ECare - Chapter 18 (Cardiac Emergencies) Flashcards
acute coronary syndrome (ACS) aka cardiac compromise
blanket term for symptoms relating to lack of oxygen (ischemia) in the heart muscle
symptom: chest pain/pressure (crushing, dull, heavy, squeezing)
most likely: heart problem
pain of heart problems usually radiate down the…
arms, upper abdomen, or jawn
common presentation of heart problems
chest pain/pressure with dyspnea and history of heart problems
symptoms of ACS
- chest pain/pressure
- epigastric pain/pressure
- difficulty breathing
- palpitations
- sweat, nausea, or vomit
- a anxiety
- irregular pulse or BP
dyspnea
shortness of breath; labored/difficult breathing
Providing care for someone with suspected ACS
- place patient in comfortable position
- give oxygen until levels are at 94% if necessary
- transport asap if no heart history, has history but no nitro, or systolic BP is less than 90-100
- If equipped, use ECG to check for STEMI
- give nitro if meet criteria; give second if needed
- give aspirin if criteria met
when to give nitro to patient with cardiac problems
- chest pain
- history of cardiac problems
- has prescription from doc
- has nitro with patient
- systole BP is above 90-100
- no ED drugs
- medical direction gives thumbs up
give repeat in 5 minutes if no relief, systolic BP is still above 90-100, and medical direction gives thumbs up
when to give aspirin to patient with cardiac problem
- chest pain
- no allergies to aspirin
- no history of asthma
- not taking clot-preventing meds
- no contraindications
- can swallow
- medical direction gives thumbs up
coronary artery disease
diseases affecting the arteries of the heart
heart muscle receives oxygen from
blood pumping through coronary arteries
two common sites of an aneurysm
aorta and brain
consequence of artery rupture from an aneurysm
shock
myocardial infarction
mechanism pump failure
electrical malfunctions of the heart
dysrhythmia
angina pectoris
chest pain due to lack of blood supply to the heart; pain usually goes away after stopping exertion
acute myocardial infarction
portion of myocardium dies due to lack of oxygen
medications for patients with AMI
fibronolytics (dissolve clot), aspirin (preventative measure), beta blocker (slows heart and beats less)
congestive heart failure
failure of heart to pump efficiently, leading to excessive blood/fluids in the lungs and/or body
edema
swelling from fluid build up
progression of congestive heart failure
- AMI; myocardium in left ventricle dies
- blood backs up to pulmonary circulation and then the lungs (SOB or dyspnea occurs)
- left failure failure and eventually right heart failure
pulmonary edema
accumulation of fluid in the lungs
symptoms of CHF
tachycardia dyspnea normal/high BP cyanosis diaphoresis pulmonary edema anxiety/confusion due to hypoxia pedal edema engorged pulsating neck veins enlarged liver/spleen
chain of survival for cardiac arrest paitents
- immediate recognition and activation
- early CPR
- rapid defibrillation
- effective advance life support
- integrated post-cardiac arrest care
when is CPR not useful?
if defibrillation arrives within 2 minutes
intervention to reduce brain damage in resuscitated patients
controlled hypothermia
ventricular fibillation
heart’s electrical impulses are disorganizes; heart muscle can’t contract normally
ventricular tachycardia
heartbeat is very fast, if fast enough it wont allow heart’s chambers to fill with enough blood between beats to produce sufficient blood flow
pulseless electrical activity
heart’s electrical rhythm remains normal, but mechanical pumping activity fails to follow electrical activity; causing cardiac arrest
asystole
heart has ceased generating electrical impulses (flatline)
when to use ABC vs. CAB
ABC: signs of life
CAB: cardiac arrest
contradictions of using a defibrillator
cardiac arrest due to trauma
patient has an LVAD
will not have pulse, rely on consciousness and breathing of patient. do not do CPR
when to stop resuscitation efforts
- spontaneous circulation occurs (with or without breathing)
- trained rescuer takes over
- turn care of patient to higher level
- too tired
- no resuscitation order from physician
termination criteria: arrest not witnessed, no pulse after 3 rounds of CPR, AED did not detect rhythm to shock
