Download Emergency Medical Responder

8/21/2016
Emergency Medical Responder
First on Scene
TENTH EDITION
CHAPTER
14
Caring for Cardiac
Emergencies
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Objectives
1. Review cardiovascular anatomy and
physiology.
2. Define the following terms:
a.
b.
c.
d.
e.
Angina
Cardiac compromise
Conduction pathway
Heart failure
Myocardial infarction
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Objectives
3. Describe the normal flow of blood
through the heart.
4. Explain common causes of cardiac
compromise.
5. Describe the signs and symptoms of a
patient experiencing cardiac
compromise.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
1
8/21/2016
Objectives
6. Differentiate and explain the
pathophysiology of angina, myocardial
infarction, and heart failure.
7. Explain the appropriate assessment
and care for a patient experiencing
cardiac compromise.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Objectives
8. Demonstrate the ability to
appropriately assess and care for a
patient experiencing cardiac
compromise.
9. Value the importance of caring for all
patients with chest pain as though it
were cardiac compromise.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Media Directory
Slide 18
Slide 21
Slide 30
Heart Attack Video
Angina Video
Congestive Heart Failure Video
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
2
8/21/2016
Topics
Normal Heart Function
Cardiac Compromise
Emergency Care for Cardiac Compromise
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
NORMAL HEART FUNCTION
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Normal Heart Function
• The heart beats 100,000 times per day.
 6,000 to 7,500 liters of blood circulates
through the body each day.
• The heart muscle receives its blood
supply from the coronary arteries.
 Blockage in an artery results in
decreased blood flow to the heart.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
3
8/21/2016
Figure 14.3
The coronary arteries supply blood to the heart muscle (myocardium).
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Normal Heart Function
• Cardiac cycle
 Blood flows from the body, into the right
atrium, down into the right ventricle and
then into the lungs.
 Blood exits the lungs and enters the left
atrium then flows into the left ventricle.
 Once the blood exits the left ventricle, it
flows out to the body and the cycle
begins again.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.1
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Major anatomy of the heart including blood flow through the chambers.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
4
8/21/2016
Normal Heart Function
• The conduction pathway is the core of
the electrical system that keeps the
heart beating and the cardiac cycle
going.
• Damage to the conduction pathway can
lead to an abnormal heart rhythm and
is a common cause of poor circulation
and perfusion.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.2
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
The heart’s conduction pathway, highlighted in green.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Think About It
• The heart is a muscle with a big job to
do.
• Problems can arise that affect the heart
tissue and/or the electrical system.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
5
8/21/2016
CARDIAC COMPROMISE
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Cardiac Compromise
• Cardiac Compromise Symptoms








Chest discomfort
Diaphoresis
Dyspnea
Nausea/vomiting
Anxiety/irritability
Abnormal pulse
Abnormal blood pressure
Feeling of impending doom
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Heart Attack Video
Click on the screenshot to view a video on the topic of heart attacks.
Back to Directory
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
6
8/21/2016
Angina Pectoris
• Angina pectoris (angina) is pain in the
chest.
• Decreased oxygenated blood supply in
the coronary arteries leads to an
increased oxygenated blood demand in
the heart muscle.
 Exertion
 Partial blockage
 Spasm
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Angina Pectoris
• Signs and symptoms of angina are
nearly identical to a heart attack.
• No actual damage to the heart muscle
• Patients with angina history typically
carry nitro.
• Treatment for angina and myocardial
infarction (heart attack) is the same.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Angina Video
Click on the screenshot to view a video on the topic of angina.
Back to Directory
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
7
8/21/2016
Myocardial Infarction
• Myocardial infarction (MI)
 Myo, muscle
 Cardial, heart
 Infarction, tissue death
• Blockage or narrowing of the coronary
arteries leads to a permanent decrease
in oxygenated blood supply.
• Without oxygenated blood, the tissue of
the heart begins to die.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Myocardial Infarction
• Typical signs and symptoms
 Pain, pressure, tightness, or heaviness
to the chest/upper abdomen
 Pain or discomfort behind the sternum
 Pain radiating to the shoulders or arms
 Pain to the back, neck, jaw or upper
abdomen
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Myocardial Infarction
• Atypical signs and symptoms
 "Flu-like" signs and symptoms such as
nausea and vomiting
 Indigestion
 Feeling of general weakness
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
8
8/21/2016
Myocardial Infarction
• Large amounts of tissue death or
damage over an important electrical
pathway may lead to cardiac arrest.
• Patients in cardiac arrest are
unresponsive, not breathing, and have
no pulse.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Figure 14.4 Both myocardial infarction and angina can present with symptoms of chest pain. Treat all cases of
chest pain as a true cardiac emergency.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Heart Failure
• Congestive heart failure (CHF)
 Weakened heart muscle is unable to
pump blood efficiently and manage
normal blood volume.
• Chronic due to cardiac diseases
• Sudden after a myocardial infarction
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
9
8/21/2016
Heart Failure
• Congestive heart failure (CHF)
 Fluid backs up within the circulatory
system.
• Lungs
• Lower extremities
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Heart Failure
• Signs and Symptoms of Heart Failure







