Cardiac Emergencies

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Cardiac Emergencies
Jim Bennett Paramedic and Clinical Education
Coordinator American Medical Response Spokane,
Washington
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The Heart
-------Aorta
Pulmonary Veins----
----Pulmonary Arteries
Superior Vena Cava------
------Left Atrium
Right Atrium-----
-------Left ventricle
Right Ventricle----------
Inferior Vena Cava--
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Cardiac Conductive System

• Heart is more than a muscle
• Specialized contractile and conductive tissue in
  the heart
• Electrical impulses

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The Conduction System(The electrical path)
Sinoatrial
(SA) node -----
-------------Atrioventricular (AV) node
Ventricular conduction system--
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Arteries

• Function carry blood away from the heart to the
  rest of the body

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Major Arteries
----Carotid
-----Brachial
-----Radial
Femoral----------
--------Dorsalis pedis
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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.

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Blood Composition

• Red blood cells
• Give the blood its color
• Carry oxygen to organs
• Carry carbon dioxide away from organs

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Blood composition continued

• White blood cells part of the bodys defense
  against infections
• Plasma fluid that carries the blood cells and
  nutrients
• Platelets essential for the formation of blood
  clots

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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

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Physiology continued

• Blood Pressure
• Systolic - the pressure exerted against the
  walls of the artery when the left ventricle
  contracts
• Diastolic the pressure exerted against the
  walls of the artery when the left ventricle is at
  rest

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Cardiovascular disorders

• Coronary artery disease
• Aneurysm
• Electrical malfunctions
• Mechanical malfunctions
• Angina pectoris
• Acute myocardial infarction
• Congestive heart failure

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Inadequate circulation

• Shock (hypoperfusion) a state of profound
  depression of the vital processes of the body.

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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

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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

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Cardiac compromise continued

• Abnormal pulse rate (may be irregular)
• Abnormal blood pressure
• Epigastric pain
• Nausea/vomiting

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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

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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

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Emergency Care
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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.

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What type of equipment needs to be taken to the
side of every cardiac patient?
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Equipment should include

• Oxygen
• Oxygen adjuncts
• Suction equipment
• Equipment to assess vital signs
• Defibrillator

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• What are the treatment
• priorities ?

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Treatment Priorities

• ABCs
• Oxygen
• Vital signs
• Nitroglycerin
• Rapid Transport

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What assessment information do you need to obtain
next ?
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Assessment

• Onset
• Provocation
• Quality
• Radiation
• Severity
• Time

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Assessment continued

• Signs and symptoms
• Allergies
• Medications
• Past medical history
• Last meal
• Events leading up to the illiness

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Medication

• Nitroglycerin

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Medication Name

• Generic Name
• Nitroglycerin

• Trade Name
• Nitrostat
• Nitrolingual Spray

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Acute Coronary Syndromes (Chest Pain)

• Primary ABCD Survey
• Body Substance Isolation procedure
• Assess responsiveness
• Open airway
• Assesses pulse
• Attaches monitor

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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

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Acute Coronary Syndromes(Chest Pain) continued...

• Treatment
• Administers 325mg Aspirin
• Administers Nitro 0.4mg SL then Q 5 minutes X2,
  (if B/P gt 100 Systolic pain not relieved)
• Know contraindications
• Hypotension
• Suspected increased intracranial pressure
• Viagra or Levitra within past 24 hours Cialis
  within past 96 hours

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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 hearts ability to function
properly during a respiratory
emergency. B. Any kind of problem with the
heart. C. The right atriums receiving blood
from the bodys veins. D. The left ventricles
receiving blood from the pulmonary veins.
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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 patients heart rhythm D. Give
the patient nitroglycerin
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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.
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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
patients 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. Thr
ombus
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9. A malfunction of the hearts electrical
system will generally result in an A. Embolism
B. Occlusion C. Aneurysm D. Arrhythmia 10. T
he pulmonary valve prevents blood from returning
to the A. Right atrium B. Right ventricle
C. Left ventricle D. Left Atrium
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Wrapping it up

• Questions or Comments

Renee Anderson andersr_at_inhs.org 509-232-8155 Fax
509-232-8344