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Chapter 15
Cardiovascular
Emergencies
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
15.1 List and describe the anatomical
structures of the cardiovascular system.
15.2 Describe the functions of the
cardiovascular system.
15.3 Describe the flow of blood through the
cardiovascular system.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
15.4 Define the following:
a.
b.
c.
d.
e.
acute myocardial infarction
atherosclerosis
cardiovascular disease
coronary artery disease
hypertension
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
15.5 List the signs and symptoms for each of
the following cardiovascular disorders:
a.
b.
c.
d.
e.
f.
acute myocardial infarction
aortic aneurysm
cardiogenic shock
congestive heart failure
pericardial tamponade
pulmonary embolism
15.6 List the arrhythmias associated with
sudden cardiac death.
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
15.7 Describe and demonstrate how to
assess a patient with a cardiovascular
emergency.
15.8 Describe and demonstrate the proper
care of a patient with a cardiovascular
emergency.
15.9 List three common cardiac medications.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
15.10 Describe and demonstrate how to
perform CPR on the following:
a. a child
b. an infant
c. an adult
15.11 Describe and demonstrate the proper
use of an AED.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 Common Causes
 Types of Cardiovascular Emergencies
 Assessment
 Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
You are called to a remote trail location where a 42year-old man complains of chest pain and appears to
be in considerable distress. He was snowshoeing
with his family when he felt sudden stabbing pain in
his chest that radiated down his left arm. He is pale,
sweating, feels nauseous and is weak. He has a
history of heart problems, but never this bad.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Three
major components of the
Cardiovascular System:
◦ The Heart
◦ Blood vessels
◦ Blood
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Heart
 Muscular
organ that pumps blood
throughout the body
 Heart structure provides for receiving
deoxygenated blood from the body,
pumping it to the lungs for reoxygenation, and returning it to the
body full of oxygenated blood.
 100,000 beats/day
 2000 gallons of blood/day
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Heart
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Blood Vessels
 Carry
blood to and from the heart.
 Three types: arteries, capillaries,veins
◦ Arteries transport blood away from the
heart (except?)
◦ Capillaries = bridge between arteries
and veins
◦ Veins return deoxygenated blood to the
heart (via which 2 major veins?)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Blood Vessels
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Blood Vessels
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Blood
 Blood
transports and deposits
materials from one area of the body to
another.
 The more active the body is, the more
the body needs nutrients and oxygen
- which is carried by blood.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Causes
of Cardiovascular Emergencies
 Most
causes of CV system failure are
due to cardiovascular disease (CVD)
 CVD is the leading cause of death
worldwide
 1/3 of American adults have CVD
 CVD is caused by either coronary
artery disease (CAD) or
atherosclerosis of the heart’s
arteries.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Atherosclerosis
 “Hardening
of the arteries”
 Plaques form and build up along the
inner lining of the arteries.
 Heart doesn’t receive the oxygen and
nutrients it needs, which causes the
heart muscle to die
 This type of CVD leads to
hypertension, heart failure, AMI, and
sudden cardiac death.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Atherosclerosis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Hypertension
 Abnormally
elevated blood pressure,
over 140/90
 Damages blood vessels over time
 Affects nearly 1B people worldwide;
1/3 in the US
 If untreated, it can lead to stroke and
kidney failure, and more
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Congestive Heart Failure
 Occurs
when the heart can’t
adequately pump blood to the body
 Right-sided heart failure results in
back-up into the systemic circulation,
and then the dependent tissues, esp.
the ankles and feet
 Left-sided heart failure causes backup into the lungs, resulting in
pulmonary edema
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pulmonary Edema
 Accumulation
of fluid in the lungs
 Caused by severe left-sided
congestive heart failure, which in turn
results from acute MI, direct trauma to
the lungs, certain medical conditions,
and certain drugs
 As the condition worsens, the patient
goes into cardiogenic shock from
profound hypoxia
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Angina Pectoris
 Chest
pain/discomfort caused by
ischemia of the myocardium
 Occurs when the oxygen demands of
the heart exceed the available supply
 Common occurrence in people with
CAD due to narrowing of the arteries
 Can also be caused by
vasoconstriction or spasm of the
coronary arteries
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Angina Pectoris
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Myocardial Infarction
 Mostly
(90%) caused by blood clots
that in turn cause blockage of the
coronary arteries.
