3. INTRODUCTION
• Sudden cardiac arrest(SCA) refers to an abrupt loss of
cardiac function resulting in complete cardiovascular
collapse due to either an acute life-threatening cardiac
arrhythmia or abrupt loss of myocardial pump function
that requires emergency medical intervention for
restoration of effective circulation.
4. EPIDEMIOLOGY
• It is responsible for half of all heart disease deaths,
affects men & women alike, especially above 41yrs of
age
• Globally out of hospital cardiac arrest is a major
public health challenge with an incidence of 55 cases
per 100,000
• A study done in UCH, Ibadan, Nigeria in
2014,showed an incidence of 34.6 : 10,000
7. Presentation
• Cardiac arrest is an emergency condition, in about
50% of cases warning symptoms could occur; chest
pain, fatigue, blackouts, dizziness.
• SCA typically present with; loss of consciousness, no
palpable pulse, no breathing, central and peripheral
cyanosis.
• Irreversible brain damage occurs after 5mins of
arrest if adequate resuscitation measures are not
instituted
8. INVESTIGATIONS
• Cardiac arrest is an emergency condition the absence
of carotid pulse is a gold standard in making a
diagnosis.
• Some investigations should run concurrently with
resuscitation however elaborate investigations should
be made after the patient has been adequately
resuscitated to identify the cause, treat as appropriate &
prognosticate if need be
10. Protocols for Cardiac Resuscitation
• Basic life support (BLS)
• Advanced cardiac life support (ACLS)
• Paediatric advanced life support (PALS)
• Neonatal resuscitation program (NRP)
12. BLS
• These are sequences of procedures performed to restore
the circulation of oxygenated blood after a sudden
pulmonary and/or cardiac arrest.
• It’s cardiopulmonary resuscitation
• It combines rescue breathing and chest compressions
• It requires knowledge and skill to perform CPR and operate
the AED/Defibrillator
20. Chest Compression
• Position yourself at patients side
• Victim should be laid on firm, flat surface
• Remove the clothing of the patient
• Put the heel of one hand on the centre of the chest
(sternum) at the level of nipples and put your other
hand on the top of the former hand
21. Chest compressions contd.
• Strengthen arms and shoulders directly over the hands
• Lock all joint; movement is allowed only at the hip joint
• Push hard and fast (100-120times/min), depth of 5-6cm
• At the end of each compression, chest is allowed to recoil
completely
• Avoid excessive ventilation
• Then give the next chest compression immediately
25. Airway
• Assess patient’s airway
• Open Air way by head tilt chin lift maneovre,
• Jaw thrust should be used instead if a neck injury is
suspected.
30. Rescue Breaths
• Recommendations
• Tidal Volume
500-600ml
• Respiratory rate
• Give each breath over 1 second with enough volume
to make the victims chest rise
31. • Alternate between providing 30compressions and 2
rescue breaths.
• If you are unable to provide ventilations, give
continuous chest compressions.
36. Bag and Mask Ventilation
• Position yourself directly above patients head
• Perform head tilt
• Make ‘C’ with thumb and index finger to seal the
mask
• And other 3 fingers forms ‘E’ jaw thrust
• Chest rise is checked with squeezing the bag to give
breaths to the patient
37.
38. Defibrillation
• Defibrillation is used for the treatment of
tachydysarythmias
• Defibrillation depolarizes the critical mass of
myocardial cell at once. It recaptures the SA node as
its pace maker
• It’s the treatment of choice for pulseless Ventricular
Tachycardia and Ventricular fibrillation.
39.
40. Defibrillator contd.
Defibrillators can be
classified as
Monophasic (delivers
current of one polarity) 360J
Biphasic (deliver current two
polarity ) 150-200J
41. Defibrillator contd.
• As soon as the AED arrives, or if one is already available at the
site of the cardiac arrest, switch it on.
• Attach the electrode pads to the victim's bare chest according to
the position shown on the AED or on the pads.
• If more than one rescuer is present, continue CPR whilst the
pads are being attached.
• Follow the spoken (and/or visual) prompts from the AED.
• Ensure that nobody is touching the victim whilst the AED is
analysing the heart rhythm.
42. Defibrillator contd.
• If a shock is indicated, ensure that nobody is touching the
victim.
• Push the shock button as prompted. Immediately restart CPR
with
• 30 compressions.
• If no shock is indicated, immediately restart CPR with 30
• compressions.
• In either case, continue with CPR as prompted by the AED.
• There will be a period of CPR (commonly 2 min) before the AED
prompts for a further pause in CPR for rhythm analysis.
43. Defibrillator contd.
• 1st paddle- on the right side just below the clavicle
• 2nd at the precordial region
44.
45.
46. • When BLS is complete or patient is conscious and
responsive, ACLS survey is carried out with the aim
of sustaining resucitative measures, identifying and
treating the underlying cause(s) of cardiac arrest
• This usually occurs when a patient is transferred to a
hospital
47. Foreign body airway obstruction
• Suspect choking if someone is suddenly unable to
speak or talk, particularly if eating.
• Encourage the victim to cough.
• The cough becomes ineffective, give up to 5 back
blows:
Lean the victim forwards
Apply blows between the shoulder blades using the
heel of one hand
48. If back blows are ineffective, give up to 5 abdominal thrusts:
Stand behind the victim and put both your arms around
the upper part of the victim's abdomen.
Lean the victim forwards.
Clench your fist and place it between the umbilicus (navel)
and the ribcage.
Grasp your fist with the other hand and pull sharply
inwards and upwards.
49. • If choking has not been relieved after 5 abdominal
thrusts, continue alternating 5 back blows with 5
abdominal thrusts until it is relieved, or the victim
becomes unconscious.
• If the victim becomes unconscious, start CPR
50. CONCLUSION
• Cardiac arrest is an emergency condition affecting the
world at large particularly individuals with
cardiomyopathies. The urgency & adequacy to which
these resuscitative measures are instituted determines
the extent to which a patient recovers with/without
permanent end organ damage.
51. REFRENCES
• CHRISTINE M. ALBERT, WILLIAMS G. STEVESON. CARDIOVASCULAR
COLLAPSE,CARDIAC ARREST,SUDDEN CARDIAC DEATH; HARRISON 20TH
EDITION; PAGE 2059-2064
• SHIJIAO YAN,YONG GAN,CHINANZHU LAV. THE GLOBAL SURVIVIAL RATE
AMONG ADULT OHCA; 2020
• A RUKERE, A FATIREGUN,TO OSUNLAGA.CARDIAC ARREST DURING
ANAESTHESIA.ATA UNIVERSITY HOSPITAL IN NIGERIA; 2014; VOLUME 17;
PAGE 28-31
• ADVANCED CARDIAC LIFE SUPPORT ONLINE TRAINING
• MEDI STUDENT; BASIC LIFE SUPPORT; 2017
• SLIDE SHARE. SCA & SCD. DR ABDULLAH ANSARI
• VIJAYARADDI VANDALI, KAMEL ABDI. BASIC LIFE SUPPORT.DEPT OF
NURSING.KOMAR UNIVERSITY OF SCIENCE & TECHNOLOGY, SULEMANI,
KURDISTAN.
