Chapter 18 Cardiac Emergencies Flashcards
Acute Coronary Syndrome
A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle. Also called cardiac compromise
What are some typical sxs someone with ACS may experience?
Crushing, dull, heavy or squeezing. Pain radiating into arms or lower abdomen anxiety or sense of impending doom Dyspnea Nausea, epigastric pain Unusual generalized weakness
Dyspnea
Shortness of breath; labored or difficulty breathing
What are some signs someone with ACS may display?
Sudden onset of sweating
Bradycardia or tachycardia and/or an irregular pulse
Hypotension or hypertension
Palpitations
Approximately ____ to ____ of people do not have the typical chest discomfort presentation when suffering from ACS?
1/2 to 1/3
What is the next steps after performing scene size up and primary assessment on the responsive patient experiencing chest pain?
History (HPI and PMHx)
Physical exam
Vital signs
How should you position a patient when you suspect ACS?
Position of comfort, usually sitting up, may prefer lying down if hypotensive
When should you administer O2 in a patient suspected is having an ACS?
Hypoxic - SpO2 less than 94%
Altered mental status, respiratory distress or pale skin
In the patient you suspect of having ACS; what are some indications that call for immediate transport?
No hx of cardiac problems
Hx of Cardiac problems but does not have nitro
SBP
What does STEMI stand for?
ST elevation myocardial infarction
What term describes the obstruction of blood supply to an organ or region of tissue causing local death of the tissue?
Infarction
What is PCI?
Percutaneous coronary intervention
What conditions must be met prior to administering nitroglycerin?
Pt c/o chest pain Hx of cardiac problems Rx'd NTG Pt has NTG on him/her SBP > 90 Pt has not taken ED med in last 48-72 hrs Med direction authorization
When would you give a repeat dose of NTG?
No relief with previous dose
SBP remains > 90
Med Direction authorization
What is the maximum number of times you can administer NTG?
3
What should you do if you administer NTG and the SBP drops below 90-100
Treat for shock and transport
What are the side effects of NTG?
Hypotension
Headache
Pulse rate change
What are some contraindications of NTG use?
SBP
What conditions must be met prior to administering asprin?
Pt c/o chest pain Pt has no allergy to asprin No Hx of asthma Not taking a medication to prevent clotting No other contraindications Able to swallow Med direction authorization
Coronary artery disease
Diseases that affect the arteries of the heart
Thromubs
A clot formed of blood and plaque attached to the inner wall of an artery or vein
Occlusion
Blockage, as of an artery by fatty deposits
Embolism
Blockage of a vessel by a clot or foreign material brought to the site by the blood current
What are the non-modifiable risk factors for CAD?
RASH Race AGE Sex Heredity
What are the modifiable risk factors for CAD?
SHEDS Smoking HTN Exercise Diet -DM - cholesterol - triglycerides Stress
Which patient populations usually experience atypical MI sxs?
Geriatric patients
Women
Diabetics
What are some complications of MI?
Cardiac dysrhythmias
Sudden cardiac arrest
CHF (pump inefficiency)
Cardiogenic shock (pump failure)
Aneurysm
The dilation or ballooning of a weakened section of the wall of an artery
Dysrhythmia
a disturbance in heart rate and rhythm
What are the two most common sites of aneurysms that you will encounter in emergency situations?
Aorta
Brain
What are the causes of cardiac conditions covered in this chapter?
Coronary artery disease Aneurysm Electrical malfunctions Mechanical malfunctions Angina pectoris Acute Myocardial Infraction Congestive Heart Failure
Angina Pectoris
Pain in the chest occurring when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough O2
How does angina pectoris usually present?
Pain with exertion, relief with rest
Acute Myocardial Infarction (AMI)
the condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by laypersons
Sudden death
A cardiac arrest that occurs within 2 hours of the onset of sxs. Pt may have no prior cardiac Hx
What are some way’s patients are treated for AMI at hospitals?
with fibrinolytics
Balloon angioplasty or balloon catheterization
What are some meds a Pt may be prescribed upon discharge from a Hospital after an MI?
Aspirin
Beta-blockers (slow HR and make it beat less strongly)
Congestive heart failure
the failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body or both
Edema
swelling resulting from a buildup of fluid in the tissues
Pulmonary edema
accumulation that of fluid in the lungs
what might you hear when listing to the lungs of a patient with pulmonary edema?
crackles (rales)
CHF on what side of the hear might lead pedal edema?
right sided
what are some s/sxs of a Pt with CHF?
Tachycardia, dyspnea, normal BP or HTN, cyanosis, diaphoresis, Pulmonary edema, coughing up white or pink sputum, anxiety or confusion, pedal edema, engorged pulsating neck veins, enlarged liver with abdominal distention
What are the five elements in the chain of survival?
Immediate recognition and activation Early CPR Rapid Defibrillation Effective advance life support Integrated post cardiac arrest care
