I took the course which started in May and was 6 weeks long. We were in Samui, Thailand.
This course is offered by Dr. Benjamin Abella, MD, MPhil. Clinical resuscitation Science department of emergency in the University of Pennsylvania.
II. Now... Here is my special story about this special course...
1. I came across this course and I thought: "hum... now that I know about it... I have no choice but to enroll. What if someone collapses in front of me, and I don't have enough knowledge to do anything to save him apart from calling for help?"
2. I wrote a page about the basics of cardiac arrest on my blog. I asked my family to read it. And a big thank you to Dr. Benjamin Abella who took the time to always answer personally to important questions on forums (I wanted to make sure my blog had no mistakes, so I asked for details...). That, I had never experienced to that point before on Coursera. I believe all peers felt the level of caring from the teacher in this course was very high.
3. The week of my final test for this course, a family member had a heart attack immediately followed by a cardiac arrest. But, everyone knew what to do...
4. He is doing great! He was put in hypothermia. Brain damages are minor or non existent!
5. My contribution if any was really minor. But I was glad I did enroll just in time!
Note that this course has been designed for a large public and not specifically for health care providers. Plus this course is made absolutely CRYSTAL CLEAR for beginners even when it gets a bit more technical. Thanks Dr. Benjamin Abella!
You will find on my blog some basic knowledge concerning cardiac arrest (based mainly on week 1 course) plus the syllabus of the course.
Please note that I am NOT a healthcare professional, so I urge you to visit professional health pages too.
If you see the tiniest mistake in procedure in this page, please report it immediately by adding a comment. Thanks
CPR stands for Cardio Pulmonary Resuscitation.
So, to make it very simple to start with, if anyone collapses on the ground unconscious, this is probably a cardiac arrest. You need to have someone call the emergency. If they don't answer proceed with CPR immediately to augment his chances to survive: 100 pushes per minute WITHOUT mouth to mouth:
For teen and adults:
100 compression per minute: PUSH FAST
2 inches depth =5 cm in depth PUSH HARD
As long as necessary PUSH as LONG as needed.
No Mouth to Mouth
As long as necessary meaning until the victim regains consciousness or until the victim can get defibrillated if necessary. There should be the shortest possible lap between the two actions.
Or chances of survival can be dramatically reduced...
Vinnie Jone's video has already save many people...
The rhythm of the compression has to be fast:
100/minutes
Too often people (even heath care providers according to data) don't do it fast enough.
In a lab, on animals, it has been observed that doing less than 80 compression per minute leads in most cases to death.
THE 3 C:
1. CHECK:
- Check the scene is safe depending on the situation
-Response: Yes or No.
2. CALL
- Call Emergency or ask someone to call
3. CARE
- CPR immediately
- Keep on with CPR or use the defibrillator (AED) if on site and if appropriate to the case.
(Use the AED directly on the victim if less than 3 minutes have past since the person collapsed OR if more than 3 minutes have passed, do 200 compression CPR hands only before using a defibrillator)
- Do not stop CPR. Even after more than 20 minutes of CPR, chances are you can resuscitate the victim.
AND... "S":
S is for switch: switch performing CPR with someone else every 2-3 minutes.
CPR: 100 pushes per minute + no mouth to mouth.depth: 2/3 of the depth of the victim's chest (2 inches=5cm for adults)
Defibrillator
If a defibrillator is available then, you can go ahead and use it if it is required.
You DO NOT need to be a professional to use it.
Check the Wiki link...
Ok, so that is the basic stuff.
Now, this course has no copyright on it. Meaning, I can just share with you all I want about the course (apart from the test I believe). So! Let's go into more details. To do so, I have been using my notes from the video lectures along with pictures I found on the web.
1. What is cardiac arrest?
- Functional Cardiac Output:
When the heart beats normally, the electrical recording of the heart rhythm is regular: the heart moves blood in the body.
- Non Functional Cardiac Output:
When the cardiac rhythm is chaotic, no blood can flow in the body. This is cardiac arrest. This situation cannot sustain life without outside help.
