VII: Cardiac Emergencies
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 a heart attack (also known as myocardial
infarction) and cardiac arrest.
1. A heart attack refers to a condition in which the blood flow to the heart muscle
is compromised and the heart begins to die.
2. The term cardiac arrest refers to a condition in which the heart stops beating.
Cardiopulmonary resuscitation (CPR) is a combination of chest compressions and rescue
breathing.
Cardiac chain-of-survival:
1. Early recognition and early access
2. Early CPR
3. Early defibrillation
4. Early advanced medical care
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.
Any severe chest pain, pain lasting longer than 3-5 minutes or chest pain accompanied by
other signals of a heart attach should receive emergency medical care immediately.
Other signals include—
1. Trouble breathing.
2. Paleness.
3. Ashen skin or bluish skin, particularly around the face.
4. Skin may also be moist.
As with men, a woman’s most common heart attack signal is chest pain or discomfort.
Women are somewhat more likely to experience other warning signals, particularly—
1. Shortness of breath.
2. Nausea or vomiting.
3. Back or jaw pain.
Care for a Heart Attack
Follow Check—Call—Care.
1. Call 9-1-1 or the local emergency number.
2. Have the victim stop all physical activity.
3. Loosen any restrictive clothing and have the victim rest.
4. Monitor the victim closely.
5. Be prepared to perform CPR or use an AED.
6. Talk to bystanders.
7. Assist the victim.
8. Do not try to drive the victim to the hospital yourself.
9. Demonstrate a calm, reassuring manner.
Angina pectoris develops when the heart needs more oxygen than it gets. When
the coronary arteries are narrow and 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 and therefore helps relieve the
pain. If there is no relief after 10 minutes, call for help.
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 circulation.
Signs of circulation include—
1. Normal breathing.
2. Coughing or movement in response to rescue breaths.
3. A pulse.
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 may not
have shown any warning signals. This condition is called sudden death.
The primary signal of a heart attack is chest pain. Cardiopulmonary resuscitation
(CPR) must be started promptly and followed by rapid advanced life support to give the
victim a chance of survival.
A victim who is in cardiac arrest is unconscious, not breathing and shows no signs
of circulation. CPR can help circulate blood containing oxygen by a combination of chest
compressions and rescue breaths.
CPR for an Adult
When you perform CPR, give cycles of 30 compressions and 2 breaths for an adult.
1. Check scene, then check person
2. Tap shoulder and shout, “Are you OK?”
3. No response, send someone to call 9-1-1
4. Open airway (tilt head, lift chin), check for signs of life (movement and
breathing) for no more than 10 seconds
5. If no signs of life, give 2 rescue breaths
6. Check pulse
7. Position the shoulders over the hands and compress the chest smoothly to a depth
of 1 ½ -2 inches – 30 times at a rate of about 100 compressions/minute.
8. Give 2 rescue breaths
9. Continue CPR
Continue CPR until
1. The scene becomes unsafe
2. The victim shows signs of life
3. An AED becomes readily available and is ready to use
4. You are too exhausted to continue
5. EMS personnel arrive and take over
6. Another trained rescuer arrives and takes over
Cardiac Emergencies in Children and Infants
Children seldom initially suffer a cardiac emergency. They suffer a respiratory
emergency that results in a cardiac emergency.
CPR for a Child
To give CPR to a child, use only the heel of the hand that is closer to the child’s feet.
When giving CPR to a child, do cycles of 30 compressions and 2 breaths.
1. Check scene, then check person
2. Tap shoulder and shout, “Are you OK?”
3. No response, send someone to call 9-1-1
4. Open airway (tilt head, lift chin), check for signs of life (movement and breathing)
for no more than 10 seconds
5. If no signs of life, give 2 rescue breaths
6. Check pulse
7. Place one hand on the forehead and one hand in the middle of the chest and
compress the chest smoothly to a depth of 1-1 ½ inches – 30 times at a rate of about
100 compressions/minute.
8. Give 2 rescue breaths
9. Continue CPR
CPR for an Infant
Unlike adults, infants seldom initially suffer a cardiac emergency. Instead, they suffer a
respiratory emergency that results in a cardiac emergency.
Check an infant’s pulse at the brachial artery and check for other signs of circulation.
Two or three fingers are used to compress the chest.
1.
2.
3.
4.
5.
Check scene, then check infant
Obtain consent from parent or guardian, if present
Flick foot or tap shoulder and shout, “Are you OK?”
No response, call 9-1-1. If alone – give about 2 minutes of care. Then call 9-1-1.
Open airway (tilt head, lift chin), check for signs of life (movement and
breathing) for no more than 10 seconds.
6. If no breathing, give 2 rescue breaths
7. If breaths go in, check for pulse (and severe bleeding).
8. If the infant is not breathing and shows no signs of life, find the finger position in
the center of the chest over the breastbone. Place the other hand on the forehead to
maintain an open airway. Place the pad of your index finger on an imaginary line
between the nipples. Place the pads of the two fingers next to your index finger on
the sternum.
