I. Causes of Loss of Consciousness
II. Cardiac Arrest Rhythms
III. Cardiopulmonary Resuscitation
IV. Defibrillation
V. Drugs for Cardiac Arrest
VI. Perspectives and Research Implications
VII. Outcomes of Out-of-Hospital Cardiac Arrest
VIII. The Heimlich Maneuver
GLOSSARY
cardiac output the volume of blood pumped by the ventricles per unit of time expressed in liters per minute: it is a function of the stroke volume multiplied by the heart rate.
cardiac tamponade compression of the heart by fluid in the pericardial sac causing hemodynamic compromise that leads to cardiogenic shock and death if not immediately corrected.
hyperkalemia high levels of serum potassium.
myocardial infarction death of an area of heart muscle due to blockage of a coronary artery by blood clot and atheroma; medical term for a heart attack or coronary thrombosis.
syncope temporary loss of consciousness caused by lack of blood supply to the brain; fainting describes a simple syncopal attack.
ventricular fibrillation the heart muscle does not contract but quivers; therefore, there is no heartbeat (cardiac arrest) and no blood is pumped out of the heart; death occurs within minutes if the abnormal heart rhythm is not corrected.

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• I. CAUSES OF LOSS OF CONSCIOUSNESS
  Patients may lose consciousness and fall because of several reasons such as syncope, seizure, stroke, or cardiac arrest.
• II. CARDIAC ARREST RHYTHMS
  There are only two cardiac arrest rhythms to consider: ventricular fibrillation and pulseless ventricular tachycardia (VF/VT).
• III. CARDIOPULMONARY RESUSCITATION
  CPR is only a temporary measure. The aim is to get blood containing a fresh supply of oxygen to the brain. Therefore, it is necessary to breathe enough air into the patient’s lung, then compress the chest to cause the nonbeating heart to expel blood into the arteries. This produces circulation of the blood to the brain. Rarely, the patient may be revived, and the heart begins to beat spontaneously. In patients with ventricular fibrillation, death will occur unless the heart is defibrillated. The hope is that the ambulance has a portable defibrillator and a team that can defibrillate the patient.
• IV. DEFIBRILLATION
  The first shock setting should be 200 joules followed by a second shock of 300 joules. One defibrillator paddle is positioned to the right of the sternum below the clavicle. The other paddle is placed to the left of the left nipple with the center of the paddle in the mid-axillary line. An appropriate gel is one that has a low impedance. Because gel spreads during chest compression, shocks may arc across the chest surface thus, the gel must be toweled off. Conducting gel pads should be used but must be changed between shocks. Heavy arm pressure should be applied to each paddle applied to the chest and defibrillation should take place when the victim’s phase of ventilation is in full expiration. In the UK the lower paddle is placed over the points designated as V4 and V5 for the ECG, that is, a little outside the position of the normal apex beat. The paddle should be placed at least five inches away from a pacemaker generator.
• V. DRUGS FOR CARDIAC ARREST A. Epinephrine (Adrenaline)
  For more than 40 years epinephrine has been a key agent used during cardiac arrest. Epinephrine is both an alpha-and beta-adrenergic agonist; therefore, it stimulates spon¬taneous cardiac contractions, increases systemic vascular resistance resulting in an increased aortic diastolic per-fusion pressure, and improves coronary blood flow. It is relevant that epinephrine constricts peripheral vessels but preserves flow to vital organs causing coronary artery dilation.
• VI. PERSPECTIVES AND RESEARCH IMPLICATIONS
  Automated external defibrillators are now increasingly placed where people congregate such as shopping malls, stadiums, casinos, exercise facilities, airports, and airplanes. They should be in the homes of patients at risk, because the majority of cardiac arrests occur in the home. Most important, a bag-valve mask and an artificial airway should be provided with the defibrillator. This would assist considerably with mouth-to-mouth resuscitation, which has its disadvantages. A miniature apparatus to compress the chest more adequately than the use of the arms would be an advantage.
• VII. OUTCOMES OF OUT-OF-HOSPITAL CARDIAC ARREST
  Bunch et al. conducted a population-based analysis of the long-term outcome and quality –of life of survivors of out-of-hospital cardiac arrest from ventricular fibrillation.
• VIII. THE HEIMLICH MANEUVER
  This maneuver is used for removing foreign bodies from the airway. You must stand behind and wrap your arms around the waist of a conscious victim. Then place the thumb side of your fisted hand above the victim’s navel and well below the lower tip of the breastbone. Using the other hand, forcefully push the fist with a quick upward thrust into the victim’s abdomen. Repeat the thrust a few times if necessary. An unconscious victim is placed face upward. The rescuer kneels and places the heel of one hand above the navel and with the second hand on top pushes into the abdomen with a quick upward thrust.
• BIBLIOGRAPHY
  Abella, B. S., Sandbo, N., Vassilatos, P., Alvarado, J. P., O’Hearn, N.,