National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 15 Cardiovascular Emergencies

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Objectives 15.1 List and describe the anatomical structures of the cardiovascular system Describe the functions of the cardiovascular system Describe the flow of blood through the cardiovascular system. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Objectives 15.4 Define the following: a.acute myocardial infarction b.atherosclerosis c.cardiovascular disease d.coronary artery disease e.hypertension continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Objectives 15.5 List the signs and symptoms for each of the following cardiovascular disorders: a.acute myocardial infarction b.aortic aneurysm c.cardiogenic shock d.congestive heart failure e.pericardial tamponade f.pulmonary embolism 15.6 List the arrhythmias associated with sudden cardiac death. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Objectives 15.7 Describe and demonstrate how to assess a patient with a cardiovascular emergency Describe and demonstrate the proper care of a patient with a cardiovascular emergency List three common cardiac medications. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Objectives Describe and demonstrate how to perform CPR on the following: a.a child b.an infant c.an adult Describe and demonstrate the proper use of an AED.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Common Causes Types of Cardiovascular Emergencies Assessment Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are called to a remote trail location where a 42- year-old man complains of chest pain and appears to be in considerable distress. He was snowshoeing with his family when he felt sudden stabbing pain in his chest that radiated down his left arm. He is pale, sweating, feels nauseous and is weak. He has a history of heart problems, but never this bad.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Three major components of the Cardiovascular System: ◦ The Heart ◦ Blood vessels ◦ Blood

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Heart Muscular organ that pumps blood throughout the body Heart structure provides for receiving deoxygenated blood from the body, pumping it to the lungs for re- oxygenation, and returning it to the body full of oxygenated blood. 100,000 beats/day 2000 gallons of blood/day

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Heart

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Blood Vessels Carry blood to and from the heart. Three types: arteries, capillaries,veins ◦ Arteries transport blood away from the heart (except?) ◦ Capillaries = bridge between arteries and veins ◦ Veins return deoxygenated blood to the heart (via which 2 major veins?)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Blood Vessels

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Blood Vessels

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Blood Blood transports and deposits materials from one area of the body to another. The more active the body is, the more the body needs nutrients and oxygen - which is carried by blood.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Causes of Cardiovascular Emergencies Most causes of CV system failure are due to cardiovascular disease (CVD) CVD is the leading cause of death worldwide 1/3 of American adults have CVD CVD is caused by either coronary artery disease (CAD) or atherosclerosis of the heart’s arteries.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Atherosclerosis “Hardening of the arteries” Plaques form and build up along the inner lining of the arteries. Heart doesn’t receive the oxygen and nutrients it needs, which causes the heart muscle to die This type of CVD leads to hypertension, heart failure, AMI, and sudden cardiac death.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Atherosclerosis

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Hypertension Abnormally elevated blood pressure, over 140/90 Damages blood vessels over time Affects nearly 1B people worldwide; 1/3 in the US If untreated, it can lead to stroke and kidney failure, and more

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Congestive Heart Failure Occurs when the heart can’t adequately pump blood to the body Right-sided heart failure results in back-up into the systemic circulation, and then the dependent tissues, esp. the ankles and feet Left-sided heart failure causes back- up into the lungs, resulting in pulmonary edema

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pulmonary Edema Accumulation of fluid in the lungs Caused by severe left-sided congestive heart failure, which in turn results from acute MI, direct trauma to the lungs, certain medical conditions, and certain drugs As the condition worsens, the patient goes into cardiogenic shock from profound hypoxia

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Angina Pectoris Chest pain/discomfort caused by ischemia of the myocardium Occurs when the oxygen demands of the heart exceed the available supply Common occurrence in people with CAD due to narrowing of the arteries Can also be caused by vasoconstriction or spasm of the coronary arteries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Angina Pectoris

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Myocardial Infarction Mostly (90%) caused by blood clots that in turn cause blockage of the coronary arteries. The result is ischemia and death of heart muscle served by the affected coronary artery(ies). If enough tissue dies, life is threatened because the heart can’t pump

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Myocardial Infarction

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Myocardial Infarction

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Cardiac Arrhythmias Irregular heart beat or heart rhythm While many are benign, life- threatening arrhythmia is caused by ischemia of the heart muscle. Effects? Bradycardia,tachycardia, or altered regulation of the rhythm. Can lead to shock, or cause blood to pool/clot inside the heart

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Sudden Cardiac Arrest Abrupt cessation of effective electrical activity within the heart. Result is an immediate inability of the heart to pump blood into the coronary arteries, brain, or other vital organs. No pulse will be present Leading cause of death in the US continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Sudden Cardiac Arrest SCA occurs without warning and often without prior symptoms Causes include ◦ Ventricular fibrillation ◦ Pulseless ventricular tachycardia ◦ Asystole (usually fatal)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Thromboembolism Stationary blood clot, or thrombus, that travels to the lungs, heart or brain. Can go undetected for months/years until it disrupts blood flow Deep venous thrombosis (DVT) is the widely known source of thrombus Pulmonary embolism is the most lethal form

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pericarditis and Pericardial Tamponade Pericarditis is an inflammation of the pericardial sac that surrounds the heart ◦ Causes include MI, bacterial and viral infections, and trauma Pericardial tamponade occurs when excess fluid builds up in the pericardial space PT is life-threatening, requires emergency fluid removal

