Cardiac arrest

“ The campaign also offers educational materials for both the general public and healthcare professionals to encourage communication among doctors, other healthcare providers, and their patients about the importance of recognizing heart attack signs and getting treatment quickly.
Far too many Americans are also unaware of the dangers of cardiac arrest, in which the heart suddenly loses its ability to function. Most cases of cardiac arrest that result in sudden death occur when the diseased heart's electrical impulses become rapid and then chaotic. ”

“ The AHA has developed a nationwide educational campaign called "Operation Heartbeat," to increase public awareness about cardiac arrest. "Operation Heartbeat" is educating the public about the warning signs of cardiac arrest, the importance of calling 911 immediately, and the benefits of administering CPR until defibrillation can be given.
When Americans take personal steps to improve their health, our whole society benefits. ”

“ Initial arrest etiology was thought to be secondary to hypovolemic shock from blood loss because of his initial presentation of hematemesis and laboratory result, but the degree of anemia did not explain his cardiac arrest. However, toxicology report was positive for benzodiazepines and cocaine and his acetaminophen level was greater than 300. ”

“ For the last 7 years, we've worked hard to enhance the health and safety of the American people. Today I'd like to talk about new measures we're taking to save the lives of many thousands of men and women who fall victim to one of America's biggest killers, sudden cardiac arrest. ”

“ Anchoring is defined as bias that describes the common human tendency to rely too heavily on the first piece of information offered (the “anchor”) when making decisions [7] [8] [9] . During decision-making, anchoring occurs when individuals use an initial piece of information to make subsequent judgments [8] . In this case, the initial history of GI bleed with the first laboratory value of significant low hemoglobin and hematocrit led to the belief that the patient’s cardiac arrest was due to hypovolemia from significant blood loss. ”

“ If this entire Nation comes together to place AED's in airplanes, Federal buildings, and other key locations, we can save more than 20,000 lives every single year. I expect there are very few people listening today who don't know someone who has been struck down by sudden cardiac arrest. ”

“ MODE OF DEATH IN THE ACCIDENTS FROM CHLOROFORM. In all the cases in which the symptoms which occurred at the time of death are reported, there is every reason to conclude, as shown above, that death took place by cardiac syncope, or arrest of the action of the heart. ”

“ Shock.—An injury is often apparently not enough to account for the fatal result so speedily. The marks of external injury may fail entirely or be very trifling. Thus more than once persons have died in railway collisions with no external marks of violence. So, too, a blow on the upper abdomen, on the “pit of the stomach,” has been rapidly fatal without any visible injury to the viscera. Death is attributed to the effect on the cardiac plexus, and there may be no marks externally or only very superficial ones. ”

“ However, if the wound involve the base of the organ, with extensive laceration of the surrounding parts, death is practically instantaneous. It would seem that injury to the muscular walls of the heart is much less efficient in the production of immediate death than destruction of the cardiac nervous mechanism, serious irritation of the latter producing almost instantaneous death from shock. ”

“ Cheatle, the patient died of suppurative pericarditis, secondary to a wound of which the external apertures had closed. In this patient both auricle and ventricle were scored externally by the passage of the bullet.
I am, however, disinclined to allow that many patients survived direct blows on the heart, since I believe that in the majority if not in all cardiac wounds the actual cause of death was not hæmorrhage, but sudden stoppage of the heart's action. ”

“ We see the same thing sometimes in horses. What exactly has taken place in these hearts we cannot say, but their reserve force is lost, and with it the power of meeting the demands exacted in maintaining the circulation during severe exertion.63 The heart-shock of Latham64 includes cases of this nature—sudden cardiac breakdown during exertion and not due to rupture of a valve. It seems probable that some cases of sudden death in men and animals during long-continued violent efforts, as in a race, are due to over-distension and paralysis of the heart. ”

