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Agenda • Sean add whatever you want • Next phase of scenario prep – Final exam – Practical final • Run Reports – Will send out Google doc to fill out • Lecture code – - = MI – - = Angina Angina vs. MI • Causes – MI: complete blockage of the blood supply to the heart muscle – Angina: decrease in blood supply to the heart • Symptoms – MI: chest pain with damage to the heart • • • • • Severe, steady, crushing pain Radiates to the left neck Weak, rapid pulse Hypotension Low grade fever – Angina: best pain with no damage to the heart • Tightness or pressure in the chest • Severity – MI: may cause permanent damage • irreversible damage prevented if blood supply restored within 20 min • Symptoms persist after 15 minutes and not relieved by nitro – Angina: symptoms relieved by rest or nitro within 10-15 minutes Medications • • Administration criteria (DICE) – Drug/Dosage – Integrity/Indications (right patient?) – Clarity/Contraindications – Expiration Date Nitroglycerin – Take BP before administration and 5 minutes after administration • Why? – May cause hypotension due to vasodilation – Indications • Symptoms of chest pain • Systolic BP >100mm/Hg – Contraindications • Patient does not meet indication or criteria for administration Patient has taken 3 doses before EMS arrival within the last 5 minutes Last dose was < 5 minutes ago Systolic blood pressure < 100mm/Hg Administration of Sildenafil citrate (Viagra7) or similar medication within 36 hours Medications • Preparation/administration – Tablet • Remove from container and check if in tact • Place under pt’s tongue • Instruct patient to allow tablet to dissolve, not swallow – Spray • One spray delivers 0.4 mg of nitro sublingually Reassessment • Repeat every 5 minutes – AKA primary assessment – Vital signs – Relevant part of a secondary assessment Things to think about in the field … •Cause •Onset of pain •Location •History •What makes it better or worse? Onset Was it… •Sudden? •Gradual? •Lasts Minutes? •Lasts Hours? •Varies? Quality • Does the chest feel like it is spasming? • Is there a sharp pain when inhaling? • Is there any tightness/heaviness? • Can the pain be pinpointed? • Is the pain not easy to pinpoint? Is there a burning sensation? • Does the pain feel “tearing”? Location • Below the sternum • Center of chest • Lateral chest • Lower part of the chest • Radiates to jaw, neck, back of arm Things to consider about pt Hx • • • • • Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) • Previous diagnosis – HTN, angina Signs/Symptoms? • Shortness of breath (dyspnea – know this term for final) • Diaphoresis • Nauseous • Syncopal episode or weakness What makes it worse? • Breathing • Position of comfort (sitting, laying down, or just moving in general) • Stress/anxiety What makes it better? • Rest/little movement • Position of comfort • Antacids • Medications Angina Onset of Pain • • • • • Sudden Gradual Lasts Minutes Lasts Hours Varies Angina Quality of Pain • • • • • Sharp pain upon inhalation Spasm Tight/heavy Sharp/Burning TEARING / EXCRUCIATING Angina Location • Below the sternum • Center of chest • Lateral chest • Lower part of the chest • Radiates to jaw, neck, back of arm • VAGUE Angina History • • • • • Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) • Previous diagnosis – HTN, angina Angina Signs and Symptoms • Shortness of breath (dyspnea – know this term for final) • Diaphoresis • Nauseous • Syncopal episode or weakness What Makes Angina Worse? • Breathing • Position (sitting, laying down, or just moving in general) • Stress/anxiety What Makes Angina Better? • Rest/little movement • Position of comfort • Antacids • Medications MI Onset • Sudden • Gradual • Lasts Minutes • Lasts Hours • Varies Quality of MI • Does the chest feel like it is spasming? • Is there a sharp pain when inhaling? • Is there any tightness/heaviness? • Can the pain be pinpointed? • Is the pain not easy to pinpoint? Is there a burning sensation? • Does the pain feel “tearing”? MI Location • Below the sternum • Center of chest • Lateral chest • Lower part of the chest • Radiates to jaw, neck, back of arm MI History • • • • • Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) • Previous diagnosis – HTN, angina MI Signs and Symptoms • Shortness of breath (dyspnea – know this term for final) • Diaphoresis • Nauseous • Syncopal episode or weakness What Makes MI Worse? • Breathing • Position (sitting, laying down, or just moving in general) • Stress/anxiety What Makes MI Better? • Rest/little movement • Position of comfort • Antacids • Medications See you next week!! References Carroll, Laurie, RN, and Will Grundy. “Cardiac Differential Diagnosis”. Lecture.
