UKC

Just heard that a mate of mine had a cardiac arrest yesterday, whilst playing football.

Fortunately, due to swift CPR action by his teammates, and quick use of an AED (within five minutes), he beat the odds, and survived. Hopefully without any significant ill effects.

I shall be brushing up on my CPR and AED training...

Best wishes for a speedy recovery for him without too much lasting damage

Glad he is going to be okay and hopefully no lasting effects.

Your post has reminded me re putting an AED in at work, for the last 15 years everyone at our place is emergency first aid trained and I keep meaning to get an AED installed but then we get busy and it gets forgotten about. 

An AED is really the secret to survival. CPR is really only a stop gap to AED, and, as you know, is bloody hard work.

Glad they got to him in time. If you don’t mind me asking how old was he ? 

Yep, chances of survival without very swift AED are minimal. Your friend is very lucky, hope there are no ill effects.

Early 60's.

To have a heart attack where he did; yes. To have a heart attack; no...

Survival rate outside hospital is about 1 in 10.

I have had at least 2, possibly three. I am very much in favour of the placement of De Fibrilators around the country.
It is to the credit of The Wayfarers, who have a DeFib at the Robertson Lamb Hut.

When I had my Cardiac Arrests, in an A and E, thats a long story, my wife was in tears, but told the nurses she knew CPR. They said without a DeFib pretty damn smart, CPR is just going to keep you occupied. 

All climbing huts should have a DeFib.

A heart attack and cardiac arrest are different things.

I knew someone would be pedantic, but too late to edit. Not really in the mood for pedantry.

Yes, he suffered a cardiac arrest. Hence the need for CPR and AED. He was unlucky to suffer a cardiac arrest, but lucky it occurred where it did.

They are, but it's appears from the above that the former led to the latter if you read through.

You are right though, people should learn to identify both and there is action that will help a heart attack before it leads to cardiac arrest.

Sorry I wasn’t trying to be a c0ck. It’s an important point.

of course I am glad he was close to an AED. I play football with older people so I shall be making a note of where their AED is.

Less than a grand. do it tomorrow

Absolutely.When one considers most climbing clubs have trousered £10k - £16K  of tax payers money during the pandemic, it is rather surprising that every climbing hut does not have a DeFib.

As someone has pointed out can get a completely automatic one online for around £1k. Having had some heart issues identified in the family and knowing that cat 2 ambo waiting times are up to 12 hrs the first thing I did was buy one ….a k isn’t much if it saves a life.

In reply to dunc56:

A heart attack and cardiac arrest are different things.

Only in the sense that a cardiac arrest is a specific medical term and a heart attack is a colloquialisms, using either term is fine. 

Cardiac arrest is when the heart stops pumping blood.

A heart attack is when the blood supply to the heart muscles is impeded.

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/he...

A timely reminder to everyone who may be involved in a first aid incident to find out where the closest Defibs are to their regular places of work/leisure.

That's great that prompt and good quality CPR followed by application of a defib saved his life, what a brilliant outcome for all concerned  

If anyone does get an AED installed at their workplace or wherever as a result of hearing of incidents like this, please register it with your local ambulance service/ambulance trust so someone making a 999 call can be told exactly where the nearest AED is (so someone can go and get the AED if someone else is able to do CPR on the patient). An ambulance will be sent immediately but is not going to arrive for a few minutes at least, so immediate, good quality CPR and early defibrillation (if the patient's cardiac rhythm is suitable) gives the best chance of survival. Most if not all ambulance services have a link on their websites to register public access AEDs. 

For those not familiar with them, AEDs (Automated External Defibrillators) contain simple instructions on how to apply the pads, and don't require people using them to know what rhythm scan be shocked or not - so that stops you from accidently giving a shock to a heart which is actually beating okay but you maybe just hadn't detected their pulse when checking manually (..... or doing the opposite, i.e. shocking a heart with no electrical activity ... unfortunately too many people who've watched misleading tv shows or films where a "flat line" asystole rhythm is shocked and the person magically comes back to life  think a defib can re-start a heart with no electrical activity...).

In reply to jt232:

As posted by a couple of other people, they are different things - and like the other posters, please believe I'm not saying it pedantically or to be a dick, it's just useful to know. If someone is having a heart attack (medical term is myocardial infarction), giving them aspirin is likely to be the first action, and CPR would not be appreciated by the patient!  If someone has suffered a cardiac arrest, giving them an aspirin to chew isn't much good.  ..  Fortunately 999 call takers know that people get the terms confused, so ask questions to establish what the patient's condition is, rather than just assuming the caller has used the correct term for the patient's condition - so can then give instructions for CPR or to give aspirin as appropriate. 

