Cardiac Arrest: Symptoms, Causes, and Management - CPR & AED

Chapter 5 Cardiac arrest Ghada faour 1 What is cardiac arrest (Ca.A )? A Ca.A is an electrical disorder. In a Ca.A, the heart stops beating completely. During Ca.A, people typically collapse & become unresponsive. Why do cardiac arrests happen? Wit...

Chapter 5 Cardiac arrest Ghada faour 1 What is cardiac arrest (Ca.A )? A Ca.A is an electrical disorder. In a Ca.A, the heart stops beating completely. During Ca.A, people typically collapse & become unresponsive. Why do cardiac arrests happen? With Ca.A , abnormal, rapid impulses abruptly override the normal electrical impulses that start your heartbeat. When your heart isn’t beating, there’s no way to get oxygen-rich blood to the rest of your body. Is cardiac arrest the same as sudden cardiac death? With Ca.A , the heart stops beating, but a rescue is still possible. With immediate treatment, you can survive.Sudden cardiac death refers to a Ca.A without someone saving you& happens in people with & without heart disease. Having a heart attack or other heart condition can significantly increase your risk. When Ca.A occurs, circulation to the brain ceases &consciousness is lost within seconds. Left untreated, irreversible brain damage & death will rapidly follow. The chance of survival with a favorable neurological outcome declines rapidly the longer someone remains in Ca.A. 2 Clinical presentation Patients may initially be awake, although once the heart stops, loss of consciousness rapidly ensues due to a critical lack of perfusion of the brain. Signs & Symptoms of Ca.A S. & Symptoms before Ca. A  pallor  absent breathing Fainting  Heart palpitations  absent peripheral pulses  Dizziness  Lightheadedness.  hypotension(unmeasurable B.P) Chest pain.  Nausea & vomiting.  poor oxygen saturations  Shortness of breath.  unconscious (low GCS) The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a 3 person's level of consciousness after a brain injury. Classification Ca.A can be classified according to whether the presenting arrhythmia can be successfully treated with a shock from a defibrillator or not. The majority of Ca.A s are with non-shockable rhythms.  non-shockable rhythms (80%)  asystole  pulseless electrical activity (PEA)  shockable rhythms (20%)  ventricular tachycardia (pVT)  ventricular fibrillation (VF)  Ca. A can be fatal if it lasts longer than 8 minutes without CPR.  Brain damage can happen after just 5 minutes. 4 What causes cardiac arrest? Arrhythmias are the immediate cause of Ca.A.Abnormal heart rhythms that cause Ca.A may include:  Ventricular fibrillation.  Ventricular tachycardia.  Cardiomyopathy.  Drugs(cocaine,…).  Heart attack.  Heart failure.  Illegal drugs, like cocaine.  Long QT syndrome(LQTS).  Severe illness or injury (trauma) with major blood loss.  Electrical abnormalities  Blood vessels abnormalities 5 Clinical Examinations & Signs Absence of carotid pulse: How do you detect cardiac arrest?  Asystole /Ventricular fibrillation Unconsciousness:  Electrical activity without pulse  The patient does not answer a simple question: "Can you hear me? Talk to me! »  The patient does not react when asked to shake hands: "Shake my hand!" Vigilance is a waking state:  Eye opening /Consciousness is the knowledge of oneself & one's environment:  Verbal response & Motor response Absence of breathing, apnea:  Lack of exhaled air flow through the nose & mouth  Absence of breathing sounds  Absence of respiratory movements 6 Cardiac arrest( Ca. A) Management? 1-Cardiopulmonary resuscitation (CPR): Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many emergencies, such as a heart attack or near drowning, in which someone's breathing or heartbeat has stopped. Immediate CPR is one of the most important treatments to improve Ca.A survival. CPR is often performed until an AED is ready. CPR uses chest compressions to replace the heart’s pumping action. It moves small amounts of blood from your heart to your brain. 2-Automatic defibrillator or external defibrillator AED: An automated external defibrillator (AED) is a lightweight, portable device. It delivers an electric shock through the chest to the heart when it detects an abnormal rhythm & changes the rhythm back to normal. 7 Adult CPR AED C-Chest compressions 1.Put the person on his or her back on a firm surface. 2.Kneel next to the person's neck &shoulders. 3.Place the lower palm (heel) of your hand over the center of the person's chest, between the nipples. 4.Place your other hand on top of the first hand. Keep your elbows straight & position your shoulders directly above your hands. 