1. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 14 Cardiac and Respiratory Emergencies

2. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Topics Cardiac Emergencies Respiratory Emergencies

3. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies

4. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Patient assessment First responder care Specific cardiac conditions

5. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Occur from abnormal heart rhythms Interruption of oxygen to the heart –Coronary artery disease

6. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Coronary artery disease –Blood vessels feeding the heart are narrowed –Artery continues to narrow, reducing oxygen supply –Complete blockage results in a heart attack –Lack of oxygen causes chest pain

7. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies

8. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Patient assessment –Chest pain or discomfort that may radiate –Difficulty breathing –Unusual heart beat –Sweating –Feeling of impending doom

9. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies

10. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies

11. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Patient assessment –O: Onset –P: Provocation –Q: Quality –R: Region –R: Radiation –R: Relief –S: Severity –T: Time

12. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies First responder care –Place patient in a position of comfort –Ensure adequate breathing –Administer oxygen –Loosen tight clothing –Continually monitor the patient

13. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Angina pectoris –Acute myocardial infarction Treatment is the same

14. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Angina pectoris Chest pain or discomfort when the heart does not get enough oxygen Usually associated with physical exertion Palpitations Skin changes Difficulty breathing

15. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Angina pectoris Reversible Generally relieved with rest Patient may take nitroglycerin May result in heart attack if untreated

16. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Nitroglycerin Can lower blood pressure Should not take with systolic blood pressure < 100 mmHg Can be taken up to 3 times in 5-minute intervals Do not administer without approval of medical director

17. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Acute myocardial infarction Results in death of heart tissue Four serious consequences Sudden death Shock Congestive heart failure Cardiac dysrhythmias

18. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Acute myocardial infarction Signs and symptoms Chest pain or discomfort Skin changes Difficulty breathing Abnormal heartbeats

19. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Cardiac Emergencies Specific cardiac conditions –Acute myocardial infarction Aspirin Dose is 2–4 chewable baby aspirin Confirm that patient is not allergic Do not administer if patient is on blood thinners Only administer if patient is conscious Only administer with approval of medical director

20. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies

21. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Patient assessment First Responder care Specific respiratory conditions

22. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Patient assessment –Signs and symptoms Inability to speak full sentences Abnormal respirations Accessory muscle usage Tripod position Skin changes Altered mental status

23. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies

24. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies First Responder care –Ensure adequate breathing –Apply oxygen –Place patient in position of comfort –Comfort and reassure the patient

25. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –COPD –Asthma –Pneumonia –Acute pulmonary edema –Hyperventilation

26. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Chronic obstructive pulmonary disease (COPD) Emphysema Alveoli loose elasticity Chronic bronchitis Inflammation, edema, and excessive mucus Productive cough for 3 months, for 2 consecutive years May have a hypoxic drive

27. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Chronic obstructive pulmonary disease Signs and symptoms Shortness of breath Tripod position Bulging neck veins Cyanosis Pursed lip breathing

28. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Asthma Attacks vary in duration, intensity, and frequency Airway obstruction caused by: Bronchospasm Swelling of bronchial walls Plugging of bronchi by thick mucus

29. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Asthma Tripod position High-pitched wheezing Minimal air movement Rapid, shallow respirations Inability to speak full sentences

30. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Asthma Status asthmaticus Life-threatening, prolonged, asthma attack Bronchi may be constricted, preventing wheezing Exhaustion Pursed lip breathing

31. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies

32. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Asthma Treatment Prescribed inhaler Dilates air passages Be sure medication is indicated and allowed As the patient takes a deep breath, activate the inhaler Have patient hold his or her breath Reassess

33. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Pneumonia Lung infection with fluid- or pus-filled alveoli Caused by bacteria, virus, or aspirated materials

34. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Pneumonia Signs and symptoms Chest pain made worse with breathing Respiratory distress Productive cough, possibly discolored Fever, chills, and hot, dry skin

35. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Acute pulmonary edema Caused by damage to the heart or lungs Fluid builds up in the alveoli

36. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Acute pulmonary edema Signs and symptoms Shortness of breath Rapid, labored breathing Pink, frothy sputum Bulging neck veins Rapid pulse with cool, clammy skin

37. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies

38. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Hyperventilation Breathing too fast Usually associated with anxiety Exhales too much carbon dioxide

39. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory Emergencies Specific respiratory conditions –Hyperventilation Signs and symptoms Carpal pedal spasms Blurred vision Chest pain Syncope Numbness and tingling

40. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Summary Regardless of the cause, treat all patients with chest pain the same Be prepared for the patient experiencing chest pain to become unresponsive Never withhold oxygen from a patient complaining of difficulty breathing Only administer medications with the prior approval of your medical director