1. Cardiac Emergencies Jim Bennett Paramedic and Clinical Education Coordinator American Medical Response Spokane, Washington

2. The Heart Pulmonary Veins---- Inferior Vena Cava-- Superior Vena Cava------ Right Atrium----- Right Ventricle---------- -------Aorta ----Pulmonary Arteries ------Left Atrium -------Left ventricle

3. Cardiac Conductive System  Heart is more than a muscle  Specialized contractile and conductive tissue in the heart  Electrical impulses

4. The Conduction System (The electrical path) (SA) node ----- Sinoatrial -------------Atrioventricular (AV) node Ventricular conduction system--

5. Arteries  Function – carry blood away from the heart to the rest of the body

6. Major Arteries ----Carotid -----Brachial Femoral---------- -----Radial --------Dorsalis pedis

7. Arterioles, Capillaries, Venules, and Veins  Arterioles – Smallest branch of an artery leading to capillaries.  Capillaries – Connection to venules.  Venules – Smallest branch of a vein leading to the capillaries.  Veins – Carry blood back to the heart.  Venae Cavae – Carries oxygen-poor blood.

8. Blood Composition  Red blood cells Give the blood its color Carry oxygen to organs Carry carbon dioxide away from organs

9. Blood composition continued…  White blood cells – part of the body’s defense against infections  Plasma – fluid that carries the blood cells and nutrients  Platelets – essential for the formation of blood clots

10. Physiology  Pulse Left ventricle contracts sending a wave of blood through the arteries Can be palpated anywhere an artery simultaneously passes near the skin surface and over a bone. Peripheral  Radial  Brachial  Posterior tibial  Dorsalis pedis Central  Carotid  Femoral

11. Physiology continued… o Blood Pressure o Systolic - the pressure exerted against the walls of the artery when the left ventricle contracts o Diastolic – the pressure exerted against the walls of the artery when the left ventricle is at rest

12. Cardiovascular disorders  Coronary artery disease  Aneurysm  Electrical malfunctions  Mechanical malfunctions  Angina pectoris  Acute myocardial infarction  Congestive heart failure

13. Inadequate circulation  Shock (hypoperfusion) – a state of profound depression of the vital processes of the body.

14. Inadequate circulation  Characterized by signs and symptoms such as: Pale, cyanotic Cool, clammy skin Rapid, weak pulse Rapid and shallow breathing Restlessness, anxiety or mental dullness Nausea and vomiting Low or decreasing blood pressure

15. Cardiac Compromise  May include one or all of the following: Squeezing, dull pressure, chest pain commonly radiating down the arms or to the jaw Sudden onset of sweating Difficulty breathing Anxiety, irritability Feeling of impending doom

16. Cardiac compromise continued… Abnormal pulse rate (may be irregular) Abnormal blood pressure Epigastric pain Nausea/vomiting

17. Causes of cardiac compromise  Coronary Artery Disease-narrowing or blocked coronary arteries  Aneurysm-weakened sections in the arterial walls  Electrical malfunctions-an irregular, or absent, heart rhythm  Mechanical malfunctions-mechanical pump failure

18. Causes continued…  Angina Pectoris- a pain in the chest  Acute myocardial infarction- heart muscle that dies due to oxygen starvation  Congestive heart failure-excessive fluid build-up  Hypertensive Crisis- High blood pressure

19. Emergency Care

20. Case Study You respond to a complaint of chest pain. As you enter the apartment, your partner rolls her eyes. The patient is an obese 37 yo/fe. She is breathing rapidly and crying, and you note a cast on her right lower leg. You find: BP-108/68mmHg, P-124/min, 02 sats-92%, breath sounds show clear bilaterally. She rates her chest pain at 8/10 radiating down her left arm.

21. What type of equipment needs to be taken to the side of every cardiac patient?

22. Equipment should include…  Oxygen  Oxygen adjuncts  Suction equipment  Equipment to assess vital signs  Defibrillator

23. What are the treatment priorities ?

24. Treatment Priorities  ABC’s  Oxygen  Vital signs  Nitroglycerin  Rapid Transport

25. What assessment information do you need to obtain next ?

26. Assessment  Onset  Provocation  Quality  Radiation  Severity  Time

27. Assessment continued…  Signs and symptoms  Allergies  Medications  Past medical history  Last meal  Events leading up to the illiness

28. Medication o Nitroglycerin

29. Medication Name  Generic Name Nitroglycerin  Trade Name Nitrostat ™ Nitrolingual ® Spray

30. Acute Coronary Syndromes (Chest Pain)  Primary ABCD Survey Body Substance Isolation procedure Assess responsiveness Open airway Assesses pulse Attaches monitor

31. Acute Coronary Syndromes (Chest pain) continued…  Secondary Survey Obtains vital signs Places Patient on 02 at appropriate rate Initiates IV line Performs targeted history, OPQRST, SAMPLE

32. Acute Coronary Syndromes (Chest Pain) continued...  Treatment Administers 325mg Aspirin Administers Nitro 0.4mg SL then Q 5 minutes X2, (if B/P > 100 Systolic & pain not relieved) Know contraindications  Hypotension  Suspected increased intracranial pressure  Viagra or Levitra within past 24 hours & Cialis within past 96 hours

33. Test Questions 1. The blood vessels include arteries, capillaries, and A.Veins B.SA node C.AV node D.Ventricles 2. Cardiac compromise refers to: A.The heart’s ability to function properly during a respiratory emergency. B.Any kind of problem with the heart. C.The right atrium’s receiving blood from the body’s veins. D.The left ventricle’s receiving blood from the pulmonary veins.

34. 3. What is the maximum number of (0.04 sublingual nitroglycerin) doses that can be given to a patient with chest pain that has stable vital signs? A.There is no maximum (as long as vitals are stable) B.2 doses C.4 doses D.3 doses 4. Whenever you are managing a patient with chest pain, you should: A.Attach electrode pads to the patient B.Treat the situation as a cardiac emergency C.Analyze the patient’s heart rhythm D.Give the patient nitroglycerin

35. 5. Cardiac compromise may include all of the following signs or symptoms EXCEPT: A.Difficulty breathing B.Warm, dry skin C.Nausea or vomiting D.Epigastric pain 6. An important consideration of managing any patient with chest pain is that he or she may: A.Deteriorate into cardiac arrest. B.Need automated external defibrillation. C.Require positive pressure ventilation. D.Need oxygen administration and chest compressions.

36. 7. Before administering a second dose of nitroglycerin to a patient, you must: A.Perform CPR for 1 minute. B.Request authorization from medical control. C.Provide supplemental oxygen via nasal cannula. D.Check the patient’s pupils for excess dilation. 8. Fluid buildup in the lungs caused by inadequate pumping of the heart is known as: A.Pulmonary edema B.Angina pectoris C.Arrhythmia D.Thrombus

37. 9. A malfunction of the heart’s electrical system will generally result in an: A.Embolism B.Occlusion C.Aneurysm D.Arrhythmia 10.The pulmonary valve prevents blood from returning to the: A.Right atrium B.Right ventricle C.Left ventricle D.Left Atrium

38. Wrapping it up… Questions or Comments Renee Anderson andersr@inhs.org 509-232-8155 Fax: 509-232-8344