 The result is ischemia and death of
heart muscle served by the affected
coronary artery(ies).
 If enough tissue dies, life is
threatened because the heart can’t
pump
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Myocardial Infarction
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Myocardial Infarction
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiac Arrhythmias
 Irregular
heart beat or heart rhythm
 While many are benign, lifethreatening arrhythmia is caused by
ischemia of the heart muscle.
 Effects? Bradycardia,tachycardia, or
altered regulation of the rhythm.
 Can lead to shock, or cause blood to
pool/clot inside the heart
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Sudden Cardiac Arrest
 Abrupt
cessation of effective electrical
activity within the heart.
 Result is an immediate inability of the
heart to pump blood into the coronary
arteries, brain, or other vital organs.
 No pulse will be present
 Leading cause of death in the US
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Sudden Cardiac Arrest
 SCA
occurs without warning and
often without prior symptoms
 Causes include
◦ Ventricular fibrillation
◦ Pulseless ventricular tachycardia
◦ Asystole (usually fatal)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Thromboembolism
 Stationary
blood clot, or thrombus,
that travels to the lungs, heart or
brain.
 Can go undetected for months/years
until it disrupts blood flow
 Deep venous thrombosis (DVT) is the
widely known source of thrombus
 Pulmonary embolism is the most
lethal form
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pericarditis and Pericardial
Tamponade
 Pericarditis
is an inflammation of the
pericardial sac that surrounds the
heart
◦ Causes include MI, bacterial and viral
infections, and trauma
 Pericardial
BRADY
tamponade occurs when
excess fluid builds up in the
pericardial space
 PT is life-threatening, requires
emergency fluid removal
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Aneurysm/
Aortic Dissection
Aneurysm – a ballooning
outwards of the aorta
 Aortic
◦ Two types: abdominal and thoracic
 Aortic
Dissection - disruption of the
innermost lining of the aorta that tears
away from the artery wall
◦ High death rate if rupture occurs, and is
often symptomless
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Aneurysm
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Dissection
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Heart Valve Disorders
 Malfunctioning
of one or more of the
four heart valves.
 Causes the heart to work harder,
blood can leak backward, or blood
may pool/clot within the heart
 Usually congenital
 Can also be caused by heart disease,
myocardial infarction, infection, and
trauma.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Concurrent Disease
 Cardiovascular
diseases often occur
in combination with one another
 It is critical that any suspected
cardiovascular disorder must be
considered serious until evaluated by
a physician.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
 Scene
safety issues and actions?
 What do his ABCs and vitals tell you?
 What do you find in the physical
exam?
 What does his emotional condition tell
you?
 What requests do you make for
assistance and/or supplies?
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Follow
BRADY
normal assessment protocols
 How might you find the patient in
SCA? What does this mean for
assessment and/or treatment?
 For other CV emergencies, as you do
the SAMPLE history, what should you
pay close attention to?
 What other special considerations are
there for different types of CVD
emergencies?
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Hypertension
 S/S
often go unnoticed until BP
reaches high levels
 S/S include: headache, vision
disturbances, nausea and/or vomiting,
facial flushing, bounding pulse and
nosebleeds.
 If hypertension is dangerously high,
chest pain, shortness of breath, or
confusion can be present
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Angina and Myocardial
Infarction
 Both
caused by insufficient perfusion,
so they may present in the same way
 Chest pain can be crushing or heavy,
stationary or radiating.
 Women have painless MI more often
than men.
 S/S can include anxiety, dizziness,
nausea, diaphoresis, feelings of doom
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Cardiogenic Shock
 Patients
appear deathly ill and in
shock: pale skin, diaphoresis, anxiety,
respiratory distress.
