Download Cardiac Emergencies - INHS Health Training

Cardiac Emergencies
Jim Bennett
Paramedic and Clinical
Education Coordinator
American Medical Response
Spokane, Washington
The Heart
-------Aorta
Pulmonary Veins---Superior Vena Cava------
----Pulmonary
Arteries
------Left Atrium
Right Atrium-----------Left ventricle
Right Ventricle---------Inferior Vena Cava--
Cardiac Conductive System
Heart is more than a muscle
 Specialized contractile and
conductive tissue in the
heart
 Electrical impulses

The Conduction System
(The electrical path)
Sinoatrial
(SA) node -----------------Atrioventricular (AV) node
Ventricular conduction system--
Arteries

Function – carry blood away
from the heart to the rest of the
body
Major Arteries
----Carotid
-----Brachial
Femoral----------
-----Radial
--------Dorsalis pedis
Arterioles, Capillaries,
Venules, and Veins

Arterioles – Smallest branch of an artery
leading to capillaries.


Capillaries – Connection to venules.
Venules – Smallest branch of a vein
leading to the capillaries.


Veins – Carry blood back to the heart.
Venae Cavae – Carries oxygen-poor
blood.
Blood Composition

Red blood cells



Give the blood its color
Carry oxygen to organs
Carry carbon dioxide away from organs
Blood composition continued…



White blood cells – part of the
body’s defense against infections
Plasma – fluid that carries the
blood cells and nutrients
Platelets – essential for the
formation of blood clots
Physiology

Pulse




Left ventricle contracts sending a wave of
blood through the arteries
Can be palpated anywhere an artery
simultaneously passes near the skin surface
and over a bone.
Peripheral
 Radial
 Brachial
 Posterior tibial
 Dorsalis pedis
Central
 Carotid
 Femoral
Physiology continued…
o
Blood Pressure
Systolic - the pressure exerted
against the walls of the artery
when the left ventricle contracts
o Diastolic – the pressure exerted
against the walls of the artery
when the left ventricle is at rest
o
Cardiovascular disorders
Coronary artery disease
 Aneurysm
 Electrical malfunctions
 Mechanical malfunctions
 Angina pectoris
 Acute myocardial infarction
 Congestive heart failure

Inadequate circulation

Shock (hypoperfusion) – a state
of profound depression of the
vital processes of the body.
Inadequate circulation

Characterized by signs and
symptoms such as:







Pale, cyanotic
Cool, clammy skin
Rapid, weak pulse
Rapid and shallow breathing
Restlessness, anxiety or mental dullness
Nausea and vomiting
Low or decreasing blood pressure
Cardiac Compromise

May include one or all of the
following:





Squeezing, dull pressure, chest pain
commonly radiating down the arms or
to the jaw
Sudden onset of sweating
Difficulty breathing
Anxiety, irritability
Feeling of impending doom
Cardiac compromise
continued…
 Abnormal
pulse rate (may be
irregular)
 Abnormal blood pressure
 Epigastric pain
 Nausea/vomiting
Causes of cardiac compromise




Coronary Artery Disease-narrowing
or blocked coronary arteries
Aneurysm-weakened sections in the
arterial walls
Electrical malfunctions-an irregular,
or absent, heart rhythm
Mechanical malfunctions-mechanical
pump failure
Causes continued…




Angina Pectoris- a pain in the chest
Acute myocardial infarction- heart
muscle that dies due to oxygen
starvation
Congestive heart failure-excessive
fluid build-up
Hypertensive Crisis- High blood
pressure
Emergency Care
Case Study
You respond to a complaint of chest pain.
As you enter the apartment, your partner
rolls her eyes. The patient is an obese 37
yo/fe. She is breathing rapidly and crying,
and you note a cast on her right lower leg.
You find: BP-108/68mmHg, P-124/min, 02
sats-92%, breath sounds show clear
bilaterally. She rates her chest pain at
8/10 radiating down her left arm.
What type of equipment
needs to be taken to the side
of every cardiac patient?
Equipment should include…
Oxygen
 Oxygen adjuncts
 Suction equipment
 Equipment to assess vital signs
 Defibrillator

