Sudden Cardiac Arrest vs Seizure.. IT MAY NOT BE A SEIZURE Recognizing Agonal Breathing and Sudden Cardiac Arrest.

Sudden Cardiac Arrest vs Seizure.. IT MAY NOT BE A SEIZURE Recognizing Agonal Breathing and Sudden Cardiac Arrest.

IT MAY NOT BE A SEIZURE

Recognizing Agonal Breathing and Sudden Cardiac Arrest.

A child falls to the floor, they appear to be gasping desperately, they stick their legs straight out, their arms are pulling up to their chest, wrists bent, hands “cupped”, and their eyes are rolled back in their head. Sounds like a seizure, right? Stand back and let them be until it passes, right? Unfortunately, this “wait and see” response has lead to the deaths of too many children and young adults who are actually in the midst of sudden cardiac arrest (SCA). What was just described is known as agonal breathing in conjunction with decorticate posturing. This often leads to delayed CPR since we do not expect children and seemingly healthy young persons to go into cardiac arrest. Once the “seizure” has subsided, and it becomes obvious there is something much more serious occurring, several minutes may have passed and the person’s chances of survival are greatly diminished.  

So, what should you look for when someone falls to the floor unconscious? The following should not take more than 30 seconds:

1. Shout and shake!! (Unless there is visible trauma). Are they responsive? Do they move their arms or legs in response to your voice and touch? If not, begin immediate CPR.
2. If they are ‘gasping’, place your ear next to their mouth and watch the chest. Can you feel exhales? Is their chest rising and falling? If not – begin immediate CPR.

The good(?) news is if you see someone in the midst of agonal breathing and decorticate posturing, their outcomes are far more favorable. It means you have reached them in the VERY early stages of SCA, their brain is still alive (the agonal breathing is the brain’s last-ditch primal effort to get air into the lungs), and your immediate actions will increase their chances of survival significantly. Early CPR, combined with a shock from an AED within 3 to 5 minutes, could literally mean the difference between life and death.  

While in SCA, oxygenated blood is not flowing to the brain or vital organs – which is why the victim lost consciousness in the first place. The patient is clinically dead. Four to six minutes after the stop of oxygen to the body, the brain begins to die. With this information, it should come as no surprise agonal breathing usually does not last longer than 4 minutes. Quality CPR keeps oxygenated blood, which is still present in the body even though the person is not taking in more oxygen, moving to the brain and throughout the body, but it will not restore a natural heart rhythm. An AED shock is the only way to restore the heart’s normal rhythm and is crucial to survival.

The bottom line is if someone is unresponsive and is not breathing, regardless of whether they appear to be “breathing”, starting immediate CPR greatly increases their survival chances, and the use of an AED will elevate those chances even more. Learn to recognize the signs of Sudden Cardiac Arrest!

Related: 

EMS Epilepsy and Seizure Management TRAINER’S GUIDE. PDF / Saber un poco más de epilepsia. Crisis Convulsivas

International Liason Committee on Resuscitation ILCOR 2020-2025 / The “Highlights of the 2020-2025 American Heart Association Guidelines for CPR and ECC “ / Summary of the main changes in the Resuscitation "Guidelines ERC GUIDELINES 2020" / Recomendaciones para la Resucitación 2020 del Consejo Europeo de Resucitación (ERC) 2020 / Principales novedades para las nuevas guías de RCP

The NCAA’s plan of attack. SUDDEN CARDIAC ARREST, is a leading killer of college athletes.

The NCAA’s plan of attack. SUDDEN CARDIAC ARREST,  is a leading killer of college athletes

Sudden cardiac arrest is a leading killer of college athletes. Here’s the NCAA’s plan of attack..

Basketball fans attending Loyola Marymount University’s game against the University of Portland in March 1990 thought they were in for a spirited semifinal game. But then the unthinkable happened: 23-year-old Hank Gathers, a 6-foot 7-inch superstar, collapsed on the court. Stunned fans later learned that he died of sudden cardiac arrest — a condition that still kills between five and 10 NCAA athletes every year. Now, 26 years later, the NCAA has issued new guidance on how to prevent those kinds of deaths.

It’s the result of a multi-year process initiated by the association, which convened a task force of cardiovascular and sports medicine experts, student athletes, and athletic trainers to decide what to do about sudden cardiac deaths in sports back in 2014. The group came up with a consensus statement recently published in the Journal of the American College of Cardiology. The document identifies the purpose of pre-participation evaluations, best practices for those screenings, and guidelines for how officials should plan for and handle emergency cardiac arrest when it’s in progress.

