Cardiac arrest management includes sequence of events that increases the survival rate of a person with cardiac arrest. It aims to keep the patient alive and improve the patient’s condition to some extent. Cardiac arrest can be a cause of heart attack, electric shock or drowning. The management includes basic life support (BLS), and advance life support (ALS).
Basic Life Support (BLS)
Basic life support helps in maintaining a low circulation level until expert help arrives. Basic life support follows ABCDE approach:
- A- airway
- Airway obstruction can be life threatening
- Can cause brain, heart or kidney damage, cardiac arrest and death
- It is important to look for the signs of airway obstruction, which includes paradoxical chest and abdominal movements, central cyanosis (late symptom) and absence of breath sounds near the nose and mouth.
[Air entry is diminished and noisy in case of partial obstruction]
- B- breathing
- Check for increased respiratory rate, chest expansion and duration of each breath
- See if there is any sign of respiratory distress: use of accessory muscles of respiration and abdominal muscles while breathing, sweating and cyanosis
- C- circulation
- Due to shock or any other cardiac conditions the circulation may be affected causing hypovolemia
- Hypovolemia results in increased heart rate, discoloration of distal limbs and cold limbs
- D- disability
- Disability refers to the neurological condition of the resuscitated person
- E- exposure
- To examine the patient and to use defibrillator,pp removal of clothes maybe required
If ABCs are present the following procedure should be followed:
- Call for help
- Start chest compressions
- Rescue breath
- Continue till help arrives
Chest compressions or cardiopulmonary resuscitation (CPR) is often started after cardiac arrest. Minimum 30 chest compressions are given at a time followed by rescue breath and than again chest compressions.
How to perform CPR?
- When you see a person fall tap on the shoulder, ask “Are you ok?” Or “Do you need help?”, If the person remains unconscious or gasps CPR should be performed
- Call for medical help
- Make the person lie on their back and see if there is any airway obstruction
- Ask people to stand back, to avoid suffocation of the victim
- Before starting CPR check if scene is safe enough to start the procedure, avoid traffic or fire
- Remove all the jewelry/ accessory near or around the neck and chest.
- Expose the chest area for better assessment, exposure should never harm the dignity of the person!
- Place one hand over the other and clasp it. With the heel of your palm and elbow straight perform chest compressions on the center of the chest and below the nipple line.
- Push at least 2 inches deep
- Perform 30 chest compressions at a rate of 100 times per minute
* Allow chest to rise fully between the compressions
- After 30 chest compressions perform 2 rescue breaths
- Repeat the procedure until expert help arrives or person regains its pulse or is conscious again
How to perform rescue breath?
Rescue breath can be either ‘mouth-to-mouth’ or ‘mouth-to-nose’. Mouth-to-nose is used when mouth-to-mouth is not possible to perform due to any injury or inability to seal the person’s mouth tightly.
To perform rescue breath follow the following steps:
- Tilt the person’s head backward, to open the airway
- Close the nose by pinching it by the fingers for mouth-to-mouth or close the mouth by pressing chin up in case of mouth-to-nose for preventing any leakage of air
- Seal your mouth to person’s mouth or nose
- Blow into the person’s mouth or nose
- 2 breaths at an interval of 1 second each
- Breath should be gentle i.e. avoid harsh/ forceful blow
- Break contact with person after each breath for air to flow out
- Perform 2 rescue breath after each CPR cycle
- Repeat till person gains consciousness or medical help arrives
Advance life support (ALS)
ALS restores the normal cardiac rhythm using automated external defibrillator (AED). It may even include administration of drugs to help in improving the circulation or endotracheal intubation for proper ventilation of lungs.
What is an AED?
AED, automated external defibrillator is a device used in cardiac emergencies. It is a device used to provide shock to the heart through the chest wall to help restore the normal heart rhythm.
How to use an AED?
AED can be used along with CPR to maintain proper circulation.
- AED device has 2 leads, during the time of use one is placed over the right side of the chest and other over the lateral side of left chest
- AED is administered using 150J-200J biphasic shock
- CPR is resumed after the administration of AED
- After 2 minutes of continuous CPR, check for the restored pulse. If the pulse is still absent again use AED
*Use AED at 150J in initial stage.
*Do not stop CPR after administration of AED to check restored pulse, resume CPR as early as possible after AED administration
AED devices are installed at offices, railway stations, airports, metros and hospitals.
Points to remember
- Do not start CPR as soon as you see a person gasp, as it may be a result of choking too.
- AED administration should be done by a trained professional only.
- CPR should be practiced in every 6 months to maintain one’s skill.