Cardiac Emergencies

Jim Bennett

Paramedic and Clinical Education Coordinator

American Medical Response

Spokane, Washington

The Heart

Pulmonary Veins----

Inferior Vena Cava--

Superior Vena Cava------

Right Atrium-----

Right Ventricle----------

-------Aorta

----PulmonaryArteries

------Left Atrium

-------Left ventricle

Cardiac Conductive System

Heart is more than a muscleSpecialized contractile and conductive tissue in the heartElectrical impulses

The Conduction System(The electrical path)

(SA) node -----Sinoatrial

-------------Atrioventricular (AV) node

Ventricular conduction system--

Arteries

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

Major Arteries

----Carotid

-----Brachial

Femoral---------------Radial

--------Dorsalis pedis

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.

Blood Composition

Red blood cellsGive the blood its colorCarry oxygen to organsCarry carbon dioxide away from organs

Blood composition continued…

White blood cells – part of the body’s defense against infectionsPlasma – fluid that carries the blood cells and nutrientsPlatelets – essential for the formation of blood clots

PhysiologyPulse

Left ventricle contracts sending a wave of blood through the arteriesCan be palpated anywhere an artery simultaneously passes near the skin surface and over a bone.Peripheral

RadialBrachialPosterior tibialDorsalis pedis

CentralCarotidFemoral

Physiology continued…

o Blood Pressureo Systolic - the pressure exerted against the walls of the artery when the left ventricle contracts

o Diastolic – the pressure exerted against the walls of the artery when the left ventricle is at rest

Cardiovascular disorders

Coronary artery diseaseAneurysmElectrical malfunctionsMechanical malfunctionsAngina pectorisAcute myocardial infarctionCongestive heart failure

Inadequate circulation

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

Inadequate circulation

Characterized by signs and symptoms such as:

Pale, cyanoticCool, clammy skinRapid, weak pulseRapid and shallow breathingRestlessness, anxiety or mental dullnessNausea and vomitingLow or decreasing blood pressure

Cardiac Compromise

May include one or all of the following:

Squeezing, dull pressure, chest pain commonly radiating down the arms or to the jawSudden onset of sweatingDifficulty breathingAnxiety, irritabilityFeeling of impending doom

Cardiac compromise continued…

Abnormal pulse rate (may be irregular)Abnormal blood pressureEpigastric painNausea/vomiting

Causes of cardiac compromise

Coronary Artery Disease-narrowing or blocked coronary arteriesAneurysm-weakened sections in the arterial wallsElectrical malfunctions-an irregular, or absent, heart rhythmMechanical malfunctions-mechanical pump failure

Causes continued…

Angina Pectoris- a pain in the chestAcute myocardial infarction- heart muscle that dies due to oxygen starvationCongestive heart failure-excessive fluid build-upHypertensive Crisis- High blood pressure

Emergency Care

Case StudyYou 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.

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

Equipment should include…

OxygenOxygen adjunctsSuction equipmentEquipment to assess vital signsDefibrillator

What are the treatmentpriorities ?

Treatment Priorities

ABC’sOxygenVital signsNitroglycerinRapid Transport

What assessment information do you need to obtain next ?

Assessment

OnsetProvocationQualityRadiationSeverityTime

Assessment continued…

Signs and symptomsAllergiesMedicationsPast medical historyLast mealEvents leading up to the illiness

Medication

oNitroglycerin

Medication Name

Generic NameNitroglycerin

Trade NameNitrostat ™Nitrolingual ®Spray

Acute Coronary Syndromes (Chest Pain)

Primary ABCD SurveyBody Substance Isolation procedureAssess responsivenessOpen airwayAssesses pulseAttaches monitor

Acute Coronary Syndromes(Chest pain) continued…

Secondary SurveyObtains vital signsPlaces Patient on 02 at appropriate rateInitiates IV linePerforms targeted history, OPQRST, SAMPLE

Acute Coronary Syndromes(Chest Pain) continued...

TreatmentAdministers 325mg AspirinAdministers Nitro 0.4mg SL then Q 5 minutes X2, (if B/P > 100 Systolic & pain not relieved)

Know contraindicationsHypotensionSuspected increased intracranial pressureViagra or Levitra within past 24 hours & Cialis within past 96 hours

Test Questions

1. The blood vessels include arteries, capillaries, andA. Veins B. SA node C. AV nodeD. Ventricles

2. Cardiac compromise refers to:A. The heart’s ability to function properly

during a respiratory emergency.B. Any kind of problem with the heart.C. The right atrium’s receiving blood from

the body’s veins.D. The left ventricle’s receiving blood from

the pulmonary veins.

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 dosesD. 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 patient’s heart rhythmD. Give the patient nitroglycerin

5. Cardiac compromise may include all of the following signs or symptoms EXCEPT:

A. Difficulty breathing B. Warm, dry skin C. Nausea or vomitingD. 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.

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 patient’s 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. ArrhythmiaD. Thrombus

9. A malfunction of the heart’s electrical system will generally result in an:

A. Embolism B. Occlusion C. AneurysmD. Arrhythmia

10. The pulmonary valve prevents blood from returning to the:

A. Right atrium B. Right ventricle C. Left ventricleD. Left Atrium

Wrapping it up…

Questions or Comments

Renee Anderson

andersr@inhs.org

509-232-8155

Fax: 509-232-8344