(I'm a paramedic and know that prompt, good quality CPR can make all the difference in giving someone a chance of being resuscitated. And if people on scene are giving good chest compressions when I arrive, I'll happily and gratefully keep them helping out if they're willing and able, whilst I do airway management, rhythm checks and shocks etc until other ambulance resources get there)

I rather they were in the village, or club external wall to benefit everyone.

The clubs didn't trouser anything, there were funds available nationally to many many goups. Millionaires have likely trousered millions more in the last 3 years, those clubs who are fortunate to have gained a modest buffer will likely see it eaten up in energy costs over the next two years, but will hopefully remain viable which is better than selling off the building to become a holiday let. 

Sadly, even younger people with no known history of heart problems who are considered fit and healthy can have heart attacks (leading to cardiac arrest) and sadly not surviving. I go to the gym Mon, Wed, Fri so I wasn't there Thurs morning this week but tragically a 46 year old passed away, so the lesson is that AED should be available on as many places as possible. Also reminds me my first aid is so woefully out of date, better get something booked 

Yes I advocated that, but that is a much more complex and expensive process, than having an AED in the hut, however, if a club was going to spend £1K on an AED, possibly, the local community would co fund, and an External DeFib could be placed.

Just for information. The Wayfarers, do have a DeFib at RLH, and I am led to believe that the  users of the other huts in that cluster, Bishops Scale and Rawhead, also have access to it. I have no idea how this information is passed to the hut users, and how they access RLH.

 

If there weren't so many idiots an unlocked cabinet on the wall would be fine, or the classic old phone box. Access for anyone and village training once a year would be the way to go. 

does anyone happen to know the latest on single location/map for all AEDs in the UK? i recall from previous first aid courses that there were multiple websites/lists but none of them comprehensive. i've no idea where the nearest one is to my home.

i found this for some point in the future but more for registering them if you buy one for work/club/school etc: https://www.thecircuit.uk/frequently-asked-questions

It says it is in discussion with 5/14 Uk ambulance services about creating a 'master list'. I'd assume that will include info like opening hours of the building they are in.  perhaps with an app also that locates you and tells you where nearest AED is!

My mates nephew died on the football pitch a couple of months ago. mid 20s. Heartbreaking.

I wouldn't get too hung up on what's caused the cardiac arrest beyond what was happening just prior if you were there (eg said they had chest pain, struggling to breathe or whatever else) as this is vital for the ambulance crew as they may be able to reverse certain causes on scene or they may be reversed later in hospital. The ambulance crew will ask what they need to know

At BLS level I really would just keep things simple, as you were taught, quality chest compressions, AED there ASAP with good pad placement, follow what it's telling you to do until the professionals take over. As far as I'm aware workplace/public defibs will be automatic as manual defibrillation is not something you want to be managing/thinking about after a weekend course. 

Apologies if the above seems patronising, it's really not meant to be, I've seen similar threads become so over complicated and discuss factors that will just add stress to the situation unless you're dealing with cardiac arrests regularly. 

(Paramedic trying to help ;p)

I don't think publicly available defibs are anything other than AEDs. And they will be clearly marked with placement pictograms on the pads, and usually will have voice instruction.

Just in case people are not aware of new AED's. They talk to you. A voice will tell you exactly what to do. You stand back press the button and it's smart enough to work out what's needed. I think the key thing is to have a go, rather than being intimidated by medical equipment.

Also, unless its changed, Nellie the Elephant is a good rhythm to do compressions to. If you break some ribs you're doing a good job!

If one came across someone symptomatic of an MI at what stage would you put the defib pads on with an auto defib ? 

I wont quote you on this BTW 

Ha. What a question. And exactly what I was trying to stop this thread turning into haha. 

I know exactly when I would with a confirmed MI of whatever type. 

No way I can give a definite answer for a first aider armed with basic kit and an AED!

Just an EMT so others are more qualified but...we don't shock people with a pulse. So done put them on until they go pulse less and unresponsive. Have it ready though, open it up and familiarize yourself.

