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Cardiac Arrest

What is cardiac arrest? What causes cardiac arrest? Can cardiac arrest be reversed? How many people survive cardiac arrest? What can be done to increase the survival rate?

Basic Life Support

What is CPR?

10 CPR KNOWLEDGE QUESTIONS

How often should I stop CPR to check for signs of life? What about compression-only CPR? How much of the heart's pumping does CPR really simulate? I'm worried that I might further injure someone by moving them after an accident. What should I do? Why don't you cover 2-person CPR on your site? How much good can it really do to breathe carbon dioxide into someone's lungs out of yours? How do you know if the CPR you're doing is working?

Initial Assessment: Child: 1. How far do you tilt the child’s head to open the airway? Infant: 1. How do you check an infant for consciousness? 2. How far do you tilt an infant’s head to open the airway? 3. How do you check an infant’s pulse? Adult: 1. When using a BVM, how often should you give rescue breaths? Child: 1. How far do you tilt the child’s head to open the airway? 2. When using a BVM, how often should you give rescue breaths? Infant: 1. How far do you tilt an infant’s head to open the airway? 2. When using a BVM, how often should you give rescue breaths? Conscious Choking—Adult and Child Adult: 1. To give back blows or abdominal thrusts, where would you position yourself? 2. What if the victim is obviously pregnant, known to be pregnant or too large to reach around? Child: 1. For a child, from whom would you obtain consent to give care? 2. To give back blows or abdominal thrusts, where would you position yourself? 3. When giving back blows or abdominal thrusts, what is one key item about the amount of force to use to keep in mind? Unconscious Choking—Adult and Child Adult: 1. If the first 2 rescue breaths do not make the chest clearly rise, what is your next step? 2. How far do you compress the chest of an adult? 3. What if the adult is obviously pregnant or known to be pregnant? 4. If you see the object, how do you remove it from the victim’s mouth? Child: 1. If the first 2 rescue breaths do not make the chest clearly rise, what is your next step? 2. How far do you compress the chest of a child? 3. If you see the object, how do you remove it from the child’s mouth? CPR—Adult, Child and Infant Adult: 1. How far do you compress the chest of an adult? 2. What if the adult is obviously pregnant or known to be pregnant? 3. What is the correct way to place your hands to give compressions for an adult? Child: 1. How far do you tilt the child’s head to open the airway? 2. How far do you compress the chest of a child? 3. What is the correct way to place your hands to give compressions for a child? Infant 1. How far do you compress the chest of an infant? 2. What is the correct way to place your hands to give compressions for an infant? Rate of CPR compressions 1. What is the rate of compressions for an adult, child and infant? Two-Rescuer CPR—Adult, Child and Infant Adult: 1. How far do you compress the chest of an adult? 2. What if the adult is obviously pregnant or known to be pregnant? 3. What is the ratio of compressions to breaths for an adult in two rescuer CPR? 4. The two rescuers should change positions regularly. When? Child: 1. How far do you tilt the child’s head to open the airway? 2. How far do you compress the chest of a child? 3. What is the ratio of compressions to breaths for a child in two rescuer CPR? 4. The two rescuers should change positions regularly. When? Infant: 1. What is the correct hand position for two rescuer CPR compressions on an infant? 2. What is the ratio of compressions to breaths for a infant in two rescuer CPR? AED—Adult and Child Adult: 1. Where do you attach the AED pads for an adult? Child: 1. Where do you attach the AED pads for a child? Initial Assessment: Child: 1. How far do you tilt the child’s head to open the airway? Infant: 1. How do you check an infant for consciousness? 2. How far do you tilt an infant’s head to open the airway? 3. How do you check an infant’s pulse? Adult: 1. When using a BVM, how often should you give rescue breaths? Child: 1. How far do you tilt the child’s head to open the airway? 2. When using a BVM, how often should you give rescue breaths? Infant: 1. How far do you tilt an infant’s head to open the airway? 2. When using a BVM, how often should you give rescue breaths? Adult: 1. To give back blows or abdominal thrusts, where would you position yourself? 2. What if the victim is obviously pregnant, known to be pregnant or too large to reach around? Child: 1. For a child, from whom would you obtain consent to give care? 2. To give back blows or abdominal thrusts, where would you position yourself? 3. When giving back blows or abdominal thrusts, what is one key item about the amount of force to use to keep in mind? Adult: 1. If the first 2 rescue breaths do not make the chest clearly rise, what is your next step? 2. How far do you compress the chest of an adult? About 1 1 /2 to 2 inches 3. What if the adult is obviously pregnant or known to be pregnant? 4. If you see the object, how do you remove it from the victim’s mouth? Child: 1. If the first 2 rescue breaths do not make the chest clearly rise, what is your next step? 2. How far do you compress the chest of a child? About 1 to 1 1 /2 inches 3. If you see the object, how do you remove it from the child’s mouth? CPR—Adult, Child and Infant Adult: 1. How far do you compress the chest of an adult? About 1 1 /2 to 2 inches 2. What if the adult is obviously pregnant or known to be pregnant? 3. What is the correct way to place your hands to give compressions for an adult? Child: 1. How far do you tilt the child’s head to open the airway? 2. How far do you compress the chest of a child? 3. What is the correct way to place your hands to give compressions for a child? Infant 1. How far do you compress the chest of an infant? 2. What is the correct way to place your hands to give compressions for an infant? Rate of CPR compressions 1. What is the rate of compressions for an adult, child and infant? Two-Rescuer CPR—Adult, Child and Infant 1. How far do you compress the chest of an adult? 2. What if the adult is obviously pregnant or known to be pregnant? 3. What is the ratio of compressions to breaths for an adult in two rescuer CPR? 4. The two rescuers should change positions regularly. When? Child: 1. How far do you tilt the child’s head to open the airway? 2. How far do you compress the chest of a child? 3. What is the ratio of compressions to breaths for a child in two rescuer CPR? 4. The two rescuers should change positions regularly. When? Infant: 1. What is the correct hand position for two rescuer CPR compressions on an infant? 2. What is the ratio of compressions to breaths for a infant in two rescuer CPR? AED—Adult and Child Adult: 1. Where do you attach the AED pads for an adult? Child: 1. Where do you attach the AED pads for a child?

