Cardiac Emergencies Flashcards
Right Atrium
Receives blood from veins; pumps to right ventricle.
Right Ventricle
Pumps blood to the lungs.
Left Atrium
Receives blood from lungs; pumps to left ventricle.
Left Ventricle
Pumps blood through the aorta to the body.
How does the normal function of the heart and blood vessels relate to blood pressure and distal pulses?
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How is shock related to the function of the heart and blood vessels?
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Acute Coronary Syndrome (ACS)
• Sometimes called cardiac compromise
• Refers to any time the heart may not be
getting enough oxygen
• Many different kinds of problems under the ACS heading
• Symptoms often mimic non-cardiac conditions
• Treat all patients with ACS-like signs and symptoms as though they are having a heart problem
Symptoms Acute Coronary Syndrome (ACS)
- Chest pain is best-known symptom
- Can be described as “crushing, dull, heavy, or squeezing”
- Sometimes described only as pressure or discomfort - feels like indigestion
- Radiates to arms, upper abdomen, jaw
- Dyspnea also found in ACS
- May be the only finding in some patients
- Anxiety, feeling of impending doom
- Nausea and pain or discomfort in upper abdomen (epigastric pain)
- Sweating
- Abnormal pulse (tachycardia/bradycardia)
- Abnormal blood pressure
- Women will tell you they just don’t feel like themselves
Symptoms of Acute Coronary Syndrome (ACS)
- Perform primary assessment
- Obtain history and physical exam
- Use OPQRST to get history of present illness
- Obtain SAMPLE history
- Take baseline vital signs
Treatment for Acute Coronary Syndrome (ACS)
• Place patient in position of comfort (typically sitting up)
• Apply high-concentration oxygen - if O2 Sats are good a nasal cannula’s fine
• Transport
• If trained, equipped, and authorized to do so, obtain a 12-lead electrocardiogram (ECG) - can pinpoint where the MI is occurring
• Give the patient nitro if conditions are met (makes the fuel line bigger)
• Give the patient aspirin if conditions are met
• Follow local protocol as to whether to transmit it to hospital for interpretation
Indications for administering nitroglycerin
ACS
– Chest pain
– History of cardiac problems and prescribed nitroglycerin
– Patient has nitroglycerin
– Medical direction authorizes administration
Contraindications for administering nitroglycerin
– Systolic blood pressure less than 90–100 (consult local protocol)
– Patient has taken Viagra or similar drug for erectile dysfunction within 48–72 hours
Indications for administering aspirin
– Chest pain
– Ability to safely swallow
– Medical control authorization
Contraindications for administering aspirin
– Inability to swallow
– Allergy to aspirin
– History of asthma
– Patient already taking other anti-clotting medications
Causes of Coronary Artery Disease
• Conditions that narrow or block arteries of heart
• Often result from fatty deposit build-up on inner
walls of arteries
• Build-up narrows inner vessel diameter, restricts flow of blood
• Thrombus—occlusion of blood flow caused by formation of a clot on rough inner surface of diseased artery
• Thrombus can break loose and form an embolism
• Emboli can move to occlude flow of blood downstream in a smaller artery
• Reduced blood supply to myocardium causes emergency in majority of cardiac- related medical emergencies
• Chest pain is most common symptom of reduced blood supply
What is an Aneurysm
- Weakened sections of blood vessels begin to dilate (balloon)
- Bursting can cause rapid, life- threatening internal bleeding
Dysrhtmias
Electrical Malfunctions of the Heart
• Malfunction of heart’s electrical system generally results in dysrhythmia
• Dysrhythmias include bradycardia, tachycardia, and rhythms that may be present when there is no pulse
Mechanical Malfunctions of the Heart
- Angina pectoris
* Acute myocardial infarction (AMI) • Congestive Heart Failure (CHF)
Angina Pectoris
• Chest pain caused by insufficient blood
flow to the myocardium
• Typically due to narrowed arteries secondary to coronary artery disease
• Pain usually during times of increased myocardial oxygen demand, such as exertion or stress
Acute Myocardial Infarction (AMI)
- Death of a portion of the myocardium due to lack of oxygen
* Coronary artery disease is usually the underlying reason
Congestive Heart Failure (CHF)
- Inadequate pumping of the heart
- Often leads to excessive fluid build-up in lungs and/or body
- May be brought on by diseased heart valves, hypertension, obstructive pulmonary disease
- Often a complication of AMI
Progression of CHF
- Patient sustains AMI
- Myocardium of left ventricle dies
- Because of damage to left ventricle, blood backs up into pulmonary circulation and lungs
- If untreated, left heart failure commonly causes right heart failure
Signs and Symptoms of CHF (right sided heart failure)
- Tachycardia (>100 bpm)
- Dyspnea and cyanosis
- Normal or elevated blood pressure
- Diaphoresis
- Pulmonary edema
- Anxiety or confusion due to hypoxia
- Pedal edema (sacral in a bedridden pt)
- Engorged, pulsating neck veins (late sign)
- Enlarged liver and spleen
patient will tell you they are taking a water pill
Cardiac Arrest Chain of Survival
• Five elements
- Immediate recognition and activation
- Early CPR
- Rapid defibrillation
- Effective advanced life support
- Integrated post-cardiac arrest care
Early CPR
• Increases survival chances significantly
• Three ways CPR can be delivered earlier
– Get CPR-trained professionals to patient
faster
– Train laypeople in CPR
– Train dispatchers to instruct callers how to perform CPR
Why is Rapid Defibrilation Important
• Sooner defibrillator arrives, more likely patient will survive cardiac arrest
Why is Integrated Post-Cardiac Arrest Care important
• Coordinating numerous means of assessment and interventions that together maximize the chance of neurologically intact survival
Elements of Integrated Post-Cardia Arrest Care
- Maintaining adequate oxygenation
- Avoiding hyperventilation
- Performing 12-lead ECG
- Managing treatable causes of arrest
- Appropriate destination for patient
- Possibly inducing hypothermia
Management of Cardiac Arrest
• EMT provides two links in chain of survival
– Early CPR
– Rapid defibrillation
Treatment of Cardiac Arrest
• Standard Precautions • ALS (when available) • One- and two-rescuer CPR • Using an automated external defibrillator • Artificial ventilations and airway management • Interviewing bystanders and family members • Lifting and moving patients
Two types of Automated External Defribrilator (AED)
• Semiautomatic
– Advises EMT to press button that causes
machine to deliver shock through pads • Fully automatic
– Does not advise EMT to take any action; delivers shock automatically
Classification of AED
• Classified by type of shock delivered
– Monophasic: sends single shock from
negative pad to positive pad
– Biphasic: sends shock in one direction and then the other
What are the most common condition resulting in cardiac arrest - shockable rhythms
– Ventricular fibrillation
– Ventricular tachycardia
AED Safety Measures
• Do not defibrillate soaking-wet patient
• Do not defibrillate if patient is touching anything metallic that other people are touching
• Remove nitroglycerin patches before defibrillating
• Defibrillation can be performed on patient
with an implanted device
• Position defibrillation pads on patient’s chest to avoid contact with the device
AED Maintenance
- Use checklist at beginning of every shift to ensure you have all supplies and AED is functioning properly
- Make sure battery is charged and you have a spare with defibrillator
What functions does AED Quality Improvement involve?
