09 Cardiac Emergencies and CPR

8/13/2019 09 Cardiac Emergencies and CPR

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CardiacEmergencies andCPRLesson 9


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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 cardiacarrest as a result of heart attack


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Review of

CirculatorySystem

Circulatory systemconsists of heart, blood,

and blood vessels.


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9-4

Cardiovascular System: PrimaryFunctions

Transports blood to lungs Delivers carbon dioxide and picks up oxygen

Transports oxygen and nutrients to allparts of body Helps regulate body temperature

Helps maintain bodys fluid balance


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9-5

Anatomy and Physiology of theHeart

Ventricles pump blood through two loops or cycles inbody

Right ventricle pumps blood to lungs to pick up oxygenand release carbon dioxide

Blood returns to left atrium and then flows into leftventricle 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 itmoves only in one direction through these cycles


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Heart is composed of aunique type of muscle(myocardium) that contractsto make pumping action.

Heart Muscle


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Contractions arecontrolled by electricalsignals under nervoussystem control

Heart Muscle


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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


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Pulse When left ventriclecontracts, wave of blood

is sent through arteriescausing pulsing bloodpressure changes in

arteries that can bepalpated in certain bodylocations

A pulse can be feltanywhere an arterypasses near skin surfaceand over a bone

Palpate carotid pulse oneither side of neck


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Pulse continued Palpate femoral pulsein crease between

abdomen and thigh Palpate radial pulse on

the palm side of wrist

proximal to base ofthumb Palpate brachial pulse

on the inside of armbetween elbow and

shoulder


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9-11

Capillaries

Arteries progressively branch into smallervessels 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 bodycells


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Veins

From capillaries, blood drains back to heartthrough extensive system of veins

Venous blood is dark red, deoxygenated, and

under less pressure than arterial blood Blood flows more evenly through veins, which

dont have a pulse

Veins have valves that prevent blood backflow


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9-13

Heart Rate

Heart rate, measured as pulse, is affected bymany factors

With exercise, fever, or emotional excitement,

heart rate increases to meet bodys greater needfor oxygen

Various injuries and illnesses may eitherincrease or decrease heart rate


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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


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Circulatory System:Emergencies continued

Heart attack Can lead to cardiac arrest

Ventricular fibrillation Heart muscle flutters rather than pumping

blood


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Cardiac Arrest

Heart may stop (cardiac arrest) as a result ofheart attack

Brain damage begins 4 - 6 minutes after cardiac

arrest Brain damage becomes irreversible in 8 - 10

minutes

Dysrhythmia, an abnormal heartbeat, may alsoreduce hearts pumping effectiveness


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Causes of Cardiac Arrest

Heart attack Drowning Suffocation Stroke Allergic reaction

Diabetic emergency Prolonged seizures Drug overdose Electric shock Certain injuries


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Cardiac Chain of Survival


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9-19

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 becauseof respiratory arrest


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Cardiopulmonary Resuscitation(CPR)

CPR helps keep patient alive by circulatingsome oxygenated blood to vital organs

Ventilations move oxygen into lungs where it ispicked up by blood

Compressions on sternum increase pressureinside chest, moving some blood to brain/othertissues


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Cardiopulmonary Resuscitation(CPR) continued

Blood circulation resulting from chestcompressions not as strong as circulation fromheartbeat Can help keep brain/other tissues alive until

normal heart rhythm restored


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Cardiopulmonary Resuscitation(CPR) continued

Often electric shock from AED is needed torestore a heartbeat and CPR can keep patientviable 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


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CPR Saves Lives

CPR and defibrillation within 3-5 minutescan save over 50% of cardiac arrestvictims

CPR followed by AED saves thousands oflives each year

In most cases CPR helps keep victim aliveuntil EMS or AED arrives


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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


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General Technique of CPRcontinued

Compress chest hard and fast at a rate of 100compressions/minute Adult = 1 1/2 to 2 inches deep Infant/child = 1/3 to 1/2 chest depth

Release completely between compressions


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General Technique of CPRcontinued

If alone, alternate 30 chest compressionsand 2 ventilations for any age patient

In two-rescuer CPR for infant/child,alternate 15 compressions and 2ventilations Chest-encircling method in infant

