DPT

Course:
Emergency Procedures
and Patient Care
Lecture-6
Learning Objectives
 By the end of this session you should be able to
understand and explain:
 Cardiovascular System Functions and Anatomy
 Respiratory & Cardiovascular Compromise
 Sudden Cardiac Arrest and Heart Attack
 Screening and recognition of cardiac warning signs
 Preparation for Cardiac Emergencies
 Chain of Survival
 CPR
 The Cardiovascular System
Heart, Arteries and Veins
 The heart is approximately the size of a fist.
 located in the Thoracic cavity behind the sternum
and between the lungs.
 The coronary arteries supply blood to the heart
muscles
 The function of the heart is to pump blood
 The Left Side Receives Oxygenated Blood from the
lungs and pumps it to the body through the
arteries.
 The Right Side Receives, through the veins, the
blood that has circulated through the body and
pumps it to the lungs for re-oxygenation.
Respiratory & Cardiovascular
Compromise
 When Respiratory Arrest occurs, the heart can
continue to pump for several minutes.
 Without early intervention, respiratory arrest may
lead to cardiac arrest.
 Once cardiac arrest occurs, circulation ceases and
vital organs are deprived of oxygen.
Clinical and Biological Death
 Clinical death: Occurs when a patient is in
respiratory arrest (not breathing) or in cardiac
arrest (heart not beating) or when respiratory and
cardiac arrest occur together.
 The brain is the first organ to suffer the effects of
a lack of oxygen.
 The patient has a period of4 to 6 minutes to be
resuscitated without brain damage. Clinical
death can be reversed.
 After 8 to 10 minutes the damage is irreversible.
Clinical and Biological Death (cont..)
 Biological death:
 The moment the brain cells begin to die biological
death occurs. Biological death cannot be
reversed.

 Signs of Certain Death

 Livormortis/ Lividity:
 Serum/blood
 Rigormortis:
 Stiffening of the body
 Decomposition
 Odor will come

 Only a Medical Doctor can Pronounce a

Person Officially Dead.
 Sudden Cardiac Arrest (SCA)
in General Population
 Sudden and unexpected cessation of the heart’s
pumping activity.
 The resultant lack of blood flow to the brain leads
to unconsciousness in about 20 to 30 seconds.
 When sudden cardiac arrest results in death, it is
termed sudden cardiac death.
 Common in age group 50 to 75 years.
 Overall survival rate is about 5% to 7%.
 Sudden Cardiac Arrest (SCA)
in Athletes
 Sudden Cardiac Arrest occurring within 1
hour of participation in sports or exercise.
 Consistent with the low prevalence of
cardiovascular disease in people younger than
35 years of age.
 The vast majority (85%) of sudden deaths in
athletes are a result of underlying cardiovascular
conditions.
Sudden Cardiac Arrest (SCA)
Rhythms
1. Ventricular Fibrillation (VF)

2. Pulseless Electrical activity

3. Asystole

 Sudden Cardiac Arrest should be

Differentiated from a “Heart Attack.”
1. Ventricular Fibrillation (VF)
 Most common rhythm abnormality, occurring in
about 60% of cases when assessed by an on-site
Automated External Defibrillator (AED).
 Responds quickly to Defibrillation.
 A high energy shock delivered to the heart called with
AED.

 Survival rates are as high as 74% when

defibrillation occurs within 3 minutes from the time
of collapse.
2. Pulse less Electrical Activity
 The term used for any other electrocardiographic
(ECG) rhythm, including normal sinus rhythm,
when there is no associated cardiac contraction.
 Responds to Treatment when a reversible
condition is the cause, such as Hypovolemia or
Hyperkalemia.
 Mortality from this condition is higher than for VF.
3. Asystole
 Absence of any cardiac electrical activity and
therefore the absence of any mechanical cardiac
function.
 Patients found in this rhythm have poor
prognosis, with most studies reporting survival of
only 0% to 2%.
Preventive Measures
 Screening :Every person who intends to
participate in vigorous physical activity, especially
competitive sports, should receive thorough
screening for cardiovascular and other disorders.
 Recognition of Cardiac Warning Signs:
Symptoms include syncope, palpitations, episodic
or exertional dyspnea, exertional chest pain, and
early fatigue etc.
Heart Attack
 Heart Attack (Acute Myocardial Infarction)
occurs when a blood clot blocks one of the
arteries that supply blood to the heart muscle.
 Most common cause; Coronary Heart Disease
(CHD).
 Non-Modifiable Risk Factors
 Family history, Sex, Age, Ethnic background, Society
culture.
 Modifiable Risk Factors
 Smoking, High Blood Pressure, High Cholesterol,
Physical Inactivity.
Recognition of Cardiac Warning
Signs
 Pain, Pressure, Heaviness Or Tightness in:
 Jaw, Chest, Shoulder(s).
 Neck, Arm(s), Back.

