2. Defibrillation Course

3. Cross Section of the Heart.

4. Flow of Blood Through The Heart

5. Heart Anatomy LOCATION: retrosternal – behind the sternum SIZE AND SHAPE: Little bigger than the size of your fist Base – top of the heart Apex – Bottom of the heart

6. Organ Layers: Inside layer – endocardium (smooth muscle that lines the chamber) Middle layer – myocardium (thickest muscle layer) Outside Layer – epicardium Pericardium – Protective sac surrounding the heart, 30cc of pericardial fluid acts as a lubricant and cushion.

8. Heart Chambers ATRIAL – superior chambers (if you are superior you are at the top) - Right collects blood from the vena cavas. - Left collects oxygenated blood from the lungs.

9. VENTRICLES – inferior chambers - Right pumps blood to lungs (LOW pressure) - Left pumps blood out to body (HIGH pressure) SEPTUM – wall that separates the two sides of the heart

10. The 4 Chambers of the Heart Right Atrium Right Ventricle Left Atrium Left Ventricle Receives blood from veins; pumps to right ventricle. Receives blood from lungs; pumps to left ventricle. Pumps blood to the lungs. Pumps blood through the aorta to the body.

11. Heart Valves Function – to control blood flow through the heart. A trioventicular Valves (separate the atria & ventricles) Tricuspid Valves (right side) Mitral (Bicuspid) (left side) S emilunar Valves Pulmonic (right side)-between the right ventricle & pulmonary artery. Aortic (left side)-between the left ventricle & the aorta.

12. Great Vessels Largest in the body to carry blood to and from the heart. Vena Cava: Superior – brings back blood from head and upper extremities Inferior – brings back blood from area below the heart

13. Pulmonary Artery – carries deoxygenated blood to the lungs. Pulmonary Vein – carries oxygenated blood back to the heart. Aorta – carries oxygenated blood to the body.

15. Coronary Arteries 2 main arteries which sit on the surface of the heart; come off aortic arch. IMPORTANCE – provides blood to the heart muscle itself (myocardium).

16. Flow of Blood Through The Heart

17. Oxygen Low Concentration Vena Cavae Right Atrium (Tricuspid Valve) Right Ventricle (Pulmonary Valve) Pulmonary Artery L U N G S

18. Oxygen High Concentration Pulmonary Vein Left Atrium (Mitral Valve) Left Ventricle (Aortic Valve) Aorta TO THE BODY

19. Blood Flow Through the Heart It’s coloring time…

21. Pumping Action of the Heart Stroke volume – the amount of blood ejected from the ventricles with one contraction (60- 100ml). Cardiac Output – the amount of blood pumped through the circulatory system per minute. FORMULA = heart rate x stroke volume Normal Adult Heart Rate : 60-100 times per minute

22. What regulates the heart? “Fight or Flight Response” In response to the autonomic nervous system - Parasympathetic Nervous System When activated, slows down the heart rate. - Sympathetic Nervous System Speeds up the heart rate.

23. Arteriosclerosis – hardening of the arteries Atherosclerosis – fat and cholesterol deposits line the vessels

24. Cardiac Assessment What is the chief complaint? 1. Chest pain or discomfort – OPQRSTI 2. Previous episodes & history 3. Shoulder or neck pain 4. Dyspnea – worse with exertion? 5. Syncope 6. Palpitations 7. Past Medical History

25. Properties of the Heart Automaticity ability to beat on its own Conductivity ability to pass impulses from cell to cell Contractibility ability to receive an electrical impulse and contract Excitability ability to respond to an electrical stimulus Rhythmiticity when stimulated, has rhythm

26. Depolarization: When the heart contracts or pumps blood Repolarization: When the heart is resting and refilling (RE=Rest)

27. What’s In a Heart Beat? Electrocardiograph – Machine used to measure electrical heart activity.

28. Isoelectric Line – the black line on an ECG Electrocardiogram – the read out or strip of paper showing the electrical activity.

29. ECG Placement - AED

30. Pacemakers of the Heart SA Node (sinoatrial) - Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute. AV Node (atrial ventricular) - Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute. Purkinje Fibers - Back-up pacemaker with an intrinsic rate of 20 - 40 bpm.

