Agenda Sean add whatever you want Next phase of scenario prep Final exam Practical final Run Reports Will send out Google doc to fill out Lecture code - = MI - = Angina

Angina vs. MI Causes Symptoms Severity MI: complete blockage of the blood supply to the heart muscle Angina: decrease in blood supply to the heart Symptoms MI: chest pain with damage to the heart Severe, steady, crushing pain Radiates to the left neck Weak, rapid pulse Hypotension Low grade fever Angina: best pain with no damage to the heart Tightness or pressure in the chest Severity MI: may cause permanent damage irreversible damage prevented if blood supply restored within 20 min Symptoms persist after 15 minutes and not relieved by nitro Angina: symptoms relieved by rest or nitro within 10-15 minutes We have had cardiac calls before with emsc. Back in the day the first thing someone did on scene was check for PERRL. WTF! Anyways, in the moment cardiac calls are scary/stressful. So, we want to make sure you guys are prepared so that you are confident while on scene.

Medications Administration criteria (DICE) Drug/Dosage Integrity/Indications (right patient?) Clarity/Contraindications Expiration Date Nitroglycerin Take BP before administration and 5 minutes after administration Why? May cause hypotension due to vasodilation Indications Symptoms of chest pain Systolic BP >100mm/Hg Contraindications  Patient does not meet indication or criteria for administration  Patient has taken 3 doses before EMS arrival within the last 5 minutes  Last dose was < 5 minutes ago Systolic blood pressure < 100mm/Hg Administration of Sildenafil citrate (Viagra7) or similar medication within 36 hours

Medications Preparation/administration Tablet Spray Remove from container and check if in tact Place under pt’s tongue Instruct patient to allow tablet to dissolve, not swallow Spray One spray delivers 0.4 mg of nitro sublingually

Reassessment Repeat every 5 minutes AKA primary assessment Vital signs Relevant part of a secondary assessment

Things to think about in the field … Cause Onset of pain Location History What makes it better or worse?

Onset Was it… Sudden? Gradual? Lasts Minutes? Lasts Hours? Varies?

Quality Does the chest feel like it is spasming? Is there a sharp pain when inhaling? Is there any tightness/heaviness? Can the pain be pinpointed? Is the pain not easy to pinpoint? Is there a burning sensation? Does the pain feel “tearing”?

Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm

Things to consider about pt Hx Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis HTN, angina

Signs/Symptoms? Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

What makes it worse? Breathing Position of comfort (sitting, laying down, or just moving in general) Stress/anxiety

What makes it better? Rest/little movement Position of comfort Antacids Medications

Angina Onset of Pain Sudden Gradual Lasts Minutes Lasts Hours Varies

Angina Quality of Pain Sharp pain upon inhalation Spasm Tight/heavy Sharp/Burning TEARING / EXCRUCIATING

Angina Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm VAGUE

Angina History Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis HTN, angina

Angina Signs and Symptoms Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

What Makes Angina Worse? Breathing Position (sitting, laying down, or just moving in general) Stress/anxiety

What Makes Angina Better? Rest/little movement Position of comfort Antacids Medications

MI Onset Sudden Gradual Lasts Minutes Lasts Hours Varies

Quality of MI Does the chest feel like it is spasming? Is there a sharp pain when inhaling? Is there any tightness/heaviness? Can the pain be pinpointed? Is the pain not easy to pinpoint? Is there a burning sensation? Does the pain feel “tearing”?

MI Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm

MI History Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis HTN, angina

MI Signs and Symptoms Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

What Makes MI Worse? Breathing Position (sitting, laying down, or just moving in general) Stress/anxiety

What Makes MI Better? Rest/little movement Position of comfort Antacids Medications

See you next week!!

References Carroll, Laurie, RN, and Will Grundy. “Cardiac Differential Diagnosis”. Lecture.