This document provides information on emergency care for airway obstruction and heart attack. It discusses the signs and symptoms of respiratory distress and airway obstruction, including clutching the neck and inability to speak or cough. First aid management for airway obstruction includes back blows, chest thrusts, and abdominal thrusts. For an unconscious victim, chest compressions and rescue breathing are demonstrated. The signs and symptoms of a heart attack are also outlined. Early CPR is emphasized as critical for cardiac arrest victims, with the steps of CPR described, including chest compressions, opening the airway, and rescue breathing. Hands-only CPR is recommended for untrained bystanders.

1. EMERGENCY
ERMIE V.VILLANUEVA, RN, MAN

2. Problems Requiring
Emergency Care
AIRWAY OBSTRUCTION
HEART ATTACK
HAT REQUIRE
EMERGENCY CARE

3. Objectives: AIRWAY OBSTRUCTION
1. Identify four signals of respiratory
distress.
2. Describe first aid care for a victim of
respiratory distress.
3. Demonstrate rescue breathing for an
adult.
4. Demonstrate first-aid for a conscious
victim with an obstructed airway.
5. Demonstrate first aid for an unconscious
victim with an obstructed airway.

4. HEART ATTACK
1. Identify four signals of heart attack
2. Describe how to care for a heart attack
victim.
3. Identify the primary signal of a cardiac
arrest.
4. Describe the purpose of CPR.
5. Demonstrate CPR.

5. AIRWAY OBSTRUCTION
Pathophysiology
A. Partially occluded B. completely occluded
1. hypoxia 1. permanent brain injury
2. hypercarbia or death will occur
within 3- 5 mins
3. respiratory cardiac arrest
absence of air movement
O2 sat of the Blood ↓
O2 deficit occurs in the brain Unconsciousness
Death

6. Upper Airway Causes:
1. aspiration of foreign bodies.
2. Trauma
3. Anaphylaxis
4. inhalation / Chemical burns
3. Viral or bacterial infection

7. Clnical Manifestation
A.Typically, a person cannot speak, breath,
or cough. The patient may clutch the neck
with fingers (universal distress signal).**
B. Choking, apprehensive appearance,
stridor, labored breathing, suprasternal &
intercostal retractions, flaring nostrils,
restlessness, & confusion. Cyanosis &
unconsciousness.

10. EARLY WARNING SIGNS OF
RESPIRATORY FAILURE
 unable to speak,
breath or cough
 clutches neck
(universal
distress signal)
 bluish color of
skin and lips

11. ASSESSMENT & DIAGNOSTIC FINDINGS
• Simply asking the person whether he or she is
choking.
• If the person is unconscious, inspection of the
oropharynx may reveal the offending object.
• x-rays
• Laryngoscopy, or bronchoscopy

12. SUDDEN CARDIAC
ARREST

13. Sudden Cardiac Arrest – A Health Burden
• Approximately 50% of deaths from
cardiovascular disease occur as SUDDEN
CARDIAC ARREST.
 Sudden Cardiac Arrest is the most
common mode of death in patients with
coronary artery disease.

14. Blood Supply

15. Health Burden of Sudden Cardiac Arrest
• Almost 80 percent of out-of-hospital cardiac
arrests occur at home and are witnessed by
a family member.
• Only 4-6 % of sudden cardiac arrest victims
survive because majority of those witnessing
the arrest do not know how to perform CPR .

16. Sudden Cardiac Arrest
• Unpredictable and can happen to anyone,
anywhere, at anytime
• Risk increases with age
• Pre-existing heart disease is a common cause
• May strike people with no history of cardiac
disease or cardiac symptoms

17. EARLY WARNING SIGNS OF
HEART ATTACK
 prolonged compressing
pain or unusual
discomfort in the center
of the chest
 may radiate to shoulder,
arm, neck or jaw,
usually on the left side
 may be accompanied by
sweating, nausea,
vomiting and shortness
of breath

18. The NEW Chain of Survival
• Early access: immediate recognition and activation
•Early CPR
•Early defibrillation
•Early advanced care
•Integrated post-cardiac
arrest care

19. The First Link- Early Access
 A well-informed lay person
- key in the early access
link.
 Recognition of signs of
heart attack and
respiratory failure
 Call for help immediately if
needed
 Activate the Emergency
Medical System

