HEART ATTACK

A heart attack occurs when the flow of blood to the heart is

severely reduced or blocked. The blockage is usually due to a
buildup of fat, cholesterol and other substances in the heart
(coronary) arteries. The fatty, cholesterol-containing deposits are
called plaques. The process of plaque buildup is called
atherosclerosis. Sometimes, a plaque can rupture and form a clot
that blocks blood flow. A lack of blood flow can damage or
destroy part of the heart muscle. A heart attack is also called a
myocardial infarction.
Common heart attack symptoms include:
• Chest pain that may feel like pressure, tightness, pain, squeezing
or aching
• Pain or discomfort that spreads to the shoulder, arm, back, neck,
jaw, teeth or sometimes the upper belly
• Cold sweat
• Fatigue
• Heartburn or indigestion
• Light-headedness or sudden dizziness
• Nausea
• Shortness of breath
 CARDIAC ARREST

• CARDIAC ARREST

Sudden cardiac arrest (SCA) is the sudden loss of all heart

activity due to an irregular heart rhythm. Breathing stops. The
person becomes unconscious. Without immediate treatment,
sudden cardiac arrest can lead to death.
This medical emergency needs immediate CPR or use of a
defibrillator. Hospital care includes drugs, an implantable device
or other procedures.
 CHAIN OF SURVIVAL

Chain of Survival Elements

Although there are slight differences in the Chains of Survival
based on the age of the victim and the location of the cardiac
arrest, each includes the following elements:
• Prevention and preparedness
• Activating the emergency response system
• High-quality CPR, including early defibrillation.
• Advanced resuscitation interventions
• Post-cardiac arrest care
• Recovery
• HIGH QUALITY CPR SKILLS-ADULTS

A rescuer who arrives at the side of a potential cardiac arrest victim

should follow these sequential steps
• Step 1-Verify the scene safety
Make sure that the scene is safe for you and the victim.
• Step 2- Check for responsiveness.
Tap the victim's shoulders. Shout, "Are you OK?" If the victim is not
responsive, activate the emergency response system via mobile device.
Get the Automated External Defibrillator (AED) or send someone to do so.
• Step 3- Assess for breathing and a pulse.
Assess the victim for normal pulse and breathing will help to determine
the next appropriate actions.
To minimize the delay in starting CPR, you should assess breathing at the
same time as you check the pulse. This should take at least 5 seconds
but not more than 10 seconds.
Breathing
• To check for breathing, scan the victim's chest tor rise and tall tor no
more than 10 seconds.
• If the victim is breathing: Monitor the victim until additional help
arrives.
• If the victim is not breathing or is only gasping: Be prepared to begin
high-quality CPR. Gasping is not normal breathing and is a sign of
cardiac arrest.
 Checking for the carotid pulse of an adult

•To perform a pulse check

on an adult, feel for a
carotid pulse.
•If you do not definitely
feel a pulse within 10
seconds, begin high-
quality CPR, Starting with
chest compressions.
•Follow these steps to find
and feel for the carotid
pulse.
• Locate the trachea (on the side closest to you ),using 2 or 3
fingers.
• Slide those fingers into the groove between the trachea and the
muscles at the side of the neck, where you can feel the carotid
pulse.
• Feel the carotid pulse for at least 5 but not more than 10
seconds. If you do not definitely feel a pulse within 10 seconds,
begin high-quality CPR, Starting with chest compressions.
 DISCOVER NEXT ACTION
IF THEN
• If the victim is breathing normally and pulse is • Monitor the victim
present
• Provide rescue breathing.
• If the victim is not breathing, but a pulse is • Confirm that Emergency response system has
present been activated.
• Continue rescue breathing and check the pulse
every 2 minutes as respiratory arrest can
progress to cardiac arrest.
• If you don’t feel a pulse start high quality
Cardiopulmonary Resuscitation

