“The Role of the Layman in Cases of Sudden Cardiac Arrest”, Assignments of Cardiology

Download “The Role of the Layman in Cases of Sudden Cardiac Arrest” and more Assignments Cardiology in PDF only on Docsity! Cardiorespiratory Block Scenario 1 Topics: “The Role of the Layman in Cases of Sudden Cardiac Arrest” In a guest lecture, a cardiologist said that everyone (not only health workers) must know about Basic Life Support (BLS). One of them learns about heart massage techniques (external cardiac massage). The goal is to save people if they experience cardiac arrest. If you see a family member or neighbor experiencing sudden cardiac arrest, not breathing, and unconscious, don't panic. Call for help from medical personnel and immediately perform chest compressions. It is advisable to immediately contact the nearest hospital. This action needs to be done as soon as possible, and the blood flow and respiratory system are stopped can cause brain damage and even death in just 4-6 minutes. To be able to perform chest compressions, participants are expected to know about the anatomy of the thoracic cavity, including imaginary lines and layers of the thoracic cavity wall. Clarification of Terms: • Basic Life Support (BLS) • Heart massage (external cardiac massage) • Cardiac arrest • Chest compressions • Blood flow • Respiratory system • Brain damage • Thoracic cavity Topics: • Anatomy of the thorax and thoracic cavity • Anatomy and physiology of the heart, lungs, and blood vessels Learning Objectives: 1. Students can explain the anatomy of the thorax and thoracic cavity 2. Students can explain the anatomy and physiology of the heart, lungs, and blood vessels 3. Students can explain the physiological role of oxygen in homeostatic conditions 4. Students can explain the steps of heart massage Formulation of the problem 1. What is Basic Life Support? 2. What is cardiac massage? 3. What is the purpose of doing cardiac massage? 4. Why should cardiac massage be performed as soon as possible after cardiac arrest occurs? 5. How can cardiac massage mechanisms prevent brain damage and death? 6. What are the steps taken to perform the heart massage technique? 7. Describe the imaginary line found on the thorax! 8. Describe the structure of the thoracic cavity wall! Answer: 1. What is Basic Life Support? Basic Life Support (BLS) or known as Basic Life Support (BHD) is a series of initial treatment efforts for patients who are marked or experiencing cardiac arrest (absence of effective heart contractions), unconscious patients, no pulse, respiratory arrest, or airway obstruction. The purpose of BLS is to restore respiratory and/or circulation function in someone who has stopped breathing and/or cardiac arrest (cardiac arrest). BLS includes several skills that can be taught to anyone, namely recognizing sudden cardiac arrest, activating the emergency response system, performing early cardiopulmonary resuscitation (CPR)/cardiopulmonary resuscitation (CPR), and how to use an automated external defibrillator (AED). Ideally in the world, everyone is familiar with the basic techniques of first aid and takes regular training to ensure the knowledge goes on 2. What is cardiac massage? The main purpose of BLS is an emergency oxygenation measure to maintain pulmonary ventilation and distribute oxygenated blood to body tissues. In addition, this is an effort to provide systemic circulation assistance, along with ventilation and oxygenation of the body effectively and optimally until spontaneous systemic circulation is regained or assistance with more complete equipment has arrived to carry out advanced cardiac life support measures. Cardiac massage (external cardiac massage) is one part of BLS by performing movements such as massaging the chest wall to provide positive pressure as if massaging the heart instead of heart contractions which work as a "pump" of blood in the systemic circulation and provide positive pressure ( intrathoracic pressure is higher than atmospheric pressure) to distribute oxygenated blood to body tissues. the release of the neurotransmitter glutamate stimulates the activation of lipases and proteases, leading to apoptosis (cell death). Picture 2. Schematic demonstrating the various microvascular and cellular pathophysiologic consequences which occur during the primary and secondary injury in hypoxic-ischemic brain injury. Decreased cerebral oxygen delivery manifests as reduced neuronal aerobic metabolism, causing reduced cellular adenosine triphosphate (ATP) production. Intracellular calcium accumulation leads to mitochondrial toxicity and further reduced ATP production. The inability to sustain cellular respiration results in cell death and apoptosis. Additionally, in the microvasculature, endothelial dysfunction leads to a porous blood-brain barrier, formation of cerebral edema, formation of microthrombi, and limitation of cerebral blood flow with exacerbation