Cardiovascular Emergencies CHAPTER 18 1

…more than half of them occur outside of hospitals. Cardiac emergencies are the most common medical emergencies in the U.S., with over 600,000 deaths each year... …more than half of them occur outside of hospitals. 1

Review of the Circulatory System Anatomy 1

Aorta Coronary arteries External View of Heart Aorta Superior vena cava Left pulmonary artery Coronary arteries 1

Aortic valve Atria Ventricles Internal View of Heart Aortic valve Pulmonary valve Atria C4-22 Ventricles 1

Blood flow through the circulatory system. 1

Arterial System Carotid artery Brachial artery Radial artery Femoral artery 1

Venous System External jugular vein Inferior vena cava Femoral vein Great saphenous vein 1

Blood Composition Red blood cells White blood cells Platelets Plasma Hemoglobin White blood cells Platelets Plasma Fluid that carries cells and platelets 1

Blood Composition Functions Blood Component Function Give blood its color, carry O2 to organs, carry C 02 away Red blood cells White blood cells Part of immune system Plasma Carries blood cells, nutrients Platelets Essential for clotting 1

Physiology 1

Key Pulse Points Carotid Brachial Radial Femoral Posterior Tibial Dorsalis Pedis 1

Assessing the Pulse Rate Quality Averages 60 - 80 beats per minute in adults Quality Strength? (strong or weak) Regularity? (regular or irregular) 1

Perfusion: The process of delivering blood to the organs, delivering oxygen, and removing wastes. The skin condition is a good indicator of perfusion. 1

Shock: A state or condition of inadequate perfusion to the organs and tissue. 1

Signs and Symptoms of Shock Rapid and weak pulse Pale or cyanotic skin color Cool, clammy skin Rapid and shallow breathing Restlessness and anxiety 1

Signs & Symptoms of Shock continued Mental dullness, confusion Nausea, vomiting, and thirst Low or decreasing blood pressure Subnormal temperature 1

NEVER rely solely on BP to determine the presence of shock. Low blood pressure is a LATE sign of shock (hypoperfusion). NEVER rely solely on BP to determine the presence of shock. 1

Cardiac Compromise 1

Ischemia: A condition of reduced oxygen to body tissues and cells. 1

Atherosclerosis: A condition in which cholesterol and cellular debris form a plaque on the insides of arteries, narrowing the area that the blood flows through. 1

Normal Artery Artery Clogged with plaque 1

Angina: Chest pain caused by reduced oxygen to the heart due to inadequate blood supply through the coronary arteries. 1

Acute myocardial infarction: A condition in which a part of the heart muscle dies as a result of no blood supply and prolonged lack of oxygen. 1

Acute Myocardial Infarction (AMI) Embolus (or spasm) Area of ischemia 1

Chest pain is often a symptom of an acute MI. 1

Congestive heart failure (CHF): A condition in which the heart fails to pump efficiently, causing fluid to back up into the lungs and venous system. 1

Signs & Symptoms of CHF Dyspnea JVD Pulmonary edema Pedal (peripheral) edema 1

Assessment 1

Pertinent past medical history Last oral intake (solid or liquid) Signs and symptoms Allergies Medications Pertinent past medical history Last oral intake (solid or liquid) Events leading to injury or illness 1

Onset Provocation Quality Radiation Severity Time 1

Cardiac Compromise Squeezing, dull pressure or pain in the chest (may radiate to arms, neck, jaw or upper back) Sudden onset of sweating Difficulty breathing Anxiety or irritability Feeling of impending doom Nausea or vomiting 1

Cardiac Compromise continued Epigastric pain or abdominal discomfort Abnormal and sometimes irregular pulse Sometimes abnormal blood pressure 1