cardiac emergencies jim bennett paramedic and clinical education coordinator american medical...
TRANSCRIPT
Cardiac Emergencies
Jim Bennett
Paramedic and Clinical Education Coordinator
American Medical Response
Spokane, Washington
The Heart
Pulmonary Veins----
Inferior Vena Cava--
Superior Vena Cava------
Right Atrium-----
Right Ventricle----------
-------Aorta
----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)
(SA) node -----Sinoatrial
-------------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 Pressureo 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 pressureEpigastric painNausea/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 StudyYou 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 treatmentpriorities ?
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 SurveyBody Substance Isolation
procedureAssess responsivenessOpen airwayAssesses pulseAttaches monitor
Acute Coronary Syndromes(Chest pain) continued…
Secondary SurveyObtains vital signsPlaces Patient on 02 at appropriate
rate Initiates IV linePerforms targeted history, OPQRST,
SAMPLE
Acute Coronary Syndromes(Chest Pain) continued...
TreatmentAdministers 325mg AspirinAdministers 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, andA. Veins B. SA node C. AV nodeD. 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 dosesD. 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 rhythmD. 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 vomitingD. 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. ArrhythmiaD. Thrombus
9. A malfunction of the heart’s electrical system will generally result in an:
A. Embolism B. Occlusion C. AneurysmD. Arrhythmia
10. The pulmonary valve prevents blood from returning to the:
A. Right atrium B. Right ventricle C. Left ventricleD. Left Atrium
Wrapping it up…
Questions or Comments
Renee Anderson
509-232-8155
Fax: 509-232-8344