Chapter 6
Cardiac Emergencies
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 oxygenrich 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)
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
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
Cardiovascular Emergencies
 Cardiac Chain of Survival: give victim of
cardiac arrest the best chance of survival
1. Early recognition and early access:
sooner 9-1-1 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
Cardiovascular Emergencies
3. 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%
4. Early Advanced Medical Care: given
by trained medical personnel, who
provide further care and transport to
hospital
Signals of
Heart Attack
 Chest pain spreading
shoulders/neck/jaw/arms
 Nausea or vomiting
 Dizziness, light headed
or fainting
* shortness of breath
* sweating
* denial
*pale, ashen (gray) or bluish
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
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
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
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
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
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
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
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”
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 9-1-1
and get an AED
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
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
Child CPR
 Same as for the adult except for
 Give 2 minutes of CPR then call 9-1-1 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)
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)
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
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
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