Chapter 34 Emergency Cardiovascular Life Support Mosby items

Objectives List the causes of sudden cardiac arrest (SCA). List the signs of SCA, heart attack, stroke, and foreign-body airway obstruction (FBAO). Describe how to perform cardiopulmonary resuscitation (CPR) on adults, children, and infants. Describe how to defibrillate with automated external defibrillators (AEDs) and manual defibrillators. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

Objectives (cont. ) State how to administer synchronized cardioversion. Describe how to evaluate quality and effectiveness of CPR. List the complications that can occur as a result of resuscitation of SCA. State when not to initiate CPR. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Objectives (cont. ) Describe how to apply key adjunct equipment during advanced cardiovascular life support (ACLS). State common drugs and drug routes are used during ACLS. Describe how to monitor patients prearrest, during CPR, and postarrest. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Causes and Prevention of Sudden Death Sudden cardiac arrest (SCA) is a leading cause of death in North America. Approximately 250, 000 people die annually from coronary artery disease. About 40% of SCA victims are in ventricular fibrillation upon collapse. Immediate CPR with defibrillation can save many lives. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

Basic Life Support 1. 2. Check for movement or response. Activate the EMS system and get automated external defibrillator. 3. Open airway and check breathing. 4. If no breathing, give two breaths. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

Basic Life Support (cont. ) 1. 2. If no response, check pulse within 10 seconds. If no pulse, give cycles of 30 compressions and two breaths until AED arrives. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Basic Life Support (cont. ) Determining unresponsiveness BLS begins when a victim is found unresponsive and not moving. If head or neck injuries are apparent, rescuer needs to careful with subsequent moving of the head or neck. The rescuer should call for help and activate the EMS system if the victim is unresponsive. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 8

Basic Life Support (cont. ) Restoring the airway After calling for help, the rescuer should open the victim’s airway. Ø Use the head-tilt/chin-lift method in most cases. Ø Use the jaw-thrust method when neck injury may be present. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 9

Basic Life Support (cont. ) Mosby items and derived items © 2009 by Mosby,

Basic Life Support (cont. ) Restoring ventilation Before attempting to provide artificial ventilation, the rescuer should assess for the presence of breathing. The rescuer should place his ear over the victim’s mouth and nose to listen for breathing while looking at the chest wall for movement for 3 to 5 seconds. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 12

Basic Life Support (cont. ) Mouth-to-mouth ventilation The rescuer should take a deep breath and exhale directly into the victim’s mouth over 1 second to produce visible chest rise. Exhaled air has 16% oxygen. Children should be given smaller volumes. Excessive volumes can cause gastric distention. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 14

Basic Life Support (cont. ) Restoring circulation After two rescue breaths, the rescuer should check to see if a pulse is present. Palpate the carotid artery in adults and children older than 1 year. If no pulse is present, external cardiac compressions must be interposed with ventilatory support. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 16

Basic Life Support (cont. ) Providing chest compressions The rescuer should compress the lower half of the sternum at a rate of 100/min. Good compressions can produce a cardiac output that is onefourth of normal with a blood pressure of 60 to 80 mm Hg. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 18

Basic Life Support (cont. ) Chest compressions under special circumstances Near drowning: victims need to be moved to a firm surface; compressions in the water not likely to be effective. Electrical shock: victim still in contact with source of electricity should not be touched; the power must be turned off first. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 20

Basic Life Support (cont. ) One- versus two-rescuer adult CPR Single rescuer gives 30 compressions to two breaths for adults, children, and infants until help arrives. When two rescuers are present, one provides ventilation while the other provides compressions (30: 2 for adults; 15: 2 for children and infants). Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 21

Basic Life Support (cont. ) One- versus two-rescuer adult CPR (cont. ) Rescue attempts should continue until Ø Advanced life support is available, Ø The rescuers note spontaneous pulse and breathing, Ø Or a physician pronounces the victim dead. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 22

Basic Life Support (cont. ) Automated external defibrillation Defibrillation is to be done after the airway has been established and CPR initiated. This recommendation is based on the fact that ventricular fibrillation is very common in victims of sudden cardiac arrest. It should be done has soon as possible following a witnessed cardiac arrest. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 23

