emt 21

Cardiac arrest indications

unresponsive, not breathing, pulseless, body is turning hypoperfused

Chain of survival

AHA’s 5 elements of emergency cardiac arrest care

5 chain of survival components

Recognizing and activating EMS, immediate CPR, rapid defibrillation, B/ALS, ALS + postarrest care

Defibrillation

sending an electrical shock to stop the fibrillation of heart muscles and restore normal rhythm 

Sudden unexpected infant death syndrome (SUIDS) causes

•  sudden infant death syndrome (SIDS)

• unknown cause

• accidental suffocation

• strangulation in bed

Potential SIDS cause

nerve cell development in the brain or chemical issue of the R system or the heart

SUIDS patients when asleep

have periods of cardiac slowdown and stopped breathing (sleep apnea), eventually breathing stops completely,

usually found morning when parents go to wake baby

Treating SUIDS babies

dont diagnose SUIDS, treat as if baby in under respiratory or cardiac arrest, always resuscitate if needed

Exception to treating SUIDS babies like cardiac patients

rigor mortis (stiffening of body after death) or lividity (small capillaries break down and bruise lower extremities during cardiac arrest)

High performance resuscitation

multiple same-time interventions taken by a team to maximize survival 

When does resuscitation occur during cardiac arrest

asap after primary assessment 

Dispatcher-aided CPR/pre-arrival instructions

EMR recognizes potential cardiac arrest situations and helps bystanders w chest compressions

Biggest EMS challenge in treating cardiac arrest

fixed response times, takes time to arrive + intervene narrowing chances of survival 

Cardiopulmonary resuscitation (CPR)

actions taken to revive by keeping the heart and lungs working

What does CPR counter

 cells in c-vascular system becoming standstill + starving for O2ed blood and organs dying

Acceptable cerebral and coronary perfusion pressures

20-25% of c-vascular function, gets some blood flow to the brain + heart muscle

Reaching acceptable cerebral and coronary perfusion pressures

hand placement, compression depth, compression rate, minimizing pauses in compressions, rescue breathing,using CPR devices

Hand placement during CPR

point of compression: lower 3rd of patients sternum 

Adult CPR hand placement

place heel of one hand on center chest and heel of other hand on top of first hand so they parallel

Pediatric CPR

same form, might not need 2 hands, infants: 2 fingers over lower sternum if w/ assist, two thumbs encircling hands technique (fingers around thorax)

Chest compression purpose

facilitate movement of blood in c-vascualr system

2 ways compressions work

1. Increasing pressure within chest + squeezing blood out of the heart and lungs

2. Full recoil of the chest creating - pressure inside and drawing blood back to heart to squeeze

Adult compression depth

min 2 inches, allow equal amount of time for chest recoil

Infant/children compression depth (until puberty)

compress ⅓ of anterior-posterior diameter of chest 1.5in for infants and 2in for kids

Proper compression form

hands overlap w interlocked fingers, elbows locked, weight of shoulders drives compressions, pivot at waist, never compress for 2+ mins

Compression rate importance

each pause drops c-vascular pressures to an inadequate level  

Adequate compression rate

100-130 compressions per min, ensured by either team leader or feedback device 

Compressing too fast/slow

too slow = inadequate cerebral coronary perfusion pressure

too fast = not enough time for heart to adequately fill w blood

Compression fraction

amount of time chest compressions are performed compared to total time of patient contact, measures CPR quality

High performance compression fraction

more than 90%

“Cardio” in CPR

chest compressions 

“Pulmonary” in CPR

lungs

AHA compression guidelines

compressions start right when c-arrest is suspected, ventilate 2 vents to 30 compressions (adult) 2:15 (child)

LUCAS CPR device steps

Standards precautions, ensure effective CPR, stop CPR to insert device under patient, attach device, restart CPR, position suction cup so lower edge is above lower end of sternum, position pressure pad so it touches chest w/out putting pressure, push ACTIVE to start compressions, apply stabilization strap before moving patient, power down when compressions are complete

Zoll autopulse

standard precautions, ensure effective CPR, putw patient on platform, chest band over patient chest, start, BVM 2 vents per 20 compressions, after 2 mins CPR reassess for shock

Successful resuscitation

heart starts pumping again, dysrhythmia is corrected

Automated external defibrillator (AED)

