Cardiac Emergencies  (book notes)

Oxygen is the most important medication for a cardiac emergency 
The heart can have a range of problems, Chest pain usually means that muscle is dying.
Signs and symptoms vary
                Most common = chest pain
                10-20% of pts w/ heart attacks experience no chest pain            

 bradycardia = <60 beats pm tachycardia =  > 100 beats pm
 hypotensive = <90 systolic

 hypertensive = >150 systolic

Patient Assessment
                Initial assessment
                Focused history
                Physical exam
                History of present illness                                

O
P
Q
R
S
T		 Onset
Provocation
Quality
Rate
Severity
Time

                SAMPLE

S
A
m
P
L
E
 Signs/Symptoms
Allergies
Medications
Past Medical Hx
Last Oral Intake
Events leading to emergency

                Baseline vitals                

Signs/symptoms commonly associated w/ cardiac comprise

Pain, pressure, discomfort in chest or upper abdomen (epigastrium)
Difficulty breathing
Palpations
Sudden onset of sweating, nausea, vomiting
Anxiety (doom)
Abnormal pulse (not 60-100 for adults)
Abnormal BP (not 60-90/90-150)

Do-
1.      position of comfort
2.      high concentration O2 thru nonrebreather
    a.       if altered mental status open airway
    b.      if not breathing adequately ventilations
3.      transport immediately if
    a.       no cardiac hx
    b.      hx of cardiac, pt has no nitorglycerin
    c.       systolic = <100
4.      assist w/ nitorglycerin if  ALL of these
    a.       chest pain
    b.      cardiac hx
    c.       prescribed nitorglycerin
    d.      prescribed nitro is there
    e.       systolic is +100
    f.        medical direction authorizes
5.      give 2nd dose of nitorglycerin IF ALL of these:
    a.       no relief
    b.      systolic is +100
    c.       medical direction authorizes

maximum # doses of nitorglycerin = 3
       0.4 mg=1 dose spray or tablet .... max 3 doses 1 x5mins  max dose = 1.2mg

if BP falls below 100 systolic (diastolic/systolic)

treatment for hypofusion (shock) + transport immediately

  Cardiac Arrest             

Elements of Chain of Survival

Early Access community provides
Early CPR EMT provides
Early Defibrillation
    Is the most important factor determining survival
    If +8mins from arrest – defibrillation …no chance of survival
    8 mins is max response time for defibrillation 		EMT provides
Early Advanced Care  

                The typical pt in cardiac arrest is a man in 60’s

 

                Mgmt of Cardiac Arrest:

                                EMT-B provides 2 links: CPR & defibrillation
                               

AEDs are only attached to pts who are
Unresponsive
Pulseless
Not Breathing

Ventricular Fibrillation Ventricular Tachycardia Pulseless Electrical Activity

Asystole

50% of all pts in cardiac arrest V-Tach 15-20% of cardiac arrest pt’s 20 – 50% of cardiac arrest pts
Primary electrical disturbance causing cardiac arrest Very fast heart muscle fails, but electrical activity is normal heart’s electrical activity has ceased
is a chaotic electrical disturbance Very unusual (less than 10% of out of hospital attacks) normal electrical activity, but pump fails no electrical activity = no pumping
    almost always terminal  no pulse
  if pt is ALERT & HAS PULSE-do NOT attach AED
The AED would advise a shock IF attached		 may mean too much blood loss no respirations
      flatline
Is a shockable rhythm Pulseless V-tach is shockable NOT shockable NOT shockable
 

 

 

   result of
ventricular fibrillation
sick heart
terminal illness,
blood loss

                                  So….6-7/10 pts with cardiac arrest will be shocked by AED

                                               

 

                               

  EMS 101

  AED

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