Transcript CARDIAC COMPLAINTS

SILVER CROSS EMS
EMD CE
FEBRUARY 2012
 Cardiovascular:
 ischemia (AMI or angina)
 pericarditis (irritation of pericardium)
 thoracic aortic dissection
 Respiratory:
 PE (pulmonary embolism)
 pneumothorax
 pneumonia
 pleural irritation
 hyperventilation (anxiety)
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Gastrointestinal:
cholecystitis (gall
bladder/gallstones)
pancreatitis
hiatal hernia (part of stomach
pushes through diaphragm)
esophageal disease/GERD
peptic ulcers
dyspepsia (indigestion)
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Musculoskeletal:
chest wall syndrome (inflamed
chest wall)
costochondritis (inflamed rib
cartilage)
herpes zoster (shingles)
chest wall trauma
chest wall tumors
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There are literally dozens of illnesses, injuries
and conditions that can cause chest pain.
Knowing common signs, symptoms and
patient presentations can help you
differentiate between different kinds of chest
pain.
Bottom Line: If you are ever not sure what
kind of chest pain you are dealing with, treat
it as cardiac.
QUESTIONS TO HELP DIFFERENTIATE
CHEST PAIN
•CAUSE
•ONSET OF PAIN
•CHARACTERISTIC OF PAIN
•LOCATION OF PAIN
•HISTORY
•ASSOCIATED Signs & Symptoms
•AGGRAVATING FACTORS
•RELIEVING FACTORS
All are further explained in
following slides
What were the doing when the pain started?
Constant?
Sudden?
How Long has it been going on?
How severe is it?
1-10 scale with 10 being the worst
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Is there anything that makes it better or
worse?
◦ Movement or Exertion (might be muscular or
cardiac)
◦ Deep breaths or coughing (might be lung or
muscular)
◦ Rest (could be angina or muscular)
◦ Position (could be muscular)
◦ Pain relievers or Antacids (usually not cardiac)
◦ Stress (may be anxiety or cardiac)
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PLEURITIC (sharp pain with inhalation)
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SPASMODIC (like a spasm)
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TIGHTNESS OR HEAVINESS
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PRESSURE- OPPRESSIVE
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SHARP/LOCALIZED (easy to pinpoint)
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VISCERAL (hard to pinpoint)/BURNING
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TEARING / EXCRUCIATING
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SUBSTERNAL
CENTER OR ACROSS CHEST
LATERAL CHEST
LOCALIZED OVER INVOLVED AREA
LOWER CHEST/EPIGASTRIC
RADIATES TO JAW, NECK, BACK OR ARM
VAGUE
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AGE
PREVIOUS EPISODES
UPPER RESPIRATORY INFECTION/FEVER
TRAUMA
STRESS
EMOTIONAL UPSET
CARDIAC DISEASE – HIGH BLOOD PRESSURE,
CORONARY ARTERY DISEASE, ANGINA
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DYSPNEA (Difficulty Breathing)
DIAPHORESIS (Sweating), COOL OR CLAMMY SKIN
NAUSEA / VOMITING
ALTERED MENTAL STATUS (Including Anxiety and
Restlessness) /WEAKNESS /LIGHTHEADEDNESS / SYNCOPE
(Fainting)
DECREASED OR ABNORMAL BREATH SOUNDS
CYANOSIS (Bluish tint to skin from lack of oxygen)
HEMOPTYSIS (coughing up blood)
PULSATING ABD MASS
ABDOMINAL or BACK PAIN
PAIN WITH PALPATION
RASH OR LESIONS
ABNORMAL BLOOD PRESSURE
Sudden onset of pain
that does not go away
with rest or analgesic
Medication. Pain will be
Substernal (center of
chest, behind breast bone)
and sometimes
radiate to left jaw, back
or shoulder.
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Shortness of breath
Skin color will be poor with sweating
Victim may be nauseated, lightheaded or
dizzy
Pain description usually varies from a
pressure/heaviness to sharp or crushing
Pain may be relieved with Nitroglycerin if
patient has been prescribed for Angina pain
WHEN IN DOUBT, ASSUME HEART ATTACK!
The next slide shows a variety of
conditions that may cause chest
pain and some of the other
associated signs and symptoms
for your review.
