CARDIAC EMERGENCIES

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Chapter 7

• CARDIAC EMERGENCIES

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THE HEART

• 42 of all deaths
• 1 out of 4 people will die from CVD
• Autopsies from Korean/Vietnam wars
• Average age 22
• 70 had advanced CVD
• Bogalusa study importance of eating right
• Age 2 signs of cholesterol levels
• Japan/Hawaii/San Francisco

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The Amazing Heart

• Beats about 70 x/minute
• 100,000 x/day
• Circulates about a gallon of blood/minute
• Circulates blood through about 60,000 mile of
  blood vessels
• Size of your fist

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• Cardiovascular disease is the
• 1 cause of death in U.S.
• Principle Components
• Coronary heart disease
• Stroke

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RISK FACTORS

• CANT Change
• Genetics
• Age
• Gender
• Race

• CAN Change
• Smoking
• Physical inactivity
• High blood pressure
• High cholesterol
• CONTRIBUTING
• Diabetes
• Obesity
• stress

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TERMS

• Cardiac arrest
• Condition in which heart stops beating
• Heart attack

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HEART ATTACK

• Sudden illness involving the death of heart
  muscle tissue when it does not receive
  oxygen-rich blood
• myocardial infarction
• 25 of victims do not have chest pain

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SIGNALS OF HEART ATTACK

• Persistent chest pain
• Shortness of breath
• Nausea or vomiting
• Dizziness, light-headed or fainting
• Pale, ashen or bluish skin
• Sweating
• denial

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SUDDEN DEATH

• Sudden or unexpected cessation
• of heart function,
• most often caused by a sudden arrhythmia
  (abnormal heart rhythm)

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ANGINA PECTORIS

• pain in the chest
• Hearts need for oxygen not being met
• Associated with physical exertion
• Reversible with no permanent damage
• Pain relieved by rest

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CONGESTIVE HEART FAILURE

• Hearts output of oxygenated blood
• does not meet needs of bodys tissues
• Fluid builds up behind failing left side of heart

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CORONARY HEART DISEASE

• Condition in which a coronary artery
• has been damaged
• 2 Types
• Atherosclerosis
• Arteriosclerosis

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Atherosclerosis

• Condition in which fatty substances build up on
  arterial walls
• Plaque build-up
• Reduction of blood flow through artery
• Leading cause of death from heart attack stroke

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Arteriosclerosis

• Disease condition in which
• arteries lose their elasticity
• Calcium deposits on wall of arteries
• Increase blood pressure
• Hardening of arteries
• (Plaque deposits of atherosclerosis)

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Links in Cardiac Chain of Survival

• Early recognition early access
• Early CPR
• Early defibrillation
• Early advanced life support

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FIRST AID CARE

• NO PULSE CPR
• Rest make comfortable
• Loosen restrictive clothing
• Assist with medications (nitroglycerin)
• 3 to 5 minutes apart
• Monitor vitals signs
• Be ready to perform CPR

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CPR SKILLS

• page 124 (Figure 7-11)

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AEDAutomated External Defibrillator
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Fact

• 1,000 people per day experience Sudden Cardiac
  Arrest (SCA)
• 350,000 people experience SCA per year
• Brain cells begin to die within 4-6 minutes
  without oxygen

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• Every minute that passes from cardiac arrest
  decreases chance of survival 10
• Many adults in VF can survive neurologically
  intact even if defibrillation is performed as
  late a 6-10 minutes after the arrest

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• CPR will not restart the heart (can keep
• oxygen flowing to the brain)
• In Odessa, 7 minutes is average response
• time for EMS

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Misconceptions

• AED
• Too hard to use
• Too dangerous
• Cardiac arrest wont happen to me

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Early Defibrillation is KEY to Survival from SCA

• 74 chance survival if defibrillated within first
  3 minutes

• Can save 100,000 lives per year

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What is an AED?

• A machine that analyzes the hearts rhythm
• Determines whether or not the persons heart is
  in a condition called ventricular fibrillation
  (VF) or ventricular tachycardia (VT)

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• Detects ventricular fibrillation, SHOCK is
  advised
• Shock, called defibrillation, is the only
  definitive treatment to help the heart
  reestablish an effective rhythm
• NO HEART BEAT NO READING !

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• An initial 200-J (joules) shock recommended
  (usually 150-J though), with increases in energy
  levels to either 200 or 300 and then to 360-J for
  subsequent shocks
• (JAMA,1992 268 2211-2)

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Precautions

• Do not touch victim while analyzing
• Do not touch the victim while defibrillating
• Do not use alcohol to wipe the victims chest dry
  flammable!
• Do not defibrillate around flammable materials
  (gas or free-flowing oxygen)

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• Do not use in a moving vehicle
• Do not use on victim lying on a conductive
  surface (sheet metal or metal bleachers)
• Do not use on victim in contact with water

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• Do not use on a child under
• age of 8 or under 55 pounds
• Do not use on victim with nitroglycerin patch on
  chest
• Do not use a cell phone or radio
• 6 feet

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Standard of Care for SCA

• Check Consciousness
• Call 911 and Get an AED
• Perform A-B-Cs
• CPR

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Attach AED Press ANALYZE
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• Press ANALYZE
• AED reading
• (1 shock max.)
• Recheck Pulse
• Perform 1 minute CPR
• Recheck Pulse
• Repeat
• if necessary

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Requirements

• FDA requires medical authorization
• Must be labeled with the prescription statement
  (CFR 801.109)
• Users must be AED certified that matches CPR
  certification (Basic to Professional Rescuer)
• Notify local Fire Department about your AED

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PAD ProgramPublic Access Defibrillation

• Refers to accessibility for trained users to
  use AEDs in public places. Does not mean any
  member of the public should be able to use the
  device.
• Parks
• Swimming pools
• Malls
• Restaurants

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Liability

• Minimal - 2000 President Clinton passed the
  Cardiac Arrest Survival Act --- extends the Good
  Samaritan protection to AED users and acquirers
  with protection from liability
• (Texas) Liability goes back on company of the unit

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Location

• Maximum 5-minute response from
• calltoshock can be achieved
• Easily accessible
• Well-marked
• Ideally near telephone, or fire extinguisher

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You build a successful life a day at a time. Lou
Holtz