AAOS emergency care and transportation of the sick and injured 12th edition Chapter 17 Cardiovascular emergencies

Cardiovascular disease has been the leading killer since:

the 1900s

Left ventricular assist devices are used to:

enhance the pumping of the left ventricle

What is a external defibrillator vest?

it is a wearable defibrillator that can stop an abnormal heart rhythm without anyone's help

Automatic implantable cardiac defibrillators are used by:

patients who have survived cardiac arrest due to V-fib

Pacemaker malfunction can cause:

Syncope, dizziness, or weakness

what are the side effects of nitroglycerin?

Decreased blood pressure, severe headache, and causes a burning sensation in the mouth

Nitroglycerin

5

3

A

S

H

5 - WAIT 5 MINUTES TO GIVE MORE NITROGLYCERIN

3 - NO MORE THAN 3 DOSES

A - ALLERGIES

S - NO SEXUAL ENHANCING DRUGS WITHIN 24 HOURS

H - HEAD INJURIES

Nitroglycerin contraindications:

systolic BP less than 100 mm Hg, head injury, having taken erectile dysfunction (ED) drugs (Viagra) within the last 24 hours, and having the maximum prescribed dose

Nitroglycerin indications:

Chest pain of cardiac origin

what does nitroglycerin do?

1. Vasodilator, opening up vessels to increase blood supply to the heart

2. Smooth muscle relaxant

Aspirin contraindications:

Hypersensitivity, recent bleeding, Ulcers, less than 30 years of age

Aspirin indications:

chest pain

Aspirin dosage

162 to 324 mg (two to four 81 mg tablets of a chewable

baby aspirin). Aspirin does not usually need to be

administered more than once in the early treatment of

cardiac problems.

Aspirin prevents

Blood clots from forming or getting bigger

Nitroglycerin dosage:

1 tablet or 1 spray (0.4 mg) or 400 micrograms

What are the CLINICAL SIGNS of a dissecting aneurysm?

blood pressure discrepancy between arms or decrease in a femoral or carotid pulse

What are the REGION/RADIATION of a dissecting aneurysm?

back possibly involved, between the shoulder blades

What is the TIMING OF PAIN of a dissecting aneurysm?

Does not abate once it has started

What is the SEVERITY OF PAIN for a dissecting aneurysm?

Maximal from onset

What is the QUALITY OF PAIN for a dissecting aneurysm?

sharp or tearing

What is the ONSET OF PAIN for a dissecting aneurysm?

abrupt, without additional symptoms

What are the CLINICAL SIGNS for an Acute Myocardial Infarction?

Peripheral pulses are equal

What is the REGION/RADIATION for an Acute Myocardial Infarction?

Substernal, back is rarely involved

What is the TIMING OF PAIN for an Acute Myocardial Infarction?

May wax/wane

What is the SEVERITY OF PAIN for an Acute Myocardial Infarction?

the pain increases with time

What is the QUALITY OF PAIN for an Acute Myocardial Infarction?

tightness or pressure

What is the ONSET OF PAIN for an Acute Myocardial Infarction?

gradual, with additional symptoms

What are the signs and symptoms of a dissecting aneurysm?

Very sudden chest pain, comes on full force, and different blood pressures (when taken every 5 minutes)

What is the primary cause of a dissecting aneurysm?

uncontrolled hypertension

What are the 3 stages of a dissecting aneurysm?

Stage 1: rupture of the intima

Stage 2: dissection of media

Stage 3: rupture of the vessel

An aortic aneurysm is a:

weakness in the wall of the aorta

If a hypertensive emergency is left untreated it can lead to 2 things:

1. stroke

2. dissecting aortic aneurysm

What are the common symptoms of hypertensive emergencies?

- sudden, severe headache

- strong, bounding pulse

- ringing in the ears

- can cause tinnitus

- nausea/vomiting

- dizziness

- warm skin

- nose bleeds

- altered mental status

- sudden pulmonary edema

- blurry vision

What is the systolic pressure for hypertensive emergecies?

greater than 180 mm Hg

Another sign of Congestive Heart Failure is the patient has to sleep:

sitting up because if the patient lies down the patient will feel like they are drowning due to the fluid in their lungs.

The blood pressure for left and right-sided heart failure would be:

high, but you would see low blood pressure if the patient is about to die

What are the two types of heart failure?

- right-sided heart failure (you would see swelling in the body)

- left-sided heart failure (causes fluid in the lungs CHF)

pitting edema

swelling, usually of the skin of the extremities, that when pressed firmly with a finger will maintain the dent produced by the finger

Dependent edema is the:

Swelling in the part of the body closest to the ground

Congestive Heart Failure can cause:

dependent edema

What happens when your lungs become congested with fluid?

