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SAED Recertification

SAED Recertification. Prepared by: Program Co-ordinator: Tim Dodd Program Manager: Ken Stuebing. Hamilton Health Sciences Base Hospital Program. Clinical Staff Medical Director Dr. Welsford Program Managers Steve Dewar Ken Stuebing Program Co-ordinator Tim Dodd. Course Overview.

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SAED Recertification

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  1. SAEDRecertification Prepared by: Program Co-ordinator: Tim Dodd Program Manager: Ken Stuebing

  2. Hamilton Health SciencesBase Hospital Program Clinical Staff • Medical Director • Dr. Welsford • Program Managers • Steve Dewar • Ken Stuebing • Program Co-ordinator • Tim Dodd

  3. Course Overview • Chain of Survival • Pathophysiology Review • Respiratory • Circulatory • Cardiac Monitoring • Protocols • Special Circumstances • CPR & SAED Reminders

  4. Chain of Survival • Early Access (911) • Someone must realize there is an emergency an act quickly to initiate the EMS. • Early CPR • A trained individual starts CPR at once to help maintain a viable heart until help arrives. • Early Defibrillation • The first responder arrives with the training and equipment to defibrillate the heart. As time increases chances for survival decrease. • Early Advanced Life Support • ALS delivered within minutes also increases the chance for survival.

  5. Chain of Survival

  6. RESPIRATORY SYSTEM

  7. Respiratory System • UPPER RESPIRATORY TRACT: • Warms, Filters & Humidifies • Nose / Mouth • Pharynx • Voice box • LOWER RESPIRATORY TRACT: • Air Exchange • Trachea • Bronchi • Bronchioles • Alveoli

  8. LUNGS Air travels down the trachea until it enters alveoli. GAS EXCHANGE ONLY HAPPENS IN THE ALVEOLI! (STOP COMPRESSION & give slow, gentle, deep breaths) WHERE THE CIRCULATORY SYSTEM AND RESPIRATORY SYSTEM JOIN

  9. How Air Enters The Lungs INSPIRATION: - Diaphram contracts. (drops) - Intercostal muscles contract. (ribs go up & out) - Creates a negative pressure in the lungs (alveoli) in comparison to the atmosphere. - Atmospheric air rushes in to fill void. - Gas exchange occurs by diffusion. EXPIRATION: - Muscles relax Raises Pressure - Forces Air Out

  10. Oxygen Saturation • The paramedic will be able to initiate pulse oximetry monitoring and monitor the effectiveness of the patient’s respiratory status and treat to ensure that adequate and effective oxygenation is maintained. • How can the monitor be fooled?

  11. Factors Affecting Oximetry • Strong ambient light sources • Poor circulation • Cardiac arrest • Hypothermia • Shock • Anemia • CO poisoning • Nail polish

  12. Oxyhemaglobin Disassociation Curve

  13. Take Home Points • Oxygen saturation measurement may be utilized to monitor a patient’s condition but should not be used to make decisions to restrict oxygen delivery when the patient appears ill or has a condition that may require supplemental oxygen. • Remember to treat the patient not the monitor. If the patient appears ill and you feel oxygen will benefit the patient, give oxygen! - it grows on trees.

  14. Circulatory System

  15. Expectation of the PCP • Knowledge of Circulatory System components (Pipes, Pump & Fluid) • Knowledge of: heart conduction and it’s relation to specific ECG waves as well as how these waves are related mechanically to the heart muscle • Specific rhythms • NSR, VF, VT, PVC’s, Asystole, PEA, Artifact, Paced Beats.

  16. The Heart (pump)

  17. Echocardiography

  18. Heart Valve Replacement

  19. Blood Vessels - Pipes • Arteries: • carry blood away from the heart. • thick muscular walls. (3 layers) • Veins: • bring blood back to the heart. • thinner walls. (3 layers) • have valves to stop back flow. • Is the spare blood reservoir. • Capillaries: 1 cell thick. (tissue paper) • join arteries and veins together. • wraps cell & alveoli. • where diffusion takes place.

  20. Blood Vessel Diseases • Arteriosclerosis • host of diseases which cause thickening & hardening of arterial walls. • Plaque formation, calcium build up & occlusion of small branching blood vessels. • Clots can dislodge and occlude smaller vessels. • Aneurysm • weakened area in the wall of an artery will tend to balloon out & may burst.

  21. Atherosclerosis

  22. Angiogram

  23. Angioplasty

  24. Blood - Fluid • Consists of: • Red Blood Cells (RBC): which carries the oxygen from the lungs to the cells and carbon dioxide from the cells to the lungs. • White Blood Cells (WBC): which is part of our immune system to fight against infection.