9. Compress the chest smoothly to a depth of about ½ - 1 inch – 30 times at a rate of
at least 100 compressions per minute.
10. Give 2 rescue breaths.
11. Perform 4 more cycles of 30 compressions and 2 rescue breaths (about 2
minutes).
Unconscious Choking Adult
The care for an unconscious choking adult is very similar to the skill of adult CPR.
Chest compressions are used to help force air from the victim’s lungs to dislodge the
object.
The care for an airway obstruction for an unconscious victim is to give CPR and check
for an object in the mouth.
1. Check scene, then check person
2. Tap shoulder and shout, “Are you OK?”
3. No response, send someone to call 9-1-1
4. Open airway (tilt head, lift chin), check for signs of life (movement and breathing)
for no more than 10 seconds
5. If no signs of life, give 2 rescue breaths
6. If the rescue breaths do not go in – reposition the victim’s airway by tilting the
head further back and try 2 rescue breaths again
7. Find the hand position in the middle of the chest and compress the chest 30 times
to a depth of about 1 ½-2 inches.
8. Lift the jaw and tongue and look inside the mouth. If you see an object, remove it
with a finger (finger sweep).
9. Give 2 rescue breaths.
12. If the breaths still do not go in – continue cycles of chest compressions, foreign
object check and rescue breaths.
13. If breaths go in – check signs of life for no more than 10 seconds. If there are no
signs of life – give CPR.
Unconscious Choking Child
1. Check scene, then check person
2. Tap shoulder and shout, “Are you OK?”
3. No response, send someone to call 9-1-1
4. Open airway (tilt head, lift chin), check for signs of life (movement and breathing)
for no more than 10 seconds
5. If no signs of life, give 2 rescue breaths
6. If the rescue breaths do not go in, reposition the child’s airway.
7. If the breaths still do not go in – find the hand position in the middle of the chest
and compress the chest 30 times to a depth of 1-1 ½ inches – 30 times at a rate of
about 100 compressions/minute.
8. Lift the jaw and tongue and look inside the mouth. If you see an object, do a finger
sweep.
9. Give 2 rescue breaths.
10. If the breaths still do not go in – continue cycle of chest compressions, foreign
object check and rescue breaths.
11. If breaths go in – check for signs of life for no more than 10 seconds. If there are
no signs of life – give CPR
Unconscious Choking Infant
1. Check scene, then check infant
2. Obtain consent from parent or guardian, if present
3. Flick foot or tap shoulder and shout, “Are you OK?”
4. No response, call 9-1-1. If alone – give about 2 minutes of care. Then call 9-11.
5. Open airway (tilt head, lift chin), check for signs of life (movement and
breathing) for no more than 10 seconds.
6. If no breathing, give 2 rescue breaths
7. If the rescue breaths do not go in, reposition the infant’s airway and try again.
8. If breaths still do not go in – find the finger position in the center of the chest
over the breastbone. Place the other hand on the forehead. Place 2-3 fingers on an
imaginary line between the nipples.
9. Compress the chest smoothly to a depth of about ½-1 inch – 30 times at a rate
of at least 100 compressions per minute.
10. Lift the jaw and tongue and look inside the mouth. If you see an object,
remove it with your little finger. 11. Give 2 rescue breaths.
12. If the breaths still do not go in – continue cycles of chest compressions,
foreign object check and rescue breaths.
13. If the breaths go in – check for signs of life and a pulse for no more than 10
seconds.
14. If there are no signs of life or a pulse – give CPR
Using an AED
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 percent. The sooner the shock is administered, the greater the likelihood of the
victim’s survival.
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. This
shock, called defibrillation, may help the heart reestablish an effective rhythm.
Defibrillation is not intended to restart a heart without any electrical activity.
When using an AED, follow these precautions:
1. Do not touch the victim while the AED is analyzing.
2. Do not touch the victim while defibrillating.
3. Do not use alcohol to wipe the victim’s chest dry.
4. Do not defibrillate someone around flammable materials.
5. Do not use an AED in a moving vehicle.
6. Do not use an AED on a victim in contact with water.
7. Do not use and AED and/or electrode pads designed for adult victims on an
infant or a child under age 8 or weighing less than 55 pounds.
8. Do not use an AED on a victim wearing a nitroglycerin patch on the chest.
9. Do not use a mobile phone or conduct radio transmission within 6 feet of the
AED.
10. Do not place the pads directly over a pacemaker or other implanted device.
Most cardiac arrests in children are not sudden. The most common causes of cardiac
arrest in children are—
1. Airway problems.
2. Breathing problems.
3. Trauma or an accident.
4. A hard blow to the chest.
5. Congenital heart disease.
6. Sudden infant death syndrome (SIDS)
AEDs equipped with pediatric AED 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.