Congestive Heart Failure

Congestive Heart Failure often occurs:

A few days after a heart attack

With cardiogenic shock the heart lacks:

the power to force enough blood through the circulatory system

Cardiogenic shock is often caused by a:

heart attack

2 types of defibrillations include:

- regular defibrillation

- synchronized cardioversion

If the patient has asystole do not:

Shock this patient

When a patient has asystole nearly all of them:

Will die

Asystole is the:

Absence of all heart electrical activity

Defibrillation restores:

cardiac rhythms

ventricular fibrillation

Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest.

What are the 2 types of ventricular tachycardia?

- one with pulses

- one without pulses

Ventricular tachycardia occurs:

in a lot of different impulses causing the ventricles to contract at a high rate and can cause HYPOPERFUSION

Bradycardia

slow heart rate

Tachycardia

fast heart rate

premature ventricular contraction (PVC)

a common cardiac arrhythmia that results in the feeling of skipped or extra beats caused by impulses originating outside the SA node

Congestive Heart Failure has:

wet lung sounds and you will hear rails or crackles

Acute Myocardial Infarction and Cardiac Comprise "physical findings"

- fear, nausea, poor circulation

- faster, irregular, or bradycardic pulse

- decreased, normal, or elevated blood pressure

- normal or rapid, and labored respirations

- patients express feelings of impending doom

When do you not use nitroglycerin?

Low blood pressure

People that do not have signs/symptoms with an Acute Myocardial Infarction:

Older people, diabetics, and females

Signs and symptoms of an Acute Myocardial Infarction are:

- weakness, nausea, vomiting, sweating

- chest pain, discomfort, or pressure

- lower jaw, arm, back, abdomen, or neck pain

- irregular heart and syncope

- shortness of breath

- nausea/vomiting

- pink, frothy sputum

- sudden death

The coronary artery that is supplying the left ventricle is clotted and the muscles that form the left ventricle do not receive oxygen anymore after:

4 - 6 minutes they will experience chest pain and after 30 minutes there will be scar tissue

"clot-busting" (thrombolytic" drugs or angioplasty is a:

Procedure where the doctors physically remove the clot and clean the artery out to prevent further damage.

what are the 3 serious consequences of an Acute myocardial Infarction?

1. sudden death

2. cardiogenic shock

3. congestive heart failure

syncope

fainting

Once the cells are dead:

the cells cannot be revived

What are the PAIN SIGNALS of an Acute Myocardial Infarction?

Actual death of the cells in the heart muscle

Both stable and unstable angina are:

Treatable

Treat angina like a:

Acute Myocardial Infarction

stable angina occurs:

in response to exercise or activity that increases demand of the heart muscle

Unstable angina occurs:

in the absence of a significant increase in oxygen demand

Angina can be further differentiated into:

Stable and unstable angina

Angina pectoris is not apart of the:

hypoxic drive

Angina pectoris does not usually:

lead to death or permanent heart damage

Crushing or squeezing pain is caused by:

Angina pectoris

Angina pectoris occurs when the hearts:

need for oxygen exceeds the supply

Acute Myocardial Infarction is a:

heart attack

Angina Pectoris is a:

reversible illness

What is caused by a myocardial ischemia?

Acute coronary syndrome

What are the uncontrollable risk factors for an Acute Myocardial Infarction?

- older age

- family history

- atherosclerotic coronary artery disease

- race

- ethnicity

- being male

What are the controllable Acute Myocardial Infarction factors:

- cigarette smoking

- high blood pressure

- high cholesterol

- diabetes

- lack of exercise

- obesity

Coronary artery disease is the:

leading cause of death in the United States

What is embolus?

traveling blood clot

If a clot lodges in a coronary artery what can result?

Acute Myocardial Infarction

What is a thromboembolism?

It is a blood clot that is floating through blood vessels until it reaches an area too narrow for it to pass through.

What causes calcium and cholesterol build up inside the walls of the coronary blood vessels causing an obstruction in blood flow to the heart?

Atherosclerosis

causes of atherosclerosis

lifestyle (eating fatty foods); HTN; smoking; diabetes; genetic

Atherosclerosis can lead to a:

heart attack or stroke

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

Ischemic heart disease involves:

decreased blood flow to one or more portions of the heart

If blood flow is NOT restored:

the tissue dies

Ischemia

Lack of blood supply

Chest pain usually stems from:

ischemia, which is decreased blood flow

STEMI

ST elevation myocardial infarction

Cardiovascular diseases account for:

1 of every 3 deaths

These two veins bring blood low in oxygen back from the body to the right side of the heart:

Venae Cavae

This artery takes blood to the lungs to pick up oxygen

The pulmonary artery

These veins bring blood back from the lungs:

Pulmonary veins

This valve is between the atrium and ventricle of the right side of the heart:

Tricuspid valve

this ventricle pumps blood to the lungs

right ventricle