EMT Chapter 20: Cardiac Emergencies

What do patients experiencing a myocardial infarction need to diagnose?

A 12 lead

What is Coronary Artery Disease?

A condition that narrows or blocks arteries to the heart, often resulting from the build-up of fatty deposits

What is a Thrombus?

An occlusion of blood flow caused by the formation of a clot on rough inner surface of diseased artery. This can break loose and form an embolism, which can move to occlude flow of blood downstream in a smaller artery

What is the most common symptom of reduced blood supply?

Chest pain

What is an Aneurysm?

Occurs when weakened sections of blood vessels begin to dilate, forming a balloon. Bursting can cause rapid, life-threatening internal bleeding

What do malfunctions of the heart's electrical system generally result in?

Dysrhythmia (bradycardia, tachycardia, and rhythms that may be present when there is no pulse)

What are the mechanical malfunctions of the heart? (3)

1. Angina Pectoris

2. Acute Myocardial Infarction (AMI)

3. Congestive Heart Failure (CHF)

What is Angina Pectoris?

1. Chest pain that is caused by insufficient blood flow to the myocardium

2. Temporary condition, but can act as a red flag to a more serious condition

3. Results due to narrowed arteries secondary to coronary artery disease

4. Pain experienced during times of exertion or stress

What is Acute Myocardial Infarction (AMI)?

1. Death of a portion of the Myocardium due to lack of oxygen

2. Usually caused by coronary artery disease

What is Congestive Heart Failure (CHF)?

1. Inadequate pumping of the heart

2. Often leads to excessive fluid buildup in lungs or body

3. Caused by diseased heart valves, hypertension, or obstructive pulmonary disease

4. Often a complication of AMI

What is the steps of CHF? (4)

1. Patient sustains AMI

2. Myocardium of left ventricle dies

3. Because of damage to left ventricle, blood backs up into pulmonary circulation and lungs

4. If untreated, left heart failure often leads to right heart failure

What are the signs and symptoms of CHF? (9)?

1. Tachycardia

2. Dyspnea and cyanosis

3. Normal or elevated BP

4. Diaphoresis

5. Pulmonary edema

6. Anxiety/confusion due to hypoxia

7. Pedal edema

8. Engorged, pulsating neck veins (late sign)

9. Enlarged liver and spleen

What is Acute Coronary Syndrome (ACS) sometimes called?

Cardiac compromise

What is Acute Coronary Syndrome (ACS)?

Any time the heart may not be getting enough oxygen (many possible problems)

What are the signs and symptoms of ACS? (10)

1. Chest pain (best known symptom)

2. Pain radiating to arms, upper abdomen, or jaw

3. Pain in jaw and back between shoulder blades (more common in women)

4. Dyspnea

5. No pain (diabetics)

6. Anxiety, feeling of impending doom

7. Nausea

8. Sweating

9. Abnormal pulse (tachycardia/bradycardia)

10. Abnormal BP

What is the assessment of someone having cardia problems?

1. Primary assessment

2. History/Physical exam

3. OPQRST

4. SAMPLE

5. Baseline vitals

What position should you put a person having cardiac problems in?

Position of comfort (usually sitting up)

How does Aspirin help someone having cardiac problems?

Thins the blood and may allow for the blockage to pass in the coronary artery

What are some indications for administering Aspirin? (3)

1. Chest pain

2. Ability to safely swallow

3. Medical control authorization on standing order in MA

How much Aspirin should you give someone?

2-4 tablets (each 81 mg)

What are the contraindications for administering Aspirin? (4)

1. Inability to swallow

2. Allergic to Aspirin

3. History of asthma

4. Patient is already taking anti-clotting medicine

What are some indications for administering Nitroglycerin? (4)

1. Chest pain

2. History of heart problems and prescribed Nitroglycerin

3. Patient has Nitroglycerin

4. Medical direction authorizes it under standing order

What are the 5 elements in the Chain of Survival?

1. Immediate recognition and activation

2. Early CPR

3. Rapid defibrillation

4. Effective advanced life support

5. Integrated post-cardiac arrest care

What is immediate recognition and activation?

Requires a prompt notification of EMS system, usually by a bystander

What are the 3 ways CPR can be delivered earlier?

1. Get CPR-trained professionals to patient faster

2. Train laypeople in CPR

3. Train dispatchers to instruct callers how to perform CPR

How can you perform integrated post-cardiac arrest care? (6)

1. Maintain adequate oxygenation

2. Avoid hyperventilation

3. Perform 12-lead ECG

4. Manage treatable causes of arrest

5. Decide appropriate destination for patient

6. Possibly inducing hypothermia

What links in the chain of survival do EMTs provide?

Early CPR and rapid defibrillation

How should you treat a patient in cardiac arrest? (7)

1. Take standard precautions

2. Request ALS

3. Perform CPR

4. Use defibrillator

5. Artificial ventilations and airway management

6. Interview bystanders and family members

7. Lift and move patient

What is a semi-automatic AED?

Advises EMT to press button that causes machine to deliver shock through pads

What is a fully-automatic AED?

Does not advise EMT to take any action, delivers shock automatically

How are AEDs classified?

By the type of shock delivered

1. Monophasic: Sends single shock from negative pad to positive pad. Not usually used by EMS.

2. Biphasic: Sends shock in one direction then the other

What does an AED do?

Analyzes cardiac rhythm to determine whether shock is indicated

What are rhythms that are shockable by an AED?

Ventricular fibrillation

Ventricular tachycardia

AED safety (6)

1. Don't use on soaking-wet patient

2. Don't use if patient is touching anything metal

3. Remove Nitro patches first

4. Can be used on patient with implanted device

5. Remove chest hair first

6. Say CLEAR before defibrillating

AED Quality Improvement (6)

1. Medical Direction

2. Initial training

3. Maintenance of skills

4. Case review

5. Trend analysis

6. Strengthening links in Chain of Survival

For how long should you check pulse for before beginning CPR?

No more than 10 seconds

When should you reassess the patient during CPR?

After providing 2 minutes or 5 cycles of CPR

How deep should compressions be during CPR?

At least 2 inches deep for adult.

At least 1/3 depth of chest for infants and children.

What is the rate you should perform CPR at?

At least 100 compressions per minute

What should you do if the patient wakes up during CPR? (3)

1. Obtain baseline vitals

2. Administer Oxygen

3. Transport

What should you do post-CPR if the patient has a pulse? (4)

1. Manage airway, avoid hyperventilation

2. Keep defibrillator on patient during transport in case patient goes back into cardiac arrest

3. Reassess every 5 minutes

4. Consider hypothermia protocols

What should you do post-CPR if the patient goes back into cardiac arrest? (4)

1. Stop vehicle, resume CPR

2. Analyze rhythm ASAP

3. Deliver shock if indicated

4. Continue with 2 minutes of CPR (5 cycles)

What are the 2 types of mechanical CPR devices?

1. Thumper

2. Auto-Pulse

What kind of airway should you put in a patient under cardiac arrest?

OPA

What pulse should you check in a patient under cardiac arrest?

Carotid