Review

Inferior and Superior Vena Cave RA Tricuspid Valve Pulmonic Valve Pulmonary Artery Lungs {oxygenation} Pulmonary Vein Left Atrium Mitral Valve Left Ventricle Aortic Valve Circulation

Sodium Enters; Potassium leaves Depolarization

RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART

P wave- PR interval- QRS complex - ST segment- TwaveNormal 0.12 – 0.20 morphology normal isoelectric presentUpright <0.12 secondsOnly before each QRS

= NSR

RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART

Any deviation from the normal electricalrhythm of the heart

= Dysrhythmia

RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART

Causes of dysrhythmias:• MI, ischemia, necrosis• Autonomic nervous system imbalance• Distension of the chambers

notably in the arteries secondary to CHF• Blood gas abnormalities i.e. hypoxia and abnormal pH• Electrolyte imbalances• Trauma {cardiac contusion}• Drug effects and drug toxicity• Electrocution• Hypothermia• CNS damage• Idiopathic events: arising spontaneously or from an obscure or unknown cause

• Normal occurances

RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART

The absence of cardiac electrical activity

= arrhythmia

RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART

ANALYZING RATE• ECG strip method or 60 second method• “300” method or triplicate method• R-R method

CARDIAC EMERGENCIES

What’s next:• Bringing It Home• Cardiac arrest lecture• Mega code practice and scenarios• Exams

writtenMega code

BRINGING IT HOME

Cardiac Anatomy and Physiology• Flow of blood through the heart and cardiac

conductive system• Composition of Blood

Composition of the Blood

• Plasma• Red blood cells• White blood cells• Platelets

Flow of bloodArteries – arterioles - veinules - veins

Major Blood Vessels• Superior Vena Cava• Carotid Arteries• Jugular Veins• Aorta• Femoral Artery• Inferior Vena Cava• Brachial Arteries

Circulation of Blood between:• Heart and lungs• Heart and rest of the body

• Mechanical and Electrical functions of the heart in relation to pulse and blood pressure

• Shock

Cardiac CompromiseAcute Coronary Syndrome

Syndrome: In medicine and psychology, the term syndrome refers to the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others.

Cardiac Compromise:• Any kind of problem with the heart

• May lead to a high index of suspicion for possible: MI

AnginaCHF

Signs and Symptoms of Cardiac Compromise:• Dyspnea• Pain, pressure or discomfort• Palpations• Sweating• N & V• Anxiety

• Abnormal Pulse• Blood Pressure:

Hypotensive: <90/systolicHypertensive: >150/systolic or

>90/diasolic• Chest Pain

Causes of Cardiac Compromise:• CAD

AtherosclerosisArteriosclerosis

Hardening of the arteries from Ca++ deposits

• Restriction of blood through the arteryThrombus; clot and debris from plaque

Occlusion: Thrombus cuts off blood flow

Embolism: Thrombus that moves to occlude the flow of blood beyond the blockage

Risk Factors:• Heredity• Age• HTN• Obesity• Lack of exercise• Elevated cholesterol and triglycerides• Smoking

• Common SymptomChest Pain

• Aneurysm

Electrical Malfunctions of the Heart• Dysrhythmia

Mechanical Malfunctions of the Heart• Pump Failure

Angina PectorisChest Pain

• Difference between Angina & MI• NTG

• AMISudden death is considered a cardiac arrest

within 2 hrs. of symptomsRisk Factors• CAD• Chronic respiratory problems• Unusual exertion• Severe emotional stress

Treatment• Fibrinolytics• Angioplasty or Catheterization• ASA regimen

CHFLeft sided heart failure/ Right sided failure soon follows

Causes:• Diseased heart valves• HTN• COPD• As a complication of an MI

Pulmonary Edema• Rales• Blood tinged sputum• Pedal Edema• Abdominal Distension

Signs and symptoms of CHFCARDIOGENIC SHOCK

• Tachycardia• Dyspnea• Normal to elevated B/P• Cyanosis• Diaphoresis• Cool Clammy skin

• Pulmonary Edema• Anxiety or confusion due to hypoxia• Pedal edema• JVD (late sign)• ABD distension

Enlarged liver and spleen• Medication History

Lasix

PATIENT CARE• POC• O2• Identify Priority Patient

No history of cardiac problemsHx but no NTGHypotensive

• Transport: Thoughtful, calm, caring fashion

ASSIST with NTG• Clinical signs and symptoms must be present• Right med, route, dose, form, patient• Pulse rate >50 and <100

Protocol• Systolic B/P >110• Has not taken Viagra or such within 48 to 72 hrs.• Medical Control

• Remember usual protocol is 1 does q 5 minutes to 3 doses.

• CHECK BLOOD PRESSURE BEFORE ADMINISTERING

CARDIAC EMERGENCIES

LET’SPLAY