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Cardiac Emergencies &Oxygen AssistanceRakesh Bharania, EMT-B                                                              ...
Agenda           You Are Key!           Heart Overview           Cardiac Emergencies           ERT Cardiac protocols  ...
The Key To         SurvivalPresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   3
Cardiac Chain Of Survival                           Early                                    Early               Early    ...
First responders make the difference!          Cisco ERT can be the difference between life and death in a           card...
Real-world examples          Seattle, WA: CPR training is widespread and EMS response           and time to defibrillatio...
CPR and AED use is recommended for both traditional and non-     traditional public safety responders - this is a Class I ...
The HeartPresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   8
Basic Anatomy           About the size of your fist           100k beats / day           2000 gal. blood pumped / day  ...
The Heart’s Electrical System           The sinoatrial (SA) node is the heart’s            “natural pacemaker”          ...
The Heartbeat - Diastole           Diastole – atria pumping           SA node sends an electrical            signal – at...
The Heartbeat - Systole           Systole – ventricles pumping           Electrical impulse arrives at the AV node      ...
Cardiac         EmergenciesPresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   13
Cardiac Emergencies           Heart disease the #1 cause of death for Americans.           We’ll talk about the most com...
Heart Attacks           A heart attack (myocardial            infarction or MI) occurs            when the heart’s oxygen...
Heart Attacks – Typical Signs/Symptoms           Chest discomfort. Most heart attacks involve discomfort in the          ...
Heart Attacks – Women           “Atypical presentations are typical for women.”           Chest pain is not as common a ...
Sudden Cardiac Arrest - Overview           Sudden Cardiac Arrest != Heart Attack.           SCA = electrical problem    ...
Sudden Cardiac Arrest –          Signs/Symptoms           Patients will suddenly lose consciousness, without any prior   ...
ECGs in one slide           Electrocardiograms (ECG/EKG) record electrical activity of the            heart.           D...
Ventricular Tachycardia           Ventricular Tachycardia is            a rapid ventricular            rhythm           ...
Ventricular TachycardiaPresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   22
Sudden Cardiac Arrest - VFib           Ventricular Fibrillation            occurs when the heart’s            electrical ...
Defibrillation         for Everyone!Presentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   24
Defibrillation Facts          90% of adults successfully resuscitated from non-traumatic cardiac           arrest were in...
Medtronic Lifepak CR Plus AED          Fully automated.          Can detect shockable rhythms          Delivers a “biph...
Cardiac Science PowerHeartAED G3          Fully automated.          Biphasic, adjusts for patient          “Rescue Read...
Updated AHA AED Behavior          1 shock followed by immediate CPR          After two min. of CPR, second shock deliver...
So who’s got ‘em?          ERT Leads          Mobile SAS Officers/Supervisors and SAS Coordinators          Cisco NERV ...
So what about CPR?          CPR supports the patient but cannot reverse cardiac arrest.          It’s still needed to bu...
Emergency         ProtocolsPresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   31
ERT Chest Pain protocol           Ensure 911 / BSI / Scene Safety           Have someone retrieve AED           Positio...
ERT Cardiac Arrest Protocol           Ensure 911 / BSI / Scene Safety           Have someone retrieve AED           Con...
Oxygen         AssistancePresentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Public   34
Oxygen Assistance         Without a “patent” airway, regardless of any other emergency, the         patient will not survi...
Oxygen Delivery         Room air – 21% Oxygen however, we can deliver higher levels of         oxygen when required…      ...
Airway Adjuncts  If a patient is unable to manage their own airway due to altered  mental status, trauma, etc. Trained per...
PulsePoint             Location-aware public CPR/AED alert app for Apple iPhone & Android                                 ...
Now that we have AEDs & O2 how about a pony?Presentation_ID   © 2006 Cisco Systems, Inc. All rights reserved.   Cisco Publ...
