Lesson 14: Cardiac Emergencies

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Introduction

• Cardiovascular disease is the leading cause of death for men and women in the United States

• Coronary heart disease is the most common type of cardiovascular disease

• Two common cardiac emergencies are heart attack (also known as myocardial infarction) & cardiac arrest• A heart attack refers to a condition in which the blood

flow to the heart muscle is compromised and the heart begins to die

• The term cardiac arrest refers to a condition in which the heart stops beating

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Cardiac Chain of Survival • Cardiopulmonary resuscitation (CPR) is a

combination of chest compressions and rescue breaths

• Cardiac Chain of Survival: Early recognition and early access Early CPR Early defibrillation Early advanced medical care

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Cardiac Chain of Survival • CPR artificially takes over the functions of

the lungs & heart• Only about 1/3 of the normal blood flow to

the brain. Therefore, CPR alone is not enough

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red Cross

All rights reserved.

Recognizing Signals of a Heart Attack

• Heart attacks are caused by an obstruction in the coronary arteries

• This blockage leads to death of the heart muscle

• Pain is described as: Uncomfortable pressure Squeezing Crushing Tightness Aching Constricting Heavy sensation in the chest

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

• Any severe chest pain, pain lasting longer than 3 to 5 minutes or chest pain accompanied by other signals of a heart attack should receive emergency medical care immediately

• Other signals include: Trouble breathing Paleness Ashen skin or bluish skin, particularly around the

face Skin may also be moist

Recognizing Signals of a Heart Attack(continued)

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Recognizing Signals of a Heart Attack(continued)

• As with men, women’s most common heart attack signal is chest pain or discomfort

• Women are somewhat more likely to experience other warning signals, particularly: Shortness of breath Nausea or vomiting Back or jaw pain

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Care for a Heart Attack• Follow CHECK—CALL—CARE• Call 9-1-1 or the local emergency number• Have the victim stop all physical activity• Loosen any restrictive clothing and have the victim rest• Monitor the victim closely• Be prepared to perform CPR or use an AED• Talk to bystanders to find out what happened• Assist the victim to take prescribed medication• Do not try to drive the victim to the hospital yourself• Aspirin may be given under certain circumstances, after 9-1-1 has been called• Demonstrate a calm, reassuring manner

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Angina Pectoris

• Angina pectoris develops when the heart needs more oxygen than it gets

• When the coronary arteries are narrow & the heart needs more oxygen, heart muscle tissues may not get enough oxygen

• Pain associated with angina seldom lasts longer than 3 to 5 minutes

• Nitroglycerin temporarily widens the arteries & therefore helps relieve the pain

• If there is no relief after 10 minutes, call for help

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Cardiac Arrest• Cardiac arrest occurs when the heart stops beating or

beats too ineffectively to generate a pulse and blood cannot be circulated to the brain and other vital organs

• A victim in cardiac arrest is unconscious and shows no signs of life

• Causes:– Cardiovascular disease– Drowning– Suffocation– Certain drugs– Severe blood loss– Electrocution– Stroke– Other types of brain damage

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Cardiac Arrest(continued)

• Signs of life include: Normal breathing Movement A pulse (for children & infants)

• The victim’s skin may be pale, ashen or bluish, particularly around the face. The face may also be moist from perspiration

• In some cases, a victim of cardiac arrest may not have shown any warning signals. This condition is called sudden death

Lesson 15: CPR & Unconscious Choking: Adult/Child/Infant

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Introduction

• An adult victim who is in cardiac arrest is unconscious and shows no signs of life.

• CPR can help circulate blood containing oxygen by a combination of chest compressions (1.5 to 2 in) and rescue breaths.

• When you perform CPR, give cycles of 30 compressions and 2 rescue breaths for an adult.

