STS: Circulatory/Pulmonary

Transcription

1 STS: Circulatory/Pulmonary September 27, 2017

2 You have a 50 y/o male who is complaining of excruciating pain in his chest. You find him sitting down on a bench, arms in a tripod position, breathing heavily. What is the first thing you should ask him?

3 Nontraumatic Chest Pain Angina pectoris Myocardial infarction Drugs Energy drinks Acid reflux Other

4 Angina vs. MI Tightness or pressure in chest Relieved after min of rest or after nitro Severe crushing pain Radiates to left neck and down left arm Weak, rapid pulse Hypotension Low grade fever Not relieved by nitro SOB Diaphoretic Nausea/vomiting General weakness (in older females) Abdominal Pain

5 Pertinent Questions Ask for specific medication (atenolol, nitro(!), etc). History of hypertension Previous episodes of angina/mis Syncope History of heartburn* OPQRST

6 D: I: C: E: DICE a Drug

7 D: drug, dose, doctor I: integrity C: color, clarity E: expiration date DICE a Drug

8 Nitroglycerin Indications: Non-traumatic chest pain Contraindications: 53 BASH

9 Nitroglycerin Indications: Non-traumatic chest pain Contraindications: 53 BASH Last dose within 5 min Taken 3 doses per this episode of pain Systolic BP <100 mmhg ALOC Taken a Sexually enhancing drug within 72 hours Head injury

10 Nitroglycerin Administration Tablet: Remove from container and check integrity Place under pt s tongue Instruct pt to allow tablet to dissolve Spray: One spray sublingually Remember to reassess vitals after 5 min!

11 Aspirin Pt must have it on them; we can t provide this (we CANNOT administer ibuprofen) Can assist with administration Dosage: 181 or 362 mg

12 Other Conditions Drugs Recreational drugs - push for this, i.e. reassure patient you are not the police, etc. Energy drinks Caffeine to excess Acid reflux Focus on L examples?

13 Other Conditions Drugs Recreational drugs Energy drinks Caffeine to excess Acid reflux Focus on L alcohol, pepper, garlic, citrus fruits, caffeinated drinks, tomatoes

14 Nitroglycerin Aspirin Cardizem Amlodipine Carvedilol Propanolol Atenolol Common Cardiac Drugs

15 Asthma Anaphylactic shock CHF Smoking- COPD Pulmonary

16 Lung Sounds Normal Wheezing Rales Rhonchi Stridor PLEASE TAKE THESE CORRECTLY!!!

17 SOB Chest tightness Wheezing Asthma

18 Treatment Remove from environment if relevant Vitals in order of importance Help with metered dose inhaler (MDI) O2 15 L/min ALS

19 Metered Dose Inhaler (MDI) DICE Sprayed in middle of inhalation PRN

20 Anaphylaxis SOB, labored breathing Urticaria, rash, swelling Skin is red, warm Weak, rapid pulse Possible syncope

21 Pertinent Questions Focus on Allergies Past history Events for knowing cause Ask for epi, MDI

22 Treatment O2 15 L/min NC for non-life-threatening situations Vitals in order of importance EpiPen Fowler s position to assist breathing Shock position if needed If bite/sting/injection, keep below level of heart ALS

23 Epi Pen DICE Clean upper outer thigh with alcohol swabs, inner to outer concentric circles Remove cap (make sure you have the right end) --make sure you don t accidnetally poke yourself!!! Inject into pt. Reassess vitals

24 Blue to sky; Orange to thigh Epi Pen Cont d

25 Panic Attack/Hyperventilation Tingling around mouth or extremities Recent emotional upset

26 Treatment Check for cyanosis and rule out other causes Eliminate or reduce negative environmental stimuli Fowler s position Vitals in order of importance Administer low flow O2 through nasal cannula ALS Be kind and empathetic, try to calm them down, focus on breathing

27 Angina/MI Treatment Check vitals In order of IMPORTANCE Administer Nitro/Aspirin Reassess vitals every 5 minutes -- don t just stand around! Administer oxygen 15 L/min for SOB Possible vomit ALS Do NOT diagnose

28 Pneumothorax Diminished lung sounds (vitals order ) Becomes tension pneumothorax when lung sounds absent Tracheal deviation SOB Chest pain Tall, white, skinny males esp. during exercise

29 Treatment Administer O2 Fowler s ALS Sound familiar?

30 Associated Conditions CHF (heart becomes weak and loses ability to pump blood throughout body) Look for pedal edema, rapid, irregular heartbeat, pink sputum, SOB, wheezing COPD (respiratory conditions where air flow to lungs is blocked) smoking look for SOB, wheezing, chronic cough, sputum, chest tightness - baseline respiratory distress Chronic bronchitis (blue bloater) airway from trachea to lungs becomes irritated Pedal edema, wheezing/rhonchi Emphysema (pink puffers) damage to air sacs in lungs responsible for O2/CO2 exchange Accessory muscle use

31 Common Drugs Beta blockers: carvedilol, metoprolol ACE inhibitors: lisinopril, captopril Losartan, spironolactone, digoxin Diuretics: furosemide (Lasix) Xanax, ativan for anxiety

32 Scenario Commencement, complaining of chest pain

33 Run Report Clarifications Tx - In EMS, transport Any medical professional - treatment Rx - ambiguous Prescription medications OR the EMT s treatment of pt. Narrative should be a narrative! Abbreviations can be helpful, but we shouldn t need them to be able to follow your narrative.

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