Immediately call 999. First aid would be don't let them move, aspirin, reassurance, manage comfort level.if you are somewhere warm then expose the chest so that pads can go on instantly if required. If you can get some history - what led up to the event, have they experienced this before, major medical history especially cardiac, prescriptions and allergies then you will be a kick ass bystander.

In my service we consider aspirin allergies relative in this situation so if you have a strong feeling they are having an MI then don't worry about them. Life over limb.

Somebody check my work!

The 'A' bit of an AED should decide whether to shock or not, surely? IIRC, one of the steps in the AED function is 'analysing rhythm'. We were taught to let the machine decide (one reason they are expensive is the Safety of Life design and validation requirements: choosing not to shock is jus as important as shocking correctly).

'Staying Alive', or, leas optimistically, 'Another One Bites the Dust' were suggested as CPR rhythm cues...

Would a map be useful? either it's very nearby or it's no good.

Resus council is the definitive authority on this sort of stuff in the UK. Here's what they have to say on when to use an AED:

"recognise that someone who has collapsed, is unresponsive and is not breathing normally is likely to have had a cardiac arrest"

https://www.resus.org.uk/sites/default/files/2020-03/AED_Guide_2019-12-04.p...

If you know what you're looking at and have the skills and equipment to assess the patient's condition then the earlier you get the pads on the better, but that's unlikely to be the general public. I had a patient on my last block, late 70's, considerable cardiac history and called with crushing chest pain. Knew it was the real deal as soon as we walked through the door: pale, clammy, rapid breathing and a demeanour that screamed "Impending Sense of Doom". As soon as we got a reading off the BP cuff (systolic 92, heart rate 186) I attached the pads. 30 seconds later he went into VF arrest, shocked immediately and his heart kicked back in (ROSC) with a good output and breathing spontaneously, not conscious (GCS 4) got up to GCS 8 by the time we got to hospital and rejected his airway. The 12 lead showed a clear MI and given age and history I didn't give much for their chances.

Checked on them a couple of hours later and they were sat up in bed chatting away and looking the picture of health with the only hospital intervention having been a dose of PR aspirin

Yes. 

But that's not what Chris H asked me. Pads on ready and shocking someone in a shockable rhythm are not the same thing. 

**suddenly regretting contributing to the thread**

I'll bow out, I think my input is making things too complicated. 

Yeah you may be right...our cpr card training scenarios are always unresponsive, pulse less patient. That's when you put pads on.

I've responded to a lot of cardiac arrest but that's from a different perspective -we are the help! Turn up with a paramedic a lifepak etc. The only time I recall putting pads on somebody who wasn't unresponsive was much the same scenario as stichtplate describes, and was in an ambulance en route to the hospital. The paramedic set the machine and cardioverted (I think, this was some years ago and I was brand new).

I'm sorry you feel that way; I don't see anything to regret. The better people understand, the better the outcome for everyone.

I don't see any significant downside to applying pads (apart from the replenishment issue).

If the failure rate of the AED was sufficiently high that it became an issue with a 'false positive' scenario, and might cause unnecessary, and therefore dangerous shocking, I could see a reason not to apply pads as a precautionary preparation, but I suspect the failure rate is vanishingly small, so that won't be an issue.

The patient may react in fear at having the pads applied, but that can probably be mitigated with a good, reassuring 'bedside manner'. Being told they're having a heart attack is probably terrifying enough already.

There's the potential issue of privacy with needing to get to bare skin, but one would hope that most would understand the potential medical emergency, and be more concerned with that.

I'm happy to hear other potential downsides.

I'd broadly agree, but given the huge number of potential scenarios and factors, the question is inherently complicated.

AEDs aren't 100% fool proof and the shock delivered is designed to stop the heart and allow it to reboot to it's natural rhythm. The downside in prematurely attaching pads would be inadvertently shocking and thus stopping a heart that's quietly going about it's normal business.

Probably correct, but for the general public I'd still stick with Resus Council guidelines

Attaching pads would be terrifying enough without some randomer informing you you're having a heart attack. You'd need a 12 lead ECG and (to be sure) a blood test to tell you that.

Which is another reason the Resus Council guidelines instruct you to attach pads only to someone collapsed, unresponsive and not breathing normally.

I think I covered that. And it's backed up by the Resus Council guidelines saying it poses no risk to a rescuer to leave it attached whilst continuing to perform CPR. And I design safety of life kit, so know the hoops you have to jump through in design, reliability and verification...