• Involves multiple functions – Medical direction – Initial training – Maintenance of skills – Case review – Trend analysis – Strengthening links in chain of survival
What do you need to keep in mind when Coordinating CPR and AED
- Interrupt CPR only when absolutely necessary and for as short a period as possible
- CPR must be paused for rhythm analysis and defibrillation
Describe the primary assessment for a non-repsonsive patient
• Perform primary assessment
– If bystanders are doing CPR when
you arrive, have them stop
– Verify pulselessness, apnea, absence of other signs of life no longer than 10 seconds
• Apply AED
– Bare patient’s chest; quickly shave area where pads will be placed if necessary
– If available, use pediatric AED pads
– If using adult pads, do not overlap
• Use AED – Turn on AED – Attach pads to cables and then to patient – Stop CPR and analyze – Clear patient and shock if indicated
• Immediately begin CPR after delivering a shock
• Reassess patient after providing 2 minutes or 5 cycles of CPR
• If AED finds no shockable ECG rhythm, will advise that no shock is indicated
– Pulseless electrical activity – Asystole
• Resume CPR immediately
• If patient wakes or begins to move
– Obtain baseline vital signs
– Administer high-concentration oxygen
– Transport
Things to keep in mind when providing CPR
• When providing CPR
– Compressions must not be interrupted for any longer than 10 seconds
– Compressions at least 2 inches deep for adult and at least one-third depth of chest for infants and children with full chest recoil
– Rate should be at least 100 per minute
– Rotate personnel through compressor position to prevent fatigue
What is done during Post-Resuciatiion Care
• Patient has a pulse – Manage airway; avoid hyperventilation – Keep defibrillator on patient during transport in case patient goes back into arrest – Reassess frequently (every 5 minutes) – Consider hypothermia protocols
• Patient goes back into cardiac arrest – Stop vehicle, resume CPR – Analyze rhythm as soon as possible – Deliver shock if indicated – Continue with 2 shocks separated by 2 minutes (5 cycles)
Chapter Review
• Patients with cardiac compromise or ACS
can have many different presentations.
• Some complain of pressure or pain in the chest with difficulty breathing. Others may have just mild discomfort that they ignore or that goes away and returns.
Chapter Review
• Between 10%–20% of heart attack
patients have no chest discomfort.
• Because of these possibilities and the severe complications of heart problems, have a high suspicion and treat patients with these symptoms for cardiac compromise.
Chapter Review
- ACS patients need high-concentration oxygen and prompt, safe transportation to definitive care.
- You may be able to assist patients who have their own nitroglycerin.
Chapter Review
• To provide maximum chance of survival for patients in cardiac arrest, EMS agencies must strengthen their performance of the chain of survival: immediate recognition and activation, early CPR, rapid defibrillation, effective ALS, and integrated post-cardiac arrest care.
Remember
• The heart is a simple pump that moves deoxygenated blood to the lungs and oxygenated blood to the body. Pressure within the cardiovascular system is critical to the moving of blood.
Remember
- Acute coronary syndrome (ACS) is a blanket term that refers to a number of situations in which perfusion of the heart is inadequate.
- Although there are common symptoms of ACS, EMTs must recognize atypical findings and err on the side of caution.
Remember
• Oxygen, nitroglycerine, and aspirin are key medications indicated to treat ACS. However, the definitive treatment is transportation of the patient to a facility that can open the blocked artery.
Remember
- Most cardiac conditions are caused by arterial problems. Angina pectoris and acute myocardial infarction are caused by inadequate perfusion of the heart.
- Heart failure can be caused by either electrical or mechanical problems.
Remember
- The most important element of cardiac arrest care is the administration of high- quality chest compressions.
- The American Heart Association’s chain of survival describes the key elements necessary to maximize the cardiac arrest patient’s chance of survival.
Remember
- AED provides early defibrillation in cardiac arrest patients with ventricular tachycardia and ventricular fibrillation.
- Post-cardiac arrest care is an essential element of cardiac arrest care.
- Mechanical CPR devices provide automated chest compressions in cardiac arrest settings.