• Perform High Quality CPR

• If the victim is not breathing or is only gasping
and has no pulse
PERFORM HIGH- QUALITY CHEST COMPRESSIONS
The foundation of CPR is high-quality chest compressions.
Compressing the chest during CPR pumps blood from the heart
to the brain and then to the rest of the body. Each time you stop
chest compressions, the blood flow from the heart to the brain
and other organs decreases significantly. Once you resume
compressions, it takes several compressions to bring the blood
flow back up to the levels present before the interruption. Thus,
the more often you interrupt chest compressions and the longer
the interruptions are, the lower the blood supply to the brain and
critical organs.
• To maintain the high quality of the chest compressions; it is important to:
• Place the victim on a firm, flat surface
• Maintain compression ventilation ratio of 30 compressions to 2 breaths
for any age
• Compress at a rate of 100 to 120/min
• compress the chest at least 5 cm not more than 6 cm
• Allow the chest to recoil (re expand) completely after each compression
• Minimize interruptions in compression
• Do not move the victim during compressions
• Avoid Excessive ventilation
CHEST COMPRESSION TECHNIQUE
• Position yourself at the victim’s side
• Ensure victim is lying face up on a firm, flat surface. If not, carefully roll him face
up. If neck injury is suspected, keep the head, neck and torso in a line when rolling
to the faceup position
• Position rescuer’s hands and body to perform chest compression
• Place the heel of one hand in the center of the victims chest, on the lower half of
the breastbone (sternum).
• Put the heel of other hand on top of the first hand; interlock the fingers of both
hands if needed.
• Straighten the arms and position shoulders directly over the hands (perpendicular
to the patient's chest). Note that the elbows should remain straight enough.
• Give chest compression at a rate of 100-120 (Maintain high quality chest
compression).
• Press straight down on the breastbone, 5-6 cm with each compression.
• Allow the chest to recoil it completely after every chest compression
• Minimize the interruptions between the compressions less than 10 seconds
GIVE BREATHS
Airway
For effective ventilation the victim’s airway must be
opened. The techniques for opening the airway are:
• 1. Head Tilt, Chin Lift
• 2. Jaw thrust If the victim is a suspected case of
head/neck injury
Head Tilt Chin Lift
• STEP ACTIONS

• Place one hand on victim’s forehead and push with the palm, to tilt
the head back.
• Place the fingers of the other hand under the bony part of the lower
jaw near the chin.
• Lift the jaw to bring the chin forward.
• When performing a head lift- chin lift, make certain that you.
• Avoid pressing deeply into the soft tissue under the chin because
this might block the airway.
• Do not close the victim’s mouth completely
JAW THRUST
 TECHNIQUE OF JAW THRUST
• Actions

1. Place one hand on each side of the victim’s head. Rest the
elbows on the surface on which the victim is lying.
2. Place the fingers under the angles of the victim’s lower jaw
and lift with both hands, displacing the jaw forward
3. If the lips close, push the lower lip with the thumb to open
the lips.
 BARRIER DEVICES FOR GIVING BREATHS
• Barrier devices are one type of protective equipment designed to protect
rescuers from direct exposure to infection when in closed contact with
victim while ventilation. Barrier devices using as a part of standard
precautions. They include.
• Pocket Mask
• Bag Mask device
 POCKET MASK
• Using as a barrier
device for mouth-to-
mouth breath
• Usually have 1-way
valve
• Available in different
size for adults,
children, and infants
 STEPS TO USE A POCKET MASK
• Position on the victim’s side
• Place the pocket mask on victim’s face, the bridge of
nose is the guide for correct position.
• Seal the pocket mask against the face.
• Place the index finger and thumb of one hand that is
closer to the top of victim’s head, along the edge of the
mask.
• Place the thumb of the other hand on the edge of the
mask.
• Place the remaining fingers of the second hand along
the bony margin of the jaw and lift the jaw. Perform head
tilt to open the airway
• Press firmly and completely around the outside edge of
the mask to seal the pocket mask against the face.
• Deliver each breath over 1 second.
BAG MASK DEVICE
• Used to provide positive pressure ventilation to a victim who is not breathing or
normally breathing.
• This may be used with or without oxygen supply.
• Available in variety of size for infant, children and adults.
• Position directly above the victim’s head.
• Place the mask on victim’s face, the bridge of nose is the guide for correct position.

• Use the E-C clamp technique to hold the mask in place while lift the jaw to open the
airway.
• a. Perform a head-tilt.
• b. Place the mask on the face with narrow portion at the bridge of the nose.
• c. Use the thumb and index finger of one hand to make a “C” on the side of the
mask.
• d. Use remaining fingers to lift the angles of the jaw (3 fingers form an “E”).
• Squeeze the bag to give breaths (1 breath/ second).
•Adult 30:2 30:2
•Child 30:2 15:2
•Infant 30:2 15:2