• 2 devices in one (sensor and defibrillator) used to address dysrhythmia 

AED sensor

uses electrodes connected to patient chest to sense/ recognize dysrhythmia

AED defibrillation

after detecting ventricular fibrillation/tachycardia, will offer to transfer energy from its battery via electrodes to patient, can reverse life-threatening dysrhythmia

How does defibrillation interrupt dysrhythmia

exerting electrical charge and depolarizing heart cells (resetting them) goal is global reset of electrical function

Rhythms that cause cardiac arrest

ventricular fibrillation, ventricular tachycardia, asystole, pulseless electrical activity (PEA)

Asystole (rhythm)

no electrical impulses/flatline

Pulseless electrical activity (PEA) (rhythm)

normal electrical activity w/out mechanical response, may stop pumping, can't defibrillate 

Mechanical defibrillation

 using cardiac monitor/defibs to visually identify which dysrhythmia and choosing to deliver shock

Monophasic defib

sends shock from negative pad to positive pad 

Biphasic defibrillator

sends shock first in one direction then the other

roles during cardiac arrest

EMT manages basic life support, AEMT/parademic provide advanced procedures and meds

Triangle of life

first 3 providers w the patient, one gives compressions, one attaches AED, one (at patient head) manages airway and gives vents 

Integrated postarrest care

coordinating different assessment/interventions to max patients chance of neurologically intact survival

Return of spontaneous circulation (ROSC)

heart begins to beat on its own again 

Most common cause of arrest in adults

ACS

Postarrest care

asap transport and ALS support, manage airway BP, and ventilation, get ECG

If patient isn't breathing postarrest

PPV at 10-12bpm adult, 12-20 kids, do NOT hyperventilate

Creating resuscitation team

ensure ALS is otw, assign team leader (controls quality for resus team, gives roles + feed back), if no leader do preresus huddle (ensure everyone knows their job)

When to apply AED

asap w/out stopping compressions

Applying AED

turn on, place pads on bare skin, AED will analyze cardiac rhythm–stop compressions, clear patient for defib, resume compressions, restart every 2 min

AED analyzation

scans for electrical impulses in heart, looks for vent fibrillation or tachycardia and if found will announce it

Pediatric defibrillator pads

for kids under 8, smaller w lower defib doses, placed in anterior-posterior position, if none available use adult pads

Cardiac arrest 2ndary assessment

if resources are available one member will consider SAMPLE + OPQRST to find what led to arrest, brief review of physical findings and patient surroundings 

Unconscious ROSC patient pulse

recheck every 30s, if AED says shockable rhythm check for pulse asap 

No pulse after ROSC

stop bus if en route, start CPR if AED is not ready, analyze rhythm, deliver shock if needed, continue w two shocks spaced by 2 mins

When to stop CPR

sudden recirculation, sudden recirculation + breathing, another rescuer takes over, handing of patient to higher level, too tired, cease resus order

Who to handoff patient to during CPR

someone w same or greater training

Notifying death to family

be direct, allow them time w body, dont say yk how they feel, dont fake emotions

Cardiac arrest care for hypothermia

attempt defib once in hypothermic patient, wait until core temp 86º F if this doesn't work transport asap 

C-arrest care for submersion patients

same as reg exp SS issues + water environment, most submersion c-arrest is caused by asphyxia, patients need O2 + vents w compressions and defib being priority

Cardiac pacemaker

when hearts natural pacemaker doesnt function properly, artificial pace maker is placed to help heart beat, placed below a clavicle, visible as small bump do NOT put defib pad over it

Pacemaker malfunction

rare + deadly, causes slow/irregular pulse, signs of shock, care during c-arrest is same as normal 

Implanted defibrillator

miniature surgically placed defib in chest or stomach for patients at high risk of vent fibrillation, implant detects lethal cardiac rhythm and shocks patient

Implanted defib calls

immediate transport, call ALS, nonshockable dysrhythmia can cause c-arrest, use AED

Ventricular assist device (VAD)

given when one or both ventricles are weak, mechanically pumps blood for heart, connected to battery source outside patient, LVAD is more common outside hospital, patient will not have palpable pulse or BP, rely on alertness + breathing 

When to CPR VAD patient

unconscious w cyanosis (poor perfusion)

Cardiac bypass surgery

blood vessel from another body part is implanted to bypass an occluded coronary artery helping restore blood flow, same care as reg patient 

asphyxial cardiac arrest

arrest due to hypoxia from airway occlusion or impedance of bellows action of the chest

commotio cordis

c-arrest dysrhythmia caused by blunt force truama to chest