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Cisco ERT Cardiac Emergency Brownbag

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Cardiac Emergencies Brownbag as delivered to the Cisco ERT

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  • Sudden cardiac arrest video: http://www.youtube.com/watch?v=LLtzT2bXVGI
  • See: http://www.usatoday.com/news/health/2004-08-11-cpr_x.htm and http://www.americanheart.org/presenter.jhtml?identifier=4483
  • See: http://www.usatoday.com/news/health/2004-08-11-cpr_x.htm and http://www.americanheart.org/presenter.jhtml?identifier=4483
  • See: http://www.usatoday.com/news/health/2004-08-11-cpr_x.htm and http://www.americanheart.org/presenter.jhtml?identifier=4483
  • CPR Effectiveness source: JAMA, 1/18/2005 “ A common misconception is that CPR will actually restart a stopped heart; although this may occur very occasionally, this is not the expected outcome of CPR” http://members.aol.com/henryhbk/cprfaq.html
  • Online video for OPA/NPA: http://www.expertvillage.com/video/35446_perform-cpr-opa-npa.htm
  • Transcript of "Cisco ERT Cardiac Emergency Brownbag"

    1. 1. Cardiac Emergencies &Oxygen AssistanceRakesh Bharania, EMT-B We gotta go to Cisco … again!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 1
    2. 2. Agenda  You Are Key!  Heart Overview  Cardiac Emergencies  ERT Cardiac protocols  Oxygen assistance  PulsePointPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 2
    3. 3. The Key To SurvivalPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 3
    4. 4. Cardiac Chain Of Survival Early Early Early Early 911 CPR Defibrillation Advanced Care But all this starts with youPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 4
    5. 5. First responders make the difference!  Cisco ERT can be the difference between life and death in a cardiac emergency.  The numbers prove it.  Trained bystanders save as many people as ALS paramedics do, and send more home with intact brain function  Why? Time!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 5
    6. 6. Real-world examples  Seattle, WA: CPR training is widespread and EMS response and time to defibrillation is short, the survival rate for witnessed VFib cardiac arrest is about 30%.  New York City: few victims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VFib cardiac arrest averages 1–2%  Security guards at O’Hare Airport (Chicago), Las Vegas Casinos achieve a survival rate of 50-74%!  Since AED deployment, Cisco ERT has a 100% success rate (3 for 3)Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 6
    7. 7. CPR and AED use is recommended for both traditional and non- traditional public safety responders - this is a Class I recommendation. AED Programs should be implemented in sites where there is a high likelihood of witnessed cardiac arrest. - this is a Class I recommendation 2005 AHA CPR/ECC Guidelines (reaffirmed in 2010 CPR/ECC)Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Confidential Cisco Public 77
    8. 8. The HeartPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 8
    9. 9. Basic Anatomy  About the size of your fist  100k beats / day  2000 gal. blood pumped / day  Four chambers: > two atria (top) > two ventricles (bottom)  Four one-way valves: > Tricuspid > Pulmonary > Mitral > Aortic  Two coronary arteries supply the heart muscle itself (not shown)Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 9
    10. 10. The Heart’s Electrical System  The sinoatrial (SA) node is the heart’s “natural pacemaker”  Electrical impulses travel to the atrioventricular (AV) node.  Through the Bundle of His  Signal splits down the left and right bundle branches  Normal adult rate: 60-100/min, can vary due to stress, physical activity, hormonal changesPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 10
    11. 11. The Heartbeat - Diastole  Diastole – atria pumping  SA node sends an electrical signal – atrial contraction  Tricuspid and Mitral valves open, filling the ventricles  Pulmonary and Aortic valves are closed  This is the longer of the two phases of a heartbeatPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 11
    12. 12. The Heartbeat - Systole  Systole – ventricles pumping  Electrical impulse arrives at the AV node and travels down to the two bundle branches causing ventricular contraction  Pulmonary and Aortic valves are opened, blood forced out to the lungs for oxygen, and to the rest of the body  Tricuspid and Mitral valves closed, preventing backflow  This is the shorter of the two phases of a heartbeatPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 12
    13. 13. Cardiac EmergenciesPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 13
    14. 14. Cardiac Emergencies  Heart disease the #1 cause of death for Americans.  We’ll talk about the most common cardiac emergencies you may be faced with. > Heart Attacks > Sudden Cardiac Arrest Remember: While not all chest pain/discomfort is cardiac, all chest pain calls should be treated as such!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 14
