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Cardiac Emergencies > cardiovascular emergencies > Flashcards

cardiovascular emergencies Flashcards

1
Q

introduction

A
  • cardiovascular disease has been leading killer of Amercians since 1900
  • accounts for 1 of every 2.8 deaths
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2
Q

anatomy and physiology

A
  • cardiac output is the volume of blood that passes through the heart in 1 min
  • heart rate x volume of blood ejected with each contraction (stroke volume)
  • perfusion is the constant flow of oxygenated blood to tissues
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3
Q

good perfusion requires

A
  • a well functioning heart
  • an adequate volume of blood
  • appropriately constricted blood vessels
  • if perfusion fails, cellular and eventually patient death occur
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4
Q

pathophysiology chest pain

A
  • chest pain usually stems from ischemia which is decreased blood flow
  • ischemic heart disease involves a decreased blood flow to one or more portion of the heart
  • if blood flow is not restored, the tissue dies
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5
Q

pathophysiology atherosclerosis

A
  • atherosclerosis is the buildup of calcium and cholesterol in the arteries
  • can cause occlusion of arteries
  • fatty material accumulates with age
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6
Q

pathophysiology thrombo-embolism

A
  • a thrombo-embolism is a blood clot floating through blood vessels
  • if clot lodges in coronary artery, acute myocardial infarction (AMI) results
  • much more likely to happen in a hard and stiff artery
  • balloon stent catherization to fix
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7
Q

pathophysiology coronary artery disease

A
  • leading cause of death in US
  • controllable AMI risk factors:
  • cigarette smoking
  • high blood pressure
  • high cholesterol
  • high blood glucose level (diabetes)
  • lack of exercise
  • stress
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8
Q

uncontrollable AMI risk factors

A
  • older age
  • family history
  • being a male
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9
Q

acute coronary syndrome (ACS) is caused by myocardial ischemia

A
  • angina pectoris

- acute myocardial infarction

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10
Q

pathophysiology angina pectoris

A
  • occurs when the hearts need for oxygen exceeds supply
  • crushing or squeezing pain
  • does not usually lead to death or permanent heart damage
  • should be taken as a serious warning sign
  • treat angina patients like AMI patients
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11
Q

unstable angina

A

-in response to fewer stimuli than normal

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12
Q

stable angina

A

is relieved by rest or nitroglycerin

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13
Q

pathophysiology AMI

A
  • AMI pain signals actual death of cell in heart muscle
  • once dead, cells cannot be revived
  • clot busting (thrombolytic) drugs or angioplasty within 1 hour prevent damage
  • immediate transport is essential
  • AMI patients may not realize they are experience a heart attack
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14
Q

signs and symptoms of AMI

A
  • weakness, nausea, sweating
  • chest pain that does not change
  • lower jaw, arm, back, abdomen, neck pain
  • irregular heartbeat and syncope (fainting)
  • shortness of breath (dyspnea)
  • pink, frothy sputum
  • sudden death
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15
Q

AMI pain differs from angina pain

A
  • not always due to exertion
  • lasts 30 minutes to several hours
  • not always relieved by rest or nitroglycerin
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16
Q

AMI and cardiac compromise physical findings

A
  • fear, nausea, poor circulation
  • faster, irregular, or bradycardic pulse
  • decreased, normal, or elevated BP
  • normal or rapid and labored respirations
  • patients express feelings of impending doom
17
Q

three serious consequences of AMI

A
  • sudden death -> resulting from cardiac arrest
  • cardiogenic shock
  • CHF
18
Q

cardiogenic shock

A
  • often caused by heart attack
  • heart lacks power to force enough blood through circulatory system
  • inadequate oxygen to body tissues causes organs to malfunction
  • heart lacks power to pump
  • recognize shock in its early stages
19
Q

congestive heart failure

A
  • often occurs a few days following heart attack
  • increased heart rate and enlargement of left ventricle no longer make up for decreased heart function
  • lungs become congested with fluid
  • may cause dependent edema -> right sided
20
Q

hypertensive emergencies

A
  • systolic pressure greater than 160 mm Hg
  • if untreated, can lead to stroke or dissecting aortic aneurysm
  • transport patients quickly and safely
21
Q

common symptoms of hypertensive emergencies

A
  • sudden, severe headache
  • strong, bounding pulse
  • ringing in the ears
  • nausea and vomiting
  • dizziness
  • warm skin (dry or moist)
  • nose bleed
  • altered mental status
  • pulmonary edema
22
Q

aortic aneurysm

A
  • weakness in the wall of the aorta
  • susceptible to rupture
  • dissecting aneurysm occurs when inner layers of aorta become separated
  • primary cause -> uncontrolled hypertension
23
Q