* During the CPR, what is the percentage of heart efficiency as a pump? * I heard that no matter if a person is unconscious that you should perform CPR. Is this true? When should you not perform CPR? * What is the ratio of 2-person CPR? * How do I perform CPR on a person who has a trachea? Do I have to cover their mouth or just breath directly into the stoma? * When you are giving mouth to mouth are you actually breathing oxygen into the victim's lungs or are you trying to stimulate breathing by breathing carbon dioxide into their lungs? * When performing CPR, how do I know if its working? * If a person has had bypass surgery, and a situation occurs that they require CPR, are there any special considerations that need to be made? * What if the victim has a pulse, but is not breathing? * Is it easier to break an overweight persons ribs or a skinner persons ribs when performing cpr? * Can I kill someone if I do CPR incorrectly? * What if I crack a rib when I do CPR? * Will CPR always save a life? * What is the recovery position? * What should you do for a person who has been accidentally shocked by electricity? * I want to know what the current teachings are on helping a choking victim. I have heard conflicting information on back blows for an adult. Is it still recommended, or discouraged? * What if the victim vomits? * If someone has an asthma attack and collapses, what should a person do? Will CPR help? * What are some of the causes of CPR being used for in infants and children? * In regards to administering the Heimlich Maneuver to a victim while they are lying down. Should the head be facing up, as when administering CPR (in order to clear the airway), or to the side? * What if the victim is wearing dentures? * Can I get AIDS from doing CPR? * Can I get sued if I perform CPR? * Does the Good Samaritan law protect me? * What are agonal respirations? * In cardiopulmonary arrest occurring outside of a hospital what are statistics regarding successful uncomplicated recovery? Also in this situation how many patients are successfully resuscitated but are then in a vegetative state? * Can CPR be performed on dogs? * What if I'm not sure whether I feel a pulse in the neck of the victim? * If a person moves when I do CPR should I stop? * When should I stop CPR? * What chance does the person (on whom I perform CPR) have of surviving? * What should I do if I'm alone and I do not know CPR? * If a pregnant women chokes should I do the Heimlich Maneuver or can it harm the baby? * What is the reason calling 911 occurs after 1 minute of CPR for infants and children whereas for adults, the call is made immediately? * If successful CPR is dependent on a defibrillator arriving, are there any portable defibrillators available? * In a trekking guidebook I own it states that if there has been a trauma fall and the victim has no pulse, then CPR is futile, is this true? * Is it true that if a victim "regains" a pulse after doing CPR he/she has probably had a pulse all along?