Many people will know they themselves are having a heart attack. Many 'randomers' will have a pretty good idea. Not sure, but good enough to take appropriate steps. Otherwise, why would first aid courses teach diagnosis?

Receiving a peripheral shock through the palms of your hands is not the same as a direct shock directly across the axis of your heart. Odd that you'd pay attention to that part of the guidelines but choose to ignore the instruction about when to attach pads.

Nope. Fair few conditions that many will assume are MIs. I should know, I've attended quite a few.

Edit: seriously, don't go telling someone that you think they're having a heart attack. Unless you're looking at their ECG readout and informing them to gain consent for a transfer to a PCI centre, you aren't helping anyone.

I agree. Also, if you have the AED open and ready to go, chest exposed, how long does it take to put pads on - couple of seconds?

As an aside, we got ROSC two days ago which with our extended down times is a big deal. First responders did prompt CPR and O2.

Okay. I'll just suggest they chew an aspirin and let them figure it out for themselves.

Chewing an aspirin is a standard adjunct as a "just in case" for chest pain (and not one I resort to in 90% of the chest pain patient's I see). Attaching pads is something you do for people who's heart has stopped pumping.

Different presentation. Different intervention. Radically different level of physical risk.

I was addressing your advice not to mention suspected heart attack.

Despite my faith in the reliability of AEDs, I'm happy that it is better to wait for actual cardiac arrest before applying pads. Though, again, getting an AED ready is as good as telling a patient you think they may be having a heart attack.

I was recommended this android app on a recent first aid course,  I'm sure there will be a apple version...

Good Sam Alerter

Useful to assist emergency calls but also alerts local first aiders and shows locations of nearby AEDs.

https://play.google.com/store/apps/details?id=com.goodsam.alerter

Anyone else use it?

I think it's generally good advice to keep the drama as low level as possible when dealing with someone who's potentially having some sort of cardiac event (it's generally a good idea with any sort of emergency really). The last thing you want is a massive adrenalin dump in the patient. It's not great for them and it throws all your physical observations off (blood pressure, heart rate, respiration rate) just when you want to get a handle on what their body is doing. If aspirin is indicated I'll tell them to chew some. If they ask why I'll tell them it thins the blood. I do like full disclosure with patients but that means explaining things and as this thread has shown, there's a lot of confusion and conflation in many peoples minds about heart attack (issue with blood flow into heart muscle = not ideal) and cardiac arrest (your heart isn't pumping the blood round your body any more = very, very bad).

You can survive a heart attack that's been ongoing for hours. You can have a heart attack, survive it and not even know. Go into cardiac arrest and you've got minutes.

Cheers. Resus Council really do provide the definitive guidelines and despite seeming straightforward, as Peppermill wrote, it's complicated. I think I should have followed Peppermill's lead and just left it. With regards to the AED being deployed, again, it's for cardiac arrest. lots of things cause cardiac arrest. Every single one of us will arrest at some point but only a minority of us will suffer a heart attack.

Thanks …actually that has helped clarify things …get the defib ready but put pads on if / when patient unresponsive / no pulse. 

This is a video by St Johns Ambulance showing how to use an AED.

Be a bit of a bugger, to be in a situation with a person who needs help and an AED is present, and not know how to use it https://www.sja.org.uk/get-advice/first-aid-advice/how-to/how-to-use-a-defi...

The one we bought is pretty self explanatory.

I didn't realise the difference, thanks.

Does it follow that a CA is one result of a severe HA, given that the 3 main heart arteries feed the blood to make the heart work.

I presume there are numerous other factors other than a HA which might result in a CA.

There is, as you’ll no doubt expect, a web site for that.

https://www.heartsafe.org.uk/aed-locations/

The ones I've seen are literally self explanatory i.e. you open them up and they tell you exactly what to do in a sexy electronic voice.

You're correct

All heart attacks carry a risk as they can interfere with the electrical activity of the heart. A type of heart attack where there is complete blockage of an artery carries much more risk. Interference can cause it to beat or vibrate rapidly and ineffectively rather than pump blood - types of cardiac arrest. This can potentially be corrected with a defibrillator but if left the electrical activity decays away and then the defibrillator won't work.  .

There's lots of other causes of cardiac arrests ranging from blood loss, abnormalities of acid or certain salt levels in the blood, to clots in the lung or underlying heart problems. Part of the management of a cardiac arrest is trying to find out and correct potentially reversible abnormalities. 

More for finding out in non-emergency situation. But if you are somewhere new and need one then presumably it would help too. 