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Unconscious Choking: Adult

• The care for an unconscious choking adult is very similar to the skill of adult CPR, except that you look for a foreign object in the victim’s mouth between compressions & breaths

• Chest compressions are used to help force air from the victim’s lungs to dislodge a foreign object

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Child Introduction

• Children seldom initially suffer a cardiac emergency. Instead, they suffer a respiratory emergency that results in a cardiac emergency

• Use the emergency action steps: CHECK—CALL—CARE to determine if you need to perform CPR

• A child is in cardiac arrest if he or she is unconscious, shows no signs of life (movement or breathing) including no pulse

• CPR can help circulate blood containing oxygen through a combination of chest compressions and rescue breaths

• When you perform CPR, give cycles of 30 compressions and 2 rescue breaths for a child.

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Unconscious Choking: Child

• The care for an unconscious choking child is very similar to the skill of child CPR except that you look for a foreign object in the child’s mouth between compressions and breaths

• Chest compressions (1-1 ½ ) are used to help force air from the child’s lungs to dislodge the object

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Introduction• Unlike adults, infants seldom initially suffer a

cardiac emergency. Instead, they suffer a respiratory emergency that results in a cardiac emergency

• An infant is in cardiac arrest if he or she is unconscious, shows not signs of life (movement and breathing) including no pulse in an infant

• CPR can help circulate blood containing oxygen through a combination of chest compressions (1/2 -1in) & rescue breaths

• When you perform CPR, give cycles of 30 compressions and 2 breaths for an infant

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Unconscious Choking:Infant

• If you attempt rescue breaths but are unable to make the chest clearly rise, you must act quickly to get air into the infant.

• Care for an unconscious choking infant is very similar to the skill of infant CPR, with the exception that you look for a foreign object in the mouth between compressions and breaths

• Chest compressions are used to help force air from the infant’s lungs to dislodge the object

Lesson 18: Adult AED (Automated External Defibrillation)

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Introduction

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Introduction(continued)

• Most victims of sudden cardiac arrest need an electric shock, called defibrillation

• Each minute that defibrillation is delayed reduces the victim’s chances of survival by about 10%

• The sooner the shock is administered, the greater the likelihood of the victim’s survival

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Automated External Defibrillation

• Disease or injury can disrupt the heart’s electrical system and damage the heart

• An automated external defibrillator (AED) is a machine that analyzes the heart’s rhythm and, if necessary, tells you to deliver a shock to a victim of a sudden cardiac arrest

• Defibrillation is an electric shock that interrupts the heart’s chaotic electrical activity during sudden cardiac arrest, which is most commonly caused by an abnormal rhythms such as ventricular fibrillation. The shock may help restore the heart’s ability to function as a pump

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Safety Precautions When Using an AED

• When using an AED, follow these precautions: Do not touch the victim while the AED is analyzing Do not touch the victim while defibrillating Do not use alcohol to wipe the victim’s chest dry Do not defibrillate someone around flammable

materials Do not use an AED in a moving vehicle Do not use an AED on a victim in contact with water Do not use an AED and/or electrode pads designed for

adult victims & child under age 8 or weighing less than 55 pounds unless pediatric pads specific to the device are not available

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Safety Precautions When Using an AED(continued)

Do not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest

Do not use a mobile phone or conduct radio transmission within 6 feet of the AED

Do not place the pads directly over a pacemaker or other implanted device

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Using and AED Introduction

• Each minute that defibrillation is delayed reduces the victim’s chances of survival by about 10%

• The sooner the shock is administered, the greater the likelihood of the victim’s survival

Adult AED

Infant/Child AED

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Automated External Defibrillation

• Ventricular fibrillation is a type of an abnormal heart rhythm that can occur in young children.

• Most cardiac arrests in children are not sudden. The most common causes of cardiac arrest in children are: Airway problems Breathing problems Trauma or an accident A hard blow to the chest (Commotio Cordis) Congenital heart disease Sudden infant death syndrome (SIDS)

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Automated External Defibrillation(continued)

• AEDs equipped with pediatric AED pads are capable of delivering lower levels of energy (Joules) to a victim between the ages of 1 & 8 or weighing less than 55 lbs

• Pediatric pads should not be used on adult victims

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Safety Precautions When Using an Infant/Child AED

