Persistent discomfort, pressure or pain that does does not go away. 

The pain can range from discomfort to unbearable crushing sensation, often described as pressure, squeezing, tightness, aching or heaviness in the chest. 

The pain can start slowly felt in the center of the chest. It may spread to the shoulderm, arm, neck, jaw, stomach or back.The pain becomes constant is not relieve by rest, position change or medication.

Heart attacks signs and symptoms vary, so a patient who has had a heart attack may not recognize a new attack.

Pain that comes and goes, such as with angina pectoris.

People with coronary heart disease (CHD) can have chest pain or pressure that comes and goes which is usually treated with nitroglycerin pill or patches (dilates coronary arteries and reduced heart workload).

Difficulty breathing or rapid breathing (to get much-needed oxygen to the heart).

Sometimes the patient sits in a tripod position struggling to breathe.

Also possible noisy breathing and shortness of breath.

Pale or ashen skin especially around the face.

The face may be damp with sweat.

Some people sweat heavily, feel dizzy or lightheaded and/or lose consciousness.

Possible nausea.

1. Call or have someone call 911
2. Have patient stop any activity and rest
3. Loosen any tight or uncomfortable clothing
4. Closely monitor patient until more advanced medical help arrives
5. Comfort patient
6. If medically appropriate and local protocols or medical direction permits, give aspirin if patient can swallow and has no know contraindications (be sure patient's doctor has not told patient not to take aspirin)
7. Assist with prescribed medication and administer emergency oxygen if available
8. Be prepared to preform CPR and use AED

Yes, if local protocols allow it. Ask a conscious patient if:

1. allergic to aspirin
2. has stomach ulcer or stomach disease
3. taking blood thinners such as warferin
4. has been told by a physician not to take it

If no to all questions, then give two chewable (162mg) baby aspirins, or one 5-grain (325mg) adult with a small amount of water.

Do not administer acetaminophen (e.g., Tylenol) or NSAIDs; no coated or mult-symptom/use aspirin (which takes too long to dissolve).

Cardiovascular disease (about 900,000 people die annually).

Other causes include drowning, chocking, drugs, severe injury, brain damage and electrocution.

Cardiac arrest than happens without signs or symptoms.

It accounts for more than 300,000 deaths annually.

Caused by abnormal, chaotic electrical activity of the heart or arrhythmias.

The most common life-threatening abnormal arrythmia is ventricular fibrillation (V-fib).

Early CPR.

This helps keep oxygen circulating to the brain and organs until an AED is used or advanced medical care is provided.

When a patient is unconsciousness, not breathing and has no pulse.

Note: CPR in itself will not save the patient; it will keep the person alive until an AED is available or advance medical help arrives.

CPR is a combination of chest compressions and ventilations.

1. Mouth-to-mask
2. Rescuscitation using a bag-valve-mask resuscitator (BVM)
3. Fixed- and variable-flow oxygen with delivery device

1. compressions are too shallow
2. compression rate too slow
3. sub-maximum recoil
4. frequent interruptions
5. patient is not on firm, flat surface

1. Place hands over the lower half of the sternum in the middle of the chest
2. Do not press the xiphoid process at the lower end of the sternum which can break off and puncture tissue or underlying organs

Place heel of one hand in the center of the chest on the lower half of the sternum; place the other hand on top.

Use ONLY the heel of the hand to apply pressure keeping fingers off the chest (apply pressure with fingers can cause inadequate pressure or chest injury).

Note: if arthritic you can place on hand on chest and with other hand grip wrist.

Bare chest if hand position is difficult; fat does not accumulate at the sternum so patient size does not matter.

Note with infants use two or three fingers just below nipple line.

1. Compressing the chest straight down provides the best blood flow and is less tiring for rescuer.
2. Kneel at side of patient with hands in correct position
3. Keep elbows are straight as possible with shoulders directly over hands
4. Press witht the weight of the upper body, not with arms
5. Do not rock back and forth, this is less effective
6. If arms and shoulders tire quickly, you are not in the correct body position

At least 100 per minute.

One (press) and two (release) and three (press)...twenty, twenty-one, twenty-two (drop and)...thirty, then two ventilations...repeat compressions.

At least 2 inches without jerky movements in smooth rhythmic movement with no pause in between.

Note with infants compress about 1 1/2 inches.

Recoil allows the heart to fill with blood and be pumped with the next compression. Do not let the hands break contact with the chest, but do allow recoil.

Be sure patient is on a firm, flat surface. If on a bed or sofa, move patient to floor or backboard for best results.

Compressions and ventilations: after the compressions, re-establish an open airway by tilting the head and lifting the chin and then provide ventilations, then quickly reposition hands and begin compressions. 

30 compressions and 2 ventilations.

(compression rate 100 per minute and about 1 second per ventilation per second)

1. breathing resumes or other signs of life
2. AED ready
3. another trained responder takes over
4. more advanced medical personnel take over
5. presented with a valid DNR
6. your too exhausted to continue
7. the scene becomes unsafe