Chapter 34 Emergency Cardiovascular Life Support.

Chapter 34 Chapter 34

Emergency Cardiovascular Life Emergency Cardiovascular Life SupportSupport

Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2

ObjectivesObjectives

List the causes of sudden cardiac arrest (SCA).List the causes of sudden cardiac arrest (SCA).

List the signs of SCA, heart attack, stroke, and foreign-body List the signs of SCA, heart attack, stroke, and foreign-body airway obstruction (FBAO).airway obstruction (FBAO).

Describe how to perform cardiopulmonary resuscitation (CPR) Describe how to perform cardiopulmonary resuscitation (CPR) on adults, children, and infants.on adults, children, and infants.

Describe how to defibrillate with automated external Describe how to defibrillate with automated external defibrillators (AEDs) and manual defibrillators.defibrillators (AEDs) and manual defibrillators.


Objectives (cont.)Objectives (cont.)

State how to administer synchronized cardioversion.State how to administer synchronized cardioversion.

Describe how to evaluate quality and effectiveness of CPR.Describe how to evaluate quality and effectiveness of CPR.

List the complications that can occur as a result of resuscitation List the complications that can occur as a result of resuscitation of SCA.of SCA.

State when not to initiate CPR.State when not to initiate CPR.


Objectives (cont.)Objectives (cont.)

Describe how to apply key adjunct equipment during advanced Describe how to apply key adjunct equipment during advanced cardiovascular life support (ACLS).cardiovascular life support (ACLS).

State common drugs and drug routes are used during ACLS.State common drugs and drug routes are used during ACLS.

Describe how to monitor patients prearrest, during CPR, and Describe how to monitor patients prearrest, during CPR, and postarrest. postarrest.


Causes and Prevention of Causes and Prevention of Sudden DeathSudden Death

Sudden cardiac arrest (SCA) is a leading cause of death in Sudden cardiac arrest (SCA) is a leading cause of death in North America.North America.

Approximately 250,000 people die annually from coronary artery Approximately 250,000 people die annually from coronary artery disease.disease.

About 40% of SCA victims are in ventricular fibrillation upon About 40% of SCA victims are in ventricular fibrillation upon collapse.collapse.

Immediate CPR with defibrillation can save many lives.Immediate CPR with defibrillation can save many lives.


Basic Life SupportBasic Life Support

1.1. Check for movement or response.Check for movement or response.

2.2. Activate the EMS system and get automated external Activate the EMS system and get automated external defibrillator.defibrillator.

3.3. Open airway and check breathing.Open airway and check breathing.

4.4. If no breathing, give two breaths.If no breathing, give two breaths.


Basic Life Support (cont.)Basic Life Support (cont.)

1.1. If no response, check pulse within 10 seconds.If no response, check pulse within 10 seconds.

2.2. If no pulse, give cycles of 30 compressions and two breaths If no pulse, give cycles of 30 compressions and two breaths until AED arrives.until AED arrives.



Determining unresponsivenessDetermining unresponsiveness BLS begins when a victim is found unresponsive and not BLS begins when a victim is found unresponsive and not

moving.moving.

If head or neck injuries are apparent, rescuer needs to careful If head or neck injuries are apparent, rescuer needs to careful with subsequent moving of the head or neck.with subsequent moving of the head or neck.

The rescuer should call for help and activate the EMS system if The rescuer should call for help and activate the EMS system if the victim is unresponsive.the victim is unresponsive.



Restoring the airwayRestoring the airway After calling for help, the rescuer should open the victim’s After calling for help, the rescuer should open the victim’s

airway.airway. Use the head-tilt/chin-lift method in most cases.Use the head-tilt/chin-lift method in most cases. Use the jaw-thrust method when neck injury may be present.Use the jaw-thrust method when neck injury may be present.







Restoring ventilationRestoring ventilation Before attempting to provide artificial ventilation, the rescuer Before attempting to provide artificial ventilation, the rescuer

should assess for the presence of breathing.should assess for the presence of breathing.

The rescuer should place his ear over the victim’s mouth and The rescuer should place his ear over the victim’s mouth and nose to listen for breathing while looking at the chest wall for nose to listen for breathing while looking at the chest wall for movement for 3 to 5 seconds.movement for 3 to 5 seconds.





Mouth-to-mouth ventilationMouth-to-mouth ventilation The rescuer should take a deep breath and exhale directly into The rescuer should take a deep breath and exhale directly into

the victim’s mouth over 1 second to produce visible chest rise.the victim’s mouth over 1 second to produce visible chest rise.