1. How far down should the sternum be depressed while performing a chest compression on a child? 2. How far down should the sternum be depressed while performing a chest compression on an adult? 3. How far down should the sternum be depressed while performing a chest compression on an Infant? 4. What is the AHA age range for Adult procedures? 5. What is the AHA Basic Life Support age range for Infant procedures? 6. What is the AHA age range for child procedures? 7. When rescue breathing for an Infant with a pulse, give one ventilation every? 8. When rescue breathing for an Adult with a pulse, give one ventilation every? 9. When rescue breathing for a Child with a pulse, give one ventilation every? 10. How would you describe hand placement on the chest to perform a compression on an Infant? 11. How would you describe hand placement on the chest to perform a compression on an Adult? 12. How would you describe hand placement on the chest to perform a compression on a Child? 13. What is the rate of chest compressions for an Adult in one minute? 14. What is the rate of chest compressions for a Child in one minute? 15. What is the rate of chest compressions for an Infant in one minute? 16. When do you get help for an unresponsive Adult victim? 17. When do you get help for an unresponsive Child or Infant victim, when you are alone? 18. What is the step just before you ventilate in the CAB's? 19. Which of the following choices are the most modifiable risk factors for stroke and heart attack? 20. What is the most common cardiac rhythm that an adult is most likely to experience in early cardiac arrest? 21. How old should an adult victim be to have an automated external defibrillator (AED) placed on them? 22. What is the ratio of compressions to ventilations when performing one rescuer CPR on an Adult? 23. What is the ratio of compressions to ventilations when performing two rescuer CPR on an Adult? 24. What is the ratio of compressions to ventilations when performing one rescuer CPR on an Infant? 25. What is the ratio of compressions to ventilations when performing one rescuer CPR on an Child? 26. What is the ratio of compressions to ventilations when performing two rescuer CPR on a 3 week old according to the AHA Basic Life Support Healthcare Provider Standard course? 27. Pulse check location for a Child? 28. When do you reassess a victim once CPR is started? 29. A bag-valve-mask device is preferred to ventilate a non-breathing victim over a mouth-to mask device. 30. A mouth-to-mask device delivers greater tidal volume of air compared to a bag-valve-mask. 31. Why is it not advisable to do a blind finger sweep on unconscious choking infants and children? 32. When do you get help for a conscious choking adult, if you are alone? 33. When delivering ventilations to a non-breathing victim using room air only, each ventilation should be delivered over? 34. When providing a chest compression your hands should allow the chest to reach full recoil. 35. When evaluating a conscious choking persons airway for blockage, which of the following questions would be the least preferred for the rescuer to ask? 36. List three reasons when chest thrusts would be performed on a conscious choking victim instead of abdominal thrusts. 37. What are the three most common reasons that lead to gastric distention (air in the stomach)? 38. Approximately 75% of heart attack victims experience chest pain. 39. When using a bag-valve-mask as a single rescuer how is the mask held to the face? 40. What is the preferred method to open the airway of a non-trauma victim? 41. What is the AHA Chain of Survival when treating an Adult cardiac arrest? 42. The goal to save an Adult cardiac arrest is? 43. When is compression only CPR recommended with no ventilations in this country? 44. How long should the initial pulse check last? 45. What is the name given to the position of placing the victim on their side?

Q. What is CPR? Q. Who regulates CPR? Q. How often do the CPR guidelines change? Q. Does the change from ABC to CAB CPR apply to everyone? Q. Why did the AHA guidelines change so significantly? Q. What are the main characteristics of high quality chest compressions? Q. Why is continuous chest compression CPR often just as effective as traditional CPR? Q. Why not do away with rescue breathing completely? Q. If I learnt the old CPR do I need to stop administering CPR until I become certified in the new CAB way? Q. If I have recently passed my CPR certification, do I have to recertify in accordance with the new AHA guidelines? Q. Can I kill someone by giving CPR the wrong way? Q. How often does CPR save someone’s life? Q. What are the Good Samaritan Laws and will they protect me from being sued? Q. Can CPR be used on animals? Q. Ok I am convinced! Where should I take my CPR classes?

What is Hands-OnlyTM CPR?

Do you have questions on how to do CPR? If someone collapses near you do you know what to do?

1. Are you __________ Certified? 2. How long is your course(s)? Do I have to finish it all in one sitting? 3. How are your instructors trained? 4. How long will it take to receive my wallet certification card? 5. What if I don't pass the quiz at the end of the course? 6. Does your course require an outside hands-on test? 7. How much do your courses cost? 8. What happens once I've taken the __________' online course? 9. How long are your courses good for? 10. Is your certification accepted by my state? 11. What are my choices for a method of payment? 12. How do I print my certification once I have passed? 13. What is an AED?

