Emergency Care in Physiotherapy Treatment of Sudden Cardiac Death

1. Emergency Care in Athletic Training
Chapter 4
Keith Gorse, Robert Blanc, Francis Feld and Mathew Radelet
Presentation Prepared by:
Asma Lashari
University of Health Sciences

2.  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.

3.  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.

4.  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.

5.  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.

6.  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%.

7.  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.

8. 1. Ventricular Fibrillation (VF)
2. Pulseless Electrical activity
3. Asystole
 Sudden Cardiac Arrest should be Differentiated
from a “Heart Attack.”

9.  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.

10.  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.

11.  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%.

12.  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.

13.  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.

14.  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

15.  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

16. 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

17.  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.

18. 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.

19. 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.

20. 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.

22.  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

23.  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

24.  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.

26.  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

27.  "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.

28.  Obvious Mortal Wound
 Livormortis and Rigormortis
 Decomposition
 Still Birth

29.  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

30. 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
performed
Open airway not ensured
Incomplete seal around the patient's
mouth and/or nose
Ventilations are not effective
Nostrils not completely pinched and the
patient's mouth is not fully open during
mouth-to-mouth ventilation
Ventilations are not effective
Hands not in correct position or
compressions incorrectly placed
Fractured ribs; fractured sternum;
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
ration
Inadequate oxygenation of blood

31.  Defibrillators
 Ventilation Aids
 Telephone or other communications
equipment to call emergency centers or
hospitals.

32. ◦ 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.

33.  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).

34. Automated External
Defibrillator.
Standard location of
defibrillation
pads on an adult.

35.  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.

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

37. Thank you 