Transcript CHEST PAIN Introduction

CHEST PAIN
Introduction
• Chest pain (angina) may not be heart
attack but other cardiac event
• Cardiac events have potential to
progress to cardiac arrest
• EMT must treat cardiovascular events
as emergencies
• Accurate assessment and quick
management are keys to survival
Anatomy and Physiology
Review
• The left heart
– Left ventricle pumps blood around
systemic circuit
– Function of left ventricle estimated by
blood pressure
– Left ventricle not pumping adequately: low
systolic blood pressure
Anatomy and Physiology
Review (cont’d.)
• The right heart
– Right ventricle pumps blood to lungs
– Resistance is relatively low
– Requires less work than left ventricle
Anatomy and Physiology
Review (cont’d.)
• Coronary circulation
– Coronary arteries: supplies heart with
oxygenated blood
– Two main arteries branch off into several
smaller vessels
Coronary Artery Disease
• Pathophysiology of heart disease
– Atherosclerosis: process of fat buildup in
blood vessels
– Plaques or atheromas: deposits of fat
– Thrombus: blood clot
– Unstable angina: chest pains with little
exertion
– Acute myocardial infarction (AMI):
myocardial cell death
Figure 25.3
Atherosclerosis
narrows arteries
and impedes
blood flow
Coronary Artery Disease
(cont’d.)
• Risk factors
– Modifiable
• Smoking, obesity, cocaine, lack of exercise,
diet, high cholesterol
– Non-modifiable
• Sex, diabetes, age, hypertension, heredity
Signs and Symptoms
•
•
•
•
•
Tachycardia: heart beats too fast
Bradycardia: heart beats too slow
Weakness and nausea
Diaphoretic
Chest pain
Figure 25.5 Any pain from the
“nose to the navel” is cardiac until
proven otherwise
Signs and Symptoms (cont’d.)
• Noncardiac chest pain (see Table 25-3):
– Esophageal spasm
– Pleurisy
– Pneumonia
– Pneumothorax
– Rib fractures
– Gastric ulcer disease
Assessment
• Rule of thumb:
– “Any pain from nose to navel is cardiac
until proven otherwise”
• Primary assessment
– Unresponsive cardiac patient
• Begin CPR immediately
– Responsive cardiac patient
• History and focused physical examination
Assessment (cont’d.)
• History
– Onset
– Provocation
– Quality
– Radiation
– Severity
– Time/duration
Assessment (cont’d.)
• Preexisting medical conditions
– Ask about risk factors
– Hypertension
• Take blood pressure in both arms
• Difference of more than 20 mmhg may indicate
active dissection
• Hypotension may be sign of several disorders
Assessment (cont’d.)
• Baseline vital signs
– Helps determine speed at which condition
is changing
• Secondary assessment
– Focused physical examination
– Body’s effort to compensate
Assessment (cont’d.)
• Management
– Place patient in position of comfort
– Loosen constricting clothing
– Aspirin
– Nitroglycerin
Assessment (cont’d.)
• Reassessment
– Repeat vital signs as
needed
– Review history
– Be alert to possibility
of sudden cardiac
death and need to do
CPR
Transport
• Never allow patient to walk to
ambulance or stretcher
• Carry patient if necessary
• Ensure patient is comfortably seated
• Continuously monitor patient
• Avoid use of sirens and flashing lights
Transport (cont’d.)
• Aeromedical transportation
– For remote areas lacking specialized heart
centers
– Avoids traffic in urban areas
• ALS intercept
– Traditional emergency department
functions in field
Fibrinolytics
• Class of drugs used to treat AMI
• “Fibrinolytic”: to divide the fibrin
• Opens blocked arteries and
reestablishes blood flow
• Most effective within first few hours
• EMT must quickly transport patient for
rapid treatment
Interventional Cardiology
• Mechanically remove blockage
• Angioplasty
• Interventional cardiology techniques are
best first option
• Bottom line: blocked vessel must be
opened as quickly as possible
Conclusion
• Chest pain is one of most common
reasons EMS is called
• Ever-present possibility of sudden
cardiac death creates challenge
• Skills and knowledge put to ultimate test
• Thoughtful consideration and deliberate
action will improve chance for survival