Cardiac Emergencies:

1. 1 Cardiac Emergencies:

2. 2 Heart: 4 chambered muscular pump. Top called the base. Bottom called the apex. LORD.

3. 3 Atria: 2 top chambers. Right atrium pumps deoxygenated blood to right ventricle. Left atrium pumps oxygenated blood to left ventricle.

4. 4 Ventricles: 2 bottom chambers of the heart. Right ventricle pumps deoxygenated to lungs. Left ventricle pumps oxygenated blood to the entire body. Does most of the work = greater muscle mass. Most common site of injury.

5. 5 Valves: 4 located within the heart. Tricuspid. Pulmonary. Mitral or bicuspid. Aortic valve. Valves are also contained within the veins. Prevent back flow of blood.

6. 6 Cardiac Conduction System: Heart contains specialized conductive tissue. SA Node (pacemaker). Rate (60-100 bpm.). AV Node - between atria & ventricles Rate (40 - 60bpm.). Bundle of His carries impulse into right and left ventricle. Rate (20 - 40 bpm.) Purkinje Fibers imbedded in ventricular muscle. Causes ventricles to contract simultaneously propelling blood to lungs and body.

7. 7 Blood Vessels: Arteries carry oxygenated blood away from the heart. (exception pulmonary artery). Veins carry deoxygenated blood toward the heart. (exception pulmonary vein). Capillaries responsible for gas exchange and waste elimination.

8. 8 Blood Vessels: Arterioles connect arteries to capillaries. Venules connect veins to capillaries. Venae Cavae. Superior vena cava. Inferior vena cava.

9. 9 Blood: Red blood cells (Eurethrocytes). White blood cells (Leukocytes). Plasma Platelets (Thrombocytes).

10. 10 Blood Pressure: Pressure exerted during circulation of blood against the walls of the arteries. Systolic pressure = contraction of left ventricle. Diastolic pressure = relaxation of left ventricle.

11. 11 Perfusion The delivery of oxygen and nutrients and the elimination of waste products Shock (Hypoperfusion) Causes Low fluid Insufficient pump Pipe damage - dilated or leaking vessels

12. 12 Cardiac Compromise Time is muscle Permanent damage begins within first few hours of cardiac event CPR started within first 4 minutes Defibrillation Thrombolytic Drugs Clot busters

13. 13 Assessment Scene size up Initial assessment General impression 2 categories Unresponsive with no respirations or pulse Responsive patient

14. 14 Unresponsive Act immediately Patient�s older that 12 Begin CPR Apply AED Children younger than 12 or weighing less than 90 lbs.. Begin CPR

15. 15 Responsive Assure airway, breathing and circulation Note skin color, temperature, and condition Note type, location, and intensity of any pain Note any signs and symptoms of cardiac compromise Apply 15-lpm. per NRB Make early transport decision

16. 16 Focused History and Physical Exam If patient appears unstable, do not delay transport. Obtain history from patient, family or bystanders Determine if patient has been prescribed nitroglycerine Obtain vital signs

17. 17 OPQRST Onset - what triggered it Provocation - does anything make it better or worse Quality - describe the pain, sharp, dull squeezing, crushing, burning Severity - scale from 1 to 10 Time - When did the pain start, how long have you had it

18. 18 Signs & Symptoms Depends on patient�s individual response blood loss degree of heart damage 20% of heart attacks are painless or silent

19. 19 Pain or discomfort - location Sudden diaphoresis Dyspnea Lightheadedness or vertigo Anxiety and irritability Felling of impending doom Abnormal or irregular pulse rate Abnormal blood pressure Nausea or vomiting Signs & Symptoms

20. 20 Emergency Medical Care Big O�s Decrease anxiety/POC Assist with patient�s nitro./ Med. Control Consider ALS backup Initiate early transport Consider detailed physical exam Ongoing assessment Be prepared to perform CPR

21. 21 Nitroglycerine Vasodilator Dilates arteries increasing blood flow thereby increases O2 supply and decreases workload of the heart Dose 1 tablet or spray under tongue (sublingual) Repeated every 3-5 minutes, maximum of 3 doses Systolic B.P. above 100 Must have authorization from Medical Control

22. 22 Angina Pectoris Inadequate supply of oxygen to myocardium causes pain CAD Ischemia - tissue hypoxia Occurs during periods of stress Physical or emotional Pain usually relieved by rest or nitro. Pain usually last from 2 to 10 minutes Patient will usually tell the medic of Angina History

23. 23 Acute Myocardial Infarction (AMI) Commonly called �heart attack� Total or sudden blockage of blood flow through coronary artery Necrosis - tissue death CAD Usually occurs in left ventricle, but can occur anywhere in myocardium Treatment - rapid transport for thrombolytic therapy

24. 24 Signs & SymptomsAGINA VS. AMI Chest pain or pressure Anxiety Dyspnea, SOB. Diaphoresis Nausea and or vomiting Complaint of indigestion pain Chest pain or silent Anxiety Dyspnea Sense of impending doom Diaphoresis Nausea and or vomiting Lightheadedness or vertigo

25. 25 Treat all cases of chest pain as a cardiac emergency!

26. 26 Congestive Heart Failure Damaged myocardium causes inadequate pumping Increase in heart rate to maintain perfusion Enlargement of left ventricle Pressure changes Pulmonary edema (fluid in lungs) JVD Pedal edema

27. 27 Signs & Symptoms Can be acute or chronic Dyspnea - 1 or 2 word Great anxiety Desire to sit upright Chest pain - may or not be present JVD Pedal edema Rapid shallow respirations Rapid pulse Wheezing, rales, or fluid sounds during breathing

28. 28 Emergency Medical Treatment Big O�s Calm and reassure patient Place in POC Consider ALS backup Make early transport decision