What are the treatment
priorities ?
Treatment Priorities
ABC’s
 Oxygen
 Vital signs
 Nitroglycerin
 Rapid Transport

What assessment
information do you need to
obtain next ?
Assessment
Onset
 Provocation
 Quality
 Radiation
 Severity
 Time

Assessment continued…
Signs and symptoms
 Allergies
 Medications
 Past medical history
 Last meal
 Events leading up to the illiness

Medication
oNitroglycerin
Medication Name

Generic Name

Nitroglycerin

Trade Name


Nitrostat ™
Nitrolingual ®
Spray
Acute Coronary Syndromes
(Chest Pain)

Primary ABCD Survey
Body Substance Isolation
procedure
 Assess responsiveness
 Open airway
 Assesses pulse
 Attaches monitor

Acute Coronary Syndromes
(Chest pain) continued…

Secondary Survey
Obtains vital signs
 Places Patient on 02 at appropriate
rate
 Initiates IV line
 Performs targeted history, OPQRST,
SAMPLE

Acute Coronary Syndromes
(Chest Pain) continued...

Treatment
Administers 325mg Aspirin
 Administers Nitro 0.4mg SL then Q
5 minutes X2, (if B/P > 100 Systolic &

pain not relieved)

Know contraindications
 Hypotension
 Suspected
increased intracranial
pressure
 Viagra or Levitra within past 24 hours
& Cialis within past 96 hours
Test Questions
1. The blood vessels include arteries, capillaries, and
A.
Veins
B.
SA node
C.
AV node
D.
Ventricles
2. Cardiac compromise refers to:
A.
The heart’s ability to function properly
during a respiratory emergency.
B.
Any kind of problem with the heart.
C.
The right atrium’s receiving blood from
the body’s veins.
D.
The left ventricle’s receiving blood from
the pulmonary veins.
3. What is the maximum number of (0.04 sublingual
nitroglycerin) doses that can be given to a patient with
chest pain that has stable vital signs?
A.
There is no maximum (as long as vitals
are stable)
B.
2 doses
C.
4 doses
D.
3 doses
4. Whenever you are managing a patient with chest
pain, you should:
A.
Attach electrode pads to the patient
B.
Treat the situation as a cardiac emergency
C.
Analyze the patient’s heart rhythm
D.
Give the patient nitroglycerin
5. Cardiac compromise may include all of the
following signs or symptoms EXCEPT:
A.
Difficulty breathing
B.
Warm, dry skin
C.
Nausea or vomiting
D.
Epigastric pain
6. An important consideration of managing any
patient with chest pain is that he or she may:
A.
Deteriorate into cardiac arrest.
B.
Need automated external defibrillation.
C.
Require positive pressure ventilation.
D.
Need oxygen administration and chest
compressions.
7. Before administering a second dose of nitroglycerin to a
patient, you must:
A.
Perform CPR for 1 minute.
B.
Request authorization from medical
control.
C.
Provide supplemental oxygen via nasal
cannula.
D.
Check the patient’s pupils for excess
dilation.
8. Fluid buildup in the lungs caused by inadequate
pumping of the heart is known as:
A.
Pulmonary edema
B.
Angina pectoris
C.
Arrhythmia
D.
Thrombus
9. A malfunction of the heart’s electrical system will
generally result in an:
A.
Embolism
B.
Occlusion
C.
Aneurysm
D.
Arrhythmia
10.
The pulmonary valve prevents blood from
returning to the:
A.
Right atrium
B.
Right ventricle
C.
Left ventricle
D.
Left Atrium
Wrapping it up…
Questions or Comments
Renee Anderson
[email protected]
509-232-8155
Fax: 509-232-8344