 If caused by AMI, the patient will be
tachycardic and hypotensive
 If caused by abnormal heart rhythm,
the patient might be bradycardic, or
tachycardic and hypotensive.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Congestive Heart Failure
 S/S
depend on the side affected.
 Right heart failure: swollen ankles that
can progress up the leg, often with
“pitting edema.”
 Left heart failure: Shortness of breath
is common. If onset is rapid, it can be
life-threatening.
 Patients can have right and left CHF
simultaneously.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pericardial Tamponade
 S/S
include shortness of breath,
anxiety or restlessness, and pale,
cool, diaphoretic skin
 Chest pain is common
 Hypotension, distended neck veins,
and muffled/distant heart tones
 Patient might present with only fatigue
and tachycardia.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Aneurysm/Dissection
 Dissection:
◦ S/S include severe (tearing, ripping,
stabbing) chest pain that often radiates
to the back between the shoulders, and
hypertension
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Aneurysm/Dissection
Copyright David Effron, MD
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Aortic Aneurysm/Dissection
 Aneurysm:
◦ Abdominal pain radiating to the
groin/back, dizziness. Abdomen may be
tender, with a pulsatile mass.
 Ruptured?
Profound shock with
hypotension and diaphoresis.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Thromboembolus
 S/S
include sudden onset of sharp
chest pain, shortness of breath,
tachycardia, and cyanosis.
 Pulmonary embolus? Check for a
DVT, which might only show S/S in
one leg -- severe pain, tenderness to
touch, and calf edema.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Open
airway, simultaneous
assessment of breathing and pulse
 If patient is in Cardiac Arrest:
◦ Time is of the essence
◦ Request ALS immediately, and call for
oxygen and an AED.
◦ Begin CPR.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 If
patient is in Cardiac Arrest:
◦ Focus on correcting problems in
accordance with National CPR
standards
◦ Know and practice Adult, Child, and
Infant CPR standards
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Chain
of Survival
◦ Immediate recognition of cardiac arrest,
activation of EMS
◦ Early CPR emphasizing chest
compressions
◦ Rapid defibrillation if indicated
◦ Early, effective ALS
◦ Integrated post-cardiac arrest care
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Scott Smith
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 CVD
Patient NOT in Cardiac Arrest
◦ Call for immediate assistance, oxygen,
AED, and ALS.
◦ Keep patient calm, put in position of
comfort.
◦ If hypotensive, keep supine and warm,
and elevate legs
◦ If CHF, sit patient up and put legs in
dependent position
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
Copyright Edward McNamara
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Other Considerations
 Implantable
devices may be in place
 High flow oxygen therapy is crucial
 Nitroglycerin -- assist patient if they
have their prescription with them and
conditions/protocols allow
 Aspirin -- assist patient if they have
aspirin and protocols allow for it.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You administer oxygen by nonrebreather mask at 15
LPM. You place the patient in the semi-Fowler’s
position. Soon after ALS personnel arrives, you
assist them in transporting the patient. Later, you
learn that the patient had an MI. He underwent a
procedure to open up the vessel and is expected to
recover.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Cardiovascular
disease is the number
one cause of death worldwide.
 Chest pain and shortness of breath
are serious symptoms that may
indicate a life-threatening problem.
 If a cardiovascular emergency is
suspected, immediately summon ALS
assistance.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Shortness
of breath or fatigue may be
the only indications that a patient is
having a cardiovascular emergency.
 Administer high-flow oxygen to any
patient complaining of chest pain or
shortness of breath.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Any
patient with chest pain, shortness
of breath, or fatigue should be
encouraged to seek medical care at a
hospital.
 A conscious patient experiencing
presumed cardiac chest pain should
be given an aspirin as soon as
possible if permitted by local protocol.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
performing CPR, “Push hard,
push fast” (greater than
 100 times a minute), allowing full
chest recoil and minimize any
interruptions in compressions.
 AEDs may be used on patients of any
age.
 When
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