EMERGENCY FIRST AID FOR HEART ATTACK

EMERGENCY FIRST AID FOR HEART ATTACK

Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginald Odbert, GP
Important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.

What should you do if someone has a heart attack? If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand. To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential. How can you tell if someone is having a heart attack? If the person is unconscious:

• Are they breathing? Look at the patient's chest to see if it is rising and falling. • Do they have a pulse? Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse. If the patient has a pulse but is not breathing: • Could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them. • Call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives.
If there is no breathing or pulse, the patient has had a cardiac arrest. What help is needed? • If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart • Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
If these actions do not restore a pulse or if the subject doesn't begin to breathe again: • Call for help, stating that the casualty is having a cardiac arrest but stay with the patient. • Find out if anyone else present knows CPR. • Provide artificial respiration immediately. • Begin CPR immediately.
How to give artificial respiration• Tilt the head back and lift up the chin. • Pinch the nostrils shut with two fingers to prevent leakage of air. • Take a deep breath and seal your own mouth over the person's mouth. • Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest. • Do this twice. • Check to see if the chest rises as you breathe into the patient. • If it does, enough air is being blown in. • If there is resistance, try to hold the head back further and lift the chin again. • Repeat this procedure until help arrives or the person starts breathing again.
Artificial respiration and CPR should both be performed at the same time • If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.) • The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR. • Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again. • If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.

Make sure the patient continues breathing and has a pulse until the ambulance arrives • If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened. Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance. How to Perform CPR (Cardiopulmonary Resuscitation)There is no substitute for learning cardiopulmonary resuscitation (CPR), but emergencies don't wait for training. These instructions are for conventional adult CPR. If you've never been trained in CPR and the victim collapsed in front of you, use hands-only CPR.

There are three types of CPR that we will cover in this manual:
1. CPR for infants (0 – 1 year)
2. CPR for children (1- 8 years)
3. CPR for adults

Infant CPR (0 – 1 year)1. Stay SafeChildren may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, take universal precautions and wear personal protective equipment, if available. 2. Try to wake the infantLittle babies respond well having the soles of their feet rubbed or tapped. For infants more than 2 months old, tap their shoulder or chest. In either case, call out his name in a loud voice. Don't hurt the baby but be aggressive; you're trying to wake him up. If the infant does not wake up, have someone emergency services immediately. If no one else is available to call, continue to step 3 and do CPR for about 2 minutes before emergency services. 3. Open the airway and check for breathingPut the baby on a flat, hard surface like a table or the floor. Tilt the infant's head back a little to open the airway. Put an ear to the baby's mouth and listen for breathing sounds. While listening, watch the chest to see if it's rising and falling. If you don't see or hear any signs of breathing, go to step 4 immediately. If the baby is breathing, then emergency services immediately if no one else has already done it. If the baby vomits, turn him to the side to keep him from choking on the vomit. If the baby stops breathing, go to step 4. 4. Give the baby two breathsIf the baby is not breathing, give him two breaths. Cover the baby's entire mouth and nose with your mouth and gently blow until you see his or her chest rise. Let the air escape - the chest will go back down - and give one more breath. If no air goes in when you try to blow, adjust the baby's head and try again. If that doesn't work, then go to step 5. 5. Begin chest compressionsPut two fingers on the breastbone directly between the baby's nipples. Push straight down about an inch and then let the chest all the way back up. Do that 30 times, about twice per second. After 30 pushes on the chest, give the baby two more rescue breaths (as described in step 4). Keep going - 30 chest compressions followed by 2 breaths - for about two minutes. If you still haven't called 911 yet, do it now. Keep doing 30 chest compressions followed by 2 breaths until the baby starts breathing on his own, or until help arrives.Tips:1. When checking for breathing, if you're not sure then assume the baby isn't breathing. It's much worse to assume a baby is breathing and not do anything than to assume he or she isn't and start rescue breaths. 2. Put a book under the baby's shoulders -- if you have time -- to help keep his head tilted back. 3. When asking someone else to call emergency services, make sure you tell them why they are calling. If not, they may not tell the emergency services exactly what's going on. If the emergency services knows the baby isn't breathing or responding, the dispatcher may be able to give you instructions to help over the phone.

