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Unformatted text preview: CARDIOVASCULAR EMERGENCIES EMERGENCY MEDICAL EMERGENCY TECHNICIAN - BASIC TECHNICIAN Temple College EMS Program 1 Cardiovascular Disease s 63,400,000 Americans have one or 63,400,000 more forms of heart or blood vessel disease disease s 50% of all deaths are cardiovascular 50% disease disease Temple College EMS Program 2 Cardiovascular Disease sAcute Myocardial Infarction (Heart cute yocardial nfarction Attack) - leading cause of death in U.S. Attack) s 1.5 million Americans will have AMI’s 1.5 this year this x Of these .5 million will die! x 350,000 will die in first two hours! Temple College EMS Program 3 Cardiovascular Disease Risk Factors s Major Uncontrollable x Age x Sex x Race x Heredity Temple College EMS Program 4 Cardiovascular Disease Risk Factors s Major Controllable Major x Smoking x High BP x High blood cholesterol x Diabetes Temple College EMS Program 5 Cardiovascular Disease Risk Factors s Minor Controllable x Obesity x Lack of exercise x Stress x Personality Temple College EMS Program 6 Cardiovascular Disease Control risk factors - decrease Control Coronary Artery Disease and Acute Myocardial Infarction Temple College EMS Program 7 Coronary Artery Disease s Myocardium (heart muscle) requires Myocardium continuous oxygen and nutrient supply continuous s Myocardial blood supply passes Myocardial through coronary arteries through Temple College EMS Program 8 Coronary Artery Disease s Atherosclerosis x Narrowing of lumen 3 plaque formation - related to Risk Factors 3 results in decreased myocardial perfusion x Poor tissue perfusion causes: x tissue damage (ischemia) x tissue death (infarction) Temple College EMS Program 9 Atherosclerotic Plaque Formation Temple College EMS Program 10 Angina Pectoris “A choking in the chest” s Angere - to choke s Myocardial oxygen Myocardial demand exceeds supply during periods of increased activity, exercise, or stressful event event Temple College EMS Program 11 Angina Pectoris s During stress the myocardium During demands more O2 demands s Coronary arteries would normally Coronary dilate to supply more blood and O2 dilate s In Angina Pectoris, the coronary In arteries are unable to dilate sufficiently to increase perfusion to Temple College EMS Program 12 Symptoms -Angina Pectoris s Pain x Substernal x Squeezing/Crushing/Heaviness x May radiate to arms, shoulders, jaw, May upper back, upper abdomen back upper x May be associated with shortness of May breath, nausea, sweating breath, Temple College EMS Program 13 Symptoms -Angina Pectoris s Pain usually associated with 3E’s x Exercise x Eating x Emotion Temple College EMS Program 14 Symptoms -Angina Pectoris s Pain seldom lasts > 30 minutes Pain s Pain relieved by x Rest x Nitroglycerin Temple College EMS Program 15 Symptoms -Angina Pectoris s Great anxiety/Fear s Fixation of the body Fixation s Pale, ashen, or livid face s Dyspnea (SOB) may be associated Temple College EMS Program 16 Symptoms -Angina Pectoris s Nausea s Diaphoresis s BP usually up during attack s Dysrhythmia may be present Temple College EMS Program 17 Angina Pectoris s Following an angina attack there is Following no residual damage to the myocardium myocardium Temple College EMS Program 18 Forms of Angina Pectoris s Stable Angina x Occurs with exercise x Predictable x Relieved by rest or Nitroglycerin Temple College EMS Program 19 Forms of Angina Pectoris s Unstable Angina x More frequent/severe x Can occur during rest x May indicate impending MI x Requires immediate treatment and Requires transport to appropriate facility transport Temple College EMS Program 20 Acute Myocardial Infarction “Heart Attack” s Inadequate perfusion Inadequate of myocardium of x Death of myocardium 3Infarct x Damage to myocardium 3Ischemia Ischemia Temple College EMS Program 21 Symptoms - AMI s Chest Pain - cardinal sign of myocardial infarction myocardial x Occurs in 85% of MI’s x Substernal x “Crushing,” “squeezing,” “tight,” Crushing,” “heavy” “heavy” Temple College EMS Program 22 Symptoms - AMI s Chest Pain x May radiate to arms, shoulders, jaw, May upper back, upper abdomen back upper x May vary in intensity x Unaffected by: swallowing swallowing 3 coughing 3 deep breathing 3 movement 3 Temple College EMS Program 23 Symptoms - AMI s Chest Pain x Unrelieved by rest/nitroglycerin x Pain lasts longer than angina pain (up Pain to 12 hours) to x “Silent’ MI Silent’ 3 15% 15% of patients with MI, 3 particularly common in elderly and particularly diabetics diabetics Temple College EMS Program 24 Symptoms - AMI s Shortness of