of cellular ischemia. AQP 4 Aquaporin-4, RBC Red blood cells, WBC White blood cells 5. How can cardiac massage mechanisms prevent brain damage and death? The heart massage mechanism on the outside of the chest will generate and maintain blood flow during the action. To date, there are two main theories: (1). Cardiac pump theory, which assumes that blood flow is driven by direct compression of the heart. Blood flows during compression because the heart is directly squeezed between the spine and the sternum. (2). The “thoracic pump” theory, hypothesizes that blood flow is caused by changes in intrathoracic pressure. Forward blood flow occurs because the intrathoracic pressure during compression exceeds the extrathoracic pressure. This increases the pressure in the blood vessels, causing blood to be forced from the thorax to the systemic veins, with the heart acting as a passive conduit rather than a pump. The most recent hypotheses including the ''atrial pump'' (atrial pump), ''lung pump'' (lung pump), and ''respiratory pump'' have also been proposed to enrich the theory of cardiac massage hypothesis. Based on current evidence, one theory may not be sufficient to explain how cardiac massage produces blood flow to the systemic circulation. This suggests that different simultaneous mechanisms may be involved. The occurrence of this mechanism also depends on several factors, such as delay in starting resuscitation, force, and rate of compression, body habitus, airway pressure, and electrocardiogram results. Picture 3. The main theories about the production and maintenance of blood flow during the cardiac massage. (a) In the pump theory of the heart, during compression, the mitral valve closes (white arrow), while the aortic valve opens (red arrow) when intraventricular pressure exceeds aortic diastolic pressure. During recoil, the aortic valve closes and the mitral valve opens, allowing “diastolic” filling. Similar changes can be seen in the right-sided heart valve. (b) In the thoracic pump theory, during compression, the intrathoracic pressure increases and forces blood from the thoracic vessels into the systemic circulation, with the heart acting as a conduit and not as a pump. Thus, a venous-arterial pressure gradient develops, leading to antegrade blood flow through the atrioventricular, aortic, and pulmonary valves during compression. This theory requires that the mitral valve be open throughout the cardiac cycle (white arrow) and implies a minimal change in ventricular volume. 6. What are the steps taken to perform the heart massage technique? If someone is not breathing, there is no pulse and there is no response, then the person is said to be in cardiac arrest. In this situation, the steps that must be taken are to activate the emergency response system and contact the nearest emergency health service center. Steps to do the heart massage technique a. Place the victim on a flat, firm surface to ensure that the victim receives adequate pressure. b. Make sure the victim's chest is exposed to ensure correct hand placement and to see chest recoil. c. The two hands are linked, the position of one hand is like overlapping the other so that the two hands overlap and are parallel. d. The hands, especially the book, are placed in a position as if to press in the middle of the chest wall, between the nipples (in the middle of the lower half of the sternum). e. Straight arm position. The arm should be straight at 90 degrees to the victim's chest, with the rescuer's shoulder as the top support. Picture 4. Heart massage (lower half of sternum) f. Push down straight, at least 4-6 cm 'depth'. g. Do it at a speed of 100-120x/minute. h. Gives the chest a chance for perfect recoil. During compressions, ensure that the chest wall is allowed to expand back to its original shape (full recoil) so that the pumping power of the heart works optimally. i. Frequency of 30 compressions: 2 ventilations. Give 2 breaths after every 30 chest compressions, with a duration of 1 second for each breath. Make sure the chest expands for each rescue breath. For rescuers who are not trained in performing CPR, it is advisable to perform continuous chest compressions only. j. Every 2 minutes people who perform compressions must be changed (rotation of the heart massager), because no one can do compressions at that speed. k. Minimal interruption during compression < 10 seconds l. Check a pulse every 2 minutes (5 cycles) "If the massage is of good quality (good and correct), it takes less than 10 minutes for the patient to be conscious or return to a spontaneous response" Daftar Pustaka  Cipani, S., Bartolozzi, C., Ballo, P., & Sarti, A. (2018). Blood flow maintenance by cardiac massage during cardiopulmonary resuscitation: Classical theories, newer hypotheses, and clinical utility of mechanical devices. Journal of the Intensive Care Society, 175114371877848. doi:10.1177/1751143718778486