COMPARISON OF CHEST PAIN
CAUSE
ONSET OF PAIN
Acute MI
Sudden onset,
Pressure, burning, aching, across chest, may
duration >30-60 mins. tightness, choking
radiate to jaw and neck,
down arms and back
Angina
sudden onset, lasts
minutes
aches, squeezing, choking, substernal,may radiate to Hx of angina, circumheaviness, burning
jaw, neck, arms or back stances precipitating,
pain characteristics,
relieved by nitro
Dissecting
Aneurysm
sudden onset
excruciating, tearing pain center of chest, radiates non-specific, pain
into the back or abdomen usually worse at onset
Pericarditis
most common- suddensharp, knife-like
onset
retrosternal, may radiate Hx of URI or fever
to the neck & left arm
deep breats, chest move-sitting upright, leaningfriction rub, paradoxic
ment, swallowing
forward
pulse
Pneumonia
gradual, varies
pleuritic, sharp
localized over affected
area
URI, elevated temp
breathing, laying
down
Pneumothorax
sudden onset
tearing, pleuritic
lateral chest (AS)
no hx-spontaneous
chest trauma
respiration
chest wall movement
Pulmonary Embolussudden onset
crushing-most common
can mimic AMI or anginal
lateral chest
phlebitis, a fib
respiration
smoking, BCP, post surgical, prolonged inactivity
Gastrointestinal
sudden onset
gripping, burning, spasmodiclower substernal, upper
or constant
abdomenal
Hiatal hernia
sudden onset
sharp, severe
lower chest, upper abdomen
may or maynot be
present
heavy meals, supine
position
mild activity (walking),
bland diet, antacids,
semi-fowlers or sitting
upright
vague or diffuse c/o CP
vague
increased RR
reduce anxiety,
Hyperventilation / sudden onset
CHARACTERISTIC OF PAIN LOCATION OF PAIN
HISTORY
PAIN WORSENED BY
PAIN RELIEVED BY OTHER
40-70 years,
may or maynot have
hx of angina
movement, anxiety
nothing- no movementShortness of breath,
position or breathing diaphoresis, anxiety,
Medication-MS
weakness
may or maynot be
present
hyperventilation,
lying down, eating, stress,rest, oxygen, nitro
cold weather, exertion,
anger
nothing
position, meds
unstable anginaappears at rest
BP difference betwee
R & L arms
dyspnea,decrease
or abn. BS,
decreased BP
dyspnea, increased HR
decreased BS, trachea
deviation (UAS)
holding breath
cyanosis, dyspnea,
hemoptysis
"impending doom"
eating or ETOH, supine antacids, bland diet
position
"can be talked down"
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The heart must receive a constant supply of
oxygen or it will die.
The heart receives its oxygen through a
complex system of coronary arteries.
◦ These arteries may narrow as a result of
atherosclerosis.
◦ Progressive atherosclerosis can cause angina
pectoris, heart attack, and cardiac arrest.
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Results when one
or more of the
coronary arteries is
completely
blocked
Two causes of
coronary artery
blockage:
◦ Severe
atherosclerosis
◦ Blood clot
Your protocol will be changing to include the administration of
aspirin to victims that may be having a heart attack.
Why, you ask? Read on……
 Most heart attacks develop when a cholesterol-laden plaque in a
coronary artery ruptures. Relatively small plaques, which produce
only partial blockages, are the ones most likely to rupture. When
they do, they attract platelets to their surface. Platelets are the
tiny blood cells that trigger blood clotting. A clot, or thrombus,
builds up on the ruptured plaque. As the clot grows, it blocks the
artery. If the blockage is complete, it deprives a portion of the
heart muscle of oxygen. As a result, muscle cells die — and it’s a
heart attack.
 Aspirin helps by inhibiting platelets. Only a tiny amount is
needed to inhibit all the platelets in the bloodstream; in fact,
small amounts are better than high doses. But since the clot
grows minute by minute, time is of the essence. Chewed Aspirin
can work in 5-15 minutes and can really make a difference in
patient outcome.
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Key questions will
include:
 Descriptions of pain
and associated S & S
 Availability of aspirin
on scene
 Allergies to aspirin
 Bleeding disorders or
recent GI bleed
Most be aspirin or aspirin
containing product.
Pre-arrival Instructions:
 Calm, reassure patient
 Let them assume
comfortable position and
loosen tight clothing
 If they have medications for
chest pain follow their
doctors orders
 If there are no
contraindications, advise
them to chew 1 adult or 4
low dose (baby) aspirins
which they may follow with
a few sips of water
Other pain relievers do
not have the same affect!
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The final revisions are being made and will be
going to Dr. Dave for approval soon. Watch
for future announcements and flipchart
review sessions to go over the changes.