Ch 17 - Cardiac Emergencies - Review Flashcards
Angina Pectoris (S/S)
a. Usually felt in the midportion of the chest, under the sternum
b. Can radiate to the jaw, arms (frequently the left arm), midback, or epigastrum
c. Usually lasts from 3 to 8 minutes but rarely longer than 15 minutes
d. May be associated with shortness of breath, nausea, or sweating
e. Usually disappears promptly with rest, supplemental oxygen, or nitroglycerin (NTG)
Acute Myocardial Infarction (AMI) (S/S)
a. Sudden onset of weakness, nausea, and sweating
b. Chest pain, discomfort, or pressure that is often crushing or squeezing that does not change with each breath
c. Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck
d. Irregular heartbeat and syncope
e. Shortness of breath
f. Nausea/vomiting
g. Pink, frothy sputum
h. Sudden deatha. Physical Findings a. General appearance: fear, nausea, poor circulation
b. Pulse: faster, irregular, or bradycardic
c. Blood pressure: decreased, normal, or elevated
d. Respirations: normal or rapid and labored
e. Mental status: feelings of impending doom
Aortic Aneurysm/Dissection (S/S)
a. Onset of pain is abrupt without additional symptoms b. quality of pain is sharp and/or tearing c. severity is maximal at onset d. pain does not abate once it has started e. pain is possibly felt in back, between shoulder blades f. blood pressure discrepency between arms or a decrease in a femoral or carotid pulse
Thromboembolism (S/S)
a. Major controllable risk factors:
i. Cigarette smoking
ii. High blood pressure
iii. Elevated cholesterol level
iv. Diabetes
v. Lack of exercise
vi. Obesity
b. Major uncontrollable risk factors:
i. Older age
ii. Family history
iii. Race
iv. Ethnicity
v. Male sex
Hypertensive Emergencis (S/S)
Systolic pressure greater than 180 mm Hg Sudden, severe headache
Strong, bounding pulse
Ringing in the ears Nausea and vomiting
Dizziness
Warm skin (dry or moist)
Nosebleed
Altered mental status
Sudden pulmonary edema
Chest Pain (patho)
usually stems from ischemia, which is decreased blood flow resulting in cardiac cell death
Angina Pectoris (patho)
- It can result from a spasm of an artery but is most often a symptom of atherosclerotic coronary artery disease.
a. May be triggered by large meal or sudden fear
b. When increased oxygen demand goes away, the pain typically goes away
Acute Myocardial Infarction (AMI) (patho)
when a clot lodges in a coronary artery
Aortic Aneurysm/Dissection (patho)
weakness in the wall of the aorta; Dissecting aneurysm occurs when inner layers of aorta become separated
Thromboembolism (patho)
blood clot floating through blood vessels.
Congestive Heart Failure (CHF) (patho)
A. (CHF) often occurs within the first few days after a myocardial infarction.
1. CHF develops when increased heart rate and enlargement of the left ventricle no longer make up for decreased heart.
2. It is called “congestive” because lungs become congested with fluid (pulmonary edema) once the heart fails to pump effectively.
a. Occurs suddenly or slowly over months
b. In acute-onset CHF, severe pulmonary edema is accompanied by pink, frothy sputum and severe dyspnea.
3. With right side heart failure, blood backs up in the vena cavae, causing fluid to collect in other parts of the body (dependent edema), such as in the feet and legs.
a. Right heart failure can result in an inadequate supple of blood to the left ventricle, resulting in a drop in the systemic blood pressure.
b. Patients may present with signs of both left- and right-side heart failure because left-side failure often leads to right-side failure.
Cardiac Emergency ABC care priority
- Form a general impression.
a. If the patient is unresponsive and is not breathing, begin CPR, starting with chest compressions, and call for an AED. - Assess the patient’s airway and breathing.
a. If dizziness or fainting has occurred due to cardiac compromise, consider the possibility of a spinal injury from a fall.
b. Assess breathing to determine whether the ailing heart is receiving adequate oxygen.
i. Shortness of breath, with no signs of respiratory distress
(a) If oxygen saturation is less than 95%, administer oxygen at 4 L/min via nasal cannula.
(b) If they do not improve quickly, apply oxygen with a nonrebreathing mask at 15 L/min.
ii. Not breathing or inadequate breathing
(a) Apply 100% oxygen with a bag-mask device
iii. Pulmonary edema
(a) Positive pressure ventilation with bag-mask device or (CPAP) 3. Assess the patient’s circulation.
a. Pulse rate and quality
b. Skin color, moisture, and temperature
c. Capillary refill time
d. Consider treatment for cardiogenic shock early to reduce the workload of the heart.
e. Position the patient in a comfortable position, usually sitting up and well supported. - Make a transport decision based on whether you were able to stabilize life threats during the primary assessment.
a. Remainder of the assessment can be performed en route, if time allows.
i. Most patients with chest pain should be transported immediately.
ii. Follow local protocol for determining what receiving facility is most appropriate.
b. Determine whether to use the lights and siren for each patient, partially based on estimated transport time.
c. As a general rule, patients with cardiac problems should be transported in the most gentle, stress-relieving manner possible.
Emergency Medical Care for Chest Pain
A. Ensure a proper position of comfort.
1. Allow patients to sit up if most comfortable.
2. Loosen tight clothing.
B. Give oxygen if indicated.
1. Continually reassess oxygen saturation and patient’s respiratory status.
a. Use nasal cannula for patients with mild dyspnea.
b. Use nonrebreathing face mask for patients with more serious respiratory difficulty.
c. If signs of pulmonary edema are present, CPAP may be indicated.
d. Assist unconscious patients with breathing as well as those with obvious respiratory distress.
C. Depending on local protocol, prepare to administer low-dose aspirin and assist with prescribed nitroglycerin.
Emergency Medical Care for Cardiac Arrest