Exhaled air has 16% oxygen.Exhaled air has 16% oxygen.

Children should be given smaller volumes.Children should be given smaller volumes.

Excessive volumes can cause gastric distention. Excessive volumes can cause gastric distention.





Restoring circulationRestoring circulation After two rescue breaths, the rescuer should check to see if a After two rescue breaths, the rescuer should check to see if a

pulse is present.pulse is present.

Palpate the carotid artery in adults and children older than 1 Palpate the carotid artery in adults and children older than 1 year.year.

If no pulse is present, external cardiac compressions must be If no pulse is present, external cardiac compressions must be interposed with ventilatory support.interposed with ventilatory support.





Providing chest compressionsProviding chest compressions The rescuer should compress the lower half of the sternum at a The rescuer should compress the lower half of the sternum at a

rate of 100/min.rate of 100/min.

Good compressions can produce a cardiac output that is one-Good compressions can produce a cardiac output that is one-fourth of normal with a blood pressure of 60 to 80 mm Hg.fourth of normal with a blood pressure of 60 to 80 mm Hg.





Chest compressions under specialChest compressions under special circumstancescircumstances Near drowning: victims need to be moved to a firm surface; Near drowning: victims need to be moved to a firm surface;

compressions in the water not likely to be effective.compressions in the water not likely to be effective.

Electrical shock: victim still in contact with source of electricity Electrical shock: victim still in contact with source of electricity should not be touched; the power must be turned off first.should not be touched; the power must be turned off first.



One- versus two-rescuer adult CPROne- versus two-rescuer adult CPR Single rescuer gives 30 compressions to two breaths for adults, Single rescuer gives 30 compressions to two breaths for adults,

children, and infants until help arrives.children, and infants until help arrives.

When two rescuers are present, one provides ventilation while When two rescuers are present, one provides ventilation while the other provides compressions (30:2 for adults; 15:2 for the other provides compressions (30:2 for adults; 15:2 for children and infants).children and infants).



One- versus two-rescuer adult CPR (cont.)One- versus two-rescuer adult CPR (cont.) Rescue attempts should continue untilRescue attempts should continue until

Advanced life support is available,Advanced life support is available, The rescuers note spontaneous pulse and breathing,The rescuers note spontaneous pulse and breathing, OrOr a physician pronounces the victim dead. a physician pronounces the victim dead.



Automated external defibrillationAutomated external defibrillation Defibrillation is to be done after the airway has been established Defibrillation is to be done after the airway has been established

and CPR initiated.and CPR initiated.

This recommendation is based on the fact that ventricular This recommendation is based on the fact that ventricular fibrillation is very common in victims of sudden cardiac arrest.fibrillation is very common in victims of sudden cardiac arrest.

It should be done has soon as possible following a witnessed It should be done has soon as possible following a witnessed cardiac arrest.cardiac arrest.



Evaluating the effectiveness of CPREvaluating the effectiveness of CPR Observe the chest wall rise and fall.Observe the chest wall rise and fall.

Compressions at a rate of 100/min with a depth of 1½ to 2 Compressions at a rate of 100/min with a depth of 1½ to 2 inches (for adults) are most effective.inches (for adults) are most effective.

Allow the chest to recoil completely after each compression. Allow the chest to recoil completely after each compression.



Hazards and complicationsHazards and complications Neck injuries can be aggravated.Neck injuries can be aggravated.

Gastric inflationGastric inflation

VomitingVomiting

Internal traumaInternal trauma

Advancement of foreign objects in the upper airwayAdvancement of foreign objects in the upper airway



Health concerns of CPRHealth concerns of CPR Risk of disease transmission during mouth-to-mouth Risk of disease transmission during mouth-to-mouth

resuscitation is small.resuscitation is small.

Use of an appropriate barrier device (e.g., pocket mask) will Use of an appropriate barrier device (e.g., pocket mask) will reduce the risk of disease transmission.reduce the risk of disease transmission.



Dealing with an obstructed airwayDealing with an obstructed airway Conscious victim with obstructed upper airway will usually Conscious victim with obstructed upper airway will usually

clutch his or her throat (universal distress signal).clutch his or her throat (universal distress signal).

Abdominal thrusts should be used to clear the obstruction.Abdominal thrusts should be used to clear the obstruction.

Back blows and chest thrusts can be used with infants and Back blows and chest thrusts can be used with infants and pregnant women.pregnant women.



