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Hi I'm Ashley Tomlinson. And I'm David

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Com And and. Hi, I'm Asha Tomlinson. And I'm

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is a Cbc podcast. Hi.

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I'm Doctor Brian Goldman. Welcome to the

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Goes! Every day

0:42

paramedics bring patients to the hospital

0:45

in cardiac arrest. which means our

0:47

hearts have stopped. The key to

0:49

their survival. Is. Less about.

0:51

What We do. And more about

0:53

what you can do at the scene. So

0:55

this week on the dose were asking what

0:57

do I need to know about cardiac arrest.

1:00

Hi Ruby welcome to the Dose! High

1:02

grades. Great to be here and it's great to be

1:04

talking to. You want to ask a question? Have you.

1:07

Ever witnessed a cardiac arrest? not in

1:10

hospital, but in public? You know, like

1:12

in a stadium? or and now you

1:14

know, in a in a jam or

1:16

something like that. Yeah, I've definitely

1:18

witnessed a cardiac arrest a in

1:20

the public. I'm it is the

1:22

I you know for someone who

1:25

isn't the medical profession, probably something

1:27

you jumped right into on you

1:29

know coming closer to see assessing

1:31

the situation, but I can see

1:33

why it might not be as

1:35

much of a knee jerk reflex

1:38

for as someone who doesn't have

1:40

that kind of background. Yeah, exactly

1:42

like you and I are trained to do it.

1:44

We drop tools and we run to the scene

1:46

in a have we have something called code Blue

1:48

Will they don't have a Code Blue in in

1:50

the field? What they have to do is actually

1:52

activate the Code Blue. And you're the

1:54

best person to tell us about the.

1:57

What That's all about. So before we begin our

1:59

com British you can you give us a hi

2:01

my name is tell us what you do and

2:03

where you do it. Absolutely. Hi my

2:05

name is Repent or Sand do

2:08

I'm a cardiologist that specializes in

2:10

heart rhythm disorders and I'm the

2:13

director of the Women Cardiovascular Health

2:15

Initiative and the Martha Broward Care

2:17

in Women's Cardiovascular Health Research at

2:20

the Live In Cardiovascular Institute at

2:22

the University of Calgary. Okay,

2:24

here we go. Explain.

2:27

What? Heart. And stroke means

2:29

when they talk about something called the

2:31

Scene of survival. The

2:33

when we're thinking about the chain

2:35

of survival, we really wanna see

2:38

what needs to be done right

2:40

away when someone is having a

2:42

cardiac arrest. So that means that

2:44

you're calling or is there somebody

2:47

around and ask you for her.

2:49

Ah Nine One One, you're gonna

2:51

shout out for an eighty again

2:54

if someone's around and you're gonna

2:56

start Cpr right away. It's is

2:58

that the patient can be transported

3:00

to the hospital where they will

3:03

undergo. Any other advanced,

3:05

the lived supports management and

3:07

then it's the care. After

3:10

the patient has that cardiac

3:12

arrest. So so

3:14

it's a very specific order of things

3:17

that are done in a row. What's

3:19

the sense behind behind doing that? The

3:22

sensors That each of these

3:24

things are really instrumental in

3:26

trying to improve a patient's

3:29

chance of surviving to the

3:31

hospital and then discharged from

3:33

the hospital. Explain.

3:35

To me on the importance of

3:37

lay people trained and basic life

3:39

support and and and why they are

3:41

important to initiating the scene of

3:43

survival. Will bear the

3:46

first. Very. Critical Step.

3:48

In trying to reach survival

3:51

so being able to perform

3:53

Cpr and having an easy

3:56

can actually double your chance

3:58

of survival. What does

4:00

some of the signs that someone is

4:02

going into cardiac arrest that you would

4:04

want people to recognize out in the

4:06

field? Lay people. Don't we

4:09

want people to remember that

4:11

when someone's having a cardiac

4:13

arrest, this means that their

4:15

heart stopped beating and it's

4:17

often sudden and unexpected Cynthia

4:19

gonna collapse. You're gonna be

4:21

unresponsive and not breathing. and

4:23

if the are predicting Bill

4:25

Hudnut gasping sounds that you

4:27

might see or. Two. That

4:29

is your first sign that somebody

4:31

could be having a cardiac arrest.

4:35

And this is a bugbear of

4:37

mine. But please explain for lay people

4:40

the difference between a heart attack

4:42

and a cardiac arrest because often in

4:44

the les press they are used

4:46

interchangeably. Yeah, and it's a

4:48

really important distinction. And so a

4:50

cardiac arrest as an electrical problem.

4:52

So think about it as if

4:55

a breaker is turned off. The

4:57

is no blood that is being

4:59

pumped from the heart to the

5:01

brain for the rest of the

5:03

vital organs And that is why

5:05

the patient will or the person

5:07

will ah collapse or be unresponsive.

