CH 7 Circulatory Emergencies Flashcards
Define circulatory emergency
emergencies that affect the heart or vascular system
Blood flow into & out of the heart (blood pathway)
O2 poor blood
R. atrium
R. ventricle
Lungs via pulmonary artery
L. atrium
L. ventricle
Body
Define cardiovascular disease
refers to a broad range of abnormal conditions affecting the heart and blood vessels
examples of cardiovascular diseases (6)
coronary heart disease
cerebrovascular disease
congentital heart disease
deep vein thrombosis
pulmonary embolism
peripheral artery disease
what circulatory emergencies does CVD increase the risk of? (2)
stroke
myocardial infarctions
Define arteriosclerosis
occurs when the arteries become hardened, narrowed & less elastic.
Reduces the supply of oxygen to affected tissues. Can result in coronary heart disease
how does atherosclerosis occur? (3)
-gradually
-cholesteral & plaque builds up on the interior walls of the arteries
-the arteries become more narrow, reducing the volume of blood flow through them
contributing factors to atherlosclerosis (3)
high BP
smoking
high cholesterol/triglycerides in blood
controllable risk factors of cardiac disease (9)
-hypertension
-high cholesterol
-diabetes*
-heart disease
-overweight
-excessive alcohol consumption
-lack of exercise
-smoking
-stress
uncontrollable risk factors of cardiac disease (6)
-age
-gender
-family Hx
-ethnicity
-Hx stroke/TIA
-Diabetes*
define myocardial infarction
complete blockage of coronary artery that leads to muscle death in the heart
why is hypertension the silent killer
causes damage to the blood vessel walls (scarring) that prompts build up of fatty plaque=narrowing of arteries/clots/embolisms/strokes
define angina
intermittent chest pains/pressure associated with coronary heart disease. Occurs when O2 demands exceed the available supply
Angina MOI (6)
-exercise
-physical activity
-stress
-periods of extreme heat or cold
-after heavy meals
-while drinking or smoking
How does angina occur? (3 steps)
1+ coronary arteries are partially blocked
Blood & O2 not reaching heart
chest pain
Define stable Angina
-diagnosed
-every attack feels the same/last 10 min
-can be relieved with rest + nitroglycerin
-usually not life threatening
Define unstable Angina
-diagnosed with Angina, but this pain is not the same as their stable Angina (pain is not typical)
-may occur at rest & last 10+ mins
-does not respond to medication
-warning sign of an MI
S/S Angina (7)
pain in centre of chest
-tightness, squeezing of chest, achey feeling in chest/arms
-persistent feeling of moderate to severe indigestion
-nausea/vomitting
-pale, cool sweaty skin
-discomfort in chest/neck/jaw
-numbess in arms, wrist/shoulders
Angina treatments
- comfortable position
- nitroglycerin (3 doses in 5 min max)
- ASA (acetylsalicylic acid)
- O2 administration
- monitor vitals
What is nitroglycerin & how is it administered
Is a vasodialator
-sublingual spray
-pill
-patch
Goal of nitroglyerin & what should you always check before giving it
Increase the quality of O2 reaching the heart, which can reduce the patients chest pain
Always:
- Check 6R’s
-Check BP
-Check if they are on other vasodialtors (erectile dysfunction drugs)
-Check how many does the person has already taken
Myocardial Infarction (MI) S/S
pale/blue skin
sweaty skin
change in pulse
mild discomfort of chest
gastric/indigestion discomfort
difficulty breathing
pain radiating in chest, neck, shoulders, arm, jaw
Mi treatments
ASA
plus: call EMS right away & prepare for CPR/AED
define congestive heart failure
abnormal condition in which the hearts pumping ability is diminished
describe L side heart failure
-Left ventricle loses ability to pump blood through the body
-Blood coming into the L ventricle gets backed up
-Blood backs up into the aveoli which causes SOB, increased resp. rate
describe R sided heart failure
-Uusally occurs due to L sided heart failure
-Blood backs up in to the veins which causes pooling of fluid in tissues & swelling in extremities
What is L sided heart failure caused by
MI
Chronic hypertension
What is R sided heart failure caused by
-L sided heart failure
-Pulmonary embolism
-Long standing COPD
- MI
L sided heart failure S/S
SOB
Increase resp. rate
cyanosis
coughing up foamy blood
SOB when supine
increased HR
wheezing
cool/clammy skin
restlessness
confusion
normal-high BP
Right sided heart failure S/S
SOB
swellling in lower extremities/lowerback
urinating more frequenty
JVD
tachycardia/arrhythmia
weakness/fatigue
synscope (fainting)
Define Cerebrovascular accidents (stroke)
Disruption of blood flow to part of the brian
-deficits in speech, motor skills, memory etc…)
Define the 2 types of strokes
- Ischemic- Occurs when a cerebral artery becomes blocked/narrowed restricting blood to the brain
-develops overtime - Hemorrhagic- Occurs when there is a break in a brain blood vessel (1/5 chance)
-results from head injuries, hypertension or ruptured aneurysm
Describe the 2 types of Hemorrhagic strokes
- Subarachnoid- Occurs when an artery at the surface of the brain bursts, filling the subarachnoid space
- Intracerebral- vessels in the brain tissue burst and bleeds into surrounding tissue causing the tissue to become hypoxic
Describe the 2 causes to an ischemic stroke
- Thrombotic- when a blood clot develops in a cerebral artery (build up of plaque)
- Embolic- Occurs when a piece of material forms outside of the brain breaks off & is carried to the cerebral artery by the circulatory system
Define Transient Ischemic Attack (TIA)
-Caused by reduced flow to the brain
-S/S disappear within minutes
-Reffered to as a warn ing stroke
-Clot is formed, then is pushed through & blood flow returns to normal
Stroke & TIA S/S
-sudden weakness in face, arm or leg on one side of the body (opposite side to where the clot is)
-difficulty speaking/understanding
-blurred vision
-pupils are unequal
-sudden/severe headache
-dizziness
confusion
-unresponsiveness
-loss of bowel/bladder control
Care for stroke/TIA (4)
-Its life threatening so rapid transport is needed
1. My have difficulty manageing own airway
2. do not give them anything to eat or drink
3. do not give asprin
4. put in recovery position w/affected side downwards
define cardiac arrest
-when the heart stops circulating blood and vital organs do not receive oxygen rich blood & the cells start dying
define clinical death
-The cessation of circulation & respiration
-reversible through immediate interventions
-0-4mins
What is your goal if someone goes into cardiac arrest
Continue to circulate oxygenated blood through the body.