CPR information STANDARD CPR FOR ADULTS - CPR in three simple steps HANDS-ONLY CPR FOR ADULTS - CPR in two simple steps CPR FOR CHILDREN - CPR in three steps for small children CPR FOR INFANTS - CPR for infants in five simple steps STANDARD CPR POCKET GUIDE - Printable CPR instructions HANDS-ONLY CPR POCKET GUIDE - Printable CPR instructions CPR FOR CATS & DOGS - CPR instructions for your family pet STANDARD CPR FOR ADULTS VIDEO - Standard CPR techniques for adults HANDS-ONLY CPR FOR ADULTS VIDEO - Hands-only CPR techniques for adults CPR FOR CHILDREN VIDEO - CPR techniques for children CPR FOR INFANTS VIDEO - CPR techniques for infants CHOKING ADULT VIDEO - First aid for a choking conscious adult CHOKING CHILD VIDEO - First aid for a choking conscious child CHOKING INFANT VIDEO - First aid for a choking conscious infant FREE iPHONE APP - Take the videos wherever you go free. FREE ANDROID APP - Free training app for Android equipped phones. CONSCIOUS ADULTS - First aid for a conscious adult CONSCIOUS CHILD - First aid for a choking child CONSCIOUS INFANTS - First aid for a choking infant CPR FAQ - Have a question about CPR? Check here first CPR FACTS - Facts and general information about CPR CPR LINKS - Links to other great CPR resources CPR QUIZ - Think you're an expert? Take our quiz and test yourself CPR HISTORY - Interested in learning about the history of CPR?

Advanced Cardiovascular Life Support Prolonged Life Support (PLS) What is cardiac arrest?

Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.

What causes cardiac arrest?

The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease. Most cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart. This is called bradycardia.

Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking and trauma. Cardiac arrest can also occur without any known cause.

Differential Diagnosis

Why did arrest occur?
Are there any other factors?
Can we reverse the cause(s)?
7 H's and 6 T's: pnemonic for mechanisms

* hypoxia
* hypovolemia
* hyperkalemia
* hypokalemia
* hypoglycemia
* hypothermia
* hydrogen ions (acidosis)

* thrombosis (MI)
* tension pneumothorax
* tamponade
* toxins/therapeutics
* thromboembolism
* trauma

Heart conditions that can lead to sudden cardiac arrest

More often, a life-threatening arrhythmia develops in a person with a pre-existing heart condition, such as:

* Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart. This can make it harder for your heart to conduct electrical impulses smoothly.

* Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of scar tissue. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.

* Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. In both cases, your heart's muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.

* Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle, or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia.

* Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition that was present at birth (congenital heart disease). Even adults who've had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest.

* Electrical problems in the heart. In some people, the problem is in the heart's electrical system itself, instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as Brugada's syndrome and long QT syndrome.

Can cardiac arrest be reversed?

Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes.

How many people survive cardiac arrest?

No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent.

What can be done to increase the survival rate?

Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. For instance, in June 1999, automated external defibrillators (AEDs) were mounted 1 minute apart in plain view at Chicago's O'Hare and Midway airports. In the first 10 months, 14 cardiac arrests occurred, with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.

If bystander CPR was initiated more consistently, if AEDs were more widely available, and if every community could achieve a 20 percent cardiac arrest survival rate, an estimated 40,000 more lives could be saved each year. Death from sudden cardiac arrest is not inevitable. If more people react quickly by calling 9-1-1 and performing CPR, more lives can be saved.

Cardiopulmonary Resuscitation (CPR)

What is CPR?

Cardiopulmonary resuscitation (CPR) is a combination of rescue breathing and chest compressions delivered to victims thought to be in cardiac arrest. When cardiac arrest occurs, the heart stops pumping blood. CPR can support a small amount of blood flow to the heart and brain to “buy time” until normal heart function is restored.

Cardiac arrest is often caused by an abnormal heart rhythm called ventricular fibrillation (VF). When VF develops, the heart quivers and doesn't pump blood. The victim in VF cardiac arrest needs CPR and delivery of a shock to the heart, called defibrillation. Defibrillation eliminates the abnormal VF heart rhythm and allows the normal rhythm to resume. Defibrillation is not effective for all forms of cardiac arrest but it is effective to treat VF, the most common cause of sudden cardiac arrest.

Cardiac arrest refers to the loss of heart function. In many cases, it is an expected outcome to a serious illness. Cardiac arrest often results in death.

* Sudden cardiac arrest refers to the heart unexpectedly stopping activity due to a potentially reversible cause. Brain death occurs within a few minutes if the situation is not reversed.

o Sudden cardiac arrest may be caused by many different conditions. It does not necessarily mean that the person has had a heart attack.