5:09

Much different than a heart attack.

5:12

A heart attack is when you

5:14

have a partial or complete block

5:16

in one of. The first specials

5:18

and that means that there

5:20

is impaired blood supply to

5:22

part of the heart muscle

5:24

but the hearts and still

5:26

pump. Patients are able to

5:28

experience symptoms and then they

5:30

can get help. As

5:32

a cardiologist, you see lots of people

5:34

with heart disease and I know they

5:36

are among the the most likely to

5:38

have a cardiac arrest, but. Let.

5:41

People listening to us know who are

5:43

the kinds of people that are most

5:45

likely to have a cardiac arrest? How

5:47

old are they? What kinds of diseases

5:49

of a half. So you're

5:51

absolutely right when ah, the

5:53

something is a cardiac arrest

5:55

the most common reason when

5:57

we are looking at identifiable

5:59

causes. Is a history of

6:01

having heart disease to that can

6:04

be previous blockages a heart attacks.

6:06

He can be our weakness of

6:08

the heart muscle and we know

6:11

that there is a distinction between

6:13

men and women were as women

6:15

of the other have a lower

6:18

likelihood of having i'm Her a

6:20

previous history of heart disease. Most

6:22

cases at the sudden cardiac arrest

6:25

is the first manifestation of having

6:27

any. Disease. Other

6:29

causes can be congenital, they can

6:32

be a primary electrical problem, up

6:34

speed, causes that are unrelated to

6:36

the heart, so anything that causes

6:39

a respiratory distress, or for example,

6:41

drug use. And in the most

6:43

recent statistics we have learned that

6:46

ah, cardiac arrest or at least

6:48

half of them occur in patients

6:50

that are less than sixty five

6:53

years of age. And we think

6:55

that. That. Could be related to

6:57

an increase in the a bit crap

6:59

out of crisis and also because of

7:01

the corporate conduct. You

7:04

was sub specialize in heart rhythm

7:07

disturbances, so so I have a

7:09

particular question for you on that

7:11

subject. There are people who are

7:14

more prone. To. Have

7:16

a cardiac arrest in the course

7:18

of doing strenuous exercise. To

7:20

talk about that. Yeah,

7:23

I mean the the cardiac arrest

7:25

when it is because of an

7:27

electrical problem is due to a

7:30

really chaotic your regular rhythm from

7:32

the bought bottom chamber of the

7:34

heart. I'm hoping to killer fibrillation

7:37

so it's it's it's a short

7:39

circuit that happens and sometimes we

7:42

do see that people can have

7:44

this when they're exercising and may

7:46

be related out sometimes to an

7:49

underlying primarily electrical problem that they

7:51

have. but it could

7:53

also be from somebody who has

7:55

a history of heart disease and

7:57

be exertion that me cause i'm

8:00

almost like a supply demand mismatch that

8:02

causes them to go into one of

8:05

these lethal life threatening arrhythms.

8:08

To what extent can you prevent cardiac arrest

8:10

by addressing risk factors for heart disease? This

8:13

is one of the keys is

8:15

to be able to identify risk

8:17

factors for heart disease and

8:21

particularly be aggressive in modifying

8:23

those ones that can be.

8:26

So for example, high blood pressure, diabetes,

8:29

obesity and smoking. What

8:33

about an implanted defibrillator?

8:36

How important are they for people who

8:38

are at risk of

8:40

going into ventricular defibrillation on

8:43

a recurrent basis? So we know that there

8:45

are certain people that are at high risk

8:47

for having one of these

8:49

lethal fast rhythms from the

8:52

bottom chamber of the heart. And

8:54

those are people that we know

8:56

have a history of weak heart

8:58

muscle who are on the

9:00

proper heart medications and

9:04

their heart muscle just doesn't recover. These

9:07

people, we wanna put in defibrillators

9:10

before they have a

9:13

cardiac arrest. And then of course,

9:15

there are people that do have a cardiac arrest

9:17

and we wanna protect them from having a second

9:19

cardiac arrest if there isn't

9:21

something that is reversible.

9:24

So there isn't a clear cause

9:26

for why they have that cardiac arrest. Between

9:28

today's wellness fads and news about tomorrow's

9:30

medical breakthroughs, it's hard to know what

9:32

health information actually applies to you. Luckily,

9:35

there's a podcast that breaks through the

9:37

noise. TED Health from the TED Audio

9:39

Collective. Join host Dr. Shoshana

9:41

Unger-Lider as she introduces you to leading

9:43

health experts that break down the questions

9:45

you didn't know you had. Well, eating

9:48

a plant-based diet make you healthier. How

9:50

does your neighborhood impact your health? How

9:52

will medical treatments change in the future?