“ SHOCK The treatment of shock will probably always be unsatisfactory as the cause is so varied, and, although circulatory prostration and vasomotor paresis always constitute the acute condition, the physiologic health of the heart and blood vessels is so varied. The patient in shock has low temperature, low blood pressure, and a pulse either rapid or slow, but excessively feeble; the face is pale, the surface of the body cold, and there is more or less clammy perspiration; there may be dyspnea and cardiac anxiety, or the patient may hardly breathe. ”

“ Studies show that after a first heart attack, women are less likely than men to receive diagnostic, therapeutic, and cardiac rehabilitation procedures, and are more likely to die or have a second heart attack. ”

“ There are only four ways of arresting arterial [Pg 126] hemorrhage. First, by cautery; second, by division of the artery, when that is not complete—for then the extremities contract and the blood clots—or by a ligature, or by the application of substances which arrest blood flow, aided by a compressive bandage. Other means are inefficient, and seldom and, at most, accidentally successful. His instruction for first aid to the injured in case of hemorrhage in the absence of the physician, is to apply pressure directly upon the wound itself. ”

“ The longest period during which any patient survived the injury was fourteen hours.
Among the older writers who note this traumatic injury are Fine, who mentions concussion rupturing the right ventricle, and Ludwig, who reports a similar accident. Johnson mentions rupture of the left ventricle in a paroxysm of epilepsy. There is another species of rupture of the heart which is not traumatic, in which the rupture occurs spontaneously, the predisposing cause being fatty degeneration, dilatation, or some other pathologic process in the cardiac substance. ”

“ In wounds of the heart death rarely occurs from external hemorrhage, which may be quite slight or even altogether wanting where the wound is due to a crush or fracture of the ribs. Death is usually due to the compression of the heart by the blood in the pericardium. This usually causes syncope, or a slighter pressure may be fatal by causing cerebral or pulmonary anæmia or shock. Death may occur suddenly in this manner or not until after some time. ”

“ Severe mechanical injury of a vital organ, such as crushing of the heart, lungs, brain, etc. This crushing may be accompanied by hemorrhage, but death may be more immediate than the hemorrhage would account for. The mechanical injury done to the vital centres in the medulla by the act of pithing is the direct cause of the sudden death which follows it. Exceptionally slight violence to a vital organ is fatal, but this may be better explained by attributing it to shock. ”

“ In wounds of blood-vessels death may occur from the entrance of air into them. In some cases where this is supposed to have occurred it is quite probable that death was really due to hemorrhage. A considerable quantity of air may enter the circulation, especially the arterial circulation, without a fatal result. When death does occur it is owing (1) to “mechanical over-distention of the right ventricle of the heart and paralysis in the diastole,” or (2) to “asphyxia from obstruction to the pulmonary circulation consequent upon embolism of the pulmonary artery.” ”

“ Nonfatal Cardiac Injuries.—Wounds of the heart are not necessarily fatal. Of 401 cases of cardiac injury collected by Fischer there were as many as 50 recoveries, the diagnosis being confirmed in 33 instances by an autopsy in which there were found distinct signs of the cardiac injury. By a peculiar arrangement of the fibers of the heart, a wound transverse to one layer of fibers is in the direction of another layer, and to a certain extent, therefore, valvular in function; it is probably from this fact that punctured wounds of the heart are often attended with little or no bleeding. ”

“ In fact death often is the result of acute cardiac paralysis. The striking point of difference is the generally reported absence of manifestations of neuritis and Nocht in an autopsy of a case failed to find evidence of degeneration of the peripheral nerves. ”

“ The heart beats with violence, the lungs gasp for more air, they have not pressure enough; the blood begins to ooze out of the minute vessels ramifying through the tissue of their delicate cells; blood issues from the nose, the eyes, the ears; the slightest exertion becomes oppressive—a mile or two higher, and death is inevitable. ”

