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Cardiovascular Emergencies CHAPTER 17 Review Circulatory System ◦ Three major components Conduction System ◦ Specialized cells ◦ Three pacemaker sites ◦ Sympathetic nervous system Heart ◦ Right Ventricular Failure ◦ Usually caused by COPD ◦ Left Ventricular Failure ◦ High Blood Pressure or damage The Vessels The Blood ◦ Formed elements Thrombus Platelets Thrombin Fibrin Electrocardiogram Graphic representation of the heart’s electrical activity Human body acts as a conductor If conduction is damaged or disturbed causes PVC’s ◦ Too many PVC’s can result in V-Tach Depolarization Repolarization P wave QRS complex T wave Blood Pressure Amount of pressure exerted on the arterial wall during circulation ◦ Systolic ◦ Diastolic Inadequate Circulation PerfusionHypoperfusion ◦ What are the causes? Cardiac Compromise & ACS AHA reports 7-8 million seek treatment for chest discomfort 2 million will actually have a cardiac related event 1.5 million will have MI 500,000 will die from MI 250,000 will die within 1 hour of onset of signs & symptoms Cardiac Compromise & ACS Key treatment ◦ Early recognition Time is critical-time is muscle Death of muscle is permanent Atherosclerosis •Smallest arterial structures to become stiff & less elastic •Inflammatory disease •Starts at innermost lining of vessels •Common Risks Smoking Diabetes Hypertension High LDL’s Low HDL’s Acute Coronary Syndrome Unstable Angina ◦ Discomfort that is prolonged or worsening, or occurs without exertion Myocardial Infarction ◦ Muscle death Angina Pectoris PATHOPHYSIOLOGY SIGNS/SYMPTOMS Inadequate O2 supply to heart muscle Steady discomfort Cool, clammy skin Lack of O2 causes the discomfort Anxiety Dyspnea Usually occurs during time of stress Usually will go away within 2-15 minutes Diaphoresis Nausea &/or vomiting Indigestion Assessment Women, elderly & diabetics may not experience these symptoms Pain usually goes away with Nitro If pain does not go away then question MI Treatment Maintain airway O2 NRB @ 15 L Assist with Nitro with medical direction permission Administer ASA 160-325 mg per protocol Acute MI PATHOPHYSIOLOGY SIGNS & SYMPTOMS Causes severe narrowing or complete blockage to coronary arteries Chest discomfort After 20-30 minutes without O2, cells begin to die Anxiety Ischemic heart tissue will become irritable Goal-reestablish blood flow ◦ Catheterization ◦ medications Symptoms last longer Nitro does not relieve Dyspnea Sense of impending doom Diaphoresis Nausea &/or vomiting Light-headed/dizzy Weakness Feel like need to have BM Assessment Diabetics, elderly, & women usually do not experience these symptoms Reassessing constantly due to risk for cardiac arrest Never leave alone AED must be close Airway O2 Position of comfort Assist with Nitro per medical control 160-325 mg ASA per protocol ACS in Female patients “CLASSICAL” FINDINGS “ATYPICAL” FINDINGS Dull substernal chest pain Neck ache Pressure in the chest Respiratory distress Nausea, vomiting Pains in the back, breast, or upper abdomen Tingling in fingers Unexplained fatigue or weight gain Diaphoresis Insomnia Aortic Aneurysm or Dissection Pain may be confused with MI Aortic Aneurysm ◦ Weakened wall of vessel ◦ Occur most often in abdominal region ◦ Aorta usually not felt, but will feel pulsating mass when in final stage Aortic Dissection ◦ ◦ ◦ ◦ ◦ ◦ ◦ Tear in lining Occur in thorax Pain described as sharp or tearing Syncope may be only sign Sometimes can mimic stroke or MI Systolic BP difference of 20 mmHg between upper arms Severe pulse amplitude difference from upper & lower extremities Aortic Aneurysm or Dissection Treatment O2 Do not administer ASA Rapid transport Heart Failure Inability for heart to blood out of ventricle ◦Causes ◦Heart damage ◦Valve disorder ◦Hypertension ◦Pulmonary edema ◦Cardiac rhythm disturbance ◦Certain drugs Need figure 17-12 Heart Failure LEFT SIDE RIGHT SIDE Left ventricle unable to pump effectively Blood backs up venous system Reduces blood flow to the body Creates a traffic jam Can lead to pulmonary edema Causes ◦ Hypertension ◦ COPD Cardiogenic Shock Can occur in either right or left failure Fail to pump enough blood to meet body needs Common cause MI ◦ ◦ ◦ ◦ Sustained hypertension Valve damage Extremes in heart rate Other cardiac muscle diseases What’s the difference? LEFT FAILURE RIGHT FAILURE Cardiac output drops Hypoxia Drop in systolic BP Diminished or absent peripheral pulses Respiratory distress Altered mental status Jugular vein distention Changes in heart rate Peripheral edema Poor urinary output Respiratory distress Inspiratory crackles (rales) Possible pulmonary edema Congestive heart Failure Buildup of fluid Commonly leads to pulmonary & perpheral edema Fluid accumulates in liver causing it to enlarge May also collect in abdomen Treatment These patients will commonly tell you “I’m on a water pill” Airway Oxygen Nitroglycerin for chest discomfort per protocol Continually assess Hypertensive emergencies PATHOPHYSIOLOGY SIGNS AND SYMPTOMS Primary hypertension-most common Strong bounding pulse Skin warm, dry, or moist Severe headache Secondary hypertension-caused by underlying disease process Ringing in the ears Nausea/vomiting Elevated BP Respiratory distress Chest pain Seizures Focal neural deficits Possible nosebleed Indications of organ dysfunction Treatment Airway Oxygen Position of comfort-preferred semi fowlers nitroglycerin Potent vasodilator Works quickly Can be sublingual or a spray Indications ◦ Signs & symptoms of chest pain ◦ Physician prescribed medication (POM) ◦ EMT received approval from medical control Contraindications ◦ ◦ ◦ ◦ ◦ ◦ Baseline SBP <90 mmHg HR less than 50 or greater than 100 Suspected head injury Infant or child 3 doses have been given Patient has taken Cialis, Levitra, or Viagra within last 24 hours Nitro continued Administration ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Complete history Assess baseline vital signs Obtain approval from medical control 6 rights Wear gloves when giving medication Place under the tongue Reassess after 2 minutes Document Dosing ◦ 0.4 mg(SL) or 0.3 mg (spray) every 3-5 minutes X 3 doses ◦ If Nitro is still active-will create tingling sensation under tongue Nitro ACTIONS SIDE EFFECTS Dilates blood vessels Headache Decreases workload of heart Drop in BP Decreases cardiac oxygen demand Change in pulse rate Assessment & care guidelines Scene Size up Primary assessment Secondary assessment ◦ ◦ ◦ ◦ SAMPLE history OPQRST Physical exam/baseline vital signs Signs & symptoms