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Aneurysm/ Aortic Dissection Aortic Aneurysm – a ballooning outwards of the aorta ◦ Two types: abdominal and thoracic Aortic Dissection - disruption of the innermost lining of the aorta that tears away from the artery wall ◦ High death rate if rupture occurs, and is often symptomless

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Aneurysm

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Dissection

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Heart Valve Disorders Malfunctioning of one or more of the four heart valves. Causes the heart to work harder, blood can leak backward, or blood may pool/clot within the heart Usually congenital Can also be caused by heart disease, myocardial infarction, infection, and trauma.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Concurrent Disease Cardiovascular diseases often occur in combination with one another It is critical that any suspected cardiovascular disorder must be considered serious until evaluated by a physician.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Scene safety issues and actions? What do his ABCs and vitals tell you? What do you find in the physical exam? What does his emotional condition tell you? What requests do you make for assistance and/or supplies?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Follow normal assessment protocols How might you find the patient in SCA? What does this mean for assessment and/or treatment? For other CV emergencies, as you do the SAMPLE history, what should you pay close attention to? What other special considerations are there for different types of CVD emergencies?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Hypertension S/S often go unnoticed until BP reaches high levels S/S include: headache, vision disturbances, nausea and/or vomiting, facial flushing, bounding pulse and nosebleeds. If hypertension is dangerously high, chest pain, shortness of breath, or confusion can be present

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Angina and Myocardial Infarction Both caused by insufficient perfusion, so they may present in the same way Chest pain can be crushing or heavy, stationary or radiating. Women have painless MI more often than men. S/S can include anxiety, dizziness, nausea, diaphoresis, feelings of doom

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Cardiogenic Shock Patients appear deathly ill and in shock: pale skin, diaphoresis, anxiety, respiratory distress. If caused by AMI, the patient will be tachycardic and hypotensive If caused by abnormal heart rhythm, the patient might be bradycardic, or tachycardic and hypotensive.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Congestive Heart Failure S/S depend on the side affected. Right heart failure: swollen ankles that can progress up the leg, often with “pitting edema.” Left heart failure: Shortness of breath is common. If onset is rapid, it can be life-threatening. Patients can have right and left CHF simultaneously.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pericardial Tamponade S/S include shortness of breath, anxiety or restlessness, and pale, cool, diaphoretic skin Chest pain is common Hypotension, distended neck veins, and muffled/distant heart tones Patient might present with only fatigue and tachycardia.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Aneurysm/Dissection Dissection: ◦ S/S include severe (tearing, ripping, stabbing) chest pain that often radiates to the back between the shoulders, and hypertension

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Aneurysm/Dissection Copyright David Effron, MD

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Aortic Aneurysm/Dissection Aneurysm: ◦ Abdominal pain radiating to the groin/back, dizziness. Abdomen may be tender, with a pulsatile mass. Ruptured? Profound shock with hypotension and diaphoresis. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Thromboembolus S/S include sudden onset of sharp chest pain, shortness of breath, tachycardia, and cyanosis. Pulmonary embolus? Check for a DVT, which might only show S/S in one leg -- severe pain, tenderness to touch, and calf edema.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Open airway, simultaneous assessment of breathing and pulse If patient is in Cardiac Arrest: ◦ Time is of the essence ◦ Request ALS immediately, and call for oxygen and an AED. ◦ Begin CPR. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management If patient is in Cardiac Arrest: ◦ Focus on correcting problems in accordance with National CPR standards ◦ Know and practice Adult, Child, and Infant CPR standards continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Chain of Survival ◦ Immediate recognition of cardiac arrest, activation of EMS ◦ Early CPR emphasizing chest compressions ◦ Rapid defibrillation if indicated ◦ Early, effective ALS ◦ Integrated post-cardiac arrest care continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management CVD Patient NOT in Cardiac Arrest ◦ Call for immediate assistance, oxygen, AED, and ALS. ◦ Keep patient calm, put in position of comfort. ◦ If hypotensive, keep supine and warm, and elevate legs ◦ If CHF, sit patient up and put legs in dependent position

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Other Considerations Implantable devices may be in place High flow oxygen therapy is crucial Nitroglycerin -- assist patient if they have their prescription with them and conditions/protocols allow Aspirin -- assist patient if they have aspirin and protocols allow for it.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You administer oxygen by nonrebreather mask at 15 LPM. You place the patient in the semi-Fowler’s position. Soon after ALS personnel arrives, you assist them in transporting the patient. Later, you learn that the patient had an MI. He underwent a procedure to open up the vessel and is expected to recover.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Cardiovascular disease is the number one cause of death worldwide. Chest pain and shortness of breath are serious symptoms that may indicate a life-threatening problem. If a cardiovascular emergency is suspected, immediately summon ALS assistance. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Shortness of breath or fatigue may be the only indications that a patient is having a cardiovascular emergency. Administer high-flow oxygen to any patient complaining of chest pain or shortness of breath. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Any patient with chest pain, shortness of breath, or fatigue should be encouraged to seek medical care at a hospital. A conscious patient experiencing presumed cardiac chest pain should be given an aspirin as soon as possible if permitted by local protocol. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary When performing CPR, “Push hard, push fast” (greater than 100 times a minute), allowing full chest recoil and minimize any interruptions in compressions. AEDs may be used on patients of any age.