Sudden Cardiac Arrest (SCA)

SCA is usually due to abnormal heart

rhythms called arrhythmias, the vast
majority of which are ventricular fbrillation.
Ventricular fbrillation is a condition in
which the heart twitches irregularly so that
it can no longer pump oxygenated blood
eciently to the brain, lungs, and other
organs.
!he 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.
#nli$e a heart attac$, which is the death of
muscle tissue from loss of blood supply,
many victims of SCA have no prior
symptoms.
SCA can stri$e anyone, at anytime,
anywhere.
%ost victims die out of hospital without
receiving any &'S interventions.
!ime is Critical( %inutes Count)
* mins + ,espiratory Arrest -breathing stops.
/ mins+ Cardiac arrest -0eart stops.
/12 mins + &rain damage begins
3*4 mins + 5rreversible brain damage
6hat is the current treatment of SCA7 Chain of
Survival
!he / 'in$s in the Chain of Survival
1. First Link: Early Access
5nvolves the prompt recognition of
emergencies that re8uire immediate &'S
interventions such as heart attac$, stro$e,
foreign1body airway obstruction, and
respiratory and cardiac arrests.
Also include the quick activation of
emergency medical providers. !he sooner
your community9s :mergency %edical
Services -:%S. number is called the sooner
advanced life support arrives.
2. Second Link: Early CPR
C;, is a set of actions that the rescuer
performs in se8uence to assess and
support airway, breathing, and circulation
as needed.
C;, supports the delivery of oxygen to the
brain and heart, through mouth1to1mouth
breathing and chest compressions, until
the arrival of A:< and AC'S.
C;, alone cannot fully resuscitate a person
in SCA" because it does nothing to restore
normal heart rhythm. 6hile better than no
treatment, survival rate is between = to
>?.
Victims of out1of1hospital cardiac arrest
who receive C;, from bystanders are more
than twice as li$ely to survive as victims
who do not receive C;,.
!he strength of this lin$ is dependent on
the number of lay people trained in C;,
and the number of training programs in
your community.
3. Tird Link: Early !e"#rillation
%ost adults with sudden -witnessed., non1
traumatic cardiac arrest are found to be in
Ventricular @ibrillation -V@.. V@ is an
abnormal, chaotic heart rhythm that
prevents the heart from pumping blood.
!he treatment for V@ is defbrillation.
<:@5&,5''A!5AB is the delivery of a shoc$
to the heart that stops V@ and allows a
normal heart rhythm to resume.
,ecogniCed as the most critical step in
restoring cardiac rhythm and resuscitating
a victim of SCA.
Strength of lin$ depends on A:<
availability.
Survival ,ates
!ime 'apse between Arrest and <efbrillation
Survival from cardiac arrest caused by V@
declines by approximately D? to 3*? for
each minute without defbrillation.
E*? within 3 minute
>*? within > minutes
F*? within D minutes
3*? within E133 minutes
=?1>? beyond 3= minutes
!he sooner defbrillation is attempted, the
better the victim9s chance of survival.
C;, 4 <efbrillation
5n the frst few minutes after successful
defbrillation, asystole or bradycardia may
be present and the heart may pump
ineGectively.
C;, may be needed for several minutes
following defbrillation until ade8uate
perfusion is present.
C;, has been shown to double or triple
survival from witnessed SCA at many
intervals to defbrillation.
$. Fourt Link: Early ACLS
AC'S are interventions used to treat and
stabiliCe adult victims of cardiorespiratory
emergencies and resuscitate victims of
cardiac arrest.
5t includes C;,, basic and advanced airway
management, tracheal intubation,
medications, electrical therapy, and
intravenous -5V. access.
:arly AC'S improves survival rate to =*? in
communities with :%S system that have
sucient number of responders trained in
AC'S -a minimum of = AC'S and = &'S
providers at the scene..
<eterminants of Survival from SCA
!he most important determinant of survival
from sudden cardiac arrest is the presence of a
trained rescuer who is ready% &illin'% a#le% and
e(ui))ed to act.