31. CardiacConductionSystem

32. Cardiac Conduction & the ECG SA node AV node Bundle of His Bundle Branches Purkinje fibers

33. What happens in a single heart beat??? - The “PQRST” P wave –Atrial depolarization –SA Node Fires T wave -Ventricular Repolarization QRS - Ventricular depolarization - AV Node Fires ATRIA RELAX BEFORE VENTRICLES CONTRACT

34. The PR Interval Atrial depolarization + delay in AV junction (AV node/Bundle of His) (delay allows time for the atria to contract before the ventricles contract)

35. Types of AEDs Biphasic Sends shock in both directions, measures resistance, and adjusts energy Causes less damage to heart muscle Monophasic Sends single shock (energy current) from one pad to the other

36. Rationale for Early Defibrillation Most frequent initial rhythm in sudden cardiac arrest is ventricular fibrillation (VF) The only effective treatment for VF is defibrillation Probability of successful defibrillation decreases rapidly over time

37. Safety Considerations Water Dry patient’s chest; remove from wet environment. Metal Ensure no one is in contact with the patient and they are not touching any metal.

38. Additional Safety Considerations Medication Patch If patch is visible on the chest, remove it with gloved hands before delivering shock.

39. Safety Considerations DO NOT defibrillate in a moving ambulance – stop the vehicle to deliver the shock. Road noise interferes in the operation and it decreases the chance of shocking another person Use the proper pads: Adult pads for 8 and older and/or signs of puberty & Child Pads for 1 – 8 years old

40. Time is Critical Immediately………….>95% 1 – 3 min……………..84% 4-6 min………………28 – 40% >10 min……………...<5%

41. Causes of Cardiac Arrest Other Than Heart Disease Drowning Trauma Electrocution Acid Base imbalance Electrolyte imbalance Drug toxicity Hypovolemia Hypoxia

42. Chain of Survival

43. Rhythms you NEED to know!!! Ventricular Fibrillation - VF

44. Ventricular Tachycardia – VT

46. Asystole Normal Sinus Rhythm

47. Pulseless Electrical Activity – PEA Agonal – Dying Heart

48. Artifact

49. Premature Ventricular Contractions – PVC’s

50. Pacemaker

51. THE END

52. Not Shockable Rhythms An AED will not shock: Asystole (20-50% of victims) OR Pulseless electrical activity (PEA) (15-20% of victims) Typically only 6-7 out of 10 patients are in a shockable rhythm.

53. Safety Considerations An AED must be applied ONLY to a patient who is unresponsive, apneic, and pulseless.

54. Say "Clear!" Ensure no one is touching patient. Press analyze button.

55. If AED advises shock, say "Clear," ensure no one touching patient, and press shock button. Repeat until up to 3 shocks are delivered.

56. Stacked Shocks K ey Term Called stacked because after the first and second shocks in each set, pulse checks and CPR are not performed

57. After delivery of shock(s), check carotid pulse.

58. If there is no pulse, resume CPR for one minute. Check effectiveness of CPR by evaluating pulse.

59. Insert an airway adjunct and ventilate with high-concentration oxygen.

60. After one minute of CPR, clear patient and repeat sequence of analyses and up to three additional shocks.

61. If no shock is advised, check carotid pulse. If present, assess adequacy of breathing.

62. If breathing is adequate, give high- concentration oxygen by nonrebreather. If inadequate, ventilate with high- concentration oxygen.

63. If the AED gives 3 consecutive no- shock messages with no carotid pulse...... or a total of six shocks are delivered... then transport with CPR and oxygen.

64. If advanced life support is not available, transport when: Patient regains pulse, OR You have delivered 6 shocks, OR AED has given 3 consecutive no-shock messages

65. Do not touch patient when analyzing rhythm and delivering shocks. Do not analyze rhythm or defibrillate in a moving ambulance. Stop first. General AED Procedures

66. AED in Progress If AED is in use by a first responder when you arrive, ensure they are performing properly, and continue with shocks.

68. What happens in a single heart beat? P wave - SA node fires -Depolarization of atria (contract) QRS Complex -AV node fires -Depolarization of the ventricles. (contract) T Wave -Repolarization of the ventricles (rest and refill) ATRIA RELAX BEFORE VENTRICLES CONTRACT