5.Push straight down on (compress) the chest at least 2 inches (5 centimeters) but no more than 2.4 inches (6 centimeters). 9 6. Use your entire body weight (not just your arms) when doing compressions. 7. Push hard at a rate of 100 to 120 compressions a minute. 8. The AHA suggests performing compressions to the beat of the song "Stayin' Alive." Allow the chest to spring back (recoil) after each push. 9. continue chest compressions until there are signs of movement or until emergency medical personnel take over. Go on to opening the airway and rescue breathing. 10  A-Open the airway Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. 11  B- Rescue breathing(R-B) R-B can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. Current recommendations suggest performing R-Busing a bag-mask device with a high-efficiency particulate air (HEPA) filter. 1) Pinch the nostrils shut for mouth-to-mouth breathing & cover the person's mouth with yours, making a seal. 2) Give the first rescue breath, lasting 1 second, & watch to see if the chest rises. If it rises, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver first and then give the second breath. Be careful not to provide too many breaths or to breathe with too much force. 3) After 2 breaths, restart chest compressions to restore blood flow. Thirty chest compressions followed by 2 rescue breaths is considered 1cycle. 4) As soon as an AED is available, apply it & follow the prompts. Give 1 shock, then resume chest compressions for 2 more minutes before giving a second shock. Continue CPR until there are signs of movement or emergency 12 medical personnel take over. CHILD CPR AED C-Chest compressions Adult CPR Techniques can be used in children(compression1/3 of the depth of the chest). 1) Call EMS 2) Place the child on his or her back on a firm surface. 3) Kneel next to the child's neck and shoulders. 4) Place 2 hands (or only 1 hand if the child is very small) on the lower half of the child's breastbone (sternum)& compress the chest about 2 inches (approximately 5 centimeters). 5) Push hard and fast — 100 to 120 compressions a minute. 6) Go on to opening the airway and rescue breathing. A-Open the airway using the head-tilt, chin-lift maneuver. Place your palm on the child's forehead and gently tilt his or her head back. 13 With the other hand, gently lift the chin forward to open the airway.  B- Rescue breathing(R-B) Breathing: Breathe for the child 1.Cover the child's mouth with yours, making a seal. 2.Breathe into the child's mouth for one second & watch to see if the chest rises. If it rises, give a second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver first, & then give the second breath. After the 2 breaths, immediately begin the next cycle of compressions & breaths. 3.If there are 2 people available, give 1 to 2 breaths every 15 compressions). 4.As soon as an AED is available, apply it & follow the prompts. Use pediatric pads for children older than 4 weeks old & up to age 8. 5.Give 1 shock, then restart CPR - starting with chest compressions - for 2 more minutes before giving a second shock. Continue until the child moves or help arrives. 14 15 BABIES/INFANTCPR AED To perform CPR on a baby 4 weeks old or older Ca.Ain babies is usually due to a lack of O2, such as from choking. If you know that the baby has an airway blockage, perform1st aid for choking. If you don't know why the baby isn't breathing, perform CPR.  Evaluate the situation. Touch the baby & watch for a response, such as movement. Don't shake the baby.  If there's no response, call EMS, then immediately start CPR.  Follow the compressions, airway & breathing (C-A-B) procedure (below) for a baby under age 1 (except newborns, which include babies up to 4 weeks old.  If you saw the baby collapse, get the AED, if one is available, before beginning CPR.  If another person is available, have that person call for help immediately & get the AED while you stay with the baby & perform CPR. 16  C-Chest compressions  Restore blood flow  Place the baby on his or her back on a firm, flat surface, such as a table or floor.  Imagine a horizontal line drawn between the baby's nipples.  Place 2 fingers of one hand just below this line, in the center of the chest.  Gently compress the chest about 1.5 inches (about 4 centimeters).  Count aloud as you push in a fairly rapid rhythm. You should push at a rate of 100 to 120 compressions a minute. 17  A-Open the airway Gently tip the head back by lifting the chin with 1hand & pushing down on the forehead with the other hand. B- Rescue breathing(R-B)  Cover the baby's mouth & nose with your mouth& give 2 rescue breaths.  Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth 1 time, taking 1 second for the breath.  Watch to see if the baby's chest rises: If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver & then give the second breath. If the baby's chest still doesn't rise, continue chest compressions.  Give2 breaths after every 30 chest compressions. If 2 people are performing CPR, give 1 to 2 breaths after every 15 chest compressions.  Continue CPR until you see signs of life or until medical personnel arrive. 18  If the baby shows signs of becoming responsive, such as, coughing, opening their eyes, making a noise, or starts to breathe normally, put them in the recovery position.  Monitor their level of response and prepare to give CPR again if necessary. Sudden cardiac arrest(SCA): Occurs when the heart suddenly stops beating. How to save a Life RECOGNIZE SCA CALL EMS START CPR USE AED 19 Adult CPR AED Child CPR AED 20 Infant CPR AED CPR-AED 1- Ensure scene safety. 2-Check for response. 3-Shout for help. 4-Check for no breathing or only gasping.. 5-Begin high quality CPR. 6- Use an AED. 7-Continue CPR. 21 22 Automatic external defibrillator AED Once connected, this device delivers a brief electrical current (shock) to the chest. The current travels to the heart. This stops the abnormal impulses & restores the normal impulses that make it beat. It may take more than 1 shock for the heart to pump on its own again. AEDs help people who have a sudden cardiac arrest, which occurs when the heart suddenly stops beating regularly. AEDs may have 2 sets of pads — adult & child pads.  Types of AED: Monophasic, Biphasic ,Tri-phasic  Component of AED: o Machine ,scable,cissors , razors, compresses o Base that delivers shock, with speaker, self- The energy of a biphasic AED defibrillator powered. is defined in joules. Joules is the unit of o On/off button -PADDLE measurement associated with 1 Amp of o Shock button according to model current passing through 1 Ohm of 23 resistance for 1 second. How does an AED work?  Turn on the AED &follow the voice prompts.  Remove all clothing covering the chest. If necessary, wipe the chest dry.  Peel away the backing from the pads & attach the pads to the person’s bare chest following the illustration on the pads.  Plug the pads connector into the AED, if necessary.  The AED will check to see if the person needs a shock &will automatically give 1or tell you when to give 1. While the AED is analyzing, make sure no 1 is touching the person  Resume CPR if no shock is needed. If a shock is needed, make sure no 1 is touching the person & press the shock button, then immediately resume CPR.  Continue CPR until emergency medical personnel arrive. Risks and constraints:  Wet floor, Metal surface  Pacemaker, Drug patch 24 Difference between AED and Defibrillator  AEDs and defibrillators are both devices that are used to treat cardiac resuscitation.  AEDs are portable devices that can be used by trained laypeople to provide emergency care. Defibrillators, on the other hand, are larger devices that require professional training to operate.  AEDs work by delivering a shock to the heart, which helps to restore normal electrical activity. Defibrillators, on the other hand, work by delivering a high-energy shock to the heart, which interrupts the abnormal electrical activity and allows the heart to return to its normal rhythm.  AEDs are recommended for use in public places. Defibrillators are typically found in hospitals and other medical settings. 25 Post-resuscitation care If still looking after a patient following a cardiac arrest & successful resuscitation: Monitor vital signs and oxygen saturation, administer oxygen to achieve a target saturation of 94 – 98% Monitor & maintain the patient’s airway Observe for any seizure activity and manage as appropriate. Monitor and record the blood sugar level (. Leave the AED pads in position on the patient, even if they regain consciousnesses If breathing is present, but inadequate in rate & volume if unconscious apply assisted breathing with a bag-valve-mask. Document the number of shocks given and estimated duration of CPR given, ensure this information is handed over to emergency medical services when they arrive Medication: Adrenaline,amiodarone 26  BLS -IN HOSPITAL If no signs of life: unconscious, breathless, pulseless…… 1 Shake gently Shout loudly 2 Check breathing? Apparently no breath Shout for help &Assess movement (not more than patient 10s.) 4 3 Call CPR team 5 CPR Team: Insertion of IV line and administration of drugs as ordered by the Team leader 27 Attach monitor Start CPR 30:2