    15. 15. Heart Attacks  A heart attack (myocardial infarction or MI) occurs when the heart’s oxygen supply is blocked & heart muscle is damaged (infarction)  Caused by plaque buildup in the coronary arteries  When plaque ruptures, platelets form clots around the plaque  This can restrict blood to distal portions of the heart  Drugs: asprin, thrombolytics “clot busters”, vasodilators such as nitroglycerinPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 15
    16. 16. Heart Attacks – Typical Signs/Symptoms  Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.  Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.  Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.  Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness, denialPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 16
    17. 17. Heart Attacks – Women  “Atypical presentations are typical for women.”  Chest pain is not as common a symptom of a heart attack in women as it is in men (43% reported no chest pain/pressure)  Women are more prone to experience so-called “atypical” symptoms than men before and during a heart attack  Such symptoms include (but are not limited to): Back, neck, or jaw pain Nausea Vomiting Indigestion Weakness Fatigue Dizziness LightheadednessPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 17
    18. 18. Sudden Cardiac Arrest - Overview  Sudden Cardiac Arrest != Heart Attack.  SCA = electrical problem  MI = plumbing problem  It is the largest cause of natural death in the U.S., causing about 250,000 adult deaths each year  SCA occurs most frequently in adults mid-30s to mid-40s, and affects men twice as often as it does women  We worry about two rhythms, ventricular tachycardia (VTach), and ventricular fibrillation (VFib)Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 18
    19. 19. Sudden Cardiac Arrest – Signs/Symptoms  Patients will suddenly lose consciousness, without any prior warning.  No breathing (there may be ineffective breathing motions, however – “agonal breathing” – does not count as breathing)  No pulsePresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 19
    20. 20. ECGs in one slide  Electrocardiograms (ECG/EKG) record electrical activity of the heart.  Does not automatically correspond to physical action of the heart.  Normal Sinus Rhythm includes a P wave, a QRS Complex and a T wave.  P = current for atrial contraction  QRS = current for ventricular contraction  T = ventricular repolarization (atrial repolaraization is hidden by QRS)  The ECG is so familiar to the general population that it is part of the logo of many medical organizations, representing the technical side of medicinePresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 20
    21. 21. Ventricular Tachycardia  Ventricular Tachycardia is a rapid ventricular rhythm  Heart rate 140-250 but ineffective perfusion Normal Sinus Rhythm  Can degrade to VFib  Treated with: Valsalva maneuvers, anti-arrhythmic drugs (Rakesh’s favorite: adenosine), cardioversion  Pulseless VTach is shockable by an AED (not all VTach is pulseless) Two examples of VTachPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 21
    22. 22. Ventricular TachycardiaPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 22
    23. 23. Sudden Cardiac Arrest - VFib  Ventricular Fibrillation occurs when the heart’s electrical activity loses all coordination  Pulseless, no BP Normal Sinus Rhythm  Respiration will stop, unconsciousness will occur  Asystole (and death) will result unless treated  This is the most common cardiac arrest rhythm Two examples of VFibPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 23
    24. 24. Defibrillation for Everyone!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 24
    25. 25. Defibrillation Facts  90% of adults successfully resuscitated from non-traumatic cardiac arrest were in VFib  The success of defibrillation is directly related to the time to defibrillation  Chances of successful defibrillation of pulseless VTach or VFib is 70-80% at time zero. Each minute that passes, chances of successful defibrillation decreases between 2-10%  Ten minutes after the event, chances of survival is near zero  Defibrillation does not “restart” a stopped heart (asystole), regardless of what the movies showPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 25
    26. 26. Medtronic Lifepak CR Plus AED  Fully automated.  Can detect shockable rhythms  Delivers a “biphasic” shock. Accommodates patient impedance  Pads are compatible with Medtronic ALS ECG monitors  20 minutes ECG record timePresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 26
    27. 27. Cardiac Science PowerHeartAED G3  Fully automated.  Biphasic, adjusts for patient  “Rescue Ready” indicatorPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 27