9:54

Learn all this and more on TED

9:56

Health. Find TED Health wherever you get

9:58

your podcasts. You

10:02

know, Rupi, of course, as you know,

10:04

I'm an emergency physician, you're a sub-specialist

10:06

in cardiology, and we like to think

10:08

that we're the ones that

10:10

save lives when patients go into cardiac arrest.

10:13

But when they have a witness to arrest in the

10:15

field, it's really

10:18

important that lay people know what they're doing

10:20

and know how to begin the process of

10:22

getting patients to the hospital where we can

10:24

do the magic things that we do. Isn't

10:26

that right? Absolutely. The

10:29

lay person is really the

10:31

key to survival. So for

10:34

them to be able to

10:36

recognize and activate the emergency

10:39

response system, perform early CPR

10:41

and rapid defibrillation with an

10:44

AED is really the

10:46

key steps to survival

10:48

for someone who suffers

10:51

a cardiac arrest. And

10:53

those key things include, first of all,

10:55

I guess, establishing from the things that

10:58

you described off the top that they

11:00

are unresponsive and then checking breathing and

11:02

initiating breathing and then

11:04

starting CPR. And

11:08

how are they supposed to juggle when

11:10

to get help, when to activate the

11:12

emergency response when they're by themselves? Well,

11:16

when they're by themselves, I would

11:18

call 911 right away and start

11:20

CPR immediately following. If

11:22

there is somebody around, then you do want to shout

11:25

out to them and say, call 911, shout out

11:28

for an AED while you

11:30

are starting CPR. And

11:33

they're going to be doing CPR. How

11:35

important is good quality CPR in maintaining

11:37

that chain of survival and keeping people

11:39

going until they can be defibrillated? It

11:42

really is critical to

11:44

be able to perform good CPR.

11:47

And what that means is you're placing

11:49

the heel of your hand in the

11:52

center of the chest. You're interlocking your

11:54

fingers of your other hand on top

11:56

and you're pushing hard and

11:58

fast. sure that

12:00

your elbows stay locked and

12:03

that's about 100 and 120 times per minute. And a lot

12:07

of people say if you're just

12:10

thinking about different tunes and specifically

12:12

staying alive to think about how

12:14

fast and hard that you should

12:17

be performing secure. It's a

12:19

good trick. Yeah and for

12:21

you staying alive by the Bee Gees would be

12:23

an archival bit of music. That

12:26

would be to me listening to

12:28

the Whiffenpuffs song from the 1920s

12:30

or a great Cole Porter song

12:33

but yes, staying alive by the Bee

12:35

Gees, that's the song, that's the tempo

12:37

and the rhythm of good quality CPR

12:39

isn't it? Absolutely. Automatic

12:42

external defibrillators or AEDs are one

12:44

of the most important tools that

12:46

help resuscitate people who have had

12:48

cardiac arrest. How do they work? So

12:51

the AED is really an

12:54

easy to use device and

12:56

I want to make sure that people know

12:58

it's a safe device to use. And

13:00

what an AED does, it can analyze

13:03

the heart rhythm and if

13:05

necessary, it can deliver

13:07

an electrical shock to help the

13:09

heart establish an effective rhythm. Have

13:12

you ever recommended that somebody purchase

13:14

an AED for personal use? I've

13:17

not recommended that anybody purchase

13:20

an AED for personal use.

13:23

We do want to

13:25

make sure that AEDs are located

13:29

where people normally have

13:31

a cardiac arrest. So

13:33

in public high traffic

13:35

areas like for

13:38

example in schools

13:40

and in gyms, having

13:42

said that, we know that women are more

13:46

likely to have a cardiac arrest at

13:48

home, we just haven't got

13:50

to the point yet and we

13:52

need more data to suggest whether it's

13:54

beneficial for everyone to have something like

13:57

an AED at home. The

14:00

circumstances generally speaking, do much

14:02

younger people say people in

14:04

their late teens and early

14:06

twenties sir have a cardiac

14:08

arrest. Super. Really younger or

14:10

young people have taken about

14:12

cardiac arrest bad or for

14:14

example sports related and and

14:16

we see that a lights

14:19

in the media are those

14:21

cases are really something that

14:23

corners of lot of attention

14:25

and and pay me be

14:27

an unrelated to to an

14:29

underlying heart condition. But

14:31

sometimes they are. The. A

14:33

manifestation of of having a primary

14:36

electrical issue or are abnormality in

14:38

the heart muscle that hasn't been

14:40

previously detected and then of course

14:43

they increase in be opioid crisis

14:45

is it and other reason we're

14:47

seeing a younger a part of

14:50

the population having a cardiac arrest

14:52

or along with Cope it. Let's

14:56

take those the in one of the

14:58

time. Ah, Buell. I'm thinking

15:00

about the that Buffalo Bills football player

15:02

who was struck in the chest and

15:05

and has had a cardiac arrest right

15:07

there on the field and Chris was

15:09

successfully resuscitated. What was going on there.

