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Non-Urban Cardiac Arrest Management (Nucam)

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Non-Urban Cardiac Arrest Management (Nucam) M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) 1 M ODULE 7 NN OO NN -- UU RR BB AA NN CC AA RR DD II AA CC AA RR RR EE SS TT MM AA NN AA GG EE MM EE NN TT (( NN UU CC AA MM )) PEAK Emergency Response Training Advanced Protocol Training Program 2 M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) Intentionally Blank PEAK Emergency Response Training Advanced Protocol Training Program M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) 3 O VERVIEW AND L IABILITY This ‘ Non - Urban Cardiac Arrest Management Protocol (NUCAM ) Tra ining M odule ’ i s not exhaustive. It is designed to be used in conjunction with an extensive practical and theoretical training program, which includes a written an d prac tical examination. Annual recertification is required for maintenance of PEAK’ S ‘Non - Urban Cardiac Arrest Management Protocol (NUCAM)’ certification. ‘90 - day S kills R efreshers’ are strongly encouraged. This ‘ Non - Urban Cardiac Arrest Management Pro tocol Training Module’ is intended to be utilized by professional (paid & volunteer) n o n - u rb an r esponders such as ski/bike patrollers , s earch and r escue technicians, guides and other n on - u rban f i rst r esponders that are tasked with providing advanced emerge ncy medical care . Candidates must hold, at a minimum, a current certification in at least one of the following programs (or equivalent): Non - Urban Occupational First Aid (NUOFA 3), Non - Urban Emergency Care (NUEC 3), Outdoor Emergency Care (OEC), Occupat ional First Aid Level 3 (OFA Level - 3) or the Canadian Ski Patrol First Aid Course (CSP) . Po tential candidates mu st also hold a current (within one y ear) CPR certification. This ‘ Non - Urban Cardiac Arrest Management Protocol Training M odule ’ is as printed and carries no g uarantee whatsoever. PEAK assumes no responsibility to any party for lo ss or damage alleged to be caused by the information contained or by any alleged omission in this ‘ Non - Urban Cardiac Arrest Management Protocol Training M odule ’ . Furt hermore, PEAK pr ohibits any individual, corporation or entity from copying, altering, l oanin g or using this manual in full or in part without prior express written permission of PEAK . PEAK Emergency Response Training Advanced Protocol Training Program 4 M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) S UDDEN C ARDIAC A RREST (SCA) Sudden Cardiac Arrest (SCA) is the lead ing cause of death among adults striking nearly 45,000 Canadian s ann ually. The Canadian Heart and Stroke Foundation support implementing the “ Chain of Survival ” to assist people who suffer a cardiac arrest in the community. The ad ult chain consists of: ► Early Recognition and Activation of EMS ► Early CPR ► Rapid Defibr illat ion ► Effective Advanced Life Support Care ► Integrated Post - Cardiac Arrest Care It is estimated that for every minute a person remains in cardiac arrest, surv ivability is reduced by 7 - 10%. The definitive treatment for Ventricular Fibrillation ( VF ), the most common ‘treatable’ type of cardiac arrest , or Ventricular Tachycardia (VT) , is defibrillation. Early defibrillation, in conjunction with cardiopulmonary re suscitation (CPR), incre ases survival rates by nearly 50%. What is Sudden Cardiac Ar rest (SCA)? SCA is death resulting from an abrupt loss of heart function (cardiac arrest). Most victims of SCA are middle - aged or elderly: the average victim is about 6 5 years old; however, ma ny victims are in their 40’s and even younger. Very often, the re is no previous history of heart problems; in many cases SCA is the first symptom. All known heart diseases can lead to SCA and death. Most deaths resulting from S CA occur when the electr ical impulses in the diseased heart become too rapid ( Ventricul ar Ta chycardia ) or chaotic ( Ventricular Fibrillation ) – originating from incorrect parts of the heart. These irregular heart rhythms ( arrhythmias ) produce ineffective or absent contractions res ulting in the cessation of blood flow and ultimately death. C PR / AED – Survival Rates Early CPR Delayed CPR Defibrillation Defibrillation 2 - 8% survive Early CPR Defibril l ation 2 0 % surv iv e Early CPR Defibrillation PEAK Emergency Response Training Advanced Protocol Training Program M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) 5 SCA ( CONT ’ D ) What Causes Sudden Cardiac Arrest? When SCA occurs in young adults (up to approximately 35 years of age), pre - exi sting heart abnormalitie s and/or respiratory compromise is likely the cause. Adrenalin e rel eased during intense physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present. Also, under certain conditions s ome heart medications an d other drugs (as well as recreational drugs) can lead to abnor mal h eart rhythms that can cause SCA. In 90% of the adult victims of SCA, two or more major coronary arteries are found to be narrowed by fatty build - ups. In addition, heart muscle scarring fr o m a prior heart attack (often presented as a ‘silent’ attack), is o bserved in two - thirds of the victims. In order to understand how these ‘ narrowings ’ and blockages of coronary arteries can lead to SCA, it ’ s essential to review o ur knowledge of the anat o my and physiology (‘meat and motion’) of the respiratory and c ardia c systems. Following this review, we must understand the electrical anatomy and physiology (electro - physiology) of the heart in order that we can understand how i t is that arterial block a ges lead to d eath of heart muscle tissue and interrupted elect rical cardiac signals. Subsequently this may lead to malfunctioning cardiac muscle, decreased blood flow and ultimately SCA. PEAK Emergency Response Training Advanced Protocol Training Program 6 M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) R ESPIRATORY / C ARDIAC A NATOMY & P HYSI OL OGY ► T HE R ESPIRATORY S YSTEM We already know that our Primary Assessment includes making sure the patient has a clear airway and effective breathing, or by providing the necessary critical interventions. To ensure that we have a firm foundation upon whi ch to add the NUCAM Protocol , should it be required , it is important to go through a quick review of the anatomy & physiology (A&P) of the respiratory system. The airway is separated into two sections: the upper airway and the lower airway . The upper air way is composed of the mouth, nose, pharynx and epiglottis . The tongue is located in the upper airway and is the most common source of airway obstruction in an unresponsive patient (GCS < 8) . The lower airway is made up of the larynx, trachea, bronchi, br onchioles and alveoli . Air Flow Through the Respiratory System Air enters through the nose or mouth, where it is warmed and filtered before passing through to the pharynx . The pharynx is divided into two sections: the nasopharynx (located behind the no se), and the oropharynx (located behind the mouth). The air then continues to travel down the pharynx and past the epiglottis (the flap that covers the larynx preventing food and liquid from entering the lower airway when eating). The air then enters t he lower airway. The air enters the larynx (voice box) after passing the epiglottis. The larynx lies between the areas that you palpate (feel) when checking the carotid pulse. T he cricoid cartilage makes up the bottom portion of the larynx, and the trac hea lies just below the larynx. Air passes through the trachea , which branches into the left and right bronchi – leading to the left and right lungs. The air follows the bronchi which further divide into many bronchioles , which eventually end in alveo lar sacs located in the lung tissue. Once the air reaches the capillaries surrounding the alveoli, gas exchange occurs (CO 2 [carbon dioxide] is off - loaded from the blood cells, and O 2 [ Oxygen ] is loaded onto the blood cells – ‘oxygenating’ the blood for its return back to the heart). The lungs are referred to as the ‘ pulmonary ’ component of the respiratory system. PEAK Emergency Response Training Advanced Protocol Training Program M ODULE 7 – N ON - U RBAN C ARDIAC A RREST M ANAGEMENT P ROTOCOL (NUCAM) 7 R ESPIRATORY / C ARDIAC A NATOMY AND P HYSIOLOGY ( CONT ’ D ) ► T HE C ARDIO - P ULMONARY S YSTEM – M ECHANICAL A & P P ULMONARY (R) S IDE S YSTEMIC (L) S IDE The heart is an involuntary muscle that is about the size of two clenched adult fists (one fist for children) . It is composed of car diac muscle, called myocardium , and it is responsible for pumping Oxygen - rich blood to the body (including its own heart tissue) and Oxygen - depleted blood back to the lungs. The heart is divided into four chambers, with the septum separating the left an d right sides. Each side is further divided in half with the atria being the upper chambers and the ventricles being the lower. Blood Flow Through the Cardio - Pulmonary System The superior vena cava receives Oxygen - depleted blood from the head and the upper body and the inferior vena cava receives blood from the lower body. This blood is delivered into the ‘relaxed’ right atrium , which, when the atria contract, expels the blood through a one - way valve (the tricuspid valve) into the right ventricle. T his creates the ‘ l ub’ of the familiar ‘ l ub - d ub ’ sound associated with a heart beat.
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