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Chapter 14
Cardiac and Respiratory
Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Cardiac Emergencies
Respiratory Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Patient assessment
First responder care
Specific cardiac conditions
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Occur from abnormal heart rhythms
Interruption of oxygen to the heart
– Coronary artery disease
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Coronary artery disease
– Blood vessels feeding the heart are narrowed
– Artery continues to narrow, reducing oxygen
supply
– Complete blockage results in a heart attack
– Lack of oxygen causes chest pain
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Patient assessment
– Chest pain or discomfort that may radiate
– Difficulty breathing
– Unusual heart beat
– Sweating
– Feeling of impending doom
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Patient assessment
–
–
–
–
O: Onset
P: Provocation
Q: Quality
R: Region
–
–
–
–
R: Radiation
R: Relief
S: Severity
T: Time
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
First responder care
– Place patient in a position of comfort
– Ensure adequate breathing
– Administer oxygen
– Loosen tight clothing
– Continually monitor the patient
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Angina pectoris
– Acute myocardial infarction
Treatment is the same
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Angina pectoris
Chest pain or discomfort when the heart
does not get enough oxygen
Usually associated with physical exertion
Palpitations
Skin changes
Difficulty breathing
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Angina pectoris
Reversible
Generally relieved with rest
Patient may take nitroglycerin
May result in heart attack if untreated
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Nitroglycerin
Can lower blood pressure
Should not take with systolic blood pressure
< 100 mmHg
Can be taken up to 3 times in 5-minute
intervals
Do not administer without approval of
medical director
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Acute myocardial infarction
Results in death of heart tissue
Four serious consequences
Sudden death
Shock
Congestive heart failure
Cardiac dysrhythmias
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Acute myocardial infarction
Signs and symptoms
Chest pain or discomfort
Skin changes
Difficulty breathing
Abnormal heartbeats
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cardiac Emergencies
Specific cardiac conditions
– Acute myocardial infarction
Aspirin
Dose is 2–4 chewable baby aspirin
Confirm that patient is not allergic
Do not administer if patient is on blood thinners
Only administer if patient is conscious
Only administer with approval of medical director
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory
Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Patient assessment
First Responder care
Specific respiratory conditions
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Patient assessment
– Signs and symptoms
Inability to speak full sentences
Abnormal respirations
Accessory muscle usage
Tripod position
Skin changes
Altered mental status
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
First Responder care
– Ensure adequate breathing
– Apply oxygen
– Place patient in position of comfort
– Comfort and reassure the patient
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– COPD
– Asthma
– Pneumonia
– Acute pulmonary edema
– Hyperventilation
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Chronic obstructive pulmonary disease
(COPD)
Emphysema
Alveoli loose elasticity
Chronic bronchitis
Inflammation, edema, and excessive mucus
Productive cough for 3 months, for 2 consecutive
years
May have a hypoxic drive
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory
conditions
– Chronic obstructive
pulmonary disease
Signs and symptoms
Shortness of breath
Tripod position
Bulging neck veins
Cyanosis
Pursed lip breathing
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Asthma
Attacks vary in duration, intensity, and
frequency
Airway obstruction caused by:
Bronchospasm
Swelling of bronchial walls
Plugging of bronchi by thick mucus
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Asthma
Tripod position
High-pitched wheezing
Minimal air movement
Rapid, shallow respirations
Inability to speak full sentences
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Asthma
Status asthmaticus
Life-threatening, prolonged, asthma attack
Bronchi may be constricted, preventing wheezing
Exhaustion
Pursed lip breathing
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory
conditions
– Asthma
Treatment
Prescribed inhaler
Dilates air
passages
Be sure medication
is indicated and
allowed
As the patient takes a deep breath, activate the
inhaler
Have patient hold his or her breath
Reassess
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Pneumonia
Lung infection with fluid- or pus-filled alveoli
Caused by bacteria, virus, or aspirated
materials
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Pneumonia
Signs and symptoms
Chest pain made worse with breathing
Respiratory distress
Productive cough, possibly discolored
Fever, chills, and hot, dry skin
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Acute pulmonary edema
Caused by damage to the heart or lungs
Fluid builds up in the alveoli
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Acute pulmonary edema
Signs and symptoms
Shortness of breath
Rapid, labored breathing
Pink, frothy sputum
Bulging neck veins
Rapid pulse with cool, clammy skin
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Hyperventilation
Breathing too fast
Usually associated with anxiety
Exhales too much carbon dioxide
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Respiratory Emergencies
Specific respiratory conditions
– Hyperventilation
Signs and symptoms
Carpal pedal spasms
Blurred vision
Chest pain
Syncope
Numbness and tingling
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Regardless of the cause, treat all
patients with chest pain the same
Be prepared for the patient
experiencing chest pain to become
unresponsive
Never withhold oxygen from a patient
complaining of difficulty breathing
Only administer medications with the
prior approval of your medical director
Limmer, First Responder: A Skills Approach, 7th ed.
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