Child CPR (1 – 8 years of age)

1. Stay SafeChildren may be infected with contagious diseases. If you are concerned about possible exposure to contagious disease, take universal precautions and wear personal protective equipment, if available. 2. Try to Wake the ChildGently tap or shake the child's shoulders and call out his or her name in a loud voice. Don't hurt the child, but be aggressive, you're trying to wake them up. If the child does not wake up, have someone call emergency services immediately. If no one else is available to call emergency services, continue to step 3 and do CPR for about 2 minutes before calling emergency services. 3. Open the Airway and Check for BreathingPut the child on a flat, hard surface, such as a table or the floor. Tilt the child's head back a little to open the airway. Put an ear to the child's mouth and listen for breathing sounds. While listening, watch the chest to see if it's rising and falling. If you don't see or hear any signs of breathing, go to step 4 immediately. If the child is breathing, then call emergency services immediately if no one else has already done so. If the child vomits, turn the child to the side to keep him or her from choking on the vomit. If the child stops breathing, go to step 4. 4. Give the Child Two BreathsIf the child is not breathing, give him or her two breaths. Cover the child's mouth with yours, and pinch his or her nose closed with your hand. Gently blow until you see his or her chest rise. Let the air escape; the chest will go back down. Then give one more breath. If no air goes in when you try to blow, adjust the child's head and try again. If that doesn't work, then go to step 5. 5. Begin Chest CompressionsPut the heel of one of your hands on the child's breast bone (directly between the child's nipples). Push straight down about 1.5 inches, then let the chest retract all the way back up. Do that 30 times, about twice per second. After 30 pushes on the chest, give the child two more rescue breaths (as described in step 4). Keep going -- 30 chest compressions followed by 2 breaths -- for about two minutes. If you still haven't called emergency services yet, do it now. Keep doing 30 chest compressions followed by 2 breaths until the child starts breathing on his or her own, or until help arrives.Tips:1. When checking for breathing, if you're not sure then assume the child isn't breathing. It's much worse to assume a kid is breathing and not do anything than to assume he or she isn't and start rescue breaths. 2. Put a book under the child's shoulders, if you have time to help keep his or her head tilted back. 3. When asking someone else to call emergency services, make sure you tell them why they are calling. If not, they may not tell the emergency services exactly what's going on. If the emergency services knows the baby isn't breathing or responding, the dispatcher may be able to give you instructions to help over the phone.

Adult CPR:Difficulty: EasyTime Required: CPR should start as soon as possible

1. Stay Safe! The worst thing a rescuer can do is become another victim. Follow precautions and wear personal protective equipment if you have it. Use common sense and stay away from potential hazards. 2. Attempt to wake victim. Briskly rub your knuckles against the victim's sternum. If the victim does not wake, emergency services and proceed to step 3. If the victim wakes, moans, or moves, then CPR is not necessary at this time. Call emergency services if the victim is confused or not able to speak. 3. Begin rescue breathing. Open the victim's airway using the head-tilt, chin-lift method. Put your ear to the victim's open mouth: • look for chest movement • listen for air flowing through the mouth or nose • feel for air on your cheek If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours. Give the victim a breath big enough to make the chest rise. Let the chest fall, then repeat the rescue breath once more. Begin chest compressions. Place the heel of your hand in the middle of the victim's chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest about 1-1/2 to 2 inches (4-5 cm). Allow the chest to completely recoil before the next compression. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate. Repeat rescue breaths. Open the airway with head-tilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another. Perform 30 more chest compressions. Repeat steps 5 and 6 for about two minutes. Stop compressions and recheck victim for breathing. If the victim is not breathing, continue chest compressions and rescue breaths. Keep going until help arrives.Tips:1. Chest compressions are extremely important. If you are not comfortable giving rescue breaths, still perform chest compressions! 2. It's normal to feel pops and snaps when you first begin chest compressions - DON'T STOP! You aren't going to make the victim any worse. Cardiac arrest is as bad as it gets. 3. When performing chest compressions, do not let your hands bounce. Let the chest fully recoil, but keep the heel of your hand in contact with the sternum at all times.

Reference:2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005 Dec 13;112(24 Suppl):IV1-203. Epub 2005 Nov 28