Shortness of breath
Chest pain/discomfort
Rapid pulse rate
Pedal edema (swollen ankles)
Jugular Vein Distention (JVD)
Pale, moist skin
Altered mental status
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Congestive Heart Failure Video
Click on the screenshot to view a video on the topic of CHF.
Back to Directory
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
10
8/21/2016
Figure 14.5a
Signs of heart failure include bulging neck veins.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.5b
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Signs of heart failure include swollen ankles (pedal edema).
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Think About It
• Cardiac compromise is a life
threatening condition.
• Why is it important to rapidly identify
cardiac compromise?
• Describe the difference between angina
and MI.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
11
8/21/2016
EMERGENCY CARE FOR
CARDIAC COMPROMISE
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Care for Cardiac
Compromise
• Emergency Care
 Take appropriate Standard Precautions.
 Perform a primary assessment and
support the ABCs as necessary.
 If allowed, provide oxygen per local
protocols.
• SpO2 should read between 95–100%.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Care for Cardiac
Compromise
• Emergency Care
 Determine chief complaint.
•
•
•
•
•
•
Onset
Provocation
Quality
Region and radiate
Severity
Time
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
12
8/21/2016
Figure 14.6
Algorithm for the emergency care of a patient with signs and symptoms of cardiac compromise.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Care for Cardiac
Compromise
• Emergency Care
 Provide emotional support and reassure
the patient.
 Allow the patient to maintain a position
of comfort, usually sitting up.
 Obtain vital signs.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.7
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Algorithm for assessment of patients with chest pain.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
13
8/21/2016
Emergency Care for Cardiac
Compromise
• Emergency Care
 Assist the patient with the prescribed
dose of nitroglycerin, if your protocols
permit. Consult medical direction.
 Continue to monitor vital signs.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Care for Cardiac
Compromise
• Medications
 Nitroglycerin
• Tablets, spray, paste
• Prescribed for angina or previous MI
• Dilates blood vessels
• Decreases blood pressure and reduces
cardiac workload
• Dizziness and feeling lightheaded are
common side effects.
• Assist patient according to protocols.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Nitroglycerin Medication Form – Tablet
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
14
8/21/2016
Nitroglycerin Medication Form – Sublingual Spray
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Care for Cardiac
Compromise
• Medications
 Aspirin
Analgesic
Clot inhibitor
Prescribed daily for angina
Beneficial for patients exhibiting signs
and symptoms of an MI
• Assist patient according to protocol.
•
•
•
•
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Think About It
• What does "Time is Muscle" mean?
• Performing a thorough assessment and
appropriate treatment can contribute to
how well the patient recovers from
cardiac compromise.
• Emergency Medical Responders make a
difference.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
15
8/21/2016
SUMMARY
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Summary
• A healthy heart is the core of the
cardiovascular system.
• Blood flows through the heart in a
precise way.
• Electrical impulses flow along the
conduction pathway.
• There are key signs and symptoms of
cardiac compromise.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Summary
• Angina results from a diminished
supply of oxygenated blood to the
heart.
• Myocardial infarction occurs when a
portion of the heart dies due to
inadequate blood supply.
• Congestive Heart failure (CHF) is
caused by a weakened heart that can
no longer pump blood efficiently.
continued on next slide
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
16
8/21/2016
Summary
• Care for cardiac compromise includes:





The ABCs
Supplemental oxygen
Obtaining a thorough medical history
Keeping the patient at rest
Monitoring vital signs
• Initiate ALS transport if available.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
REVIEW QUESTIONS
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Review Questions
1. Describe the normal flow of blood
through the heart.
2. What are some vague symptoms of MI
that may be seen in women or the
elderly?
3. What is the appropriate assessment
and care for a patient experiencing
cardiac compromise?
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
17
8/21/2016
Please visit
www.bradybooks.com
and follow the Resource Central
links to access content for this
text.
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
18