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
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
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
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
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
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
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
8
Q
uncontrollable AMI risk factors
A
- older age
- family history
- being a male
9
Q
acute coronary syndrome (ACS) is caused by myocardial ischemia
A
- angina pectoris
- acute myocardial infarction
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
11
Q
unstable angina
A
-in response to fewer stimuli than normal
12
Q
stable angina
A
is relieved by rest or nitroglycerin
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
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
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
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
coronary artery bypass graft (CABG)
-chest or leg blood vessel is sewn from the aorta to a coronary artery beyond the point of obstruction
26
percutanous transluminal coronary angioplasty (PTCA)
-a tiny balloon is inflated inside a narrowed coronary artery
27
cardiac pacemkaers
- 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
automatic implantable cardiac defibrillators (AICDs)
- 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
4 groups of cardiac distress
- ventricular fib
- pVT
- asystole
- PEA- pulseless electrical activity
30
epinephrine
- 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
VF, pVT
- epinephrine is given after the second shock
- epinephrine is given every other cycle after its given (everyone 3-5 mins)
- lidocaine
- amiodarone
32
asystole/PEA
- 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
check pulse or get AED first
- get the AED
| - as soon as you see someone unconscious get the AED
34
bradycardia
- 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
tachycardia dysrhythmias
- 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
don't need to know
- sotalol iv dose
| - procainamide iv dose