Basic Life Support (cont. ) Evaluating the effectiveness of CPR Observe the chest wall rise and fall. Compressions at a rate of 100/min with a depth of 1½ to 2 inches (for adults) are most effective. Allow the chest to recoil completely after each compression. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 24

Basic Life Support (cont. ) Hazards and complications Neck injuries can be aggravated. Gastric inflation Vomiting Internal trauma Advancement of foreign objects in the upper airway Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 25

Basic Life Support (cont. ) Health concerns of CPR Risk of disease transmission during mouth-to-mouth resuscitation is small. Use of an appropriate barrier device (e. g. , pocket mask) will reduce the risk of disease transmission. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 26

Basic Life Support (cont. ) Dealing with an obstructed airway Conscious victim with obstructed upper airway will usually clutch his or her throat (universal distress signal). Abdominal thrusts should be used to clear the obstruction. Back blows and chest thrusts can be used with infants and pregnant women. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 27

Basic Life Support (cont. ) Evaluating the effectiveness of foreign body removal Confirmed expulsion of the foreign body Clear breathing and the ability to speak Return of consciousness Return of normal color Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 28

Advanced Cardiovascular Life Support (ACLS) ACLS includes Using accessory equipment to support ventilation and oxygenation Monitoring the ECG Establishing an intravenous route for drugs Applying selected pharmacological agents and electrical therapies Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 29

Advanced Cardiovascular Life Support (ACLS) (cont. ) Support for oxygenation The highest concentration of oxygen should be administered as soon as possible. Concerns about oxygen toxicity are not valid. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 30

Advanced Cardiovascular Life Support (ACLS) (cont. ) Airway management Pharyngeal airways can help restore airway patency and improve ventilation, especially when using a bag-valve-mask. Two types exist Ø Nasopharyngeal Ø Oropharyngeal Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 31

Advanced Cardiovascular Life Support (ACLS) (cont. ) Mosby items and derived items © 2009

Advanced Cardiovascular Life Support (ACLS) (cont. ) Endotracheal intubation Allows the delivery of ventilations that are nonsynchronous with chest compression Restores airway patency Maintains adequate ventilation Reduce the risk of aspiration Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 33

Advanced Cardiovascular Life Support (ACLS) (cont. ) Endotracheal intubation (cont. ) Provides access for clearance of secretions Provides an alternate route for drug administration It is the preferred method for securing the airway during CPR. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 34

Advanced Cardiovascular Life Support (ACLS) (cont. ) Ventilation Health care providers who respond to cardiac arrests should be trained in the use of bag-valve-masks. The rescuer should deliver tidal volumes adequate to produce visible chest rise over 1 second. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 35

Advanced Cardiovascular Life Support (ACLS) (cont. ) Restoring cardiac function ECG monitoring during CPR should be started as soon as possible. Rescuers may see Ø Ventricular tachycardia Ø Ventricular fibrillation Ø Supraventricular tachycardia Ø Pulseless electrical activity Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 36

Advanced Cardiovascular Life Support (ACLS) (cont. ) Pharmacological intervention Unless and central vein is already cannulated, the ideal route for drug administration during CPR is the peripheral IV line. Drugs are given by rapid bolus injection. Selected drugs such as epinephrine, lidocaine, and atropine also may be given through the endotracheal tube. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 37

Advanced Cardiovascular Life Support (ACLS) (cont. ) Electrical therapy Defibrillation is an unsynchronized shock used to simultaneously depolarize the myocardial fibers. It is the definitive treatment for ventricular tachycardia and pulseless ventricular tachycardia. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 38

Advanced Cardiovascular Life Support (ACLS) (cont. ) Electrical therapy (cont. ) Cardioversion is slightly different than defibrillation. Ø The shock is synchronized. Ø The shock uses less energy. Electrical pacing: intermittently timed, low-energy discharges to pace the heart Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 39

Advanced Cardiovascular Life Support (ACLS) (cont. ) Monitoring during ACLS Usually limited to ECG, pulse, blood pressure, and intermittent arterial blood gas sampling The ECG provides the basis for selecting various drugs and electrical therapies during CPR. Mosby items and derived items © 2009 by Mosby, Inc. , an affiliate of Elsevier Inc. 40