Cardiac Emergencies Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington
The Heart -------Aorta Pulmonary Veins---- Superior Vena Cava------ Right Atrium----- Right Ventricle---------- Inferior Vena Cava-- ----Pulmonary Arteries ------Left Atrium -------Left ventricle
Cardiac Conductive System Heart is more than a muscle Specialized contractile and conductive tissue in the heart Electrical impulses
The Conduction System (The electrical path) Sinoatrial (SA) node ----- -------------Atrioventricular (AV) node Ventricular conduction system--
Arteries Function carry blood away from the heart to the rest of the body
Major Arteries ----Carotid -----Brachial Femoral---------- -----Radial --------Dorsalis pedis
Arterioles, Capillaries, Venules, and Veins Arterioles Smallest branch of an artery leading to capillaries. Capillaries Connection to venules. Venules Smallest branch of a vein leading to the capillaries. Veins Carry blood back to the heart. Venae Cavae Carries oxygen-poor blood.
Blood Composition Red blood cells Give the blood its color Carry oxygen to organs Carry carbon dioxide away from organs
Blood composition continued White blood cells part of the body s defense against infections Plasma fluid that carries the blood cells and nutrients Platelets essential for the formation of blood clots
Physiology Pulse Left ventricle contracts sending a wave of blood through the arteries Can be palpated anywhere an artery simultaneously passes near the skin surface and over a bone. Peripheral Radial Brachial Posterior tibial Dorsalis pedis Central Carotid Femoral
Physiology continued o Blood Pressure o Systolic - the pressure exerted against the walls of the artery when the left ventricle contracts o Diastolic the pressure exerted against the walls of the artery when the left ventricle is at rest
Cardiovascular disorders Coronary artery disease Aneurysm Electrical malfunctions Mechanical malfunctions Angina pectoris Acute myocardial infarction Congestive heart failure
Inadequate circulation Shock (hypoperfusion) a state of profound depression of the vital processes of the body.
Inadequate circulation Characterized by signs and symptoms such as: Pale, cyanotic Cool, clammy skin Rapid, weak pulse Rapid and shallow breathing Restlessness, anxiety or mental dullness Nausea and vomiting Low or decreasing blood pressure
Cardiac Compromise May include one or all of the following: Squeezing, dull pressure, chest pain commonly radiating down the arms or to the jaw Sudden onset of sweating Difficulty breathing Anxiety, irritability Feeling of impending doom
Cardiac compromise continued Abnormal pulse rate (may be irregular) Abnormal blood pressure Epigastric pain Nausea/vomiting
Causes of cardiac compromise Coronary Artery Disease-narrowing or blocked coronary arteries Aneurysm-weakened sections in the arterial walls Electrical malfunctions-an irregular, or absent, heart rhythm Mechanical malfunctions-mechanical pump failure
Causes continued Angina Pectoris- a pain in the chest Acute myocardial infarction- heart muscle that dies due to oxygen starvation Congestive heart failure-excessive fluid build-up Hypertensive Crisis- High blood pressure
Emergency Care
Case Study You respond to a complaint of chest pain. As you enter the apartment, your partner rolls her eyes. The patient is an obese 37 yo/fe. She is breathing rapidly and crying, and you note a cast on her right lower leg. You find: BP-108/68mmHg, P-124/min, 02 sats-92%, breath sounds show clear bilaterally. She rates her chest pain at 8/10 radiating down her left arm.
What type of equipment needs to be taken to the side of every cardiac patient?
Equipment should include Oxygen Oxygen adjuncts Suction equipment Equipment to assess vital signs Defibrillator
What are the treatment priorities?
Treatment Priorities ABC s Oxygen Vital signs Nitroglycerin Rapid Transport
What assessment information do you need to obtain next?
Assessment Onset Provocation Quality Radiation Severity Time
Assessment continued Signs and symptoms Allergies Medications Past medical history Last meal Events leading up to the illiness
Medication onitroglycerin
Medication Name Generic Name Nitroglycerin Trade Name Nitrostat Nitrolingual Spray
Acute Coronary Syndromes (Chest Pain) Primary ABCD Survey Body Substance Isolation procedure Assess responsiveness Open airway Assesses pulse Attaches monitor
Acute Coronary Syndromes (Chest pain) continued Secondary Survey Obtains vital signs Places Patient on 02 at appropriate rate Initiates IV line Performs targeted history, OPQRST, SAMPLE
Acute Coronary Syndromes (Chest Pain) continued... Treatment Administers 325mg Aspirin Administers Nitro 0.4mg SL then Q 5 minutes X2, (if B/P > 100 Systolic & pain not relieved) Know contraindications Hypotension Suspected increased intracranial pressure Viagra or Levitra within past 24 hours & Cialis within past 96 hours
Test Questions 1. The blood vessels include arteries, capillaries, and A. Veins B. SA node C. AV node D. Ventricles 2. Cardiac compromise refers to: A. The heart s ability to function properly during a respiratory emergency. B. Any kind of problem with the heart. C. The right atrium s receiving blood from the body s veins. D. The left ventricle s receiving blood from the pulmonary veins.
3. What is the maximum number of (0.04 sublingual nitroglycerin) doses that can be given to a patient with chest pain that has stable vital signs? A. There is no maximum (as long as vitals are stable) B. 2 doses C. 4 doses D. 3 doses 4. Whenever you are managing a patient with chest pain, you should: A. Attach electrode pads to the patient B. Treat the situation as a cardiac emergency C. Analyze the patient s heart rhythm D. Give the patient nitroglycerin
5. Cardiac compromise may include all of the following signs or symptoms EXCEPT: A. Difficulty breathing B. Warm, dry skin C. Nausea or vomiting D. Epigastric pain 6. An important consideration of managing any patient with chest pain is that he or she may: A. Deteriorate into cardiac arrest. B. Need automated external defibrillation. C. Require positive pressure ventilation. D. Need oxygen administration and chest compressions.
7. Before administering a second dose of nitroglycerin to a patient, you must: A. Perform CPR for 1 minute. B. Request authorization from medical control. C. Provide supplemental oxygen via nasal cannula. D. Check the patient s pupils for excess dilation. 8. Fluid buildup in the lungs caused by inadequate pumping of the heart is known as: A. Pulmonary edema B. Angina pectoris C. Arrhythmia D. Thrombus
9. A malfunction of the heart s electrical system will generally result in an: A. Embolism B. Occlusion C. Aneurysm D. Arrhythmia 10. The pulmonary valve prevents blood from returning to the: A. Right atrium B. Right ventricle C. Left ventricle D. Left Atrium
Wrapping it up Questions or Comments Renee Anderson andersr@inhs.org 509-232-8155 Fax: 509-232-8344