15:12

So. That was referred to

15:14

as Commercial Court is it's

15:17

when there is a blow

15:19

to the chest over the

15:22

heart when the heart is

15:24

going through a critical part

15:26

of the electrical resetting. A

15:29

blow at that vulnerable period

15:31

can initiate ventricular rhythm for

15:33

that very fast chaotic on

15:35

short circuit from the bottom

15:37

chamber of the heart that

15:39

leads to cardiac arrest. You.

15:43

Mentioned. A younger people

15:45

and opioids and of course in

15:47

a were so moments of the

15:49

opioid crisis and and we're dealing

15:51

with Fentanyl on the streets in

15:54

many parts of of Canada and

15:56

elsewhere out What role does not

15:58

lox owner nor can be opioid

16:00

antagonist play in the the resuscitation

16:03

or people in the field. So

16:06

door camera versus the effects

16:08

of opiates including respiratory depression

16:11

and hypertension that can lead

16:13

to a cardiac arrest. It

16:15

should be given if there

16:17

a high suspicion of opiate

16:20

overdose after an active here

16:22

we is managed. but it

16:24

won't treat cardiac arrest so

16:26

that still requires early Cpr

16:29

and December elation. And finally

16:31

how. Hard is it to learn

16:33

basic life support. Learning. Basic

16:35

life support is pretty.

16:38

Easy to do at. There

16:41

are a tremendous amount of

16:43

resources available through a lot

16:45

of bar on organizations are

16:47

such as the Heart and

16:50

Stroke Foundation, but you know

16:52

anybody can just go online

16:54

and see a You Tube

16:57

video a part of perform

16:59

Cpr and I would encourage

17:01

everybody to really take the

17:03

ten minutes to look to

17:06

see what resources are available

17:08

and. Learn Cpr. Well.

17:10

Rupee? Yeah! thank you so much for

17:13

coming onto the dose to talk about

17:15

this important subject. And you know I

17:17

hope people love who don't know Cpr

17:19

don't know basic life support are motivated

17:21

to go out and get some training

17:23

because it can make a big difference.

17:25

You're still welcome. Thank you. Dr.

17:29

Ruined Her son Do is the

17:31

Heart Rhythm Specialist professor and cardiac

17:33

Sciences and director of the Women's

17:35

Cardiovascular Health Initiative at the Live

17:38

In Cardiovascular Institute at the University

17:40

of Calgary. Years ago

17:42

society face hurts, stoppage or cardiac

17:44

arrest is common. Nearly. Ninety

17:46

percent of cardiac arrests in a public

17:49

place or witness and is lay people

17:51

who are trained and basic like supports

17:53

can save lives. organizations

17:55

like the heart stroke foundation introduced

17:57

something called the chain of survival

18:00

It's the order of steps that need to happen

18:02

from the moment of a witness cardiac arrest. The

18:05

chance of survival goes up a lot

18:07

when four key steps are followed quickly

18:10

and effectively. Here are the

18:12

four steps. The first is to

18:14

recognize that someone is in cardiac arrest.

18:17

That means the person is unresponsive, isn't breathing, and

18:19

doesn't have a pulse. At that

18:21

point, either you or a partner call

18:24

911 or call out for help and

18:26

grab the Automatic External Defibrillator or AED.

18:29

The second step is to begin good quality

18:31

CPR. The third step is

18:34

to attach the AED. Follow

18:36

its voice prompts and push a button to defibrillate

18:38

the patient if the voice prompt tells you to

18:40

do so. The fourth step

18:42

is advanced cardiac life support, the stuff paramedics

18:45

and people like me do. Although

18:47

cardiac arrest is more likely in older patients,

18:49

it can happen to younger people too. Given

18:53

the opioid crisis and the wide availability of

18:55

illegal fentanyl on the street, the

18:57

prompt use of naloxone or Narcan has

18:59

been incorporated into the first response by

19:01

laypeople. The chain of

19:04

survival works when trained bystanders recognize and

19:06

respond to cardiac arrest. You

19:08

have an important role to play in saving

19:10

lives. If you have topics

19:12

you'd like discussed or questions answered, our email address

19:14

is the dose at cbc.ca. If

19:17

you liked this episode, please give us a rating and

19:19

review wherever you listen. This edition

19:21

of The Dose was produced by Samir Chhabra

19:23

and Isabelle Galand, our senior producer is Colleen

19:25

Ross. The Dose wants you to be

19:28

better informed about your health. If you

19:30

are looking for medical advice, see your health care provider.

19:32

I'm Dr. Brian Goldman. Until your next dose.