Temple College EMS Program*CARDIOVASCULAR EMERGENCIESEMERGENCY MEDICAL TECHNICIAN - BASIC

Temple College EMS Program

Temple College EMS Program*Cardiovascular Disease63,400,000 Americans have one or more forms of heart or blood vessel disease50% of all deaths are cardiovascular disease

Temple College EMS Program

Temple College EMS Program*Cardiovascular DiseaseAcute Myocardial Infarction (Heart Attack) - leading cause of death in U.S.1.5 million Americans will have AMIs this yearOf these .5 million will die!350,000 will die in first two hours!

Temple College EMS Program

Temple College EMS Program*Cardiovascular Disease Risk FactorsMajor UncontrollableAgeSexRaceHeredity

Temple College EMS Program

Temple College EMS Program*Cardiovascular Disease Risk FactorsMajor Controllable SmokingHigh BPHigh blood cholesterolDiabetes

Temple College EMS Program

Temple College EMS Program*Cardiovascular Disease Risk FactorsMinor ControllableObesityLack of exerciseStressPersonality

Temple College EMS Program

Temple College EMS Program*Cardiovascular DiseaseControl risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction

Temple College EMS Program

Temple College EMS Program*Coronary Artery DiseaseMyocardium (heart muscle) requires continuous oxygen and nutrient supplyMyocardial blood supply passes through coronary arteries

Temple College EMS Program

Temple College EMS Program*Coronary Artery DiseaseAtherosclerosisNarrowing of lumenplaque formation - related to Risk Factorsresults in decreased myocardial perfusionPoor tissue perfusion causes:tissue damage (ischemia)tissue death (infarction)

Temple College EMS Program

Temple College EMS Program*Atherosclerotic Plaque Formation

Temple College EMS Program

Temple College EMS Program*Angina Pectoris A choking in the chestAngere - to chokeMyocardial oxygen demand exceeds supply during periods of increased activity, exercise, or stressful event

Temple College EMS Program

Temple College EMS Program*Angina PectorisDuring stress the myocardium demands more O2Coronary arteries would normally dilate to supply more blood and O2 In Angina Pectoris, the coronary arteries are unable to dilate sufficiently to increase perfusion

Temple College EMS Program

Temple College EMS Program*Symptoms -Angina PectorisPainSubsternalSqueezing/Crushing/HeavinessMay radiate to arms, shoulders, jaw, upper back, upper abdomen backMay be associated with shortness of breath, nausea, sweating

Temple College EMS Program

Temple College EMS Program*Symptoms -Angina PectorisPain usually associated with 3EsExerciseEatingEmotion

Temple College EMS Program

Temple College EMS Program*Symptoms -Angina PectorisPain seldom lasts > 30 minutes Pain relieved byRestNitroglycerin

Temple College EMS Program

Temple College EMS Program*Symptoms -Angina PectorisGreat anxiety/FearFixation of the body Pale, ashen, or livid faceDyspnea (SOB) may be associated

Temple College EMS Program

Temple College EMS Program*Symptoms -Angina PectorisNauseaDiaphoresisBP usually up during attackDysrhythmia may be present

Temple College EMS Program

Temple College EMS Program*Angina PectorisFollowing an angina attack there is no residual damage to the myocardium

Temple College EMS Program

Temple College EMS Program*Forms of Angina PectorisStable AnginaOccurs with exercisePredictableRelieved by rest or Nitroglycerin

Temple College EMS Program

Temple College EMS Program*Forms of Angina PectorisUnstable AnginaMore frequent/severeCan occur during restMay indicate impending MIRequires immediate treatment and transport to appropriate facility

Temple College EMS Program

Temple College EMS Program*Acute Myocardial Infarction Heart AttackInadequate perfusion of myocardiumDeath of myocardiumInfarctDamage to myocardiumIschemia

Temple College EMS Program

Temple College EMS Program*Symptoms - AMIChest Pain - cardinal sign of myocardial infarctionOccurs in 85% of MIsSubsternalCrushing, squeezing, tight, heavy

Temple College EMS Program

Temple College EMS Program*Symptoms - AMIChest PainMay radiate to arms, shoulders, jaw, upper back, upper abdomen backMay vary in intensityUnaffected by: swallowingcoughingdeep breathingmovement

