EMR Chapter 14 - Cardiac Emergencies

angina

a chest discomfort or pain that occurs when the heart muscle does not receive enough oxygen-rich blood.

caused by partial blockage or spasm, often triggered by physical exertion

cardiac compromise (the signs/symptoms that indicate emergency heart issue)

Chest discomfort

Disphoresis (sweating) 

Dyspnea (shortness of breath)

Anxiety or annoyed

abnormal BP or pulse

Feeling of IMPENDING DOOM

heart failure

when heart can’t pump blood efficiently.

Patient often feels like they can’t breath more than chest pain (have the patient sit up, NOT laying down)

cardiac arrest

when the person’s mis-fires electrical signals, creating a life threatening, irregular pulse (ventricular fibrillation).

how often does the heart beat + how much blood? per day

100,000 times per day

6,000-7,500 liters of blood per day

heart anatomy

flows into the heart through the superior vena cava to the right atrium.

Then it exits through the right ventricle, to the lungs.

In the lungs, the blood picks up oxygen and returns to the heart, entering the left atrium.

Then it exits through the left ventricle to the entire body.

Coronary arteries provide heart with blood (most common issue with heart is these being narrowed or blocked)

conduction pathway

route of electrical impulses within the heart.

damage here causes abnormal heart rhythms (then body can’t pump blood correctly)

myocardial infarction

a heart attack - occurs when part of a heart muscle dies because of inadequate blood flow (likely from blockage)

signs and symptoms of heart failure

• shortness of breath

• chest pain/discomfort

• Rapid pulse rate

• Edema of the lower extremities

• Jugular vein distention (JVD)

• Pale, moist skin

• Altered mental status due to a decrease in perfusion to the brain

• Increased difficulty breathing while lying flat

cardiac compromise care

1. BSI + PPE

2. check ABC’s, support if needed

3. as OPQRST about chief complaint

4. Vital signs

5. oxygen administration (only if their oxygen is under 94 percent. Generally use cannula at 6 LPM)

6. keep patient at rest in position of comfort

7. assist with prescribed medications (consult medical direction to ensure this is legal)

8. continue to monitor vital signs

assisting with nitroglycerin

patient should be sitting or lying down, as it often makes the patient dizzy

MAX 3 doses (each does is equal to 0.4 mg). wait 3 to 5 minutes between doses

when to assist with nitroglycerin

• Patient complains of chest pain.

• Patient has a history of cardiac problems.

• Patient’s health care provider has prescribed nitroglycerin.

• Systolic blood pressure is greater than 100 mm Hg. (Local protocols may vary.)

• Medical direction authorizes administration of the medication.

when to NOT give nitroglycerin

• Patient has a systolic blood pressure below 100 mm Hg. (Local protocols may vary.)

• Patient has a head injury.

• Patient has already taken the maximum prescribed dose.

• Patient has taken an erectile dysfunction (ED) medication in the past 24 hours (e.g., Viagra, Cialis). These medications also cause dilation of the blood vessels.

• Altered mental status.

steps to assist with nitroglycerin

1. Perform a focused secondary assessment for the cardiac patient.

2. Obtain vital signs including blood pressure. (Systolic pressure must be above 100. Local protocols may vary.)

3. Contact medical direction if there are no standing orders.

4. Ensure right medication, right patient, right dose, right route, and right time. Check the expiration date.

5. Ensure that the patient is alert.

6. Question the patient regarding any improvement following the last dose.

7. Ask the patient to lift their tongue, and place a tablet or spray dose under the tongue. If you are assisting, be sure you are wearing gloves.

8. Have the patient keep their mouth closed with the tablet under their tongue (without swallowing) until the medication is dissolved and absorbed.

9. Recheck blood pressure within 2 minutes.

10. Record administration, route, and time.

11. Perform a reassessment.

administering aspirin

Don’t use for people with history of bleeding disorders or ulcers, or are allergic.

One dose = 325 mg (or 4 low doses, each 81 mg)

• Perform a focused secondary assessment for the cardiac patient.

• Obtain vital signs.

• Contact medical direction if there are no standing orders.

• Ensure right medication, right patient, right dose, right route, and right time. Check the expiration date.

• Ensure that the patient is alert.

• Assist the patient as they chew and swallow the tablet(s).

• Record administration, route, and time.

• Perform a reassessment.