can happen to anyone, at any time and not just to adults. • Use the same procedure as the adult • With small children or infants, the pads may be placed on the chest and upper back

28. Skill Practice and Scenarios Now it is time to practice!