Transcript Chest Pain
The Beat Goes On… “The mind can only learn, What the butt can endure! ” Mnemonics CTH JPN, JFN OTD, AMF FIG LOLNADWADAO OGMOF TSTD TMBD DRT Crazier than hell Just plain nuts…. Out the door, Adios my friend Found in gutter Little old lady, no apparent distress, weak and dizzy all over Oh great mound of flesh Too stupid to die Too many birthdays Dead right there Cardiac Arrest Cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation Cardiac Arrests in the U.S. 330,000 coronary heart disease deaths occur out-of-hospital on in hospital E.R.’s annually 2/3rd’s of unexpected cardiac deaths occur without prior recognition of cardiac disease 60% of unexpected cardiac deaths are treated by EMS EMS treats 107,000-240,000 cardiac arrests in the U.S. Of these, 20 to 38% have V-fib or V-tach as the first recorded rhythm (21,000-91,000 vfib arrests annually Get Back To The Basics O-ONSET P-PROVOCATION Q-QUALITY R-RADIATION S-SEVERITY T-TIME Onset Sleeping Exercising Resting Beating the kids Provocation Activity Sports Resting Lifting Strenuous actions Quality Sharp Knifelike, stabbing, piercing Dull “There’s an elephant sitting on my chest” Squeezing “Tight band around my chest” Pain through to the back Radiation Men: left jaw, left neck, left chest, left arm Women: Any presentation of pain anywhere can result in cardiac complications! (almost) Severity Ask them: “On a scale of one to ten, with ten being the worst pain you have ever had, what number would you rate your pain?” Time “How long have you been bothered by this episode of pain?” Minutes, hours, days Visual and Tactile Assessment (yes, you have to look at and touch your patient!) What are their living conditions like? (clean, dirty, poverty) What do they look like? (thin, fat, goofy, dirty, or extremely clean and organized) Skin condition: pale, diaphoretic, cool, clammy, hot, red, moist, dry Multiple pill bottles …meanwhile back at the Ranch A-airway B-breathing C-circulation D-deficits E-exposure F-Fahrenheit G-gadgets H-history I-inspect Gadgets Cardiac monitor Blood pressure Saturation monitor Glucose monitor Medications OXYGEN MORPHINE ASA NITRO! REMEMBER! Treat the Patient Not The machine! Drug therapy Oxygen 15 liters non-rebreather mask Aspirin 81 mg p.o. Nitroglycerin 0.4 mg S.L. every five min. up to 3 Morphine (Intermediate, Paramedic) 2-5 mg I.V. A cardiac patient needs TWO things… YOU CANNOT PROVIDE EITHER OF THESE TWO THINGS Rhythm Interpretation The 4 “thingy’s” to Rhythm Interpretation Is there a P wave? Is there a QRS complex? Are they “married” (p wave with every QRS complex) Is the rate regular, fast, or slow? What is the “P” wave? The first “bump” in the tracing It represents the Atrium depolarizing What is the “Q” wave? The first downward deflection in the tracing The Q wave is often not present. What is the “R” wave? It is the first upward deflection in the tracing It is associated with the ventricle depolarizing What is the “S” wave? The downward deflection after the “R” wave in the tracing. Ventricle depolarizing What is the “T” wave? The first bump after the QRS complex in the tracing. It represents the ventricle repolarizing How to figure out the Rate First: Find a specific R wave that falls on a heavy black line. Next: Count off “300, 150, 100” for each heavy black line that follows. Then: Count off the next three lines after “300, 150, 100” as “75, 60, 50.” Memorize these triplicates. Still figuring the Rate At the top of the EKG tracing are small marks which signify “three second” intervals. Taking two of the three second intervals, we have a six second strip. Count the number of complete cycles (R wave-to-R wave) Multiply the number you get by 10. Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia Ventricular Tachycardia Ventricular Fibrillation Asystole Idioventricular Rhythm Atrial Fibrillation Atrial Flutter Premature Ventricular Contractions(P.V.C.’s) Pacer Spikes Pulseless Electrical Activity 1st Degree Block Lengthening P-R interval Regular Rhythm 2nd Degree Block Wenckebach or Type 1 P-R Interval lengthens and then drops a QRS complex 2nd Degree Block Type 2 QRS complex drops without warning rd 3 Degree or Complete Block Complete disassociation of the P-waves and the QRS complex’s What about your patient? What changes will you see, or should you see in your patient? Oxygen—decrease in chest pain ASA—makes RBC’s slick, decreases clotting abilities NTG.—decrease in chest pain, hypotension, nausea, dizziness. Morphine—Decreases work load of the heart, decrease in chest pain, decrease in all pain, hypotension, nausea, dizziness, respiratory depression. Now that we are all EDUCATED (or if your from Utah County, learned) What good is it? What causes cardiac pain? Lack of oxygen enriched blood to the heart tissues Blockage Narrowing of the passageways Lack of oxygen in the blood stream Damaged or inefficient pump Complete obstruction of the Left Anterior Descending Coronary Artery Circumflex Artery Heart Catheter Left Anterior Descending Coronary Artery Opened to blood flow ….and how do we cure it? INCREASE THE OXYGEN IN THE BLOOD! GET THAT BLOOD TO THE HEART! There are two things a cardiac patient needs… and you cannot provide either of the two. Thrombolytics Cath lab Soooooo, after all that, what else causes CHEST PAIN? Muscle aches Pneumonia Pleurisy Costochrondritis Rib fractures Virus’ Flu One of the best diagnostics tool you have is….. ….your GUT instinct! Thank You The End!