Emergency Cardiac Help

Basic Life support (BSL)
Definition:
Out of hospital care to a person who has suddenly become unresponsive and pulseless.

Any cardiac event occurring out of hospital in western countries:
Survival rate = 10%

Any cardiac event occurring out of hospital and patient was provided bystander CPR
Survival rate = 20℅

Sudden cardiac arrest occurs when the heart develops an abnormal rhythm and cannot pump the blood.
It is different from heart attack which occurs when the blood flow to part of heart muscle is blocked.
Death occurs within minutes if the victim does not receive immediate life saving treatment.

Causes:

-Coronary ischemia
-cardiomyopathy
-structural heart lesion
-electrical conduction abnormalities
-metabolic disturbances
-toxic ingestion
Non cardiac causes: drowning.

Epidemiology:

Half a million of people worldwide have out-of-hospital cardiac arrest.

Types:

1. Shockable:
   Ventricular fibrillation
   pulseless ventricular tachycardia
2. Non shockable:
   Pulseless Electrical activity
   Asystole

Initial assessment:
-Verify scene safety
-shout for nearby help
-activate emergency services

• assess the victim for normal breathing and a pulse
• this should not take more than 10 seconds.

Pulse and Breathing:

-Only carotid pulse is palpated

• victims chest is examined for rise and fall.
  -Gasping or agonal gasps is not normal breathing.
• next action depends on the presence or absence of normal breathing and pulse.

1. If the victim is breathing normal and a pulse is present:
   MONITOR
   Recovery position:
   To lie in Left lateral position with head resting on right hand and left hand on the floor while the left leg in flexion and right in extension.
2. If the victim is NOT breathing normal
   And a pulse is present:
   Provide rescue breathing every 8 seconds and do Pulse check every 2 minute.
3. If the victim is not breathing normal and the pulse is absent:
   Begin high quality CPR
   (Cardiopulmonary resuscitation)
   It begins with CAB followed by Defibrillator.

CHEST COMPRESSIONS

-Single rescuers should use the compression to ventilation ratio of 30 compressions to 2 breath when giving CPR to any age patient (30:2)
-Push hard around 5-6cm deep.
-Push fast: 100-120comp/min
-Minimize interruptions in compressions.
-Avoid hyperventilation.(8-10breaths/min).

Steps:
-Position yourself at the victim side.
-Make sure the victim is lying Face Up On a firm surface.

• position your hands and body to perform chest compressions:

1. Put the heel of one hand in the centre of the victims chest on lower half of the breastbone/sternum.
2. Put the heel of your other hand on top of the first hand.
3. Straighten your arms and position your shoulder directly over your hand.

ADULT BREATHS:

Head tilt- chin tilt
Jaw thrust
Use barrier devices like pocket mask.
Deliver each breath over 1 second
Note visible chest rise with each breath
Resume chest compression in 10 seconds
The 30:2 compression ventilation cycle is repeated for 5 cycles.
Pulse check is again done within 10 seconds.

DEFIBRILLATION

-Automated external defibrillator(AED) is attached once it is available.
-Early defibrillation is important factor in Survival from sudden cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia.

Steps:
-Open the case, power on the AED.
-Attach AED pads to the victim bare chest.
-Choose adult pads for >8 years
Position of pads:
Anterolateral
Anteroposterior

-Clear the victim to let AED analyse the rhythm
-If the rhythm is shockable charge defibrillator:
Clear and give shock,
Resume compression

-If non shockable Rhythm
Continue compression:ventilation.

Take the patient to nearby hospital with emergency services as soon as possible.