Temple College EMS Program

Temple College EMS Program*Symptoms - AMIChest PainUnrelieved by rest/nitroglycerinPain lasts longer than angina pain (up to 12 hours)Silent MI 15% of patients with MI, particularly common in elderly and diabetics

Temple College EMS Program

Temple College EMS Program*Symptoms - AMIShortness of breathWeakness, dizziness, faintingNausea, vomitingPallor and diaphoresis (heavy sweating)

Temple College EMS Program

Temple College EMS Program*Symptoms - AMISense of impending doomDenial 50% of deaths occur in first two hoursAverage patient waits 3 hours before seeking help

Temple College EMS Program

Temple College EMS Program*Symptoms - AMIChanges in pulse, BP, respiration are not diagnostic of AMI

Temple College EMS Program

Temple College EMS Program*Acute Myocardial InfarctionEarly recognition of MI is critical

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainWhen in doubt, manage all chest pain as MI

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainBegin management immediately if angina or MI are suspected. Complete the history and physical exam as you treat.

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainPosition of ComfortPatent AirwayHigh concentration O2non-rebreather mask 10-15 lpm

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainReassure the patientObtain a brief history and physical examAspirin 325mg p.o.

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainNitroglycerin 0.4mg tablet sublingualPatient should be sitting or lying downHas Pt. Taken nitroglycerin in last 10 minutes? Is pain relieved? Headache?Is BP > 90 systolic?q 5 minutes until pain relieved or three tablets administered

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainIf pain is unrelieved by rest, oxygen, nitroglycerin or if a change has occurred in pattern of angina, transport immediatelyTransport in semi-sitting position if BP normal or elevated; flat if BP low

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainDo not walk patient to the ambulanceDo not use lights/siren if patient is awake, alert, breathing without distressMonitor vital signs every 5-10 minutes

Temple College EMS Program

Temple College EMS Program*Management of Cardiac Chest PainRequest early ALS back-upDeaths in MI result from arrhythmia'sArrhythmia's can be prevented with early drug therapy

Temple College EMS Program

Temple College EMS Program*Congestive Heart FailureCHF = Inability of heart to pump blood out as fast as it enters. May be left-sided, right-sided, or both.

Temple College EMS Program

Temple College EMS Program*Congestive Heart FailureUsually begins with left-sided failure.Left ventricle failsBlood stacks up in lungsHigh pressure in capillary bedsFluid forced out of capillaries into alveoli

Temple College EMS Program

Temple College EMS Program*Congestive Heart FailureRight-sided failure most commonly caused by Left-sided failure. Blood backs up into systemic circulationDistended neck veinsFluid in abdominal cavityPedal edema

Temple College EMS Program

Temple College EMS Program*Causes of CHFCoronary Artery DiseaseChronic hypertension (high blood pressure)AMIValvular heart disease

Temple College EMS Program

Temple College EMS Program*Symptoms of CHFWeaknessDyspneaDyspnea on exertionParoxysmal nocturnal dyspneaAttacks of SOB that usually occur at night that awakens the patient

Temple College EMS Program

Temple College EMS Program*Symptoms of CHFOrthopneaDifficulty breathing in any position other than standing or sittingAbdominal discomfortJugular Vein Distention (JVD)Pedal Pitting edema in lower extremities

Temple College EMS Program

Temple College EMS Program*Symptoms of CHFTachycardiaPulmonary EdemaNoisy, labored breathingCoughingRales, wheezingPink, frothy sputum

Temple College EMS Program

Temple College EMS Program*Management of CHFSit patient up, let feet dangleAdminister high concentration O2Assist ventilation as neededMonitor vital signs q 5-10 minutesRequest early ALS back-up

Temple College EMS Program

Temple College EMS Program*Pacemaker FailurePosition of comfortPatent airwayHigh Concentration O2Assist ventilations as neededALS InterceptCPR as neededDO NOT worry about damage to pacemaker

Temple College EMS Program

Temple College EMS Program*Coronary Artery BypassPosition of comfortPatent airwayHigh Concentration O2Assist ventilations as neededALS InterceptCPR as neededDO NOT worry about damage to sutures/staples or by-passed arteries

Temple College EMS Program

Temple College EMS Program*Implanted DefibrillatorIf performing CPR on a patient:Implanted defibrillator may fireMay feel slight tingle

Temple College EMS Program

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