Transcript Cardiovascular Emergencies

Cardiovascular
Emergencies
CHAPTER 17
Review
Circulatory System
◦ Three major components
Conduction System
◦ Specialized cells
◦ Three pacemaker sites
◦ Sympathetic nervous system
Heart
◦ Right Ventricular Failure
◦ Usually caused by COPD
◦ Left Ventricular Failure
◦ High Blood Pressure or damage
The Vessels
The Blood
◦ Formed elements
 Thrombus
 Platelets
 Thrombin
 Fibrin
Electrocardiogram
Graphic representation of the heart’s electrical activity
Human body acts as a conductor
If conduction is damaged or disturbed causes PVC’s
◦ Too many PVC’s can result in V-Tach
 Depolarization
 Repolarization
P
wave
 QRS complex
 T wave
Blood Pressure
Amount of pressure exerted on the arterial wall during circulation
◦ Systolic
◦ Diastolic
Inadequate Circulation
PerfusionHypoperfusion
◦ What are the causes?
Cardiac Compromise & ACS
AHA reports 7-8 million seek treatment for chest discomfort
2 million will actually have a cardiac related event
1.5 million will have MI
500,000 will die from MI
250,000 will die within 1 hour of onset of signs & symptoms
Cardiac Compromise & ACS
Key treatment
◦ Early recognition
Time is critical-time is muscle
Death of muscle is permanent
Atherosclerosis
•Smallest arterial
structures to become stiff
& less elastic
•Inflammatory disease
•Starts at innermost lining
of vessels
•Common Risks
Smoking
Diabetes
Hypertension
High LDL’s
Low HDL’s
Acute Coronary Syndrome
Unstable Angina
◦ Discomfort that is prolonged or worsening, or occurs without exertion
Myocardial Infarction
◦ Muscle death
Angina Pectoris
PATHOPHYSIOLOGY
SIGNS/SYMPTOMS
Inadequate O2 supply to heart
muscle
Steady discomfort
Cool, clammy skin
Lack of O2 causes the discomfort
Anxiety
Dyspnea
Usually occurs during time of stress
Usually will go away within 2-15
minutes
Diaphoresis
Nausea &/or vomiting
Indigestion
Assessment
Women, elderly & diabetics may not experience these symptoms
Pain usually goes away with Nitro
If pain does not go away then question MI
Treatment
Maintain airway
O2 NRB @ 15 L
Assist with Nitro with medical direction permission
Administer ASA 160-325 mg per protocol
Acute MI
PATHOPHYSIOLOGY
SIGNS & SYMPTOMS
Causes severe narrowing or
complete blockage to coronary
arteries
Chest discomfort
After 20-30 minutes without O2,
cells begin to die
Anxiety
Ischemic heart tissue will become
irritable
Goal-reestablish blood flow
◦ Catheterization
◦ medications
Symptoms last longer
Nitro does not relieve
Dyspnea
Sense of impending doom
Diaphoresis
Nausea &/or vomiting
Light-headed/dizzy
Weakness
Feel like need to have BM
Assessment
Diabetics, elderly, & women usually do not experience these symptoms
Reassessing constantly due to risk for cardiac arrest
Never leave alone
AED must be close
Airway
O2
Position of comfort
Assist with Nitro per medical control
160-325 mg ASA per protocol
ACS in Female patients
“CLASSICAL” FINDINGS
“ATYPICAL” FINDINGS
Dull substernal chest pain
Neck ache
Pressure in the chest
Respiratory distress
Nausea, vomiting
Pains in the back, breast, or upper
abdomen
Tingling in fingers
Unexplained fatigue or weight gain
Diaphoresis
Insomnia
Aortic Aneurysm or Dissection
Pain may be confused with MI
Aortic Aneurysm
◦ Weakened wall of vessel
◦ Occur most often in abdominal region
◦ Aorta usually not felt, but will feel pulsating mass when in final stage
Aortic Dissection
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Tear in lining
Occur in thorax
Pain described as sharp or tearing
Syncope may be only sign
Sometimes can mimic stroke or MI
Systolic BP difference of 20 mmHg between upper arms
Severe pulse amplitude difference from upper & lower extremities
Aortic Aneurysm or Dissection
Treatment
O2
Do not administer ASA
Rapid transport
Heart Failure
Inability for heart to blood out of ventricle
◦Causes
◦Heart damage
◦Valve disorder
◦Hypertension
◦Pulmonary edema
◦Cardiac rhythm disturbance
◦Certain drugs
Need figure 17-12
Heart Failure
LEFT SIDE
RIGHT SIDE
Left ventricle unable to pump
effectively
Blood backs up venous system
Reduces blood flow to the body
Creates a traffic jam
Can lead to pulmonary edema
Causes
◦ Hypertension
◦ COPD
Cardiogenic Shock
Can occur in either right or left failure
Fail to pump enough blood to meet body needs
Common cause MI
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Sustained hypertension
Valve damage
Extremes in heart rate
Other cardiac muscle diseases
What’s the difference?
LEFT FAILURE
RIGHT FAILURE
Cardiac output drops
Hypoxia
Drop in systolic BP
Diminished or absent peripheral pulses
Respiratory distress
Altered mental status
Jugular vein distention
Changes in heart rate
Peripheral edema
Poor urinary output
Respiratory distress
Inspiratory crackles (rales)
Possible pulmonary edema
Congestive heart Failure
Buildup of fluid
Commonly leads to pulmonary & perpheral edema
Fluid accumulates in liver causing it to enlarge
May also collect in abdomen
Treatment
These patients will commonly tell you “I’m on a water pill”
Airway
Oxygen
Nitroglycerin for chest discomfort per protocol
Continually assess
Hypertensive emergencies
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
Primary hypertension-most
common
Strong bounding pulse
Skin warm, dry, or moist
Severe headache
Secondary hypertension-caused by
underlying disease process
Ringing in the ears
Nausea/vomiting
Elevated BP
Respiratory distress
Chest pain
Seizures
Focal neural deficits
Possible nosebleed
Indications of organ dysfunction
Treatment
Airway
Oxygen
Position of comfort-preferred semi fowlers
nitroglycerin
Potent vasodilator
Works quickly
Can be sublingual or a spray
Indications
◦ Signs & symptoms of chest pain
◦ Physician prescribed medication (POM)
◦ EMT received approval from medical control
Contraindications
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Baseline SBP <90 mmHg
HR less than 50 or greater than 100
Suspected head injury
Infant or child
3 doses have been given
Patient has taken Cialis, Levitra, or Viagra within last 24 hours
Nitro continued
Administration
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Complete history
Assess baseline vital signs
Obtain approval from medical control
6 rights
Wear gloves when giving medication
Place under the tongue
Reassess after 2 minutes
Document
Dosing
◦ 0.4 mg(SL) or 0.3 mg (spray) every 3-5 minutes X 3 doses
◦ If Nitro is still active-will create tingling sensation under tongue
Nitro
ACTIONS
SIDE EFFECTS
Dilates blood vessels
Headache
Decreases workload of heart
Drop in BP
Decreases cardiac oxygen demand
Change in pulse rate
Assessment & care guidelines
Scene Size up
Primary assessment
Secondary assessment
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SAMPLE history
OPQRST
Physical exam/baseline vital signs
Signs & symptoms