1. Chapter 6
Cardiac Emergencies

2. Cardiovascular Disease
Abnormal conditions that affect the heart and blood vessels
Leading cause of death in US (male/female)
61 million suffer; 950,000 die each year (2005)
Principle components:
Coronary heart disease: arteries that carry oxygen-rich blood to heart harden or narrow from build up of fatty deposits
Stroke: disruption of blood flow to part of brain which causes permanent damage to brain tissue (cerebrovascular accident or CVA)

3. Cardiovascular Emergencies
2 common emergencies:
A) heart attack- (myocardial infarction) blood
flow to some part of heart muscle is
comprised and heart begins
to die; if enough of heart dies, heart cannot
circulate blood effectively
-B) cardiac arrest – heart stops beating

4. Cardiovascular Emergencies
Clinically dead = no signs of life (no pulse
or breathing)
Cells of brain and other vital organs continue to live until oxygen is depleted
CPR: cardiopulmonary resuscitation is needed; combination of chest compressions and rescue breathing
Together take over functions of heart/lungs until advanced medical care given
Only generates 1/3 of normal blood flow to brain

5. Cardiovascular Emergencies
Cardiac Chain of Survival: give victim of cardiac arrest the best chance of survival
1. Early recognition and early access:
sooner called; sooner early
advanced medical care arrives
2. Early CPR: helps circulate oxygen-rich
blood to vital organs until AED is ready
to be used or advanced medical help arrives

6. Cardiovascular Emergencies
Early Defibrillation: electric shock called defibrillation that can restore an effective heart rhythm to cardiac arrest victim; each minute delayed reduces chance of survival by 10%
Early Advanced Medical Care: given by trained medical personnel, who provide further care and transport to hospital

7. Signals of Heart Attack
Chest pain spreading * shortness of breath
shoulders/neck/jaw/arms * sweating
Nausea or vomiting * denial
Dizziness, light headed *pale, ashen (gray) or bluish
or fainting skin
Additional Signs felt by Women
Shortness of breath
Nausea or vomiting
Back or jaw pain
Nearly ½ of all deaths from heart attacks are Women

8. Heart Attack
Most important first aid measure is to be able to recognize signals of heart attack and take action.
Most victim’s will deny the seriousness of the signals he/she is experiencing.
Many delay seeking care – usually 2 hours or more before going to hospital
Some mistake signals for indigestion

9. Care for Heart Attack Check, Call, Care
Recognize signals of heart attack
Call 9-1-1
Help victim rest comfortably
Loosen any restrictive clothing
Assist the victim w/any prescribed medication
Monitor breathing and other signs of life
Be prepared to perform CPR or use an AED if victim’s heart stops beating

10. Heart Attack
Angina Pectoris: chest pain or pressure that comes and goes at different times
Heart needs more oxygen than it gets
Lack of oxygen causes constricting chest pain that spreads to neck, jaw, and arms
Seldom lasts longer than 3 to 5 minutes
Nitroglycerin – medication that dilates blood vessels to make it easier for blood to reach heart; relieves pain
If does not go away after 10 min; call 9-1-1

11. Cardiac Arrest
Heart stops beating or beats to ineffectively to generate a pulse and blood is not circulated to brain and other vital organs
Causes
Cardiovascular disease
Drowning *certain drugs
Severe injuries to chest *suffocation
Severe blood loss *electrocution
Stroke or other brain damage
Sudden Death- no warning signals at all
Signals: no signs of life

12. CPR for Adult Check the scene and victim
If victim is unconscious, send someone to call 9-1-1
Check for breathing for no more than 10 seconds (Look, listen, and feel)
Check for bleeding
30 chest compressions
Head tilt/chin lift
2 slow breaths
Repeat

13. CPR
Chest compressions- victim needs to be on a hard surface to be effective
Hand position: 2 hands in center of chest
kneel down beside victim
Place heel of hand on the center of victim’s sternum (breastbone)
Place other hand directly on top of first
Use heel of hand to apply pressure
Keep fingers off chest
Shoulders directly over hands
Arms straight and elbows locked

14. CPR Compressions: push sternum down 2 inches
Each movement should be smooth not jerky
Do not pause between compressions
Hands never leave chest during compressions
100 per minute (30 compressions – 18 seconds)
Count: one and two and three and four and five ….. Up to 30
Push down saying #, up say “and”

15. CPR Cycles of 30 compressions and 2 rescue breaths
Use head tilt/chin lift technique to open airway after compressions
Breath until see the chest rise (1 second); pinch nose during breath and release
If two responders, send one to call and get an AED

16. When to stop CPR Scene becomes unsafe Victim shows signs of life
An AED becomes available and is ready to use
Another trained rescuer arrives and takes over
You are too exhausted to continue

17. Child and Infant CPR
Children do not often initially suffer a cardiac emergency
Generally, they suffer a respiratory emergency that can develop into a cardiac emergency
Infant in need of CPR: no breathing and no signs of life
Causes: car crashes, drowning, smoke inhalation, poisoning, choking, firearm injury, falls, and also from acute respiratory conditions such as asthma attack

18. Child CPR Same as for the adult except for
Give 2 minutes of CPR then call if you are alone otherwise ask someone to call for you
Use heel of only two hands for compressions Shoulders over hands
Compress chest 2 inches smoothly
30 compressions in 18 seconds (100 per min)
2 slow rescue breaths (until see chest rise); pinch nose and release after breath
Repeat cycle (30 compressions and 2 breaths)

19. Infant CPR Same as for the adult except for
Use only pads of 2 fingers for compressions and the other on the infant’s forehead to maintain open airway
Shoulders over hands
Compress chest 11/2 inches smoothly
30 compressions in 18 seconds (100 per min)
2 slow rescue breaths (until see chest rise); cover infant’s nose and mouth with your mouth
Repeat cycle (30 compressions and 2 breaths)

20. Automated External Defibrillator (AED)
Abnormal rhythms of the heart
Ventricular Fibrillation (V-fib): totally disorganized electrical activity in the heart
Results in fibrillation or quivering of the ventricles
Heart cannot pump blood and no signs of life (including no pulse)
Ventricular Tachycardia (V-tach): very rapid contraction of ventricles
Regular rhythm, rate is so fast heart unable to pump blood properly
No signs of life including no pulse
Fibrillation can be corrected by early defibrillation
(85% of people)
If not corrected, all electrical activity will cease – asystole (flatline)… cannot be corrected or reversed

21. AED Precautions Do not touch victim while AED is analyzing
(disrupts analysis)
Do not touch victim during defibrillation
(you could be injured)
Do not use alcohol to wipe victim’s chest (flammable)
Do not use AED in a moving vehicle
Do not use AED on victim in contact with water
Use proper pads for adults and children (under 8 yrs and less than 55 lbs)
Do not use AED on victim with a nitroglycerin patch
Do not use cell phones or radio transmissions w/in 6 ft of AED- interrupts analysis

22. AED
How to use an AED:
As soon as it is available and safe to do so, CPR is stopped
Turn on AED
Open victim’s shirt and wipe chest dry
Attach AED pads (upper right chest, lower left side)
Plug in connector to AED
AED analyze heart rhythm
Say: “everyone stand clear” (do not touch victim)
Deliver shock by pushing button when told to do so
Say: “everyone stand clear, shocking”
AED analyze again
Recheck for pulse, provide additional shock if advised to do so
No shock advised, continue CPR, leave AED attached