20. EARLY WARNING SIGNS OF
HEART ATTACK
 prolonged compressing
pain or unusual
discomfort in the center
of the chest
 may radiate to shoulder,
arm, neck or jaw,
usually on the left side
 may be accompanied by
sweating, nausea,
vomiting and shortness
of breath

21. MANAGEMENT
Airway Obstruction

22. MANAGEMENT
• If the patient can not breath & cough
spontaneously, a partial obstruction should be
suspected.
• The victim is encouraged to cough forcefully
and to persist with spontaneous coughing and
breathing efforts as long as good air exchange
exist.
• If the patient demonstrates a weak, ineffective
cough, high-pitched noise while inhaling,
increased respiratory difficulty, or cyanosis, the
patient should be managed as if there were
complete airway obstruction.

23. ESTABLISHING AIRWAY
Establishing an airway may be as simple as
repositioning the patient’s head to prevent the
tongue from obstructing the pharynx.
Maneuvers:
1. Abdominal thrusts
2. head-tilt-chin-lift
3. jaw- thrust
4. insertion of specialized equipment
- Oropharyngeal Airway - Combitube
- Endotraheal intubation - Cricothyroidotomy

24. MANAGING A FOREIGN BODY AIRWAY
OBSTRUCTION
Asses for indication of Airway
Obstruction
 person may clutch the neck
between thumb & fingers**
 Weak, ineffective cough;
high-pitched noises on
inspiration
 ↑ respiratory distress
 inability to speak, breath, or
cough
 collapse

25. Heimlich Maneuver (subdiaphragmatic
abdominal thrust)
For standing or sitting conscious patient:
 stand behind the patient, wrap your arms around
the patient’s waist, & proceed as follows:
1. Make a fist with one hand, placing the thumb side
of the fist against the patient’s abdomen, in the
midline slightly above the umbilicus and well below
the xiphoid process. Grasp the fist with the other
hand.
2. Press your fist into the patient’s abdomen with a
quick inward and upward thrust. Each new
thrust should be a separate & distinct
maneuver.

26. Heimlich Maneuver (subdiaphragmatic
abdominal thrust)

27. For patient lying down (unconcious)
1. Position patient on the
back.
2. Kneel astride the patient’s
thighs, facing the head.
3. Place the heel of one
hand against the patient’s
abdomen, in the midline
slightly above the umbilicus
and well below the tip of
the xiphoid; place the
second hand directly on
the top of the first.
4. press into the abdomen
with a quick upward thrust.

28. FINGER SWEEP
1. Open the adult patient’s mouth
by grasping both the tongue
and lower jaw between the
thumb & fingers and lifting the
mandible.
2. Insert the index finger of the
other hand down along the
inside of the cheek & scrape
across the back of the throat.
3. use a hooking action to
dislodge the foreign body &
maneuver it out of the mouth
for removal. Care is used to
avoid forcing the object deeper
into the throat.

29. HEAD-TILT-CHIN-LIFT MANEUVER
 Place one hand on the
victim’s forehead
 Place fingers of other
hand under the bony
part of lower jaw near
chin
 Tilt head and lift jaw--
avoid closing victim’s
mouth

30. Head Tilt Chin Lift Maneuver
This maneuver prevents airway
obstruction by the epiglottis.**

31. L;

32. Effective CPR
done
immediately
after cardiac
arrest can
double a
victim’s chance
of survival.

33. What is C P R ?
• CPR = Cardio-
Pulmonary
Resuscitation

34. The NEW Chain of Survival
• Early access: immediate recognition and activation
•Early CPR
•Early
defi•bErailrllayt ion
•Integrated
post-cardiac
advanced

35. The First Link- Early Access
 A well-informed
lay person - key
in the early
access link.
 Recognition of
signs of heart
attack and
respiratory

36. EARLY WARNING SIGNS OF
RESPIRATORY FAILURE
 unable to speak,
breath or cough
 clutches neck
(universal
distress signal)
 bluish color of
skin and lips

37. Second Link - Early CPR
 Life saving
technique for
cardiac &
respiratory
arrest
Chest
compressions
+/- Rescue

38. Why is early CPR important?
 CPR is the best treatment for cardiac
arrest until the arrival of ACLS care.
 prevents VF from deteriorating to
asystole
 may increase the chance of
defibrillation
 It significantly improves survival.