-Have them stay in clinical death and not go into biological death
define biological death
death of brain cells
-Irreversible
-Happens after 6+mins
common causes of cardiac arrest (10)
-stroke & brain damage
-CVD
-resp. failure (common in babies)
-poisoning
-electrocution
-drowning
-suffocation
-certain drugs
-chest trauma
-severe blood loss
S/S cardiac arrest (heart attack): MEN (5)
-sudden cold sweat
-discomfort/tingling in the back, shoulder, jaw, neck & arms
S/S cardiac arrest (heart attack): WOMEN (9)
-extreme fatigue
-dizzy
-pain in jaw w/o chest pain
-upper back pain
-SOB
-chest pressure
-vomiting
- feeling of heart burn/indigestion
-tingling in one or both arms
2 things the heart will do in cardiac arrest
- stop
- have an arrythmia that prevents blood circulation (fibrillation)
how to stop heart fibrillation
stopping and shocking the heart momentarily can allow it to spontaneously resume an effective rythm
What is an AED
Automatic External Defibrillator
1. analyzes the hearts rhythm
2. delivers an electric shock
-only effective with certain heart rhytms
what heart rythms will the AED shock? (2) and not shock? (2)
SHOCK:
1. ventricular fibrillation
2. Ventricular tachycardia
NOT SHOCK:
1. normal rhythms (normal electrical activity)
2. Asystole (no electrical activity)
define Cardiopulmonary Resuscitation (CPR)
Combination of assisted ventilations & chest compression, which artificially replicate the functions of the lungs & heart
what does CPR do?
prevents biological death until advance medical care arrives
How to perform proper Chest Compressions (7)
- patient is on hard flat surface
- rate of 120bpm
- increase compression fraction w/ decreased off chest time
- hand positioning
- responder position
- chest recoil
- chest compression depth
define compression fraction
percent of total CPR time in which the patient is recieving compressions
defiene off chest time
time not performing chest compressions
why do you want a high compression fraction? (more on chest time)
-When compressions are interrupted the pressure in the circulatory system begins to drop almost immediately
-Takes time to get the blood circulating again after stopping
goal of compression fraction/off chest time (2)
-Maximize the compression fracture
-Minimize off chest time
Hand positioning in CPR: Adult & Child (6)
- Heel of hand over paitents sternum
- place other hand on top & grip lower hand w/ fingers
- kneel close & beside the patient, facing chest
- Arms are right angle to the patients chest
- lean forward and straighten your arms directly above hands
- Lock your elbows & press straight down onto the sternum
hand positioning CPR: Infant (2)
- two finger compression
-Use if infants torso is too lagre to encircle or performing CPR alone (maintains airway) - Hands encircle
-second person maintains airway
Define chest recoil & depth compression (adult, child & infant)
Chest Recoil:
- Allow chest to recoil after each compression
-Allows the heart to expand & fill with blood
Compression Depth:
- Adults: 2 inches
- Children & infants: 1/3 chest depth
When to stop CPR? (4)
- Another (more) trained rescuer takes over
- too exhausted to continue
- scene becomes unsafe
- pulse now present
Do not use an AED if: (4)
- you are in a vehicle
- You are in presence of flammable material (gas, O2)
- you are touching the patient
- neonatals
Special Resuscitation Situations (9)
- pregnant women- put pillow under right hip
- transdermal medication patch- take it off
- implanted pacemaker- place pads 1 inch away
- body jewlery- place pads 1 inch away
- trauma to torso- safe to use as normal
- patients in water- move patient to protect the responders who are in the water with the patient, dry chest before
- rain/snow- try and ensure the patient is as dry as possible & sheltered if possible
- excessive hair- shave chest to improve pad adherence
- wire bra- cut is necessary