Give each ventilation over 1 second Follow local protocol regarding oxygen


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Single-Rescuer CPR

1. Check patients responsiveness, openairway, and determine that patient is notbreathing adequately

2. Give 2 ventilations, each lasting 1 second3. Determine victim has no pulse


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Single-Rescuer CPR

2. Give 2 ventilations,each lasting 1second

3. Determine victim hasno pulse


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Put hand(s) in correct position for chestcompressions

Gi 30 h i f 100


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Give 30 chest compressions at rate of 100per minute

Then give 2 ventilations


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Continue CPR until: Patient begins to move AED brought to scene and ready to use

Professional help arrives to take over You are too exhausted to continue


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If patient starts moving, check foradequate breathing

If patient is breathing adequately, putpatient in recovery position and monitorbreathing

When AED arrives, start AED sequence


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Chest Compressions Alert Be careful with your

hand position For adults/children,

keep your fingersoff patients chest

Do not givecompressions over

bottom tip ofbreastbone


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Chest Compressions Alert

When compressing,keep elbowsstraight and hands

in contact withpatients chest at alltimes


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Chest Compressions Alert Compress chest

hard and fast, butlet chest recoilcompletely betweencompressions.Minimize amount oftime used givingventilationsbetween sets ofcompressions.


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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 inineffective blood flow Compressions may be given at too fast a rate Only good-quality CPR improves chances of

survival


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Chest Compressions:Bradycardia in Child

Infant or child being given rescue breathsor oxygen may have a pulse but stillinadequate perfusion

If pulse < 60 beats/minute and infant orchild has signs of poor perfusion, provideCPR


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Two-Rescuer CPR for Adults andChildren

Minimizes timebetween rescuebreaths and

compressions CPR becomes moreeffective

Can more quickly set

up AED Reduces rescuer

fatigue


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Two-Rescuer CPR

Performed in cycles of 30:2 for adult (15:2for infant or child)

One rescuer provides breaths, secondrescuer gives chest compressions

Rescuers switch positions every 2 minutes Change done after full CPR cycle Accomplish change in < 5 seconds


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Two-Rescuer CPR continued

If AED present, one rescuer gives CPRwhile the other sets up unit

If unit advises CPR, rescuers give CPRtogether

Third rescuer can apply cricoid pressure


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Two-Rescuer CPR continued

If you are assisting another trained rescuer whoplaces an advanced airway: Chest compressions given continually

No pauses for ventilations Give ventilations at rate of 8 10 breaths/

minute


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Transitioning from One-RescuerCPR to Two-Rescuer CPR

Second rescuer moves into position on other sideto prepare to take over chest compressions

First rescuer completes a cycle of compressionsand ventilationsWhile first rescuer pauses to check for a pulse,second rescuer finds correct hand position forcompressions


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Transitioning from One-RescuerCPR to Two-Rescuer CPR

When first rescuer says, No pulse, continue CPR,second rescuer begins chest compressions andfirst rescuer then gives only ventilations


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Differences in Two-RescuerTraining

If First Responder started CPR, arriving secondrescuer may have a higher level of training

Rescuer with greater training determines how

CPR should best be continued


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Skill:CPR For Adultor Child(Two Rescuers)


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


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If no pulse, rescuer 2 gives 30compressions for adult (15 for child) at

rate of 100/minute.


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Rescuer 1 gives 2 breaths.

C i l f 30 2 f d l (15 2 f


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Continue cycles of 30:2 for adults (15:2 forchild). After 5 cycles (~ 2 minutes) switchpositions.


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Adult or Child Two-Rescuer CPRContinued

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

Uses different hand position


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p 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


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Skill:CPR: Infants

Two Rescuers


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Rescuer 1 checks ABCs. Rescuer 2locates site for chest

compressions.


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If no pulse, rescuer 2gives 15 chestcompressions.


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Rescuer 1 gives 2 breaths.


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Infant Two-Rescuer CPRContinued

Continue cycles of 15:2 for ~ 2 minutes thenswitch roles

Continue CPR until:

Infant moves Advanced help arrives and takes over

If infant starts breathing, hold in recovery

position and monitor ABCs


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When Not to Perform CPR

Presence of a Do-Not-Resuscitate (DNR)order

Patient obviously dead (decapitation;

incineration; or clear signs of prolongeddeath, such as rigor mortis and dependentlividity)

Not safe to be on the scene and thepatient cannot be moved somewhere safe

A physician pronounces the patient dead

09 Cardiac Emergencies and CPR

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