I am sure it is. But watching the video from the Sja takes 4 minutes, and would give people a good idea of what is going to happen, as opposed to being with a person who has just collapsed, people maybe be shouting and screaming, whilst the first aider is trying to listen to the machine speak, and be terrified of doing the wrong thing.

 

Am I right in thinking you're a paramedic in the UK?  I find that interesting as it's been a while since I worked back home, but here in Australia (probably varies state to state) the ambulance service is very protocol-driven almost all of the 'chest pain' patients who arrive in ED are given aspirin pre-hospital.  Some for better, some for worse, but it sounds like you maybe have a bit more room to use some clinical initiative?

A bit off topic I'm afraid.  I don't have much to add about AEDs other than I think it's great that the resource can be out there in the community.  The only time I've used one was as the ICU registrar at an in-hospital arrest, but on a low-acuity ward with no manual defib.  It felt like an agonisingly long time to be waiting to analyze the rhythm when you're used to having a fully-resourced resus bay and not interrupting compressions for more than a couple of seconds.  Having said that, it was very easy to use, and appeared to be pretty idiot-proof.

Case by case. I’ll always do a 12 lead but say if it’s a 30 year old driver with sternal bruising from an RTC, why start ACS protocols? Do you have to give GTN and morphine for all chest pain too?

Interesting.  Wouldn’t be given for trauma, but of the elderly (and non so elderly) people with atraumatic chest pain (which, let’s face it, seems to be most of ED some days), I’d say the vast majority get aspirin.  It doesn’t bother me much given the benefits, the relatively low risk, and how often that reflux turns out to be a NSTEMI. 
 

GTN and morphine are also given fairly liberally here pre-hospital.  We often thrombolyse STEMIs pre-hospital, and even established inferior STEMIs often get GTN which can be a concern! 

Even clear pleuritic, non -trauma MSK or panic attacks? Our indications for aspirin in chest pain are clinical or ECG evidence suggestive of MI (basically looking, walking and quacking in a vaguely duck like manner). Still plenty of grey areas in there where they'd probably get a dose to tick the box but that's still leaving a very large majority aspirin free.

Thrombolytics were taken off us a few years ago, though I believe they're still available in areas with long run times. As to the GTN, we just have cautions for type of MI (posterior or right ventricular). Out of interest, do you need patient consent to thrombolyse?

When me an my boss did what we called "call an ambulance training", i.e. workplace first aid training, literally the only useful thing that came out of it was immediately ordering and installing an AED.

I'm in a part of the UK which still has thrombolysis as PPCI isn't yet available 24/7, and travel times can be long. Yes, we need to get patient consent. It's the most 'serious' drug treatment we give and the checklist for contraindications is done carefully and clearly with the patient (and relatives if there too) to make sure no history is missed and that they understand what the treatment is.

Generally no for those, but that leaves all the other chest pains which seems to be the majority! 
 

Being aware of the cautions for GTN seems very sensible.  It often seems to be not fully appreciated over here.  The ambo’s need consent for thrombolysis pre-hospital (they send the ECG through to us in ED to get the go-ahead).  In ED you could just proceed (as assumed std of care, as for massive PE, or even stroke) if we felt appropriate, but in reality its hard to safely rule out contra-indications in someone who isn’t orientated enough to consent without family for collateral/consent. 

Our nearest 24/7 cath lab is 400km away for failed lysis, or those with contra-indications. 

It is interesting to hear mention of GTNs.
 I presented at an A and E with chest discomfort. I was ECGd and a small tablet was put under my tongue (GTN?) .
ECG found nothing wrong and I was just about to be taken off the ECG, when I had a Cardiac Arrest.
It subsequently turned out that I tend to have low blood pressure.

I have always wondered if the GTN "crashed" me.

Small tablet under the tongue sounds like it may well have have been GTN if you still had chest pain.  If the rest of the cardiac work up was all fine it’d be pretty rare for a single dose to cause significant enough hypotension to cause an arrest, but not impossible I guess.

The main concern if you have a ‘heart attack’ is, depending on which bit of the heart is affected, that the right ventricle isn’t working properly, and is relying on pressure in the venous system to fill it up.  GTN drops that venous pressure and the ventricle can’t pump blood.

Other issues like valve diseases (e.g. aortic stenosis) or concurrent use of sildenafil (viagra) can also make people have big blood pressure drops with GTN too.