Sudden malfunction of the heart, leading to cessation of blood flow.
Electrical failure: Dysfunction at any point in the conduction system (SA node, AV node, Purkinje fibers, Bundle of His).
Mechanical failure: Muscle or valve failure due to myocardial infarction (MI), chronic hypertension, trauma, or valvular dysfunction.
Pulseless Electrical Activity (PEA): Electrical signals present, but no muscular response.
Asystole: Complete absence of electrical activity.
Dysrhythmias: Include too slow (bradycardia) or too fast (ventricular tachycardia) heart rates, or ineffective muscle contractions like in ventricular fibrillation (V-fib).
Conditions Leading to Cardiac Arrest
Ventricular Tachycardia (V-Tach): Heart beats too fast to effectively pump blood.
Ventricular Fibrillation (V-Fib): Irregular quivering of heart muscle.
Myocardial Infarction: Sudden interruption of blood flow to the heart muscle.
Commotio Cordis: Sudden blunt trauma to the chest, often seen in sports.
Corrective Measures and Importance of CPR
Sudden Cardiac Arrest (SCA)
Hands-only CPR is recommended because oxygen levels are initially normal.
Use AEDs to correct V-Fib and V-Tach.
Asphyxial Cardiac Arrest
Occurs when the heart runs out of oxygen; caused by respiratory or cardiac events leading to hypoxia.
Ventilations are essential; more common in pediatric cases.
Importance of differentiating agonal respirations from effective breathing.
Effects of Cardiac Arrest
Heart stops pumping, leading to a halt in oxygen and nutrient supply to organs.
Organ damage and failure, starting with the kidneys.
Chain of survival: Immediate help and intervention are crucial for survival.
Pediatric Cardiac Arrest
Mainly due to asphyxia: choking, respiratory issues.
Requires high-quality ventilations along with CPR.
Sudden Infant Death Syndrome (SIDS): Unexplained death, often related to sleep apnea.
Chain of Survival
Recognition and Activation of EMS
Public awareness and training, prompt 911 calls.
Dispatcher-assisted CPR instructions.
Immediate High-Quality CPR
Push hard and fast (100-120 compressions/min), depth: at least 2 inches.
Hand placement: lower third of the sternum.
Switch every 2 minutes to maintain quality.
Rapid Defibrillation
Use AEDs to correct V-Fib and V-Tach.
Types: Monophasic and Biphasic (preferred due to lower energy usage and impedance compensation).
Basic and Advanced EMS
EMTs/AEMTs/Paramedics manage the situation, administer medication, and provide defibrillation.
Advanced Life Support and Post-Arrest Care
Stabilize heart rhythms, maintain airway, transport to hospital.
High-Quality CPR Techniques
Elbows locked, using shoulder muscles for compressions.
Correct hand placement varies with size and age of the patient (infants: 2 fingers, children: 1-2 hands as needed).
Importance of full chest recoil.
Rescuers switch roles every 2 minutes.
AED Usage
Turn on the AED, attach pads to a bare, dry chest.
Follow the device prompts, ensure no one is touching the patient during analysis and shock.
Continue CPR immediately after the shock for 2 minutes.
Types: Monophasic (single direction shock), Biphasic (shock from both pads simultaneously).
Special Scenarios
Pediatric Patients: Use pediatric pads when available.
Cold Water Drowning: Continue resuscitation until the patient is warmed up.
Implanted Devices (Pacemakers/Defibrillators): Avoid placing AED pads directly over such devices.
Post-Arrest Care and Family Management
Rapid transport, continuous monitoring, and provision of advanced care to stabilize and restore patient function.
Compassionate communication with family members, providing situational updates and support.
Conclusion
Importance of public training in CPR and AED use for survival improvement.
EMS and public coordination through training programs and awareness campaigns.
Additional Notes
Use soundtracks like “Stayin’ Alive” or “Imperial March” for maintaining CPR rhythm.
Mechanical CPR devices like Lucas and AutoPulse are highly beneficial but expensive.
Encourage community participation in CPR training events.