    28. 28. Updated AHA AED Behavior  1 shock followed by immediate CPR  After two min. of CPR, second shock delivered if needed.  No more “stacked shocks.” Most biphasic AEDs convert Vf in one shock.Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 28
    29. 29. So who’s got ‘em?  ERT Leads  Mobile SAS Officers/Supervisors and SAS Coordinators  Cisco NERV disaster response trucks  Wall mounted in EBC/CBC & Fitness Center Locations  Wall mounted, one unit per building (typically first floor breakroom)  Cisco RTP and SJ Saves!!!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 29
    30. 30. So what about CPR?  CPR supports the patient but cannot reverse cardiac arrest.  It’s still needed to buy the time between arrest onset and defibrillation.  So, it’s still important. AHA: Re-emphasis on CPR. (C-A-B)  CPR is a hard skill for even those who do it all the time (paramedics, ER doctors, etc.)  Chest compressions often done too shallowly. Rate at least 100/min, Push hard, push fast.  Done properly, cartilage damage or rib breaking is common  Chest compressions can be done w/o breaths if unwilling or able to perform them!Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 30
    31. 31. Emergency ProtocolsPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 31
    32. 32. ERT Chest Pain protocol  Ensure 911 / BSI / Scene Safety  Have someone retrieve AED  Position of comfort, reassure patient  Assess vital signs, SAMPLE & OPQRST history  Oxygen (if available, and trained to do so) @ 15 lpm/NRB (preferred) or 6 lpm/cannula  Aspirin if asked by 911 and readily available. (325 mg – 4 x 81mg baby aspirin, chewed)  Be prepared to initiate CPR / AED if patient goes unresponsivePresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 32
    33. 33. ERT Cardiac Arrest Protocol  Ensure 911 / BSI / Scene Safety  Have someone retrieve AED  Confirm unresponsiveness “Are you OK?”  If there is no breathing or only agonal breathing, immediately give 30 compressions. Rate = 100/min  Open airway (head-tilt, chin lift) and deliver two rescue breaths.  Perform CPR cycles of 30:2 until AED or EMS  If CPR in progress, 3rd person can setup & attach pads.  Deliver AED shock as soon as possible.  Recheck for breathing after every five cycles of CPR. Continue if needed.Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 33
    34. 34. Oxygen AssistancePresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 34
    35. 35. Oxygen Assistance Without a “patent” airway, regardless of any other emergency, the patient will not survive. Cisco ERT Protocol (2011): Non-EMT ERT members may assist an oxygen-equipped ERT member with Oxygen What this means: YOU can setup oxygen for an ERT EMT, but you cannot actually apply the oxygen to a patient. OXYGEN SAFETY: No smoking Contents under pressure (don’t open w/o a regulator on the tank)Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 35
    36. 36. Oxygen Delivery Room air – 21% Oxygen however, we can deliver higher levels of oxygen when required… Non-Rebreather Mask (NRB) – 60-100% Oxygen at 10-15 lpm. Preferred method of O2 delivery pre-hospital. Used on distressed or other serious patients. Nasal Cannula – 24-44% Oxygen at 1-6 lpm. Common for long term O2 therapy, but not really good for pre-hospital. Used when patient won’t tolerate NRB or as a comfort measure. Bag-Valve Mask – assists a patient who is breathing too slowly or not at all. Can be connected to O2 @ 15 lpm, 100% O2 delivery. Best used with an airway adjunct. Preferred over a pocket-mask Oxygen Bear – provides “blow-by” oxygen for pediatric patients who won’t tolerate mask.Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 36
    37. 37. Airway Adjuncts If a patient is unable to manage their own airway due to altered mental status, trauma, etc. Trained persons (EMTs, etc.) are permitted to use two different types of “airway adjuncts” to help manage a patient’s airway. Oropharyngeal Airways (OPA) are “hook-like” devices that are inserted into a person’s mouth to keep the tongue and epiglottis clear. Can only be used on patients without a gag-reflex. Nasopharyngeal Airways (NPA) are trumpet-like tubes that are inserted into one of a patient’s nostrils. Can be used on conscious or semi-conscious patients. Each adjunct has its primary uses and contraindications. Neither is considered a “definitive” airway – patient could still aspirate. Intubation “secures” the airway, but is a paramedic skill.Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 37
    38. 38. PulsePoint Location-aware public CPR/AED alert app for Apple iPhone & Android www.firedepartment.mobiPresentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 38
    39. 39. Now that we have AEDs & O2 how about a pony?Presentation_ID © 2006 Cisco Systems, Inc. All rights reserved. Cisco Public 39
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