Cardiac/Cardiovascular Flashcards
What is ACS?
Acute coronary syndrome is a term that describes a range of conditions related to sudden, reduced blood flow to the heart.
What are the reversible causes of cardiac arrest (H’s & T’s)?
- Hypoxaemia
- Hypovolaemia (including anaphylaxis)
- Hypo/hyperthermia
- Hyperkalaemia
- Tension Pneumothorax
- Toxins/Drugs/Poisons
- Thrombosis
- Tamponade
What is the procedure for cardiac arrest (pt unresponsive and no pulse)?
- HPCPR (second officer)
- confirm code 2 and request backup
- apply defib pads (first officer)
- assess rhythm:* SHOCKABLE:
- defibrillate
- HPCPR and assess rhythm every 2 minutes
* administer:
- adrenaline (repeat every 2nd cycle)
- amiodarone (ICP only)
- lignocaine (ICP only)* **NON SHOCKABLE:** - HPCPR and assess rhythm every 2 minutes - administer adrenaline only (repeat every 2nd cycle) - aim for first rhythm assessment within 2 mins and advanced airway ASAP
What are the signs and symptoms of cardiogenic pulmonary oedema?
- diaphoresis
- cough
- pink, frothy sputum
- Sudden onset extreme SOB, anxiety and feeling of drowning
- crackles - in bases and spreading to apices
- tachypnoea
- tachycardia
- hypertension
- hypotension (indicates severe left ventricular and cardiogenic shock)
- cyanosis (late sign)
What is the treatment for cardiogenic pulmonary oedema?
- treat dysrhythmias if present per specific protocol
- CPAP (if indicated and Pt consents) - if don’t consent administer oxygen without CPAP
- oxygen
- GTN
- IPPV with PEEP and 100% oxygen if Pt hypoventilating
- regularly repeat ABCD
- urgent transport to ED
ICP only:
frusemide
What is cardiogenic shock?
The heart not pumping enough blood and oxygen to the brain and other vital organs causing hypotension and bradycardia.
What are the risks for stroke?
- Previous stroke or TIA
- Obesity
- Excessive alcohol consumption
- Atrial fibrillation
- Hypertension
- Smoking
- Diabetes
- Hyperlipidaemia
What are the 2 treatment windows for stroke?
<4.5hr window
<24hr window
What is the treatment for Hyperacute Stroke Mandatory Criteria -ve Pts <4.5 hrs?
treat signs and symptoms
transport to ED
What are the further assessments for FAST +ve Pts <4.5 hrs?
Hyperacute Stroke Mandatory Criteria
Pre-morbid function (mRS)
Stoke Severity (Hunter 8)
Complete Stroke Process Sheet
What is the treatment for stroke FAST +ve Pts <4.5 hrs & <24hrs?
gain IVC (18G in right ACF preferred)
cardiac monitoring
Consider:
oxygen (92% or less RA)
antiemetic
analgesia
transport to ED - do not delay IV access or ECG
What are the 4 components of the hyper acute stroke mandatory criteria?
+ve to any FAST criteria
ED <4.5 hrs from onset/last seen well
Pt >18yrs
BGL 4mmol or greater
What are the components of the FAST assessment?
Facial palsy
Arm weakness
Speech impairment/slurring
Time of onset/last seen well
What are the components of the Hunter 8 stroke score?
LOC
Commands (eyes, grip etc)
Best gaze
Facial Palsy
Motor arm
Dysarthria
Extinction/neglect
What does the pre morbid modified rankin scale assess?
level of disability
What should you include in the handover for stroke Pts?
time of onset/last seen well
Any FAST +ve criteria
Stroke process sheet
What is the treatment for stroke in Pts with onset/last seen well >24hrs?
treat signs and symptoms
transport to ED
What is the treatment for FAST -ve stroke Pts?
treat signs and symptoms
transport to ED
What are the signs and symptoms of stroke?
May include:
* Weakness or paralysis, especially on one side of the body (hemiparesis/hemiplegia)
* Slurred speech or speech impairment (dysphasia)
* Visual disturbances
* Difficulty swallowing (dysphagia)
* Ataxia (lack of muscle coordination)
What are some conditions of ACS?
APO
Angina - stable and unstable
MI
STEMI
STEMI mimic
NSTEMI
What is the treatment for STEMI Pts where the doctor advises not to thrombylise?
continue treatment
transport to ED
What is the treatment for STEMI Pts where the doctor advises to thrombylise?
- both paramedics confirm STEMI and Pt meets criteria
- explain risks to Pt and gain consent
- Administer (in order):
- clopidogrel
- tenecteplase
- enoxaparin
- Monitor Pt and repeat obs every 15 minutes
- minimise time on scene
- transport to ED
What is the treatment for STEMI Pts where the doctor advises to thrombylise but the Pt does not give consent or they do not meet checklist criteria?
Inform Dr
Transport to ED whilst continuing treatment
What is the treatment for ACS?
12L within 10 mins
Aspirin
GTN
Oxygen (if SPO2 <94%)
Fentanyl
What is the management for STEMI Pts?
- Complete perfusion checklist
- transmit 12 L (make sure call back phone is on)
- transport to ED and continue treatments depending on what Dr advises
What is the treatment for STEMI Pts where the transmission failed?
- transport to nearest ED with coverage (Coffs)
- Pre notify via control centre
- continue treatments
What is a cardiac tamponade?
Compression of the heart caused by fluid collecting in the pericardium (sac surrounding the heart)
What is dysphasia?
Difficulty understanding language or difficulty speaking