Evaluating the effectiveness of foreign body removalEvaluating the effectiveness of foreign body removal Confirmed expulsion of the foreign bodyConfirmed expulsion of the foreign body

Clear breathing and the ability to speakClear breathing and the ability to speak

Return of consciousnessReturn of consciousness

Return of normal colorReturn of normal color


Advanced Cardiovascular Life Advanced Cardiovascular Life Support (ACLS)Support (ACLS)

ACLS includesACLS includes Using accessory equipment to support ventilation and Using accessory equipment to support ventilation and

oxygenationoxygenation

Monitoring the ECGMonitoring the ECG

Establishing an intravenous route for drugsEstablishing an intravenous route for drugs

Applying selected pharmacological agents and electrical Applying selected pharmacological agents and electrical therapiestherapies


Advanced Cardiovascular Life Advanced Cardiovascular Life Support (ACLS) (cont.)Support (ACLS) (cont.)

Support for oxygenationSupport for oxygenation The highest concentration of oxygen should be administered as The highest concentration of oxygen should be administered as

soon as possible. soon as possible.

Concerns about oxygen toxicity are not valid.Concerns about oxygen toxicity are not valid.



Airway managementAirway management Pharyngeal airways can help restore airway patency and Pharyngeal airways can help restore airway patency and

improve ventilation, especially when using a bag-valve-mask.improve ventilation, especially when using a bag-valve-mask.

Two types existTwo types exist NasopharyngealNasopharyngeal Oropharyngeal Oropharyngeal





Endotracheal intubationEndotracheal intubation Allows the delivery of ventilations that are nonsynchronous with Allows the delivery of ventilations that are nonsynchronous with

chest compressionchest compression

Restores airway patencyRestores airway patency

Maintains adequate ventilationMaintains adequate ventilation

Reduce the risk of aspirationReduce the risk of aspiration



Endotracheal intubation (cont.)Endotracheal intubation (cont.) Provides access for clearance of secretionsProvides access for clearance of secretions

Provides an alternate route for drug administration Provides an alternate route for drug administration

It is the preferred method for securing the airway during CPR.It is the preferred method for securing the airway during CPR.



VentilationVentilation Health care providers who respond to cardiac arrests should be Health care providers who respond to cardiac arrests should be

trained in the use of bag-valve-masks.trained in the use of bag-valve-masks.

The rescuer should deliver tidal volumes adequate to produce The rescuer should deliver tidal volumes adequate to produce visible chest rise over 1 second.visible chest rise over 1 second.



Restoring cardiac functionRestoring cardiac function ECG monitoring during CPR should be started as soon as ECG monitoring during CPR should be started as soon as

possible.possible.

Rescuers may seeRescuers may see Ventricular tachycardiaVentricular tachycardia Ventricular fibrillationVentricular fibrillation Supraventricular tachycardiaSupraventricular tachycardia Pulseless electrical activityPulseless electrical activity



Pharmacological interventionPharmacological intervention Unless and central vein is already cannulated, the ideal route Unless and central vein is already cannulated, the ideal route

for drug administration during CPR is the peripheral IV line.for drug administration during CPR is the peripheral IV line.

Drugs are given by rapid bolus injection.Drugs are given by rapid bolus injection.

Selected drugs such as epinephrine, lidocaine, and atropine Selected drugs such as epinephrine, lidocaine, and atropine also may be given through the endotracheal tube.also may be given through the endotracheal tube.



Electrical therapyElectrical therapy Defibrillation is an unsynchronized shock used to Defibrillation is an unsynchronized shock used to

simultaneously depolarize the myocardial fibers.simultaneously depolarize the myocardial fibers.

It is the definitive treatment for ventricular tachycardia and It is the definitive treatment for ventricular tachycardia and pulseless ventricular tachycardia.pulseless ventricular tachycardia.



Electrical therapy (cont.)Electrical therapy (cont.) Cardioversion is slightly different than defibrillation.Cardioversion is slightly different than defibrillation.

The shock is synchronized.The shock is synchronized. The shock uses less energy.The shock uses less energy.

Electrical pacing: intermittently timed, low-energy discharges to Electrical pacing: intermittently timed, low-energy discharges to pace the heartpace the heart



Monitoring during ACLSMonitoring during ACLS Usually limited to ECG, pulse, blood pressure, and intermittent Usually limited to ECG, pulse, blood pressure, and intermittent

arterial blood gas samplingarterial blood gas sampling

The ECG provides the basis for selecting various drugs and The ECG provides the basis for selecting various drugs and electrical therapies during CPR.electrical therapies during CPR.

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Chapter 34 Emergency Cardiovascular Life Support.

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