COMPRESSION VENTILATION RATIO

 2 rescuer BLS sequences
• If the multiple rescuers are available for a resuscitation
attempts of an unresponsive adult, quickly perform the
following steps:
• Verify scene safety, check for responsiveness, and get help.
• If victim is unresponsive: the first rescuer assesses the victim
and sends second rescuer to activate the emergency
response system and retrieve the AED and emergency
equipment.
• Assess for breathing and pulse.
• If pulse is absent; begin high quality CPR with chest
compressions.
• The First rescuer begins high quality CPR, starting with chest
compressions.
• Once the second rescuer returns, rescuers should switch the
compressors about every 2 minutes or 5 cycles. Typically, when the
AED analyzes the rhythm.
• Attempt defibrillation with the AED as soon as it is available by
following the prompts from the AED
• Resume high quality CPR, after shock delivery or if no shock is advised
and continue until advanced life support providers take over or the
victim starts to breathe, move or otherwise react.
• Rescuers tasks in 2 rescuer CPR RESCUER POSITIONS
RESPONSIBILITIES
• Rescuer 1 (Compressions) -POSITION
• At the side of the victim’s chest
• RESPONSIBILITIES
• Make sure victim is faceup on a firm, flat surface.
• Perform chest compressions.
• Switch compressors about every 5 cycles or every 2 minutes.
Take less than 5 seconds to switch.
Rescuer 2 (Breath) -POSITION
• Above the victim’s head
RESPONSIBILITIES
• Maintain an open airway by using either head tilt or jaw thrust.
• Give breaths, watching for chest rise.

• Encourage first rescuer to perform compression deep and fast

enough and allow chest recoil.
• Switch compressors about every 5 cycles or 2 minutes. Take
less than 5 seconds to switch.
 AUTOMATED EXTERNAL DEFIBRILLATOR
An automated external defibrillator, or AED, is a lightweight,
portable, computerized device that can identify an abnormal
heart rhythm that needs a shock. The AED can then deliver a
shock that can stop the abnormal rhythm and allow the heart's
normal rhythm to return. AEDs are simple to operate. They allow
laypersons and healthcare providers to attempt defibrillation
safely.
AUTOMATED EXTERNAL DEFIBRILLATOR
 DEFIBRILLATION
• The AED identifies abnormal heart rhythms as shockable or
non-shockable. Shockable rhythms are treated with
defibrillation. Defibrillation is the medical term for interrupting or
stopping an abnormal heart rhythm by using controlled
electrical shocks. The shock stops the abnormal rhythm. This
resets the heart's electrical system so a normal (organized)
heart rhythm can return.
• If effective circulation returns, the victim's heart muscle is once
again able to pump blood. The victim will have a heartbeat that
produces a palpable pulse la pulse that can be felt by the
rescuer). This is called return of spontaneous circulation, or
ROSC. Signs of ROSC include breathing, coughing, or
movement and a palpable pulse or measurable blood
 STEPS IN USING AN AED
1. Open the carrying case. Turn on the AED.
2. Follow the AED prompts
3. Peel the backing away from the AED pads.
4. Attach adhesive AED pad on victim’s bare chest. Follow placement
diagram on the pad.
5. Attach connecting cable to AED device.
6. When AED prompts, Clear the victim and allow AED to analyse the
rhythm.
7. Some AEDs will tell to push the button to begin analyzing, AED may
take few seconds to analyze.
8.If the AED advice a shock, it will tell to clear the victim and
deliver a shock.
Clear the victim before delivering the shock.
Loudly state clear the victim and make sure no one is in contact
with the victim. Press the shock button. The shock will produce a
sudden contraction of the victim’s muscles.
9.If no shock is needed and after every shock delivery,
immediately resume CPR with chest compressions.
10.After about 5 cycles of CPR, the AED will prompt to repeat
step 3 and 4.
 SPECIAL CIRCUMSTANCES IN USING AN AED
• The rescuer may require taking additional actions when
placing AED pads on following circumstances:
•  Hairy chest: If the victim has hairy chest AED may not stick
to the skin on the chest and will not be able to analyze the
heart rhythm. Therefore, observe whether victim has hairy
chest before applying the pads, if excessive hairs are present
shave the area were placing the pads by using razor from the
AED carrying case.
•  Water/Sweat: If the victim is in water, pull the victim out of
the water, quickly wipe the chest before attaching the AED
pads. If the victim is lying in snow or in a puddle, use the AED
after wiping the chest properly.
•  Implanted defibrillators and pacemakers: If an
implanted defibrillator is identified, if possible,
avoid placing AED pads directly over the
implanted device, as the implanted device may
block the shock delivery. Attach the pads below
the lump for delivering the shock.
•  Transdermal medication patches: Remove the
medication patches if any, as it may block the
energy transfer from AED pads. Wipe the surface
and proceed with defibrillation.
 BLS FOR INFANT AND CHILDREN
• If the rescuer is alone and encounters an unresponsive
infants or child, follow these steps:
• Verify scene safety, check for responsiveness, and get
help.
• Assess for breathing and pulse.
• Breathing scan, the victim’s chest rise and fall for no
more than 10 seconds.
PULSE:
• Infant: Palpate brachial pulse.Place 2 or 3 fingers
on the inside of the upper arm between infant’s
elbow and shoulder, then press the fingers to
attempt to feel the pulse for at least 5 but no more
than 10 seconds.
• Child: Palpate carotid or femoral pulse.For locating
femoral artery pulse, place 2 fingers in the inner
thigh, between the hipbone and pubic bone and
just below the crease where the leg meets the
torso.
• In the absence of pulse, activate the emergency
responds system
• Begin high quality CPR.
Single rescuer should use the following compression
techniques:

• Infants: two finger chest compression

• Child: 1 or 2 hands
Infant (1): 2 Finger Technique

Place infant on firm and

flat surface.
Place 2 fingers in the
center of the infant’s
chest just below the
nipple line on the lower
half of the breastbone.
Give compressions
• At least one third of the AP diameter of infants’ chest (about 4
cm)
• At a rate of 100 to 120/min
• Allow chest recoil.
• Minimize interruptions to less than 10 seconds

After every 30 compressions:

• Open airway with a head tilt Chin Lift
• Give 2 breaths
• Watch for chest rise
After about 5 cycles or 2 minutes of CPR, if
you are alone and the emergency response
system has not been activated, activate it and
retrieve the AED.

Continue compression and breaths in a ratio

30:2 until advanced provider arrives and use
AED as soon as available.
 2 RESCUERS
Thumb Encircling Hands Technique
• This technique is preferred 2 rescuer chest
compression technique
• Steps:
• Place both thumbs side by side in the center of the
infant’s chest on the lower half of the breastbone. The
thumbs may overlap in very small infants.
• Encircle the infant’s chest and support the infant’s back
with the fingers of both hands
• Use both thumbs with your hands encircling the chest to
depress the breastbone approximately one third of the depth of
the infant’s chest (approximately 1 ½ inches or 4cm).
• Deliver compressions in a smooth fashion at a rate of at least
100/min but not more than 120/min.
• After each compression, completely release the pressure on
the breastbone and allow the chest to recoil completely.
• After every 15 compressions, pause briefly for the second
rescuer to open the airway with the head tilt-chin lift and given 2
breaths. The chest should rise with each breath.
• Continue compressions and breaths in a ratio of 15:2 (for 2
rescuers), switch the roles every 2 minutes to avoid rescuer
fatigue.
 Ventilation for Infant or Child

Infants or children who develop cardiac arrest

often have respiratory failure or shock that
reduces oxygen content in the blood as a result, in
most of the cases chest compressions alone are
not effective, therefore. It is important to give both
compression and breaths during high quality CPR
• Use a barrier device of appropriate size.
• Use head tilt -chin lift to open the airway, if a
head or neck injury is suspected use a jaw
thrust maneuver.
• Press the mask to the face and make a seal.
• Connect to supplementary oxygen when
available
 CHOKING
• CHOKING

• Choking is a blockage of the upper airway by

food or other objects, which prevents a person
from breathing effectively. Choking can cause a
simple coughing fit, but complete blockage of the
airway may lead to death.
Signs of Choking
• Choking may cause a range of signs from mild to
severe airway obstruction
 TECHNIQUE TO RELIEVE CHOKING
• Use Heimlich maneuver (abdominal thrusts) to relieve choking by
following these steps:
• Stand or kneel behind the victim and wrap your arms around the victim’s waist.
• Make a fist with one hand.
• Place the thumb side of your fist against the victim’s abdomen, in the midline,
slightly above the navel and just below the breastbone.
• Grasp your fist with your other hand and press your fist into the victim’s
abdomen with a quick, forceful upward thrust.
• Repeat thrusts until the object is expelled from the airway or the victim
becomes unresponsive
• Give each new thrust with a separate, distinct movement to relieve the
obstruction
Relief of Choking in an Unresponsive
Adult or Child
• If a choking victim becomes unresponsive,
activate emergency response system.
• Lower the victim to the ground and begin
CPR, starting with compressions (do not
check for a pulse).
• Each time open the airway to give breaths, open the mouth wide and
look for the object, if see the object that can be easily removed, use the
fingers and remove the object.
• If do not see the object continue CPR, after about 5 cycles or 2 minutes
activate emergency response system, if not already done so.
Actions after Choking
• After removing airway obstruction:
• check for responsiveness
• check for breathing and pulse
• confirm activation of emergency response system
• provide high quality CPR as required. If victim is responsive, potential
complications from abdominal thrust should be evaluated.