 Patients may also Feel:

 Nausea/ vomiting (unrelated to other illness)
 Dizziness or light-headedness, Syncope or near-syncope
 Cold Sweats.
 Shortness of breath.

 Palpitations (fluttering in chest)

 Fatigue/weakness
Chain of Survival
 Successful Resuscitation of the victims of SCA/
Heart Attack, requires the proper interventions to
be provided in a very short time.
 The "Chain of Survival" has four links, and the
patient's chances for surviving are the greatest
when all the links come together.
1. Early Access
2. Early CPR
3. Early Defibrillation
4. Early Advanced care
 1. Early Access
Recognition of SCA/ Heart Attack and Preparing
for CPR
 Establish the need for Resuscitation.
 Determine the level of responsiveness, if
unresponsive.
 Activate Emergency Medical Service (EMS)
 Check ABC's.
 Open the Air Way (Head Tilt Chin Lift Maneuver)
 For suspected Cervical injury (Jaw Thrust Maneuver)
 Look Listen Feel
 Rescue Breathing
 2. Cardiopulmonary Resuscitation
(CPR)
 CPR involves a combination of chest compressions
and artificial ventilations designed to revive a
person and prevent biological death by mechanically
keeping a person's heart and lungs working.
 The goal of CPR is to prevent the death of cells and
organs for a few crucial minutes.
 The patient's condition needs to be monitored
throughout CPR to determine if CPR is effective.
CPR Chest Compressions
1. Chest Compressions
 Consist of rhythmic, repeated pressure over the lower half of
the sternum.
 When combined with artificial ventilation, it provides enough
blood circulation to sustain life.

