March 8, 2010
Last month I wrote about myocardial infarction, also known as a heart attack. Heart attacks are usually caused by a blood clot that stops the flow of blood in the artery of the heart. In simpler terms I like to call this a plumbing problem.
This month, I plan to discuss sudden cardiac arrest, which is an electrical problem, not a plumbing problem.
The American Heart Association defines cardiac arrest as the sudden, abrupt loss of heart function. Sudden death occurs within minutes after symptoms appear.
Sudden cardiac arrest claims about 340,000 lives a year in the United States, about 930 each day. Ninety-five percent of all cardiac arrest victims die.
CPR or cardiopulmonary resuscitation is the manual circulation of blood and the manual introduction of oxygen into the lungs of someone who is not breathing. Contrary to popular belief, CPR is unlikely to restart the heart. It is designed merely to buy us time by keeping the brain alive until an AED is applied. Brain death starts after just 4 to 6 minutes without oxygen. When we perform CPR, we manually squeeze the heart and force blood, which carries oxygen, to the brain.
Here are the steps to perform CPR.
Step 1. Check the victim to see if he/she is responsive. Talk loudly, tap him/her on the shoulder, try to wake the person up. If the person does not wake up, we have a problem and need medical help.
Step 2. Send one of the crew to call or radio for help. If you have a telemedicine service, now is the time to use it.
Step 3. Send another of the crew to grab the Automated External Defibrillator or AED.
Step 4. Look, listen and feel. Is the person breathing? Place your ear next to the victim’s mouth and listen for breathing. Look at their chest for movement and take notice if you feel their breath on your cheek. Do this for about 10 seconds.
If the person is breathing and you do not suspect spinal trauma, roll the patient on his/her side to prevent aspiration (vomit entering the lungs). If the person is not breathing begin CPR chest compressions and rescue breathing.
Step 5. If you have a barrier device such as a pocket CPR mask, begin by giving two breaths. Tilt the patient's head back to open the airway and give one breath, watch for chest rise and fall, and then give a second breath.
If you do not have a barrier device, you can still perform mouth-to-mouth by forming a tight seal around the victim's mouth, tilting their head, pinching their nose closed and lowing air into their lungs.
If you do not have a barrier device and do not wish to perform mouth-to-mouth, move right into Step 6.
Step 6. Begin chest compressions. Find the middle of the chest, between the nipples. Place the heel of your hand on the sternum. Stack your other hand on top and press down 2 inches. Do this quickly, about 100 times per minute. Now continue with 30 compressions immediately followed by two breaths, repeating the process five times. 30&2, 30&2, 30&2, 30&2 and 30&2. These five cycles should last about 2 minutes. Return to step 4.
If you do not perform rescue breathing, do 200 compressions without pause. Press down 2 inches in the center of the victim’s chest at a rate of 100 times per minute, continuing for about 2 minutes. Then return to step 4.
The CPR process continues until the victim begins breathing on his/her own, emergency personnel take over or, after repeated attempts to save the victim, you are instructed by medical professionals to discontinue care.
When to apply the AED: If the victim is not breathing, the AED should be applied immediately. The AED should be turned on, the victim's chest should be bare (you may need to shave the area where the pads will be placed or dry that area if the victim is wet). Once the AED is applied, follow the voice prompts.
We'll go into greater detail about how and when to use an AED next month.
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