When there is no blood flowing in the body, the person lacks of functional output and usually instantly collapses. Without any blood flowing to the lung or brain, the victim of cardiac arrest is technically dead and appear lifeless. But, just note that, in some situation, for brief minutes, the body may have gasping or seizure activities.
2. The immediate actions required to restore blood flow:
- CPR: you need to act fast and proceed with Cardio Pulmonary Resuscitation
- Electrical de-fibrillation:
BOTH OF THOSE CAN BE DONE BY THE LAY PUBLIC.
- Here is how to use a defibrillator:
1. Place the paddles on the chest
2. Charge
3. Decharge
However, note that there are multiple designs in defibrillators (AED).
And many more...
- Hands on only CPR:
1. "First ask: are you ok?" If you get no response, you need to assume that this is a cardiac arrest and move to step 2.
2. Put both hands on the center of the chest. And do 100 compression per minute of 2 inches of depth.
Compress as hard as you can, continuously. PUSH HARD, PUSH FAST. Note that CPR is best performed on a hard surface. Do not place the patient on a bed for example.
Only if you are trained in mouth to mouth can you proceed to CPR+Breathing.
In 2012, a consensus was created: "Consensus Resuscitation Guideline". It is updated every 5 years. It was published in the US by the American Heart Association.
Some things have changed concerning CPR:
1. Perform hands only CPR if you are not trained in mouth to mouth.
2. Practice CAB: check first circulation, then Airway, then Breathing.
3. Cardiac Arrest is different from Heart Attack
A heart Attack is a myo-cardiac infection (MI). It means that there are blockages in the coronary arteries feeding the heart. So, pieces of heart muscles lose blood supply. Now, a complete blockage does lead to death of a portion of heart muscle, but in most cases, of heart attacks, the victim lives and does not need CPR not de-fibrillation.
To treat a heart attack, you need:
- aspirin
- angioplasty
- coronary stent placement
- anticoagulant medication
It is true that in some cases, heart attacks can lead to cardiac arrest.
4. Cardiac Arrest is a massive public health issue
Cardiac arrest is the leading cause of death in the developed world. Many die before reaching the hospital. Only 10% stay alive.
Cardiac arrest commonly strikes people in their 50's and 60's. They are often active and healthy.
Cardiac arrest survival depends on the successful performance of the "chain survival".
1. Call emergency
2. CPR - Defibrillation
3. Early advanced care
Here is how you place your hands:
Survival variability depends on multiple factors. But in well prepared communities, chances of survival are quite high compared to non prepared communities.
5. De-fibrillation:
Here are two very common cases in cardiac arrest: VF and VT
- VF: ventricular de-fibrillation: heart rhythm in chaos
- VT: ventricular tachycardia: heart rhythm is very fast.
VT and VF are both shockable rhythms.
Here are two common cases in hospitals:
-PEA: pulse-less electrical activity: electrical recording can look normal, but there is no blood flowing
- Asystole: "flatline": there is no electrical activity at all.
PEA and Asystole are NON shockable rhythms.
You need to recognize those cases if you are using a manual defibrillator. However, usually, defibrillators in public places are automatic and will automatically show you what to do.
AED: automatic defibrillators are crucial to save lifes as survival also depends on rapid de-fibrillation.
6. Other treatments exist beyond CPR and de-fibrillation:
It is called ACLS: Advanced Cardiovascular Life Support
It includes:
- Medication
- Airway devices (8 to 10 breaths per minutes only, if more, the patient will almost certainly die of hyperventilation)
- Cardiopulmonary bypass machines (but those are still experimental)
Evidence for theses other treatments is modest.
CPR and de-fibrillation have the strongest strongest scientific support.
Airway device
Cardiopulmonary bypass machine
7. Brain injuries
Following resuscitation, the brain can be injured.
Brain injury can be spared by the use of new treatment options know as: "therapeutic hypothermia".
8. Survival to cardiac arrest depends on where you live
a. Professional CPR care
Let's look at some important data:
- What is the time to professional CPR delivery?