* Sudden cardiac death refers to an unexpected, heart-related death within 1 hour from the start of symptoms.

Electrical System of the Heart

Causes

Causes of cardiac arrest include:

* Ventricular fibrillation —a rapid, irregular heart rhythm preventing any circulation of blood (most common cause of sudden cardiac arrest)
* Ventricular tachycardia —a rapid but regular heart rhythm that, if sustained, may turn into ventricular fibrillation
* Dramatic slowing of heart rate due to failure of its pacemaker or severe heart block (interference with electrical conduction)
* Respiratory arrest
* Choking or drowning
* Electrocution
* Hypothermia
* Sudden loss of blood pressure
* Unknown causes

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for cardiac arrest include:

* Coronary artery disease
* Heart attack
* Cardiomyopathy
* Enlarged heart
* Congenital heart disease
* Improperly functioning heart valves
* Conditions affecting the heart's electrical system
* Severe meta2bolic imbalances
* Adverse drug effects, such as from drugs to treat abnormal heart rhythms
* Lung conditions
* Trauma to the chest
* Extensive blood loss
* Excessive overexertion in people with heart disorders
* Use of illicit substances (eg, cocaine )

Symptoms

Symptoms include:

* Loss of consciousness
* No breathing
* No pulse

Prior to cardiac arrest, some patients report the following symptoms or warning signs in the weeks before the event:

* Chest pain
* Weakness
* Pounding in the chest
* Feeling faint

Diagnosis

The first person to respond to a cardiac arrest should check if the person is responsive. If the person does not respond, call 911 right away or have someone else call. If there is an automated external defibrillator (AED) available, you or someone else should get it and follow the steps on the machine.

After calling 911, CPR will be started if the person is not breathing normally. If no AED is available or while you are waiting for it, begin doing CPR by giving chest compressions. Push in the chest at least two inches at a fast rate of at least 100 compressions per minute. If you are trained in CPR, after 30 compressions, open the person's airway and give two rescue breaths. Then, continue with the chest compressions. If you feel more comfortable, you can give the compressions without the breaths until the ambulance arrives.

Treatment

Prompt treatment improves the chance of survival. The four steps in the cardiac chain of survival are:

Call 911

Immediately call for emergency medical support. Call 911 as soon as you notice cardiac warning signs or suspect a cardiac arrest has occurred.

Defibrillation

Defibrillation sends an electrical shock through the chest. The surge of electricity aims to stop the ineffective, irregular heart rhythm. This may allow the heart to resume a more normal electrical pattern. AEDs check the heart rhythm before instructing the rescuer to give the shock.

Start CPR

CPR helps keep blood and oxygen flowing to the heart and brain until other treatment can be given. The heart and brain are very susceptible to low oxygen levels. Permanent damage can occur, even with successful resuscitation.

Advanced Medical Care

Paramedics at the scene and doctors at the hospital provide essential medical care and intensive monitoring. They will give drugs, insert a tube to maintain an open airway, and manage emergency care. Epinephrine is often given early to make the heart more receptive to electrical impulses and improve blood flow to the heart and brain. The patient will receive oxygen. Even if an effective heart rhythm is restored, low oxygen levels may cause serious complications, including damage to the heart, brain, and other vital organs. The emergency medical personnel may perform an electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle.

Doctors will attempt to find and correct the underlying cause of the cardiac arrest. At the hospital, the doctor will ask about symptoms prior to the collapse and the patient's medical and drug history.

If the patient survives, the doctor will:

* Assess the electrocardiogram.
* Perform a physical exam.
* Confirm a cardiac arrest has occurred.
* Look for the cause.
* Evaluate the effects of pre-hospital care.
* Order additional blood and diagnostic tests to help determine the cause of the arrest.

A telemetry machine will continually monitor the heart's electrical activity.

Prevention

Become aware of heart disease warning signs and promptly seek treatment for any that develop. If you do not have a heart condition, follow the rules of primary prevention of heart disease. If you have a heart condition or may be at high risk for one, ask your doctor about how to reduce your risk of sudden cardiac arrest. You might be a right candidate for certain medications that prevent heart arrhythmias or implantation of an implantable cardioverter defibrillator (ICD) device.

Also, if you are known to be at high risk, you may consider purchasing an automatic external defibrillator (AED) for home use. Discuss it with your doctor.

http://www.americanheart.org/presenter.jhtml?identifier=4481

http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=11981.html