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Chapter 12
Cardiovascular
Emergencies
12: Cardiovascular Emergencies
Objectives (1 of 6)
• Describe the structure and function of the
heart.
• Describe the care for patients experiencing
chest pain.
• Identify the indications for using an AED.
• Define the role of the EMT-B in the
emergency cardiac care system.
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12: Cardiovascular Emergencies
Objectives (2 of 6)
• Discuss the position of comfort for patients
with cardiac compromise.
• Establish the relationship between airway
management and cardiac compromise.
• Discuss fundamentals of early
defibrillation.
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12: Cardiovascular Emergencies
Objectives (3 of 6)
• Explain importance of ACLS intervention.
• Discuss various types of AEDs.
• State the need for assuring no pulse prior
to attaching an AED.
• Discuss circumstances resulting in
inappropriate shocks.
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12: Cardiovascular Emergencies
Objectives (4 of 6)
• Discuss advantages and disadvantages of
AEDs.
• List the steps for using an AED.
• Differentiate between single- and multirescuer care with an AED.
• Explain why pulses are not checked
between shocks when using an AED.
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12: Cardiovascular Emergencies
Objectives (5 of 6)
• Discuss the importance of postresuscitation care.
• Discuss the importance of completing the
AED checklist.
• Discuss the role AHA plays in the use of
AEDs.
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12: Cardiovascular Emergencies
Objectives (6 of 6)
• List the indications for the use of
nitroglycerin.
• State contraindications and side effects for
the use of nitroglycerin.
• Define the functions of all controls on an
AED.
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12: Cardiovascular Emergencies
Blood Flow Through the Heart
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12: Cardiovascular Emergencies
Electrical System of the Heart
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12: Cardiovascular Emergencies
Coronary Arteries
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12: Cardiovascular Emergencies
Cardiac Compromise
• Chest pain results from ischemia
• Ischemic heart disease involves
decreased blood flow to the heart.
• If blood flow is not restored, the
tissue dies.
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12: Cardiovascular Emergencies
Atherosclerosis
• Materials build up
inside blood vessels.
• This decreases or
obstructs blood flow.
• Risk factors place a
person at risk.
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12: Cardiovascular Emergencies
Angina Pectoris
• Pain in chest that occurs when the heart
does not receive enough oxygen
• Typically crushing or squeezing pain
• Rarely lasts longer than 15 minutes
• Can be difficult to differentiate from heart
attack
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12: Cardiovascular Emergencies
Acute Myocardial Infarction
(AMI)
• Pain signals death of
cells.
• Opening the coronary
artery within the first
hour can prevent
damage.
• Immediate transport is
essential.
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12: Cardiovascular Emergencies
Pain of AMI
• May or may not be caused by exertion
• Does not resolve in a few minutes
• Can last from 30 minutes to several hours
• May not be relieved by rest or nitroglycerin
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12: Cardiovascular Emergencies
Sudden Death
• 40% of AMI patients do not reach the
hospital.
• Heart may be twitching.
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12: Cardiovascular Emergencies
Arrhythmias
Bradycardia
Ventricular Tachycardia
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12: Cardiovascular Emergencies
Cardiogenic Shock
• Heart lacks power to force blood through
the circulatory system.
• Onset may be immediate or not apparent
for 24 hours after AMI.
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12: Cardiovascular Emergencies
Congestive Heart Failure
• CHF occurs when ventricles are
damaged.
• Heart tries to compensate.
• Increased heart rate
• Enlarged left ventricle
• Fluid backs up into lungs or body
as heart fails to pump.
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12: Cardiovascular Emergencies
Signs and Symptoms of AMI
• Sudden onset of weakness,
nausea, and sweating
• Chest pain or discomfort
• Pain in lower jaw, arms, or back
• Sudden fainting
• Pulmonary edema
• Sudden death
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12: Cardiovascular Emergencies
Physical Findings of
Cardiac Compromise (1 of 2)
• Pulse rate increases.
• Blood pressure may be normal or
falling.
• Respirations are usually normal.
• General appearance
• Frightened
• Nausea, vomiting, cold sweat
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12: Cardiovascular Emergencies
Physical Findings of
Cardiac Compromise (2 of 2)
• Ashen gray skin
• Swollen neck veins with
acute CHF
• Feeling of impending
doom
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12: Cardiovascular Emergencies
Approach to the Patient with
Chest Pain (1 of 2)
• Reassure the patient and
perform initial assessment.
• Administer oxygen.
• Measure and record vital
signs.
• Place the patient in a
position of comfort.
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12: Cardiovascular Emergencies
Approach to the Patient with
Chest Pain (2 of 2)
• Obtain focused history and
physical exam.
• Ask about the chest pain
using OPQRST.
• Assist with administration
of prescribed nitroglycerin.
• Transport promptly.
• Report to medical control
en route.
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12: Cardiovascular Emergencies
Nitroglycerin
• Forms
• Pill, spray, skin patch
• Effects
• Relaxes blood vessel
walls
• Dilates coronary
arteries
• Reduces workload of
heart
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12: Cardiovascular Emergencies
Nitroglycerin Contraindications
• Systolic blood pressure of less
than 100 mm Hg
• Head injury
• Patient age less than 15 years
• Maximum dose taken in past
hour
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12: Cardiovascular Emergencies
Assisting with Nitroglycerin (1 of 2)
• Obtain order from medical direction.