Just how bad is the problem? In 2011, researchers from the University of Washington at Seattle used an NCAA database, public media reports, and catastrophic insurance claims to come up with an incidence rate for sudden cardiac death among students who died suddenly during exercise. They found that 75 percent of sudden deaths among student athletes who died during exercise could be traced to cardiovascular causes and that the current methods of collecting data underestimate the risk of sudden cardiac death.

The NCAA itself found that the risk of a male athlete dying from sudden cardiac arrest is one in 38,000 and only one in about 122,000 for female athletes. Basketball, soccer, and football players appear to be at the greatest risk — though only 4 percent of NCAA athletes are basketball players, they represent a full 20 percent of all sudden cardiac deaths.

But though the recommendations give guidelines on how to use electrocardiograms (ECGs) to predict those kinds of risks to student athletes, they stop short of actually recommending them. “We’re not mandating or recommending that they be done across the board,” says Brian Hainline, staff senior vice president and chief medical officer of the NCAA. In 2015, Hainline, who is the NCAA’s first-ever chief medical officer, backtracked on a publicly announced plan to require all student athletes to receive ECGs when team physicians from over 100 universities protested.

“Look, people have been talking about electrocardiogram screening for a long time, but it's been so polarized that you have two camps and the two camps just keep saying the same thing and you're not moving forward in a consensus-driven manner," Hainline says. One camp insists that EKGs are a critical predictive tool that can identify cardiac conditions, like myocarditis, a disease that inflames and can damage the heart muscle and that is associated with sudden cardiac death. The other holds that since so few student athletes have the kinds of cardiac problems that can be detected by EKG and that put them at risk for sudden death, the procedure shouldn’t be performed as a requirement for participation — a position held by organizations like the American Heart Association.

“For a lot of sudden cardiac deaths, the first symptom is sudden cardiac death,” says Justin Wright, assistant professor in the Department of Family and Community Medicine at the Paul L. Foster School of Medicine in El Paso. A sports-medicine-trained physician, Wright directs the school’s sports medicine program. “Our current system isn’t perfect, but I’m not sure that EKG screening may not be the perfect answer, either.”

The new consensus statement neatly sidesteps the EKG issue: It provides best practices for institutions that choose to require the tests as part of screening, but stops short of recommending it be implemented across the board. It may be cautious when it comes to how to predict cardiac arrest risks, but when it comes to how organizations should treat it while it’s happening, the statement minces no words. “The debate about the effectiveness of various screening examinations … will undoubtedly continue,” it reads. “However, there is no debate that a well-rehearsed and effectively implemented [emergency action plan] ... is effective at reducing the risk of death.”

To that end, the statement insists that coaching staff, referees and other responders be trained, that emergency plans be in place, and that working automatic external defibrillators (AEDs) be available during practice and play. When Gathers collapsed back in 1990, CPR was initially not administered because he was responsive. However, an AED was unsuccessfully used to save his life, and once Gathers registered no pulse, CPR was unsuccessfully used.

Perhaps a more cohesive emergency plan — or a more rigorous cardiovascular screening — could have saved Gathers. But Hainline hopes that the new guidelines can keep today’s athletes and those of the future from dying during sports. “No matter what we do, there’s always going to be a risk of someone dying of sudden cardiac arrest,” he says. “In all sports settings the most important thing we can do is make certain that all of the appropriate people are CPR and AED trained.”

Wright, who oversees medical game coverage for the University of Texas at El Paso and local high schools, agrees. “Everyone thinks they’re going to rise to the occasion, but most of the time we fall back to our level of training,” he says. “It’s not difficult to learn CPR.”

CARDIAC ARREST VS. HEART ATTACK

https://www.washingtonpost.com/news/to-your-health/wp/2016/05/06/sudden-cardiac-arrest-is-a-leading-killer-of-college-athletes-heres-the-ncaas-plan-of-attack/

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iResus 2015 - now on iOS and Android RESUCITATION COUNCIL (UK). ILCOR

International Liason Committee on Resuscitation ILCOR 2015-2020 / The “Highlights of the 2015-2020 American Heart Association Guidelines for CPR and ECC “ / Summary of the main changes in the Resuscitation "Guidelines ERC GUIDELINES 2015" / Recomendaciones para la Resucitación 2015 del Consejo Europeo de Resucitación (ERC) 2015 / Principales novedades para las nuevas guías de RCP

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