1. Defense Institute For Medical Operations (DIMO) CARDIOVASCULAR Website: www.dimo.af.milwww.dimo.af.mil http://www.facebook.com/dimo.ops 1

2. Objective Based on the criteria given, students will be able to analyze pre-flight and in-flight nursing management principles and interventions used in caring for the cardiovascular patient

3. Samples of Behavior 1.Explain how the stresses of flight affect the patient with a cardiovascular disorder 2.Explain nursing management practices unique to caring for the patient with cardiovascular disorders

4. Stresses of Flight Decreased Partial Pressure of Oxygen –Adds to myocardial workload –Pre-disposes to arrhythmias –Can precipitate angina –Can lead to MI –Consider cabin altitude < 6,000 ft

5. Stresses of Flight Decreased Partial Pressure of Oxygen –Prevention / treatment of hypoxia O2 via NC or mask Backrest Minimize activity / consolidate care Frequent thorough assessments

6. Stresses of Flight Barometric Pressure Changes –Gas expansion: GI tract –Possible compressing vessels

7. Stresses of Flight Barometric Pressure Changes –Prevention / Treatment Backrests NG Tubes PRN Ambulation

8. Stresses of Flight Thermal –The volume of a gas is nearly proportional to its absolute temperature. –When flying the temperature decreases 1 degree for every 330 feet of altitude

9. Stresses of Flight Thermal –Excessive heat + Cardiac Meds = Hypotension –Hyperthermia & Hypothermia = increased cardiac O2 requirements

10. Stresses of Flight Thermal –Prevention / Treatment Anticipate thermal changes & provide blankets, warm clothing and liquids Patient Placement

11. Stresses of Flight Fatigue –Cumulative effect of all other stressors may exacerbate the patient condition –Erratic schedules, hypoxia environment, noise, vibration, and temperature changes

12. Stresses of Flight Fatigue –Prevention / Treatment Consolidate care Provide rest Get down litter available for ambulatory patient Fluids / IVs / Meals / Blankets

13. Stresses of Flight G-forces –Takeoff and landing may increase returning blood flow & cardiac workload –Treatment Backrest Supplemental O2

14. Patient Assessment History –Is patient free of chest pain –Has patient flown before? –When was last episode of chest pain? –What meds are used to relieve pain? –Is patient self medicating?

15. Patient Assessment Acute Coronary Syndrome –Recent MI patients considered for AE on individual basis –If on monitor = ACLS Medical Attendant –12 Lead EKG taken within 24 hrs should accompany patient

16. Patient Assessment Common Sense Exceptions to Recommendations: –Facility inadequate to care for MI pt. (clinic) –Patient needs further specialized services not available at MTF –Patient had MI aboard ship or in other environment where medical care is not available or not adequate –If electronically monitored, need proper equipment

17. Patient Assessment Pre-Flight Assessment : –General Appearance –Ambulatory Status –LOC –VS –JVD / Edema –Verify documentation/meals/meds available for flight

18. Positioning Cardiac Patients Get down litters Middle tier if unstable Backrest Monitors Away from busy areas/near latrine O2 (prevention is the key)

19. Patient Assessment Pacemaker / Implantable Defibrillator –WARNING: Handheld and stationary surveillance systems may interfere with these devices –Changes in pacing rate, shock and possible cardiac arrest – Use alternate anti-hijacking procedures

20. In-Flight Nursing Care O2 Backrest Fluids Blankets Monitor VS I&Os Avoid ear blocks Medications

21. Cardiac Arrest ACLS Guidelines –ABCs/CPR –IV/O2/Monitor –Strict I&Os –Notify C2 and anticipate diversion to nearest MTF capable

22. Ischemic Chest Pain Rapid recognition, treatment & communication with C2 Assessment: –ABCs –Manifested Signs/Symptoms –VS/SPO2/Cardiac Monitor –Auscultate heart/lungs?

23. Ischemic Chest Pain Treatment / Management –High Flow O2 –Nitroglycerin –Emergency Get Down Litter –Cool Cabin –Aspirin –Initiate BLS/ACLS –Contact C2

24. Congestive Heart Failure Assess BP, HR, SPO2, GCS, peripheral perfusion, edema, color, warmth of skin Signs/Symptoms: Anxiety, SOB with rales/ronchi, JVD, tachycardia, hypo/hypertension, diaphoresis, arrhythmias, ashen/cool/clammy skin Treatment: Monitor, Strict I&Os, Contact C2/PMRC

25. Cardiac Tamponade Refer to current ACLS guidelines Requires pericardiocentesis by trained professional

26. Symptomatic PVCs and VT Presence of both multifocal and/or frequent PVCs, and VT in conjunction with chest pain, SOB, low BP, change in mental status, shock, pulmonary congestion, congestive heart failure, acute MI Refer to current ACLS guidelines

27. Symptomatic Bradycardia Signs/Symptoms: Low BP, pulmonary congestion, SOB, chest pain, decreased LOC, shock, congestive heart failure, and acute MI Consider transcutaneous pacing IAW current ACLS guidelines Contact C2 / anticipate diversion

28. V-Fib and Pulseless VT Refer to current ACLS guidelines Place blanket under patient if on floor of aircraft prior to defibrillation All types of litters may be used to defibrillate

29. Objective Based on the criteria given, students will be able to analyze pre-flight and in-flight nursing management principles and interventions used in caring for the cardiovascular patient

30. SAMPLES of BEHAVIOR 1.Explain how the stresses of flight affect the patient with a cardiovascular disorder 2.Explain nursing management practices unique to caring for the patient with cardiovascular disorders

31. QUESTIONS? Website: www.dimo.af.milwww.dimo.af.mil http://www.facebook.com/dimo.ops 31