0:A,! A!!ACH AB< S!,AH:( ;revention and &'S
Care
*eart Attack
A heart attac$ -acute myocardial infarction.
occurs when the heart muscle does not
receive enough oxygen and heart muscle
starts to die.
5t is caused by bloc$age in a coronary
artery, one of the major blood vessels that
supplies blood and oxygen to the heart
muscles.
Stroke
A stro$e -cerebrovascular accident. is the
rapid onset of neurologic problems.
5t can develop when a blood vessel in the
brain becomes bloc$ed so that an area of
the brain receives no blood and no oxygen,
or it can develop when a blood vessel
ruptures and bleeds into the brain.
,is$ @actors of 0eart Attac$ and Stro$e
Bon1Controllable @actors
0eredity
Age
Sex or Iender
Controllable @actors
Cigarette smo$ing
0igh blood pressure
0igh blood cholesterol
'ac$ of exercise
Abesity
Stress
<iabetes
0eart disease
!ransient ischemic attac$s -!5A9s.
Te +arnin' Si'nals o, *eart Attack
1<iscomfort, pressure, or pain in the center of the
chest, behind the breastbone, which may spread
to the shoulder, nec$, or arms, and usually lasts
more than F1> minutes.
1'ightheadedness or Jfeeling diCCyK during the
pain.
1@ainting or loss of responsiveness.
1Sweating or Jbrea$ing out in a cold sweat all
overK but without fever.
1Bausea, usually without vomiting.
1Shortness of breath, especially worrisome if the
victim is short of breath during the pain, while
lying still or resting, or when moving only a little.
Te +arnin' Si'nals o, Stroke
1Sudden numbness or wea$ness of face, arm, or
leg, especially on one side of the body.
1Sudden confusion, trouble spea$ing, or
understanding.
1Sudden trouble seeing in one or both eyes.
1Sudden trouble wal$ing, diCCiness, loss of
balance, or coordination.
1Sudden severe headache with no $nown cause.
@ + @acial drooping
A + Arm wea$ness
S + Slurred speech
! + !rouble spea$ing
S + Severe headache
Lay Rescuer -LS Care ,or *eart Attack
,ecogniCe the JsignalsK and ta$e action.
0ave the victim sit or lie down.
Call :%S immediately. %inutes count)
Iive the victim supportive care and
reassurance.
&e prepared to perform C;, if victim
becomes unresponsive.
Lay Rescuer -LS Care For Stroke
,ecogniCe the JsignalsK and ta$e action.
0ave the victim sit or lie down.
Call :%S immediately.
Iive the victim supportive care and
reassurance.
&e prepared to perform C;, if victim
becomes unresponsive -opening the airway
may be all that is needed in the
unresponsive patient..
Te Se(uence o, -LS
A + As$ for 0elpLAirway
& + &reathing
C + CirculationLChest Compressions
< + <efbrillation
!he Adult &'S Algorithm
Te Conce)t o, .Call First and Care First/
J Call @irstK in Adults
o %ost fre8uent initial rhythm in witnessed
sudden cardiac arrest in adult is V@.
o !he most eGective treatment for V@ is
electrical defbrillation.
o :%S system is activated as soon as the
victim is found to be unresponsive.
J Care @irstK in 5nfants and Children
o %ost causes of cardiopulmonary arrests in
infants and children are related to airway
or ventilation problems.
o ,escue support -especially rescue
breathing. is essential and should be
attempted frst.
o ,escuer provides approximately = minutes
of C;, and then activates :%S system.
E0ce)tions to te .Call First and Care First/
Rule
SubmersionLnear1drowning -Jcare frst,K all
ages.
Arrest associated with trauma -Jcare frst,K
all ages.
<rug overdose -Jcare frst,K all ages.
Cardiac arrest in children $nown to be at
high ris$ for arrhythmias -Jcall frst,K all
ages.
Pro)er *and Place1ent Area on Cest
;lace the heel of one hand in the center of
the chest between the nipples.
Cest Co1)ression Tecni(ues
Victim is supine on a Mat and hard surface.
