EC Chp 18 Cardiac Emergencies Flashcards
Acute Coronary syndrome (ACS) also Cardiac Compromise
A blanket term that refers to any time the heart may not be getting enough oxygen. (Ischemia - lack of O2 in the heart muscle)
Dyspnea is…
Shortness of Breath; labored or difficult breathing
Bradycardia
When the heart rate is slow usually less than 60 BPM
Tachycardia
When the heart rate is fast or more than 100 BPM
Hypotensive
Systolic blood pressure lower than 90
Hypertensive
Systolic greater 140 or diastolic greater than 90
Coronary Artery Disease (CAD)
diseases that affect the arteries of the heart. such as narrowing or blocking of them. Result o build up of fatty deposits
Thrombus is?
A clot formed o blood and plaque attached to the inner wall of an artery or vein
A thrombus can reach a size where it can cut off blood flow is
an Occlusion (cutting off)
Embolism is when
blockage of a vessel by a clot or foreign material is brought to the site by the blood current
myocardium is the
heart muscle
reduced blood supply to the myocardium causes?
chest pain
Angina Pectoris is
Chest pain. when coronary artery disease has narrowed that arteries that supply the heart
Aneurysm is
the dilation or ballooning of a weakened section fo the wall of an artery. and when it bursts there can be life-threatening bleeding.
the two most common sites of an Aneurysm is?
the Aorta and the Brain
dysrhythmia is
a disturbance or malfunction in the heart rate and rhythm.
symptoms of dysrhythmia results are
bradycardia and tachycardia, including ventricular fibrillation
Acute Myocardial Infarction (AMI) is
often called a heart attack
the condition in which a portion of the myocardium dies as a result of oxygen starvation
Sudden death
a cardiac arrest that occurs within 2 hours of the onset of symptoms. the patient may have no prior symptoms of CAD
Congestive Heart Failure (CHF) is
a condition of excessive fluid build up in the lungs and or other organs and boy parts because of the inadequate pumping of the heart. CHF is often a complication of AMI
the fluid build up from CHF causes?
Edema
Congestive Heart Failure may be brought on by:
diseased heart valves, hypertension, or some form of obstructive pulmonary disease such as emphysema.
what happens when a patient sustains an AMI (Acute Myocardial Infarction)?`
The Myocardium in the area of the left ventricle dies.
if left heart failure is left untreated it commonly causes?
Right heart failure
when the right heart fails (which receives blood from the body and pumps to lungs)
the right side becomes congested and in the lungs as well then fluid may accumulate in the dependent (lower) extremities causing pedal edema
Pedal edema
accumulation of fluid in the feet or ankles
2 late signs of Congestive Heart Failuare
Engorged pulsating Neck veins (JVD)
enlarged liver and spleen with abdominal distention
Cardiac Arrest
an electrical issue with the heart and typically only 1-2% of emergency calls are cardiac arrests
5 Elements for the chain of survival for Cardiac Arrests
- Recognition and activation of the ERS
- Immediate high-quality CPR
- Rapid defibrillation
- Basic and Advanced EMS
- ALS and Post-Arrest care
the underlying theme of the chain of survival is ?
Teamwork: it is essential in order to maximize the chance of survival
In High Performance CPR what is the chest compression measurement
compress the chest between 2-2.4in in adults and 1.5in for infants or 1/3 of the depth allow for full relaxation on the upstroke of compressions 100-120 per min
The key to high performance CPR is
increasing cardiac output
whats the minimum time for interruptions in high performance CPR?
no more than 10 seconds
how much time to you spend on each ventilation for high performance CPR
no more than 1 second
what is the maximum response time for effective defibrillation?
8 minutes
Basic and Advanced EMS can do what that laypeople cannot?
second to defibrillation, they can put a breathing tube into someones throat and start an IV line
3 different EMT levels of practice
EMT- Cardiac
EMT- Critical Care,
EMT- Intermediate or Advanced EMT
ALS and Poset Arrest Care refers to:
the coordinating of numerous different means of assessment and interventions that together, maximize the patients chance of neurological intact survival.
controlled hypothermia refers to
an intervention used to cool patient to 90-93 degrees and maintaining it for 12-24hours which seem to lead to more survivors and less brain damage
2 types of defibrillation
Manual defibrillation and
Automated defibrillator
two types of automated external defibrillators
Semi-Automatic Fully Automatic (shocks once it's ready
the types of shocks AED’s provide
traditional Monophasic which sends a single shock at 360J and
Biphasic which sends the shock in one direction and then back the other. shock should be at 120-200J
How do AED’s work
they analyze the cardiac rhythm and determine whether or not the rhythm is shockable
The Most common conditions that result in cardiac arrest are shockable rhythms:
Ventricular fibrillation
Ventricular Tachycardia
Ventricular Fibrillation
the heart’s electrical impulses are disorganized, preventing the heart muscle from contracting normally, 50% of all cardiac arrest victims
Ventricular Tachycardia
heartbeat is quite rapid and if rapid enough, it will not allow the hearts chambers to fill with enough blood between beats to produce blood flow sufficient to meet body’s needs
pulseless electrical Activity (PEA)
the hearts electrical rhythm remains normal, yet the mechanical pumping activity fails to follow the electrical activity causing the cardiac arrest 15-20% of victims NOT A SHOCKABLE rhythm.
Asystole
condition in which the heart has ceased generating electrical impulses (flatline)n 20-50% cardiac arrest victims. NOT a shockable rhythm.
Transport as soon as 1 of the following occurs:
- You have administered 3 shocks
- You have received 3 consecutive NSI messages (separated by 2min of CPR)
- The patient regains a pulse
In infants where do you apply the pads
In the back and front of chest
apnea
no breathing
agonal breathing
irregular, gasping breaths, that precede apnea and death.
If the ALS team arrives before you have finished the first shock
they should allow you to complete the shock and then have 2 mins before they can analyze again
How often do you check the pulse of a patient whom’s recovered a pulse from shock?
every 30 seconds
contraindications for AED’s
- If the pads are touching each other on the patient
- If patient has serious traumatic injury
- Do not defibrillate a soaking wet person
- Do not defib if touching anything metallic
- If you see a nitro patch
- make sure you are clear
implants for heart
cardiac pacemaker
implanted defibrillator
ventricular assist device (VAD)
Cardiac bypass surgery
contradiction for VAD
do not perform CPR on a patient with Ventricular assist Device unless directed to so by medical direction. Doing so will cause increased cardiac output and may harm the patient and damage the vessels when crushed.
Ventricular Assist Device (VAD)
when one or both ventricles of the heart are very weak and the device pumps blood for the heart. mostly on Left side
2 Mechanical CPR devices
LUCAS and Auto-Pulse
3 things to be met before resuscitation is terminated
- The arres was not witnessed by EMS
- There are no return of circulation (pulse) after 3 rounds of CPR and rhythm is checked
- The AED did not detect shockable rhythm
what % of patients with severe heart problems have not chest discomfort at all?
10-20%
