Sudden Cardiac Arrest (SCA) SCA is usually due to abnormal heart

rhythms called arrhythmias, the vast majority of which are ventricular fibrillation.

Ventricular fibrillation is a condition in which the heart twitches irregularly so that it can no longer pump oxygenated blood efficiently to the brain, lungs, and other organs.

The cause of SCA is not well understood; many victims have no history of heart disease, or if heart disease is present, it has not functionally impaired them.

Unlike a heart attack, which is the death of muscle tissue from loss of blood supply, many victims of SCA have no prior symptoms.

SCA can strike anyone, at anytime, anywhere.

Most victims die out of hospital without receiving any BLS interventions.

Time is Critical: Minutes Count!0 mins – Respiratory Arrest (breathing stops)4 mins– Cardiac arrest (Heart stops)4-6 mins – Brain damage begins10+ mins – Irreversible brain damage

What is the current treatment of SCA? Chain of Survival

The 4 Links in the Chain of Survival1. First Link: Early Access

Involves the prompt recognition of emergencies that require immediate BLS interventions such as heart attack, stroke, foreign-body airway obstruction, and

respiratory and cardiac arrests. Also include the quick activation of

emergency medical providers. The sooner your community’s Emergency Medical Services (EMS) number is called the sooner advanced life support arrives.

2. Second Link: Early CPR CPR is a set of actions that the rescuer

performs in sequence to assess and support airway, breathing, and circulation as needed.

CPR supports the delivery of oxygen to the brain and heart, through mouth-to-mouth breathing and chest compressions, until the arrival of AED and ACLS.

CPR alone cannot fully resuscitate a person in SCA; because it does nothing to restore normal heart rhythm. While better than no treatment, survival rate is between 2 to 5%.

Victims of out-of-hospital cardiac arrest who receive CPR from bystanders are more than twice as likely to survive as victims who do not receive CPR.

The strength of this link is dependent on the number of lay people trained in CPR and the number of training programs in your community.

3. Third Link: Early Defibrillation Most adults with sudden (witnessed), non-

traumatic cardiac arrest are found to be in Ventricular Fibrillation (VF). VF is an abnormal, chaotic heart rhythm that prevents the heart from pumping blood.

The treatment for VF is defibrillation.

DEFIBRILLATION is the delivery of a shock to the heart that stops VF and allows a normal heart rhythm to resume.

Recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.

Strength of link depends on AED availability.

Survival RatesTime Lapse between Arrest and Defibrillation

Survival from cardiac arrest caused by VF declines by approximately 7% to 10% for each minute without defibrillation.

90% within 1 minute 50% within 5 minutes 30% within 7 minutes 10% within 9-11 minutes 2%-5% beyond 12 minutes

The sooner defibrillation is attempted, the better the victim’s chance of survival.

CPR + Defibrillation In the first few minutes after successful

defibrillation, asystole or bradycardia may be present and the heart may pump ineffectively.

CPR may be needed for several minutes following defibrillation until adequate perfusion is present.

CPR has been shown to double or triple survival from witnessed SCA at many intervals to defibrillation.

4. Fourth Link: Early ACLS ACLS are interventions used to treat and

stabilize adult victims of cardiorespiratory emergencies and resuscitate victims of cardiac arrest.

It includes CPR, basic and advanced airway management, tracheal intubation, medications, electrical therapy, and intravenous (IV) access.

Early ACLS improves survival rate to 20% in communities with EMS system that have sufficient number of responders trained in ACLS (a minimum of 2 ACLS and 2 BLS providers at the scene).

Determinants of Survival from SCA The most important determinant of survival

from sudden cardiac arrest is the presence of a trained rescuer who is ready, willing, able, and equipped to act.

HEART ATTACK AND STROKE: Prevention and BLS Care

Heart Attack A heart attack (acute myocardial infarction)

occurs when the heart muscle does not receive enough oxygen and heart muscle starts to die.

It is caused by blockage in a coronary artery, one of the major blood vessels that supplies blood and oxygen to the heart muscles.

Stroke A stroke (cerebrovascular accident) is the

rapid onset of neurologic problems. It can develop when a blood vessel in the

brain becomes blocked so that an area of

the brain receives no blood and no oxygen, or it can develop when a blood vessel ruptures and bleeds into the brain.

Risk Factors of Heart Attack and Stroke∞ Non-Controllable Factors

Heredity Age Sex or Gender

∞ Controllable Factors Cigarette smoking High blood pressure High blood cholesterol Lack of exercise Obesity Stress Diabetes Heart disease Transient ischemic attacks (TIA’s)

The Warning Signals of Heart Attack-Discomfort, pressure, or pain in the center of the chest, behind the breastbone, which may spread to the shoulder, neck, or arms, and usually lasts more than 3-5 minutes.-Lightheadedness or “feeling dizzy” during the pain.-Fainting or loss of responsiveness.-Sweating or “breaking out in a cold sweat all over” but without fever.-Nausea, usually without vomiting.-Shortness of breath, especially worrisome if the victim is short of breath during the pain, while lying still or resting, or when moving only a little.

The Warning Signals of Stroke-Sudden numbness or weakness of face, arm, or

leg, especially on one side of the body.-Sudden confusion, trouble speaking, or understanding.-Sudden trouble seeing in one or both eyes.-Sudden trouble walking, dizziness, loss of balance, or coordination. -Sudden severe headache with no known cause.