• Take patient’s blood pressure.
• Check that you have right medication,
patient, and delivery route.
• Check expiration date.
• Find out last dose taken and effects.
• Be prepared to lay the patient down.
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12: Cardiovascular Emergencies
Assisting with Nitroglycerin (2 of 2)
• Administer tablet or spray under tongue.
• Have patient keep mouth closed until
tablet dissolves or is absorbed.
• Recheck blood pressure.
• Record each activity and time of
application.
• Perform reassessment.
• May repeat dose in 3 to 5 minutes.
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12: Cardiovascular Emergencies
Heart Operations
• Coronary
artery bypass
graft (CABG)
• Angioplasty
• Cardiac
pacemaker
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12: Cardiovascular Emergencies
Automatic Implantable
Cardiac Defibrillators (1 of 2)
• Maintains a
regular heart
rhythm and rate
• Do not place
AED patches
over pacemaker.
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12: Cardiovascular Emergencies
Automatic Implantable
Cardiac Defibrillators (2 of 2)
• Monitor heart
rhythm and deliver
shocks as needed.
• Low electricity will
not affect rescuers.
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12: Cardiovascular Emergencies
Automated External
Defibrillation (AED)
• AEDs come in two forms:
• Automated
• Semiautomated
• A specialized computer
recognizes heart rhythms
that require defibrillation.
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12: Cardiovascular Emergencies
AED Use Problems
• Battery is dead.
• Patient is moving.
• Patient is responsive
and has a rapid pulse.
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12: Cardiovascular Emergencies
AED Advantages
• ALS providers do not need to
be on scene.
• Remote, adhesive defibrillator
pads are used.
• Efficient transmission of
electricity
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12: Cardiovascular Emergencies
Non-Shockable Rhythms
• Asystole
• Pulseless electrical activity
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12: Cardiovascular Emergencies
Rationale for Early Defibrillation
• Early defibrillation is the third
link in the chain of survival.
• A patient in ventricular
fibrillation needs to be
defibrillated within 2 minutes.
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12: Cardiovascular Emergencies
Using an AED (1 of 3)
• Assess responsiveness,
pulse, and breathing.
• Deliver breaths and
begin CPR.
• Turn on AED.
• Apply pads.
• Stop CPR.
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12: Cardiovascular Emergencies
Using an AED (2 of 3)
• Clear patient.
• Analyze rhythm.
• If no shock advised,
continue CPR.
• If shock advised,
deliver up to three
shocks.
• Check pulse and
breathing after
shocks delivered.
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12: Cardiovascular Emergencies
Using an AED (3 of 3)
• If patient begins breathing, give
oxygen, and transport.
• If patient is not breathing, ventilate
and transport.
• If there is no pulse, continue CPR for
1 minute.
• Re-analyze.
• Deliver three more shocks if needed.
• Transport and call medical control.
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12: Cardiovascular Emergencies
After AED Shocks
•
•
•
•
Check pulse.
No pulse, no shock advised
No pulse, shock advised
If a patient is breathing independently:
• Administer oxygen.
• Check pulse.
• If a patient has a pulse but breathing
is inadequate, assist ventilations.
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12: Cardiovascular Emergencies
Transport Considerations
• Keep AED attached.
• Check pulse frequently.
• Transport:
• When patient regains pulse
• After delivering six shocks
• After receiving three consecutive
“no shock advised” messages
• Stop ambulance to use an AED.
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12: Cardiovascular Emergencies
Cardiac Arrest During Transport
(1 of 2)
• Check unconscious patient’s pulse
every 30 seconds.
• If pulse is not present:
• Stop the vehicle.
• Perform CPR until AED is available.
• Analyze rhythm.
• Deliver shock(s).
• Continue resuscitation according to
local protocol.
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12: Cardiovascular Emergencies
Cardiac Arrest During Transport
(2 of 2)
• If patient becomes unconscious during
transport:
• Check pulse.
• Stop the vehicle.
• Perform CPR until AED is available.
• Analyze rhythm.
• Deliver up to three shocks.
• Continue resuscitation according to
local protocol.
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12: Cardiovascular Emergencies
Safety Considerations
• Make sure the electricity injures no
one.
• Do not defibrillate a patient lying in
pooled water.
• Dry a soaking wet patient’s chest first.
• Do not defibrillate someone who is
touching metal that others are also
touching.
• Remove nitroglycerin patches.
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12: Cardiovascular Emergencies
AED Maintenance
• Read operator’s manual.
• Check AED and battery at
beginning of each shift.
• Get a checklist from the
manufacturer.
• Report any failures to the
manufacturer and the FDA..
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12: Cardiovascular Emergencies
Medical Direction
• Should approve protocols
• Should review AED usage
• Should review speed of
defibrillation
• Should provide review of
skills every 3 to 6 months
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12: Cardiovascular Emergencies
Cardiovascular System Changes
with Age
•
•
•
•
Decreased pumping of heart
Electrical system changes
Atherosclerosis
Decreased peripheral
circulation (diabetes)
• AMI without pain
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