AMI versus aortic aneurysm

A 
AMI
-gradual, with additional symptoms
-tightness or pressure
-increases with time
-may max and wane
-substernal; back is rarely involved
-peripheral pulses equal
DISSECTING ANEURYSM 
-abrupt, without additional symptoms
-sharp or tearing pain
-maximal pain from the outset
-does not abate once it has started
-back possible involved, between the shoulder bladed
-blood pressure discrepancy between arms or decrease in a femoral or carotid pulse
24
Q

heart surgeries and pacemakers

A
  • many open heart operations have been performed in the last 20 years
  • others have implanted cardiac pacemakers
  • patients who have had open heart procedures may have long chest scar
25
Q

coronary artery bypass graft (CABG)

A

-chest or leg blood vessel is sewn from the aorta to a coronary artery beyond the point of obstruction

26
Q

percutanous transluminal coronary angioplasty (PTCA)

A

-a tiny balloon is inflated inside a narrowed coronary artery

27
Q

cardiac pacemkaers

A
  • maintain regular cardiac rhythm and rate
  • deliver electrical impulse through wires in direct contact with the myocardium
  • implanted under a heavy muscle or fold of skin in the upper left portion of the chest
  • this technology is very reliable
  • pacemaker malfunction can cause syncope, dizziness, or weakness due to an excessively slow heart rate
  • transport patients promptly and safely
28
Q

automatic implantable cardiac defibrillators (AICDs)

A
  • used by some patients who have survived cardiac arrest due to ventricular fibrillation
  • monitor heart rhythm and shock as needed
  • treat chest pain patients with AICDs like they are experiencing a heart attack
  • usually tachycardia
29
Q

4 groups of cardiac distress

A
  • ventricular fib
  • pVT
  • asystole
  • PEA- pulseless electrical activity
30
Q

epinephrine

A
  • first medication you give in any cardiac arrest
  • vasocontriction
  • 1 mg every 3-5 mins (4 mins)
  • every other cardiac cycle you are giving epinephrine once you administered it
31
Q

VF, pVT

A
  • epinephrine is given after the second shock
  • epinephrine is given every other cycle after its given (everyone 3-5 mins)
  • lidocaine
  • amiodarone
32
Q

asystole/PEA

A
  • nonshockable rhythm
  • give epinephrine while doing CPR
  • give epinephrine every four minutes or every other cycle
  • check for shockable rhythm again -> if you still dont CPR
  • think about reversable causes- hypovolemia, hypoxia, hypothermia, hydrogen ions (acidosis), hypo/hyperkalemia, tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or cardiac)
  • if there is a shockable rhythm
33
Q

check pulse or get AED first

A
  • get the AED

- as soon as you see someone unconscious get the AED

34
Q

bradycardia

A
  • give atropine every 3-5 minutes
  • give max of 3 mg up to 3 times
  • if atropine is not effective -> transcutaneous pacing
  • if all else fails use dopamine and epinephrine infusion (not as effective in directly increasing rate)
35
Q

tachycardia dysrhythmias

A
  • stable vs unstable
  • unstable is treated with electricity
  • stable -> is it narrow or wide
  • treat over 150
  • synchronized cardioversion- timed defibration- shock timed with the r wave (sedation bc this hurts)
  • narrow- SVT- vagal maneuvers, adenosine, beta blockers
  • torsades- magnesium sulfate
36
Q

don’t need to know

A
  • sotalol iv dose

- procainamide iv dose

Cardiac Emergencies (13 decks)

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