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: White blood cells: Platelets: Carries oxygen to tissues and cells Removes CO2 and waste White blood cells: Fight infection Platelets: Helps blood clot

Blood Flow Through the Heart

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Key Terms Angina pectoris Ischemia Myocardial Infarction Pericarditis Atherosclerosis Hypertension Congestive heart failure Pulmonary edema Aortic aneurysm Ischemic heart disease- dec blood flow due to anaerobic metabolism produces lactic acid and CO2 accumulation in myocardium, causing pain Infarction- death of tissue Pericarditis: inflammation of pericardium – changes breathing andn motion Angina- chest pain Pulmonary edema: fluid in lungs reduces gas echange in alveoli. From fluid back up in veins bc left ventricle cant pump blood effectively Aortic a: severe chest pain or upper back discomfort – shooting pain Tampon- filling up of pericardial sac with blood

Atherosclerosis- materials built in blood vessels

Pericarditis vs. Pericardial tamponade TIME Excess fluid build up in pericardial sac applies external pressure to the heart preventing adequate filling of the heart with blood restricts hearts ability to pump effectively Biggest symptom?

Angina Pectoris Chest pain or discomfort caused by ischemia of myocardium Two common causes: narrowing of heart muscle spasm of coronary artery

Name that Arrhythmia A bradycardia B ventricular tachycardia c. Asystole – compelte absence of heart beat due to lack of electrical activity

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 Ventricular fibrillation Ventricular tachycardia

What is the difference? Aortic aneurysm thromboembolism

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 Often crushing or squeezing Does not change with each breath http://www.bing.com/videos/search?q=anakin+you're+breaking+my+heart&FORM=VIRE1#view=detail&mid=21E9A8B9046362827FB921E9A8B9046362827FB9

What to look out for Diaphoresis (78%) Shortness of Breath (47%) Pain/discomfort (64%) Nausea/vomiting (52%) 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 Altered LOC Rapid, shallow breathing Restlessness and anxiousness Pale, cool skin= cyanotic Tachycardia/dysrhythmia Hypotension

Nitroglycerin Instruct patient to put tablet under tongue and let dissolve May administer total of three doses at five min intervals when cant you use: Expiration date Systolic lower than 100mg Taking Viagra Patient has already taken three doses Patient took cocaine Chest pain is due to trauma BSI scene safety ABC Secondary- sample pay close attention to medications including nitroglycerin or aspirin Treatment 30 Chest compressions at a rate of 100/minute Body position skin signs and color respiratory rate and effort mental status pulse rate and character

Management OPQRST: What questions are we asking? BSI scene safety ABC Secondary- sample pay close attention to medications including nitroglycerin or aspirin Look for: Body position skin signs and color respiratory rate and effort mental status pulse rate and character OPQRST: What questions are we asking? Onset – “When and at what time did it start” Provocation – “Does anything make it better or worse?” “Does it change with position, palpitation, inspiration?” Quality – “Describe the pain/discomfort in your own words” Region/Radiation – “Where does it start?” “Does it radiate anywhere?” Severity – “On a scale of 1 to 10, what was the pain/discomfort at onset?” “What is the pain/discomfort at now?’ Time – “When did this episode start?” “How long has it been going on?”

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