• When using an AED, follow these precautions: Do not touch the child while the AED is analyzing Do not touch the child while defibrillating Do not use alcohol to wipe the child’s chest dry Do not defibrillate someone around flammable

materials Do not use an AED in a moving vehicle Do not use an AED on a child in contact with

water

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

– Do not use an AED and/or electrode pads designed for adult victims on a child under age 8 or weighing less than 55 pounds unless pediatric pads specific to the device are not available

– Do not use a mobile phone or radio within 6 feet of the AED

Safety Precautions When Using an Infant/Child AED

(continued)

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing Cardiac Emergencies

• The primary signal of a heart attack is chest pain• CPR helps to circulate blood and oxygen to the brain and vital organs when

the heart stops• It is vital to call 9-1-1 or the local emergency number immediately• CPR must be started promptly and followed by rapid advanced life support

to give the victim a chance of survival• Utilizing each link of the Cardiac Chain of Survival is essential for the victim

to have the best chance of survival and recovery

• Questions?

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing Choking Adult: Unconscious

• When performing CPR on an adult, give 30 chest compressions at a rate of about 100 compressions per minute, followed by 2 breaths

• The care for an unconscious choking adult is very similar to the skill of adult CPR, except that you look for a foreign object in the victim’s mouth between compressions and breaths

• Questions?

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing Choking Child Unconscious

• Recognize the signals of a respiratory emergency quickly. Often children suffer a respiratory emergency that can ultimately lead to a cardiac emergency

• When giving CPR to a child, do cycles of 30 compressions and 2 breaths, at a rate of about 100 compressions per minute

• The care for an unconscious child is very similar to the skill of child CPR, except that you look for a foreign object in the child’s mouth between compressions and breaths

• Questions?

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing Choking Infant Unconcsious

• When giving CPR to an infant, use 2-3 fingers to compress the chest, while maintaining an open airway

• When giving CPR to an infant, do cycles of 30 compressions and 2 breaths, at a rate of about 100 compressions per minute

• Care for an unconscious choking infant is very similar to the skill of infant CPR, with the exception that you look for a foreign object in the mouth between compressions and breaths

• Questions?

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing Using AED on a Infant/Child

• Ventricular fibrillation is a type of abnormal heart rhythm• This abnormal heart rhythm can occur in young children• An AED is a machine that analyzes the heart’s rhythm and,

if necessary, tells you to deliver a shock to a victim of sudden cardiac arrest

• This shock, called defibrillation, may help the heart reestablish an effective rhythm

• AEDs equipped with pediatric pads are capable of delivering lower levels of energy to a victim between the ages of 1 and 8 or weighing less than 55 pounds

• Questions?

AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITIONCopyright © 2005, revised edition 2007, by The American National Red CrossAll rights reserved.

Closing

• Ventricular fibrillation is a type of abnormal heart rhythm

• This abnormal heart rhythm can occur in young children

• An AED is a machine that analyzes the heart’s rhythm and, if necessary, tells you to deliver a shock to a victim of sudden cardiac arrest

• This shock, called defibrillation, may help the heart reestablish an effective rhythm.

• Questions?

Basic CPR Guidelines for Performing All Levels

Action Adult Child1 – Puberty

InfantLess than 1 Year

Establish ResponsivenessPhone EMS immediately

Phone EMS immediatelyIf you are alone – Give 5 cycles of CPR & THEN call EMS

Open Airway Use  Head Tilt/Chin Lift

Check for Breathing

Open the airway -  LOOK, LISTEN & FEELTake between 5 to 10 seconds

Breaths - If not breathingGive 2 breaths that make the chest rise

1 Second each

Begin CPR

If unresponsive  -  Immediately begin CPR – Chest CompressionsPush hard and push fast

Allow the chest to recoil fully after each compressionDON'T STOP

Location of Compression Centre of breastbone between nipplesJust below nipple line on

breast bone

Method of Compression Two Hands – heel of one hand on top of the other – May use one hand for child

Two fingers

Depth of Compression 1½ to 2 in.  or 4 -5  cm

1-1 ½ in. Child, .5-1 in. Infant

Rate Of Compression 100 Per minute

Compression/ Ventilation Ratios

30:2