Chest Pain and Injury Flashcards
Heart disease
includes congenital defects, hypertensive heart disease, angina, heart attacks, arrhythmias
Antherosclerosis
Thickening of the artery wall from accumulation of fatty material
Angina
Occurs when there is deficiency of O2 for heart, causes chest pain
Stable angina
Follows same pattern for pt, typically lasts less than 5mins, usually relieved by rest
Unstable angina
Doesn’t follow same pattern, not as easily relived by rest
Angina treatment
Full assessment, O2, ASA, 12 lead, nitro, IV
Acute coronary syndrome (ACS)
Results from prolonged cardiac disorder causing myocardial ischemia or infarction
STEMI, NSTEMI or unstable angina
AMI s/s
Chest pain, nausea, jaw/neck pain, SOB, drop in CO, pallor, diaphoresis,
ASA
Platelets aggregating inhibitor, orally administer, 160mg, one dose
Nitro
Vasodilation, reduced after load, symptom relief, not life saving
-lol ending
Beta blocker - decrease rate and strength of contraction for HTN, angina, heart failure
-ine ending
Calcium channel blocker - block of calcium ions into cardiac muscle, prevents spasms
-ide ending
Diuretics - can be used for HTN
-pril
Anti HTN
Chest pain directive considerations
ACS or MI
DAA
Pneumothorax
Pulmonary embolism
Pericarditis
Chest pain directive assess chest for
Subcutaneous emphysema
Accessory muscle use
Urticaria
In drawing
Shape
Symmetry
Tenderness
STEMI bypass protocol indications
Over 18 years old
Chest pain
Time of onset less than 12 hours
12 lead indicating STEMI
STEMi bypass contraindications
CTAS 1
LBBB
Transport is more than 60mins
Patient is requiring PCP diversion
Dissecting aortic aneurysm
Middle layer of aorta tears and blood flows between middle and outer layer until outer tears
Pericardium
Sac consists of visceral and parietal layer
Flail chest
Two or more adjacent ribs are broken creating free floating area, creating paradoxical movement
Pneumothorax
Chest wall allows air to enter thoracic space creating pressure. Bubbling at sight
Tension pneumothorax
Air accumulation in intrapleural space, one way valve, JVD, Trach deviation
Hemothorax
Blood filling thoracic cavity, lack of JVD, hemoptysis, dull to percussion
Pulmonary contusion
Capillary damage results in reduced area for gas exchange
Pericardial tamponade
Excessive fluid in pericardial sac, reduced stroke volume
Becks triad for pericardial tamponade
Muffled heart tones, Hypotension, JVD
Traumatic asphyxia
Sudden forceful impact in thoracic cavity that causes pressure to be translated up
Commotio cordis
Immediate cardiac arrest caused by blunt force trauma during depolarization period
Chronic heart failure
Occurs when heart is unable to pump to meet bodies metabolic needs
Left Sided Heart Failure
Left ventricle is unable to pump enough blood sufficiently from pulmonary vessels
As result pulmonary veins become engorged with blood causing ACPE
Causes LSHF
Left ventricle was damaged from MI
Chronic HTN
Results of LSHF
Fluid in lungs
SOB
Crackles in lungs
Pt may cough up fluid
How does body’s compensation mechanisms affect heart failure
Panic and SOB trigger SNS causing BP to rise and tachycardia causing heart to work harder
Management of LSHF
O2
Decreasing workload on heart
Reducing preload so LV is less burdened
12 lead
Iv
CPAP
Continuous positive airway pressure
Holds alveoli open for gas exchange to happen normally
Causes slight decrease in BP
CPAP starting setting
5cmH2O
Paroxysmal nocturnal dyspnea
Severe SOB and coughing that happens at night
Conditions for ASA
Greater than 18 and able to swallow
Conditions for nitro in cardiac ischemia
Greater than 18 years, HR 60-159, Normotension, prior history of nitro or IV
Contraindications for ASA
Active bleeding, CVA in past 24 hours, if asthmatic no prior use of ASA
Contraindications of Nitro
SBP drops by one third initial value after nitro administered, right ventricular MI, phosphodiesterase inhibitors in last 48 hours
ASA Tx
PO
160mg
1 dose
Nitro use for NO STEMI
SBP greater than 100
SL
0.3 or 0.4mg
Every 5 mins
6 doses
Nitro Tx for a STEMI
SBP greater than 100
SL
0.3-0.4mg
every 5 mins
Max of 3
How long should it take to get first 12 lead
Less than 10 mins
nitro Tx for ACPE if BP is between 100-140
IV Yes
SL
0.3mg
Every 5 mins
6 doses
Nitro Tx for ACPE with no IV and BP greater than 140
SL
0.3mg
Every 4 mins
6 doses
Nitro Tx WITH IV and BP greater than 140
0.6mg
Every 5 mins
Max of 6 doses