Chest Pain at the Pool Deck
You are a lifeguard at an indoor pool. A 55-year-old man who was swimming laps stops, climbs out of the pool, and sits on the edge of the deck. He is clutching his chest and appears pale and sweaty. You approach and ask if he is okay. He says he has crushing chest pain that started about 10 minutes ago and radiates to his left arm. He is conscious and breathing, but his breathing is rapid and shallow. He tells you he has a history of high blood pressure and takes medication for it. He denies taking any nitroglycerin. The pool is not crowded, and another lifeguard is on duty. You have an AED nearby and a first aid kit.
1. What should you do first for this man, and what precautions should you take?
Read the worked answer
The man is showing signs of a possible heart attack (myocardial infarction): chest pain radiating to the arm, pale, sweaty, rapid breathing. The first priority is to ensure his safety and comfort. You should help him into a comfortable position, usually sitting up, to ease breathing. Do not let him walk or exert himself. Call 911 immediately if not already done. While waiting for EMS, you should monitor his breathing and consciousness. Do not give him anything to eat or drink unless directed by medical personnel. You should also ask if he has prescribed nitroglycerin, but he denied having it. Keep him calm and reassure him. Have the AED ready but do not use it unless he becomes unresponsive and not breathing. Precautions: avoid unnecessary movement, do not leave him alone, and be prepared to start CPR if he becomes unresponsive.
2. If the man becomes unresponsive and stops breathing normally, what should you do, and how does the AED fit into your response?
Read the worked answer
If the man becomes unresponsive and stops breathing normally, you should immediately begin CPR, starting with chest compressions. Send someone to get the AED if it is not already at your side. The AED should be applied as soon as possible. If the AED arrives while you are performing CPR, apply the pads to his bare chest, following the diagrams, and allow the AED to analyze the rhythm. If a shock is advised, ensure no one is touching the victim and deliver the shock. Then immediately resume CPR, starting with compressions. Continue CPR and follow the AED prompts every 2 minutes. The AED is critical because it can detect a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) and deliver a shock to restore a normal rhythm. Early defibrillation increases the chance of survival.