“ Today, the person stricken with a heart attack has a much better chance of surviving the acute episode, thanks to continued improvement in diagnosis and treatment. More and more of the stricken are reaching the hospital alive, thanks to better recognition of ominous symptoms, widespread teaching of cardiopulmonary resuscitation by the American Red Cross and the American Heart Association, and better-equipped emergency vehicles with better-trained crews. ”

“ When the heart, or the vessels within the pericardium, have been divided, it can be readily understood how life should be immediately destroyed, since the blood effused into the cavity of the pericardium by its pressure completely arrests the action of the heart. But occasionally punctured wounds, in such situations, have not been followed by instant death. In such cases, alarming symptoms occur at the time, but subside, and the patient may for some time suffer no uneasiness, but afterwards expires suddenly during muscular exertion, or perhaps in a fit of violent passion. ”

“ A portion of clothing may be carried into the wound and lead to death from hemorrhage, or death may occur from many secondary causes, such as tetanus or sepsis. Accidents so frequently occur from weapons discharged in sport, not loaded with ball or shot, that it is worth while to bear this in mind. It has been observed, for instance, that persons attempting [618] to commit suicide have forgotten to put a bullet in the pistol, nevertheless the discharge of the weapon into the mouth has sufficed, from the wadding alone, to produce a considerable laceration and hemorrhage (Taylor) . ”

“ The man who puts tobacco, flour, soap, or any other of the popular monstrosities on a wound is little short of a criminal.
While, theoretically, many people know32 that blood flowing in a steady stream is coming from a vein and that flowing in jets or spurts is coming from an artery, few know how to take advantage of that knowledge. The general rule to make pressure between the heart and the wound in case of a jet and between the wound and the extremity in case of a stream is only good as a general rule; there are exceptions and it is exceptions that make the rule dangerous. ”

“ Death from surgical operations performed for the treatment of wounds. The operation is a part of the treatment, and if it is done with ordinary care and skill the accused is responsible for the result. The necessity and mode of operation must be left to the operator’s judgment. As the defence may turn on the necessity for and the skilful performance of the operation, it is well to wait for the advice and assistance of others if practicable, for death is not unusual from severe operations. The patient may die on the operating-table after losing little blood, from fear, pain, or shock. ”

“ There may be little blood in and about the wound, but it collects in the right iliac region or in the pelvis and is not wholly coagulated. Unless the wound or rupture involves the vena cava, portal vein, or a large branch of either of these, the hemorrhage is apt to be slow and the [583] victim may survive hours or even days, except for active exertion or repeated violence. Two cases illustrating the slowness of the hemorrhage have occurred in Guy’s Hospital. In one [680] the man, showing no urgent symptoms at the time, was sent away, and died a few hours later in a police-station. ”

“ The heart, moreover, continues to contract after the lungs have ceased to perform their duty. Death is thus due to apnœa—that is, death beginning at the lungs—and not to syncope. Death in some cases is from neuro-paralysis or nervous apoplexy. In death by shock, which in most cases is instantaneous, both sides of the heart are equally filled. Death, the result of disease, may present all the signs of death from suffocation, and no suspicion may be aroused as to the cause of death from the post-mortem appearances, especially if putrefaction have set in. ”

“ Heart attacks sometimes cause the heart to stop pumping, and cardiopulmonary resuscitation (CPR) then becomes a critical and potentially life-saving first-aid procedure. Trained individuals applying CPR can often preserve the life of a heart attack victim until proper medical care can be obtained. Tens of thousands of Americans who have had heart attacks are leading productive lives today only because someone trained in CPR quickly and effectively applied this life-saving technique. ”

“ A woman received a stab-wound which perforated the right ventricle, causing a wound one centimetre long. She did not die until twelve days later, when on autopsy there was found an enormous extravasation of blood in the left pleural cavity and pericardium. The second case, though one of bullet-wound, is equally applicable and instructive in this connection. A man received a bullet-wound which perforated the left ventricle, the bullet being found later in the pericardium. ”