39. How does CPR work?
Brain
(Cerebral)
Heart
(Cardiac)
All the living cells of our
body need a steady
supply of oxygen to
keep us alive.
Lungs
(Pulmonary)
During CPR, you can breathe air into
the victim’s lungs to provide oxygen
into the blood.
When you press on the chest, you move
oxygen - carrying blood through the
body.

40. When will you do CPR?
AS SOON AS POSSIBLE!
Brain cells begin to die after
4-6 minutes without oxygen.

41. Who may learn about CPR?
• CPR is an easy and life saving procedure
and can be learned by anyone.
• One does not need to be a doctor to learn
how to do CPR.

42. THE TECHNIQUE AND STEPS IN
CPR
IF YOU WITNESS A
CARDIAC ARREST

43. CHECK AREA
SAFETY.
Survey the
scene.
See if the scene is safe to do CPR.
Get an idea of what happened.
CHECK UNRESPONSIVENESS.
Tap or gently shake the victim
Rescuer shouts “Are you OK?”
Quick check for normal breathing
If the victim is unconscious,
rescuer calls for help.
CALL FOR HELP:
Ambulance,
Emergency
Rescuer ACTIVATES the
EMERGENCY MEDICAL
SERVICES.
Get AED/Defibrillator!

44. NON-RESPONSIVE,
NO NORMAL BREATHING

45. PULSE CHECK
 Palpate for
Carotid Pulse
within 10
seconds
 (at the same
time CHECK
FOR

46. If with definite pulse
but no breathing
Do Mouth to Mouth
Breathing
 Give one
breath every
5-6 secs
(about 12
breaths/min)

47. MOUTH TO MOUTH BREATHING and
PULSE CHECK
• Deemphasized in the new guidelines
• For trained healthcare providers only
• As short and quick as possible
• Pulse check not more than 10 seconds
• If unsure, proceed directly to CHEST
COMPRESSIONS!

48. After determining unconsciousness,
C – A – B
C. COMPRESSION Do chest
compressions first
A. AIRWAY Does the victim have an
open airway (air passage
that allows the victim to
breathe)?
B. BREATHING Is the victim breathing?

49. C –COMPRESSION
(to assist CIRCULATION)
After determining unconsciousness
and calling for help,
proceed immediately to do
CHEST
COMPRESSIONS!

50. Chest Compressions
• Kneel facing
victim’s chest
• Place the heel of
your hand on the
center of the victim's
chest. Put your other
hand on top of the
first with your
fingers interlaced.

51. Place the
heel of one
hand on the
sternum in
the center of
the chest
between the
nipples and
then place
the heel of
the second
hand on top
of the first so
that the
hands are
overlapped
and parallel.
Chest Compressions

52. Give Chest Compressions at
Compress breastbone at least 2 inches deep
Compress at a rate of 100 per minute or more
100 per minute
Compress 30 times initially
Allow the chest to return to its normal position

53. Give 30 Compressions
 Compress breastbone at least 2
inches
 (30 compressions should take 15-18
sec)
 Count aloud “1, 2, 3, 4,
5,6,7,8,9,10,11,12,13,14,15,16,17,1
8,19,20,21,22,23,24,25,26,27,28,29,
and ONE!”
 Minimize interruptions
 Allow recoil after each compression

54. A - AIRWAY Open the Airway:
Use the head tilt/chin
lift method
 Place one hand on
the victim’s forehead
 Place fingers of other
hand under the bony
part of lower jaw
near chin
 Tilt head and lift jaw-
-avoid closing
victim’s mouth

55. Head Tilt Chin Lift Maneuver
This maneuver prevents
airway obstruction by the

56. B - BREATHING Give 2 one-second
breaths
• Maintain airway
• Pinch nose shut
• Open your mouth
wide, take a normal
breath, and make a
tight seal around
outside of victim’s
mouth
• Give 2 full breaths
(1 sec/ breath)
• Observe chest rise &
fall; listen & feel for
escaping air

58. PULSE CHECK
• RECHECK PULSE EVERY 2 MINUTES
(equivalent to 5 cycles CPR)
• Very brief pulse check – should take
less than 10 seconds (at the same time
check for normal breathing)
• In case there is any doubt about the
presence or absence of pulse,
CONTINUE CHEST COMPRESSIONS
• For trained healthcare providers only

60. UNTIL…
•HELP ARRIVES.
(Emergency Services, Ambulance, Doctor, AED)
•PERSON IS REVIVED.

61. If the victim is breathing
THE RECOVERY POSITION
Maintain open airway &
 The unresponsive victim with spontaneous
position the victim
respirations should be placed in the recovery
position if no cervical trauma is suspected.
 Placement in this position consists of rolling the
victim onto his or her side to help protect the
airway.

