Chapter 15: Cardiac Emergencies

Objectives • Describe structure and function of the

cardiovascular system (heart, blood vessels, and blood)

• Describe the emergency care of patient experiencing chest pain

• Management protocol for OEC

Blood vessels• Arteries, Veins, Capillaries • Which brings blood to the heart?• Which brings blood from the heart?• Which connects them?

Blood• Red blood cells:

• Carries oxygen to tissues and cells

• Removes CO2 and waste• White blood cells:

• Fight infection• Platelets:

• Helps blood clot

Blood Flow Through the Heart

Key Terms • Angina pectoris• Ischemia• Myocardial Infarction• Pericarditis • Atherosclerosis• Hypertension• Congestive heart failure

o Pulmonary edema • Aortic aneurysm

Pericarditis vs. Pericardial tamponade • TIME • Excess fluid build up in pericardial sac

o applies external pressure to the heart preventing adequate filling of the heart with blood

o restricts hearts ability to pump effectively Biggest symptom?

Angina PectorisChest pain or discomfort caused by ischemia of myocardium Two common causes:

narrowing of heart musclespasm of coronary artery

Name that Arrhythmia

Which is Which?• A. chaotic and ineffective contraction of the

ventricles that leads to cardiac arrest

• B. rapid contraction of ventricles that lead to ineffective blood flow to body tissues that leads to cardiac arrest

What is the difference?

thromboembolism

Aortic aneurysm

Signs and Symptoms • Shortness of breath• Signs of inadequate perfusion• Chest pain, pressure, or discomfort (with or

without radiation to back, neck, jaw, arm, wrists)• Nausea• Weakness/syncope• Dysrhythmias• Chest pain/discomfort

o Often crushing or squeezingo Does not change with each breath

What to look out for o Diaphoresis (78%)o Shortness of Breath (47%)o Pain/discomfort (64%)o Nausea/vomiting (52%)o No signs or symptoms (25%)

• N Eng Journal Med 1984;311:11444-7

Cardiogenic Shock• Hypoperfusion• Caused by disorders of heart muscle, valves,

conduction system• Infarction= muscle doesn’t contract • Hypoxia

NitroglycerinInstruct patient to put tablet under tongue and let dissolve

May administer total of three doses at five min intervals • when cant you use:

o Expiration date o Systolic lower than 100mg o Taking Viagrao Patient has already taken three doseso Patient took cocaine o Chest pain is due to trauma

Management• BSI scene safety• ABC• Secondary- sample pay close attention to

medications including nitroglycerin or aspirin • Look for:

o Body positiono skin signs and color o respiratory rate and effort o mental status o pulse rate and character

• OPQRST: What questions are we asking?

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