- What is the quality of the professional CPR?
Many organization in the US offer CPR training.
Millions of people get trained each year.
However... Most are health care professional performing re-certification.
Some data is missing and studies showing the quality of CPR geographically could help.
b. Lay public CPR care
- What do we know about CPR delivered by the lay public?
Well, around 26 to 38% of cardiac arrest victims receive lay person CPR.
In one large study striking differences between private and public location was found.
26% of victims bystander rate after cardiac arrest at home.
45% of victims bystander rate after cardiac arrest in a public place.
1. Most cardiac arrest occur in a private setting
2. Cardiac arrest in the home have the lowest rate of bystander.
3. Cardiac arrest in the home has the lowest ambulance responsive time.
Those a 3 reasons why cardiac arrest are such a deadly disease.
c. Quality of CPR in general makes a big difference in survival
According to a study in New York, victims receiving high quality CPR were 4 times more likely to be resuscitated.
For the lay public in particular, CPR Hands Only gives better results than breath CPR.
Special cases: CPR in infants and children:
In some cases, infants or children could be victim of a cardiac arrest and need CPR.
CPR then has to be done very differently.
- For children <1 old="" p="" year="">
2. Chest compression on an infant (>1 year old)
3. Chest compression on a child is different to CPR in a baby:
a.With one hand
b. With two hands:
Here is a detailed video about infant and child's AED:
Syllabus
Week 1: Introduction to Resuscitation Science
- Part 1 - What Is CPR? History and Differences between Cardiac Arrest and Heart Attack
- Part 2 - Cardiac Arrest Epidemiology and Chain of Survival
- Part 3 - Evidence for CPR and Challenges/Future Directions
- Part 1 - Review, Factors Influencing Layperson CPR, and Rescue Breaths
- Part 2 - Compressions and Other Factors in CPR Quality
- Part 3 - CPR Feedback
- Part 1 - Introduction, Reperfusion Injury, and History of Therapeutic Hypothermia
- Part 2 - Randomized Trials in Therapeutic Hypothermia
- Part 3 - Practical Issues in Post-Arrest Care
- Part 1 - Three Phases of Cardiac Arrest
- Part 2 - Hypothermia and Bundle of Care
- Part 3 - Emergency Cardiopulmonary Bypass
- Part 4 - Mitochondrial Medicine
- Part 5 - Other Therapies
- Part 1 - Review, When Is a Patient Dead
- Part 2 - How Do We Know Whether a Patient Will Recover
- Part 3 - What Do Survivors Experience? and Near Death Experiences
Learning from the Jungle! Cardiac Arrest Design: Creation of Artifacts in Society
The Modern and the Postmodern Critical Thinking in GlobalChallenges Synapses, Neurons and Brains
Fantasy and Science Fiction Know Thy Self The Language of Hollywood Mooc
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A close member of my family underwent sudden cardiac arrest on the beach recently. He had just been for a swim and was acting normally although he had mentioned he had had chest pain a couple of hours previously (which he thought was indigestion). He lay down on the beach, normally and I turned to fold up his towel. I heard a gasp behind me and could not believe what I saw. I quickly realised that it was not a "joke". His eyes were wide open and I knew he was dying. I stood up and shouted "he's having a heart attack, go and fetch the life guards HURRY!". I knew that heart massage and a defibrillator were necessary, but all I managed to do was call for help. A holiday maker on the beach beside us took charge! She and another person did heart massage and mouth to mouth respiration. I called the firebrigade while they were doing that. The lifeguards arrived (it seemed ages), quickly followed by the firebrigade and a helicopter! We were so lucky! Within a hour and a half the blocked artery responsible for the cardiac arrest had been unblocked. A stent was in place and the patient was placed in hypothermia. When he regained consciousness three days later, he recovered rapidly.
ReplyDeleteI am enrolling in a first aid course and trying to raise awareness or people around me of the importance of first aid training for everyone, as well as informing people of the existence and usefullness of defibrillators.
So happy for you that all for fine at the end! Thanks for sharing! Have a great day!
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