2. Position the patient.

 Must be supine on firm; flat surface, with arms on sides

3. Expose the patient's chest.

 Remove the patient's shirt (male only) providing for patient's
privacy as much as possible.
CPR Chest Compressions (cont..)
4. Get in position.
 Kneel close to the patient's side, your body centered with
the patient's sternum and your knees about as wide apart
as your shoulders.
5. Locate the compression site.
 Place your hand in the centre of chest between the nipples.
6. Position your hands.
 For adult put your free hand on top of the first hand. Extend
or interlace your fingers (do not rest them on the chest
wall).
 For children when using 2 hands, heel of one hand with
second on top or with heel of one hand only.
7. Position your shoulders.
 They should be directly over your hands.
 CPR Chest Compressions (cont..)
8. Perform Chest Compressions
 Keeping your arms straight and your elbows locked in
extension.
 Thrust straight downward from shoulders.
 Release pressure completely after each compression.
 Do not lift or move your hands, or you will lose proper
position. Count as you perform compressions.
 Adult CPR Summary
8 years and Older
 Compression depth: 4-5 cm.(1.5 to 2 inches)
 Compression Rate: 100 per minute
 Each Ventilation: 1 second
 One-Rescuer Cycle: 30 Compressions, 2 breaths
 Two-Rescuer Cycle: 15 compressions, 2 breaths
 Child CPR Summary
1-8 years of age
 Compression depth: 3-4 cm. (1/3 to 1/2 of total
chest depth)
 Compression Rate: 100 per minute
 Each Ventilation: 1 second
 One-Rescuer cycle: 30 compressions, 2 breaths
 Two-Rescuer cycle: 15 compressions, 2 breaths
 CPR Chest Compressions for
infants
 Cardiac arrest in infants is rarely caused by heart
problems. Usually the cause is Hypoxia due to;
 injuries, suffocation, smoke inhalation, etc.
 Resuscitate an infant for two minute before activating the
EMS system (if only one rescuer).
1. Position the patient.
 Place him or her on your forearm, using your palm to support the
head.
2. Expose the patient's chest.
3. Locate the compression site.
 Compression site is just below the nipple line.
4. Perform chest compressions.
 Use the flat part of your middle and ring fingers to compress the
sternum.
 Release pressure completely after each compression.
 However, do not lift or move your hands, or you will lose proper
position. Count as you perform compressions.
 Infant CPR Summary
1 year old and under
 Compression Depth: 1.5-2.5 cm. (1/3-1/2 total
chest depth)
 Compression Rate: 100 per minute or more
 Each Ventilation: 1 second
 One-Rescuer Cycle: 30 compressions, 2 breaths
 Two-Rescuer Cycle: 15 compressions, 2 breaths
 For Newborns: 3 compressions, 1 breath
Signs of Successful CPR
 "Successful" CPR does not mean that the patient
survives
 It only means that you performed it correctly.
 Very few patients will survive if they do not
receive advanced cardiac life support (ACLS).
1. Have someone feel for a pulse during compressions. A
pulse should be palpable with every compression.
2. The chest should rise and fall with each ventilation.
3. The pupils may begin to react normally.
4. Patient's skin color may improve.
5. Patient may attempt to move and try to swallow.
When Not To Begin CPR
 Obvious Mortal Wound
 Livormortis and Rigormortis
 Decomposition
 Still Birth
Complications Caused by CPR
 Even properly performed CPR can cause injuries,
including:
 Fracture of the sternum and ribs
 Pneumothorax
 Haemothorax
 Cuts and bruises to the lungs
 Lacerations to the liver
 Alternative to Complications is Death
 Mistakes in Performing CPR
Problem Result
Patient is not on a hard surface Compressions are not effective

Patient is not in horizontal position Head is higher than the rest of the
body

Head-tilt chin-lift maneuver improperly Open airway not ensured

performed
Incomplete seal around the patient's Ventilations are not effective
mouth and/or nose
Nostrils not completely pinched and the Ventilations are not effective
patient's mouth is not fully open during
mouth-to-mouth ventilation
Hands not in correct position or Fractured ribs; fractured sternum;
compressions incorrectly placed lacerated liver, spleen, lungs or
injured pleura as a result of fractured
ribs
Compressions too deep or frequent Insufficient amount of blood is
pumped
Improper compression/ventilation Inadequate oxygenation of blood
ration
Advanced Equipment and Supplies
 Defibrillators
 Ventilation Aids
 Telephone or other communications
equipment to call emergency centers or
hospitals.
Defibrillators
 Manual Defibrillators
 Automated Defibrillators

 Manual Defibrillators
 Used by medical Personnel with specific training in
cardiac rhythm recognition and management and in
operation of the defibrillator.
 Requires the user to interpret the ECG rhythm and
determine if an electric counter shock should be
delivered
 The user must be able to set the energy level,
activate the charging process, and then push a button
to deliver the shock.
 Automated External Defibrillator
(AED)
 These devices can be used by virtually anyone, even
without prior training, although training is highly advised
 These portable, battery powered devices provide verbal
and visual prompts to the user once the device is turned
on.
 The most important user action is to place the two ECG
sensing defibrillation pads onto the proper locations on
the patient’s chest .
 Some models require the user to push an “analyze”
button and/or a “shock” button to deliver the electric
shock (semiautomatic).
 Some perform analysis, charging, and shock delivery
without further user action (Fully Automatic).
AED

Automated External Standard location of

Defibrillator. defibrillation
pads on an adult.
Ventilation Aids
 Variety of Face shields and masks that cover the
victim’s mouth and nose.
 Many of these have a one-way valve to prevent
air and fluid exchange from the victim to the
rescuer.
Ventilation Aids

Example of a pocket mask (left) and a face shield (right).

Thank you for joining in 

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