  25. Blood - Fluid • Consists of: • Platelets: form the base for clots. • Plasma: water component which carries all these components. • Clotting Factors: 12 factors which work in a complicated cascade to form a clot. All 12 are needed and stored blood does not cave all 12. • Any factor affecting the ability of blood to carry oxygen to the heart and brain can cause tissue damage.

  26. M.I. – Myocardial Infarction muscle / heart death • M.I. = death of the heart muscle • Death of the muscle is due to starvation of oxygen & nutrients. • Other causes . . . • disruption of blood supply • blockage of a coronary artery, aneurysm • asphyxiation • e.t.c.

  27. Angina Pectoris • Angina pain is caused by an inadequate oxygen supply to heart. • Supply and demand • spasm, inability to open. • stress, cold,  MVO2. • Pain is similar to that of an MI • is usually relieved by: rest, nitroglycerin, oxygen

  28. STROKE or CVA • CVA - Is very similar to an MI, - irreversible damage is done to the brain by lack of blood supply. • Tissue death results from starvation of oxygen and nutrients. • Disruption of blood supply: • blockage of a cerebral artery, aneurysm • asphyxiation, strangulation • heart attack, e.t.c.

  29. STROKE • Oxygen and nutrients are supplied to the brain by two arterial systems • carotid - left and right • vertebral - left and right • Blood is returned from the brain via two large veins (left and right jugulars) • Brain receives 20% of CO • A Stroke occurs when the brain is deprived of oxygen

  30. Take Home Points • Stop compressions and allow time for diffusion of gasses. • Remember not all cardiac pain is the same. • If you are at risk for heart attacks you are at risk for stroke • a new stroke campaign is about to start in our area

  31. Cardiac Monitoring

  32. Normal Electrical Conduction

  33. Electrocardiogram

  34. Dysrhythmia Interpretation: • 5 Steps Approach • Step 1: What is the rate? • bradycardia < 60 bpm • tachycardia > 100 bpm • Step 2: Is the rhythm regular or irregular? • Step 3: Is there a P wave - is it normal? • are P waves associated with each QRS? • Step 4: P-R Interval/relationship? • PR interval (normal .12 - .20 sec) • Step 5: Normal QRS complex? • Normal QRS complex < .12sec

  35. Lethal Dysrhythmias • There are four major life threatening Pulseless Dysrhythmias: • NON SHOCKABLE RYTHMS 1) Asystole - Flat Line 2) PEA - Pulseless Electrical Activity • SHOCKABLE RHYTHMS 3) VF - Ventricular Fibrillation 4) VT - Pulseless Ventricular Tachycardia

  36. Asystole • No heart electrical activity • No excitation of the heart muscle • No Cardiac output

  37. Normal Sinus Rhythm • Regular heart electrical conduction • Heart Rate avg. 72 beats / minute • Normal Cardiac Output

  38. Pulseless Electrical Activity • PEA is an electrical disturbance in which an electrical stimulus is being generated but the muscle is NOT reacting. • DO NOT assume that since there is a rhythm on the screen that the patient has a pulse!!

  39. Ventricular Tachycardia • Stimulus is originating from the ventricles • Heart (pump) is cavitating by beating too fast • Poor cardiac output, but may produce a pulse • The SAED will shock V.T. with-in preset limits.

  40. Ventricular Fibrillation • No organized excitation of heart muscle • Heart is physically quivering compared to contracting (seizing) • No Cardiac Output Chances of survival decline ~ 7 to 10 % for every minute that defibrillation is delayed.

  41. Defibrillation • Defibrillation applies electrical energy to the heart muscle • This energy causes depolarization of all heart cells at the same time. • Therefore all repolarize at the same time. • We hope this starts an organized perfusing rhythm • We only apply a shock, via the S.A.E.D, to the heart of a VSA patient

  42. Other Rhythms

  43. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? ~ 90 bpm Irregular P waves normal, extra beats have associated P wave 0.12 - 0.20 sec Yes PACs

  44. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? Variable < 100 Irregularly Irregular No P waves None Yes Atrial Fibrillation

  45. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? A = 300 bpm V = 75 - 150 bpm Irregular -Variable Sawtooth P waves - March through QRS NA Yes Atrial Flutter

  46. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? Variable ~ 100 Irregular P waves Associated with most QRS Yes - not all Yes - but not all PVC - unifocal

  47. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? 150 Regular No P waves NA Yes Accelerated Junctional

  48. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? 40-70 Irregular P waves regular Not always with a QRS longer each beat Yes Second Degree AV Block Type 1

  49. Step 1: Rate? • Step 2: Regular or irregular? • Step 3: Is the P wave normal? • Step 4: P-R Interval/relationship? • Step 5: QRS complex < 0.12 sec? < 30 bpm Regular P waves normal, not associated with all QRS None Yes 3rd degree Heart Block

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