J;ush hard and push fast.K
<epth of 3 N to = inches -approx. / to >
cm..
,ate of about 3** compressions per
minute.
Allow complete chest recoil after each
compression.
:8ual compression and relaxation times.
%inimiCe interruptions.
+en to Sto) CPR2
A:<L<efbrillator Arrives.
A'S ;roviders !a$e Aver.
Victim Starts to %ove.
Lateral 3 *.A.4.5.E.S. Reco6ery Position
#se the lateral recovery position if the
victim is unconscious, is breathing
eGectively and there is no suspected head,
nec$ or bac$ injury.
#se modifed 0.A.5B.:.S. -high arm in
endangered spine. recovery position if a
head, nec$ or bac$ injury is suspected and
the responder is unable to maintain an
open airway or has to leave to get help
andLor an A:<.
Auto1ated E0ternal !e"#rillators (AE!s)
- &iphasic defbrillation
A:< ;,:CA#!5ABS(
o <o not use alcohol to wipe the victim9s
chest dry. Alcohol is inMammable.
o <o not touch the victim while the A:< is
analyCing. !ouching or moving the victim
may aGect the analysis.
o <o not touch the victim while defbrillating.
Oou or someone else could get shoc$ed.
o <o not use an A:< on a victim who has
nitroglycerine or other patch. ,emove any
patches from the chest before attaching
the device.
o <o not use an A:< on a victim who is in
contact with water. %ove victims away
from puddles of water or swimming pools
or out of the rain before defbrillating.
o <o not use an A:< on a victim lying in a
conductive surface. Conductive surfaces,
such as sheet metal or metal bleachers,
may transfer the shoc$ to others.
o <o not defbrillate someone around
Mammable materials, such as gasoline or
free1Mowing oxygen.
o <o not use adult pads on a child aged 3 to
P. #se specialiCed pediatric pads instead.
#se adult pads only on victims aged P and
older.
o <o not use a cellular phone or radio within
2 feet of the A:<. !his may interrupt
analysis.
o <o not use an A:< in a moving vehicle.
%ovement may aGect the analysis.
;lacement of A:< pads
;lace one A:< pad to the right of the
sternum below the clavicle.
;lace the other pad in the left mid1axillary
line.
Steps in using an A:<
6hen A:< arrives, place it at the victim9s
side.
;A6:, + ;ower on the A:<.
A!!AC0 + Attach the pads to the victim,
then attach to A:<.
ABA'OQ: + Clear the victim and allow the
A:< to analyCe the heart rhythm.
S0ACH + 5f the A:< advices a shoc$ clear
the victim and press the Jshoc$K button.
C;, + After A:< gives the shoc$, begin
C;, starting with chest compressions.
,:1ABA'OQ: + After = minutes of C;,,
allow he A:< to analyCe heart rhythm and
follow voice prompts.
Forei'n7-ody Air&ay 8#struction
Cho$ing ;revention
Cut food into small pieces and chew slowly
and thoroughly, especially if wearing
dentures.
Avoid laughing and tal$ing excitedly while
eating.
Avoid excessive inta$e of alcohol before
and while eating.
;revent children from wal$ing, running, or
playing when they have food in their
mouths.
Heep foreign objects -e.g. marbles, beads,
thumbtac$s. away from infants and
children.
<o not give foods that must be thoroughly
chewed -e.g. peanuts, peanut butter,
popcorn, hot dogs, etc. to young children.
Ty)es o, F- Air&ay 8#struction
%ild Airway Abstruction
- Victim is responsive and can cough
forcefully.
Severe Airway Abstruction
- Victim has wea$, ineGective coughs,
stridor, increased respiratory diculty,
cyanosis and unconsciousness, also
inability to spea$ or breathe.
- Victim may clutch the nec$, demonstrating
the universal cho$ing sign.
Te 9ni6ersal Cokin' Si'nal: Clutching of
hands around the nec$
!he Conscious Cho$ing Adult Algorithm
!he #nconscious Cho$ing Adult Algorithm