CFR 1

Lesson 8: Cardiac Emergencies and CPR

Introduction

  • Basic cardiac life support is essential for patients whose breathing or heart has stopped.

  • Ventilations are provided to oxygenate blood when breathing is inadequate or has ceased.

  • Chest compressions are administered to circulate blood to vital organs when the heart stops.

  • The combination of ventilation and chest compressions is known as CPR.

  • CPR is commonly used for patients in cardiac arrest due to heart attacks.

Circulatory System Overview

Components of the Circulatory System

  • Heart

  • Blood

  • Blood vessels

Primary Functions of the Cardiovascular System

  • Transports blood to the lungs to exchange carbon dioxide for oxygen.

  • Delivers oxygen and nutrients throughout the body.

  • Helps regulate body temperature.

  • Maintains the body's fluid balance.

Anatomy and Physiology of the Heart

  • The heart consists of ventricles that pump blood through two loops:

    • Right ventricle: Pumps blood to the lungs to pick up oxygen.

    • Left ventricle: Pumps oxygenated blood through arteries to the body.

  • Blood returns to the heart through veins, and valves prevent backflow, ensuring one-directional blood flow.

Heart Muscle

  • The heart is made up of myocardium, a special muscle type that contracts to facilitate the pumping action.

  • The contractions are regulated by electrical signals controlled by the nervous system.

Arteries and Blood Flow

Key Arteries

  • Carotid arteries: Supply blood to the head.

  • Femoral arteries: Supply blood to the legs.

  • Brachial arteries: Located in the upper arm.

  • Radial arteries: Located in the lower arm.

  • Arterial blood is oxygenated, bright red, and under high pressure.

Pulse Measurement

  • Pulse occurs when the left ventricle contracts, sending a wave of blood through the arteries.

  • Can be palpated in areas where arteries are near the skin:

    • Carotid pulse: Side of the neck.

    • Femoral pulse: Groin area, between abdomen and thigh.

    • Radial pulse: Palm side of the wrist.

    • Brachial pulse: Inside of the arm, between elbow and shoulder.

Capillaries and Veins

  • Capillaries:

    • Very small blood vessels connecting arteries and veins.

    • Enable exchange of oxygen and carbon dioxide with body cells due to their thin walls.

  • Veins:

    • Drain blood back to the heart, carrying dark red, deoxygenated blood under lower pressure.

    • Blood flows steadily through veins, which contain valves to prevent backflow.

Heart Rate and Circulatory Emergencies

  • Heart rate is affected by various factors, increasing with demand for oxygen (e.g., exercise, emotions).

  • Circulatory System Emergencies:

    • Conditions that impair respiration or reduce oxygen delivery include severe bleeding, strokes, heart conditions, or cardiac arrest.

    • A heart attack can lead to cardiac arrest; ventricular fibrillation disrupts proper heart function.

Cardiac Arrest

  • Cardiac arrest occurs when the heart stops; brain damage begins within 4-6 minutes and becomes irreversible after 8-10 minutes.

  • Causes of cardiac arrest include:

    • Heart attacks, drowning, suffocation, strokes, allergic reactions, respiratory arrest, diabetic emergencies, prolonged seizures, drug overdoses, electric shocks, and specific injuries.

Call First vs. Call Fast

  • Call First:

    • When alone with an unresponsive adult not breathing normally or patient seen collapse suddenly.

  • Call Fast:

    • When alone with an unresponsive child not breathing normally or a patient in cardiac arrest due to asphyxial causes.

CPR Techniques

  • CPR circulates oxygenated blood and provides artificial ventilation:

    • Chest compressions on the sternum promote blood flow to the brain and other organs.

    • Effective CPR can maintain viability until normal heart rhythm is restored, often needing an AED for shock.

  • Compressions should be at least 100 per minute and are deeper for adults compared to infants or children.

General Technique of CPR

  • Start CPR if the patient is unresponsive, not breathing normally, and has no pulse.

  • Compression Guidelines:

    • Adult: Use two hands; compress at least two inches deep.

    • Child: One or two hands, at least one-third of the chest depth.

    • Infant: Use two fingers.

  • Alternate compressions (30) with ventilations (2) for any age; for infants or children, switch to 15:2 in two-rescuer CPR.

Factors Decreasing Effectiveness of Compressions

  • Compressions too shallow or too slow.

  • Not allowing complete chest recoil.

  • Frequent interruptions.

CPR for Infants and Two-Rescuer CPR

  • Infant CPR requires unique hand positioning. Two-rescuer CPR is more effective as it minimizes fatigue:

    • Perform in cycles of 30 compressions and 2 breaths for adults and 15 compressions and 2 breaths for children.

    • Change positions every two minutes to maintain effectiveness.

Special Considerations for CPR

  • When Not to Perform CPR:

    • Presence of a DNR order.

    • Obvious irreversible death; unsafe scene conditions; physician declaration of death.

Basic cardiac life support is vital for patients experiencing respiratory failure or cardiac arrest. Cardiopulmonary resuscitation (CPR) combines chest compressions and ventilations to maintain blood circulation and oxygen delivery, especially in cases of heart attacks. The circulatory system consists of the heart, blood, and blood vessels, which play crucial roles in transporting oxygen and nutrients throughout the body, regulating body temperature, and maintaining fluid balance. Cardiac arrest can arise from various causes, such as heart attacks, drowning, or allergic reactions, and it can lead to brain damage within just 4-6 minutes if intervention is not immediate. Effective CPR techniques vary by patient age, requiring rescuers to perform compressions with adequate depth and frequency—aiming for at least 100 compressions per minute for adults, while adjusting for children and infants. CPR involves alternating compressions with rescue breaths, typically in a ratio of 30:2 for adults and 15:2 for children. Special considerations dictate when CPR should not be performed, such as in the presence of a do-not-resuscitate (DNR) order, obvious signs of irreversible death, or unsafe scene conditions. Understanding these principles is critical for effective emergency response and can significantly increase a patient's chances of survival during cardiac emergencies.