breath s Weakness, dizziness, fainting s Nausea, vomiting s Pallor and diaphoresis (heavy Pallor sweating) sweating) Temple College EMS Program 25 Symptoms - AMI s Sense of impending doom s Denial Denial x 50% of deaths occur in first two hours x Average patient waits 3 hours before Average seeking help seeking Temple College EMS Program 26 Symptoms - AMI s Changes in pulse, BP, Changes respiration are not diagnostic of AMI Temple College EMS Program 27 Acute Myocardial Infarction sEarly recognition of MI is Early critical critical Temple College EMS Program 28 Management of Cardiac Chest Pain sWhen in doubt, manage When all chest pain as MI all Temple College EMS Program 29 Management of Cardiac Chest Pain s Begin management immediately if Begin angina or MI are suspected. angina s Complete the history and physical exam as you treat. exam Temple College EMS Program 30 Management of Cardiac Chest Pain s Position of Comfort s Patent Airway s High concentration O2 x non-rebreather mask 10-15 lpm Temple College EMS Program 31 Management of Cardiac Chest Pain s Reassure the patient s Obtain a brief history and physical Obtain exam exam s Aspirin 325mg p.o. Temple College EMS Program 32 Management of Cardiac Chest Pain s Nitroglycerin 0.4mg tablet sublingual x Patient should be sitting or lying down x Has Pt. Taken nitroglycerin in last 10 Has minutes? Is pain relieved? Headache? minutes? x Is BP > 90 systolic? x q 5 minutes until pain relieved or three minutes tablets administered tablets Temple College EMS Program 33 Management of Cardiac Chest Pain s If pain is unrelieved by rest, oxygen, If nitroglycerin or if a change has occurred in pattern of angina, transport immediately transport s Transport in semi-sitting position if Transport BP normal or elevated; flat if BP low BP Temple College EMS Program 34 Management of Cardiac Chest Pain s Do not walk patient to the ambulance s Do not use lights/siren if patient is awake, alert, breathing without distress awake, s Monitor vital signs every 5-10 minutes Temple College EMS Program 35 Management of Cardiac Chest Pain s Request early ALS back-up x Deaths in MI result from arrhythmia's x Arrhythmia's can be prevented with early Arrhythmia's drug therapy drug Temple College EMS Program 36 Congestive Heart Failure s CHF = Inability of heart to pump CHF blood out as fast as it enters. blood s May be left-sided, right-sided, or both. both. Temple College EMS Program 37 Congestive Heart Failure s Usually begins with left-sided failure. x Left ventricle fails x Blood “stacks up” in lungs x High pressure in capillary beds x Fluid forced out of capillaries into alveoli Temple College EMS Program 38 Congestive Heart Failure s Right-sided failure most commonly Right-sided caused by Left-sided failure. Blood “backs up” into systemic circulation “backs x Distended neck veins x Fluid in abdominal cavity x Pedal edema Temple College EMS Program 39 Causes of CHF s Coronary Artery Disease s Chronic hypertension (high blood Chronic pressure) pressure) s AMI s Valvular heart disease Temple College EMS Program 40 Symptoms of CHF Weakness s Dyspnea s s Dyspnea on exertion s Paroxysmal nocturnal dyspnea x Attacks of SOB that usually occur at Attacks night that awakens the patient night Temple College EMS Program 41 Symptoms of CHF s Orthopnea x Difficulty breathing in any position other Difficulty than standing or sitting than s Abdominal discomfort s Jugular Vein Distention (JVD) s Pedal “Pitting” edema in lower Pedal extremities extremities Temple College EMS Program 42 Symptoms of CHF s Tachycardia s Pulmonary Edema x Noisy, labored breathing x Coughing x Rales, wheezing x Pink, frothy sputum Temple College EMS Program 43 Management of CHF s Sit patient up, let feet dangle s Administer high concentration O2 s Assist ventilation as needed s Monitor vital signs q 5-10 minutes s Request early ALS back-up Temple College EMS Program 44 Pacemaker Failure s Position of comfort s Patent airway s High Concentration O2 s Assist ventilations as needed s ALS Intercept s CPR as needed x DO NOT worry about damage to DO pacemaker pacemaker Temple College EMS Program 45 Coronary Artery Bypass s Position of comfort s Patent airway s High Concentration O2 s Assist ventilations as needed s ALS Intercept s CPR as needed x DO NOT worry about damage to DO sutures/staples or by-passed arteries sutures/staples Temple College EMS Program 46 Implanted Defibrillator s If performing CPR on a patient: x Implanted defibrillator may “fire” x May feel slight “tingle” Temple College EMS Program 47 ...
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