F – Facial droopingA – Arm weaknessS – Slurred speechT – Trouble speakingS – Severe headache

Lay Rescuer BLS Care for Heart Attack Recognize the “signals” and take action. Have the victim sit or lie down. Call EMS immediately. Minutes count! Give the victim supportive care and

reassurance. Be prepared to perform CPR if victim

becomes unresponsive.

Lay Rescuer BLS Care For Stroke Recognize the “signals” and take action. Have the victim sit or lie down. Call EMS immediately. Give the victim supportive care and

reassurance. Be prepared to perform CPR if victim

becomes unresponsive (opening the airway may be all that is needed in the unresponsive patient).

The Sequence of BLS A – Ask for Help/Airway B – Breathing

C – Circulation/Chest Compressions D – Defibrillation

The Adult BLS Algorithm

The Concept of “Call First and Care First”“Call First” in Adults

o Most frequent initial rhythm in witnessed sudden cardiac arrest in adult is VF.

o The most effective treatment for VF is electrical defibrillation.

o EMS system is activated as soon as the victim is found to be unresponsive.

“Care First” in Infants and Childreno Most causes of cardiopulmonary arrests in

infants and children are related to airway or ventilation problems.

o Rescue support (especially rescue breathing) is essential and should be attempted first.

o Rescuer provides approximately 2 minutes of CPR and then activates EMS system.

Exceptions to the “Call First and Care First” Rule

Submersion/near-drowning (“care first,” all ages)

Arrest associated with trauma (“care first,” all ages)

Drug overdose (“care first,” all ages) Cardiac arrest in children known to be at

high risk for arrhythmias (“call first,” all ages)

Proper Hand Placement Area on Chest Place the heel of one hand in the center of

the chest between the nipples.

Chest Compression Techniques Victim is supine on a flat and hard surface. “Push hard and push fast.” Depth of 1 ½ to 2 inches (approx. 4 to 5

cm). Rate of about 100 compressions per

minute. Allow complete chest recoil after each

compression. Equal compression and relaxation times. Minimize interruptions.

When to Stop CPR? AED/Defibrillator Arrives. ALS Providers Take Over. Victim Starts to Move.

Lateral & H.A.I.N.E.S. Recovery Position Use the lateral recovery position if the

victim is unconscious, is breathing effectively and there is no suspected head,

neck or back injury. Use modified H.A.IN.E.S. (high arm in

endangered spine) recovery position if a head, neck or back injury is suspected and the responder is unable to maintain an open airway or has to leave to get help and/or an AED.

Automated External Defibrillators (AEDs)- Biphasic defibrillation

AED PRECAUTIONS:o Do not use alcohol to wipe the victim’s

chest dry. Alcohol is inflammable.o Do not touch the victim while the AED is

analyzing. Touching or moving the victim may affect the analysis.

o Do not touch the victim while defibrillating. You or someone else could get shocked.

o Do not use an AED on a victim who has nitroglycerine or other patch. Remove any patches from the chest before attaching the device.

o Do not use an AED on a victim who is in contact with water. Move victims away from puddles of water or swimming pools or out of the rain before defibrillating.

o Do not use an AED on a victim lying in a conductive surface. Conductive surfaces, such as sheet metal or metal bleachers, may transfer the shock to others.

o Do not defibrillate someone around flammable materials, such as gasoline or free-flowing oxygen.

o Do not use adult pads on a child aged 1 to 8. Use specialized pediatric pads instead.

Use adult pads only on victims aged 8 and older.

o Do not use a cellular phone or radio within 6 feet of the AED. This may interrupt analysis.

o Do not use an AED in a moving vehicle. Movement may affect the analysis.

Placement of AED pads Place one AED pad to the right of the

sternum below the clavicle. Place the other pad in the left mid-axillary

line.

Steps in using an AED When AED arrives, place it at the victim’s

side. POWER – Power on the AED. ATTACH – Attach the pads to the victim,

then attach to AED. ANALYZE – Clear the victim and allow the

AED to analyze the heart rhythm. SHOCK – If the AED advices a shock clear

the victim and press the “shock” button. CPR – After AED gives the shock, begin

CPR starting with chest compressions. RE-ANALYZE – After 2 minutes of CPR,

allow he AED to analyze heart rhythm and follow voice prompts.

Foreign-Body Airway Obstruction Choking Prevention

Cut food into small pieces and chew slowly and thoroughly, especially if wearing dentures.

Avoid laughing and talking excitedly while eating.

Avoid excessive intake of alcohol before and while eating.

Prevent children from walking, running, or playing when they have food in their mouths.

Keep foreign objects (e.g. marbles, beads, thumbtacks) away from infants and children.

Do not give foods that must be thoroughly chewed (e.g. peanuts, peanut butter, popcorn, hot dogs, etc) to young children.

Types of FB Airway Obstruction Mild Airway Obstruction - Victim is responsive and can cough

forcefully. Severe Airway Obstruction - Victim has weak, ineffective coughs,

stridor, increased respiratory difficulty, cyanosis and unconsciousness, also inability to speak or breathe.

- Victim may clutch the neck, demonstrating the universal choking sign.

The Universal Choking Signal: Clutching of hands around the neck

The Conscious Choking Adult Algorithm

The Unconscious Choking Adult Algorithm