62. Summary of Key BLS Components for Adults and Children
Maneuvers Adults Children
RECOGNITION UNRESPONSIVE
No breathing,
not breathing normally (eg. only gasping)
No breathing or only gasping
CPR Sequence CAB CAB
Compression Rate At least 100/min
Compression Depth At least 2 inches (5 cm) At least 1/3 AP depth; About 2 inches
Chest wall Recoil Allow complete recoil between compressions
HCPs rotate compressors every 2 minutes
Compression
interruptions
Minimize interruptions in chest compressions
Attempt to limit interruptions to less than 10 seconds
Airway Head tilt chin lift (HCP suspected trauma: jaw thrust)
Compression-Ventilation
ratio
30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)
Ventilations: when rescuer
untrained or trained and
not proficient
Compressions only Compressions only
Ventilations with
advanced airway (HCP)
1 breath every 6-8 seconds (8-10 breaths/min)
Asynchronous with chest compressions
About 1 second per breath
Visible chest rise
DEFIBRILLATION ( AED ) Attach and use AED as soon as available. Minimize interruptions in chest
compressions before and after shock, resume CPR beginning with compressions
immediately after each shock

63. • NOT TRAINED
• DO NOT KNOW MOUTH TO MOUTH
VENTILATION
• NOT SURE ABOUT MOUTH TO MOUTH
VENTILATION
• HESITANT TO DO MOUTH TO MOUTH
VENTILATION
• DO NOT WANT TO DO MOUTH TO MOUTH
VENTILATION

64.  Hands Only CPR
Compression-only bystander CPR

65. Hands Only CPR should only
be used for adult victims who
have suddenly collapsed or
become unresponsive.

66. Hands Only CPR
Recommendations:
• All victims of cardiac arrest should receive
high-quality chest compressions
• When an adult suddenly collapses, all
bystanders should activate their community
EMS and provide high-quality chest
compressions, minimizing interruptions
(Class I).

67. Hands Only CPR
Recommendations:
• If not trained in CPR, provide hands-only
CPR (Class IIa) until
– AED arrives
– EMS providers take over care of the victim
• If trained in CPR, provide either
conventional CPR using a 30:2
compression-to-ventilation ratio (Class
IIa) or handsonly CPR (Class IIa)

69. Key Changes in the New Guidelines
• CAB instead of ABC
• Compress first
• No more Look Listen and Feel
• Harder!  At least 2 inches compression (old: 1 ½ to 2
inches)
• Faster!  At least 100/min compression (old: up to
100/min)
• Deemphasize pulse checks
– For trained healthcare providers  not more than 10 secs
• Check for normal breathing together with check for
unresponsiveness
• Hands only CPR for the untrained lay rescuer

70. Important Points
• There are no mistakes when you perform CPR.
The only harm is to delay responding.
Start chest compressions  now viewed as the most
effective procedure
All victims in cardiac arrest need chest compressions.
• Don't stop pushing.
Keep pushing as long as you can. Push until the AED is in
place and ready to analyze the heart. When it is time to do mouth
to mouth, do it quick and get right back on the chest.
• 80-90% of cardiac emergencies occur at home.
• Training is now simpler and more accessible
Reduced number of steps and simplified process

71. • Being trained to do CPR can save a
loved one.
• Effective CPR done immediately after
cardiac arrest can double a victim’s
chance of survival.

72. LEARN CPR TODAY!
INQUIRE FROM THE PHILIPPINE HEART ASSOCIATION!
www.philheart.org

73. If you want know more about
Sudden Cardiac Arrest and
CardioPulmonary
Resuscitation, contact the
Philippine Heart Association
Council on CPR

74. Thank yoEu fonr dlistening…