Chapter 18 Cardiac emergencies Flashcards
Acute Coronary Syndrome (ACS)
A blanket term used to represent any symptoms related to lack of oxygen (ischemia - Inadequate blood supply to an organ) in the heart muscle. Also called cardiac compromise.
- Refers to any time the heart may not be getting enough oxygen.
- Ex: coronary artery may become narrowed or blocked, one way valve may stop working properly, or the specialized tissue that carries electrical impulses may function abnormally
Signs and Symptoms
- pain in the center of the chest - described as Crushing, Dull, Heavy, or Squeezing
- Dyspnea
- sudden onset of sweating, nausea, and vomiting
- Commonly radiates to arms (left more then right)
- Anxious feeling
- Nausea and pain in upper abdomen
- High or low HR (lower then 60, higher then 100)
- Hypotension or hypertension (lower then 90, higher then 140 - systolic)
Treatment
- Position of comfort
- O2 Administration if SpO2 is less then 94%
- Artificial ventilation if patient is in respiratory failure
- Transport immediately
- Give patient Nitro if: complains of chest pain, history of cardiac problems, patients physician prescribed nitro, patient has nitro w/him, patient has systolic BP of 90+, patient hasn’t taken ED meds, medical direction authorizes!
- Repeat a dose in 5 minutes if: No relief, or partial relief, BP is still greater then 90, medical direction authorizes
- MAX of 3 doses reassessing patient
- Give aspirin if: Chest pain, not allergic, no history of asthma, not taking meds to prevent clotting, no other contraindications to aspiring, alert enough to swallow, medical direction authorizes
Coronary Artery Disease
When coronary arteries are narrowed or blocked, blood flow is reduced, thereby reducing the amount of oxygen delivered to the heart.
- often result of the build up of fatty deposits on the inner walls of arteries
- Plaque - fats and other particles - calcium can be deposited to site of plaque, causing are to harden
Thrombus
a clot formed of blood and plaque attached to the inner wall of an artery or vein (Grew there)
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 (flew there)
myocaridum
heart muscle
Aneurysm
The dilation, or ballooning, of a weakened section in the arterial walls
- can be rapid, life threatening internal bleeding when rupture occurs
- Death from shock can occur very quickly
- Two most common sites for aneurysms are the Aorta and the Brain
Electrical Malfunctions of the heart
will generally result in dysrhythmia
- an irregular or absent heart beat
- rhythm that may be present with no pulse like: V-fib, V-tach, systole
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 oxygen
- usually comes on after stress or exertion
- seldom does this pain last longer then 5 mins
- possession of nitroglycerin is an indicator that patient has a history with this
- patients usually allowed to take 3 doses in 10 min span before calling for help
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
- brought about by narrowing or occlusion of coronary arteries or a coronary aneurysm
Treatment
- medication called Fibrinolytics - dissolves the clot that is blocking the coronary artery
- another procedure to help is use of a Balloon angioplasty or Balloon catheterization is inserted to unclog coronary artery
- use of beta blockers (medication that slows the heart and makes it beat less strongly)
Sudden death
a cardiac arrest that occurs within 2 hours of the onset of symptoms. the patient may have no prior symptoms of coronary artery disease - 25% of patients have no previous history of cardiac problems
Beta Blockers
medication that slows the heart and makes 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 - fluid buildup causes edema - may be brought about by: diseased heart valves, hypertension, or some sort of COPD such as emphysema Signs and Symptoms - Tachycardia - dyspnea - normal or elevated BP - cyanosis - diaphoretic - pulmonary edema - anxiety (caused by hypoxia) - pedal edema - JVD - Enlarged liver/spleen with Abdominal Distention
Cardiac arrest
1-2% of calls are cardiac arrest
Chain of Survival
- Recognition and activation of the emergency response system
- immediate high quality CPR
- rapid defibrillation
- basic and advanced EMS
- ALS and post arrest care
- Teamwork
- Coordination
