Unit 6 - Chapters 14-17

Where are the coronary arteries located?

on the heart

What does the coronary arteries do?

supply the hear muscle with blood

* oxygen and nutrients

the heart muscle has its own electrical/conduction system. True or false - this means the brain does not have to tell the heart when to contract

True

what is the name of the main pacemaker of the heart that generates the impulse that triggers the rest of the heart to contract?

Sinoatrial (SA node)

What is Cardiac compromise?

Emergency relating to the heart

* myocardial infarction
* angia pectoris
* heart failure

what is angina pectoris?

Pain in the chest from a __partial blockage__ reduced by oxygen derived to the heart muscle cause by a temporary __partial blockage__ to the coronary arteries

* Resolves in 2-15 minutes

what are the signs and symptoms of angina pectoris?

* discomfort across chest


* radiating discomfort in neck, jaw, arms. and shoulders
* pain goes away with rest


* dull or heavy discomfort with a pressure or squeezing sensation
* usually lasts 2-15 minutes which subsides after activity stops

\

what is a myocardial infarction?

* myo- muscle
* cardial- heart
* infarction- bloackage
* infarction: obstruction of blood supply to an organ causing tissue death
* complete blockage
* caused by blockage of coronary arteries

What are the common symptoms of a myocardial infarction (MI)?

* chest pain, radiate to the left arm to jaw & neck
* cool, pale skin
* diaphoresis
* difficulty breathing
* light headness or dizziness
* feeling of impending boom

what are the uncommon or atypical signs and symptoms of a myocardial infarction (MI)?

* shortness of breath
* flu like symptoms
* light headednessor weakness
* “i just don’t feel right”
* “something is wrong with me”
* indigestion

who are twice as likely to get a myocardial infarction (MI)?

Women

What are the major differences between myocardial infarction and an angina pectoris?

Myocardial infarctions:

* last longer than 10 minutes
* perspiration, pale gray color, nausea, weakness, dizziness, light headedness
* often none percipating factors
* Nitroglycerin may give incomplete or no relief

\
Myocardial infarctions last longer and present with more factors compared to an Angina Pectoris that is due to other factors causing it, rest and nitroglycerin is like a cure

As an EMR, would you treat a myocardial infarction differently than you would treat an angina?

no

What is congestive heart failure (CHF)?

when weakened heart muscle is unable to pump blood efficently and blood starts to back up in the body or lungs

what happens to the lungs and lower lungs during congestive heart failure?

they fill up with fluid

what are the sign and symptoms of heart failure?

* shortness of breath
* chest pain/discomfort
* rapid pulse rate
* edema (swelling) of the lower extremities - (pedal edema)
* jugular vein distention (JVD)
* pale, moist skin
* increased difficulty in breathing while lying flat

What is a pulmonary edema?

back up of fluid in the lungs

what is a jugular vein distention (JVD) and what causes it?

back up of blood in the circulatory system as a result of heart failure can cause the large neck veins to bulge from the increase in pressure

with regards to medications, what is an indication?

the reason we give a medication

what is a contraindication?

situation in which a drug or procedure should not be used because it may be harmful

what are the 5 rights when assisting with medications?

* right patient
* right medication
* right routine
* right dose
* right date

as an EMR, are you allowed to administer or assist with medications?

only allowed to assist with medications

why do we five patients with chest pain aspirin?

may prevent complete blockage of coronary arteries by interfering with platelet function

* makes platelets slippery

what does of aspirin do we give our patients?

325 mg or 4 chewable

* document the time and dose

what is the one contraindication for assisting with aspirin?

if the patient is allergic to it

why is nitroglycerine given to cardiac patients?

* dilates blood vessels
* reduces the workload of the heart

what does nitro do to the blood vessels?

dilates or widens the blood vessels

what are the indications for assisting with nitro?

* __**chest pain**__
* __**systolic**__
* a patient has s&s of chest pain consistent with acute coronary syndrome
* has a prescription for nitro
* EMR has an online or offline medical directions to administer

Contradictions for assisting with nitro: what drugs must you make sure your patient has not taken?

* patient has taken ED drugs -erectile dysfunction
* **Cialis within 48 hours. Viagra and Levitra within 24 hours**
* systolic Blood pressure must be atleast 90mmhg

what is the proper dose of nitro?

1 pill or spray sublingually (under the tongue)

how many nitro can we give?

up to 3 doses

what must the systolic bp be in order to give nitro?

atleast 90mmhg

how do we care for a patient that is experiencing cardiac compromise?

* manage ABC’s
* supplemental oxygen at 2 or 4 Lpm, if the SpO2 is less than 95%
* if the patient has a prescription for nitoglyverin, assist
* every tablet ever 3 to 5 minutes up to 3 doses
* be sure the systolic blood pressure remains above atleaste 90mmhg
* administer 325mg of aspirin
* calls ALS for backup, immediate transport
* closely reassess ABC’s make sure SAMPLE history is done
* continue to monitor vital signs
* OPQRST

what is ventricular fibrillations (V-fib)?

disorgainized cardia rhythm that produces no pulse or cardias output

* most common rhythm that the AED defibrillates

what is asytole?

* **absence of electrical activity; flat line on the monitor**


* no pumping action or cardiac output
* chances of resuscitation are not good
* defibrillation is not appropriate

what is pulseless electrical activity(PEA)?

electrical activity appears organized, but there is no cardiac output

what are the only 2 heart rhythms an AED can defibrillate?

* Ventricular fibrillations (V-fib)
* Ventricular tachycardia (V-tach)

the _____ are tiny air sacs in the lungs surrounded by tiny blood vessels that drop off the carbon dioxide while picking up fresh oxygen

Alveoli

Respiratoy drive is controlled by the respiratory control center found in the brain’s: _______ _______

medulla oblongata

what is the definition of respiratory compromise?

any condition resulting in the inability of a person to breath adequately

what is hypoxia?

inadequate oxygen supply to the body’s cells

* alerted mental status
* pale skin
* cyanosis of nail beds and lips

what is hypercardia and what causes it?

condition of having too much carbon dioxide CO2 in the blood

what is respiratory failure and what makes it different from respiratory distress?

when the body’s ability to compensate for inadequate oxygen fails

* breathing rate begins to slow
* tidal volume begins to get shallow
* **can progress to respiratory arrest**

what are the 6 characteristics of normal or adequate breathing?

* open airway
* average rate 12-20 breaths adult
* normal depth
* work of breathing
* able to speak in full sentences without having to catch a breath
* normal skin condition

what are the 6 characteristics of abnormal or inadequate breathing?

* increased work of brething
* increased respiratory rate (early sign)
* decreased respiratory rate (late sign)
* respirations too deep or too shallow
* irregular breathing rhythm
* audible breath sounds, such as gurgling, snoring or wheezing

what is the tripod position?

hands on knee leaning forward

what are the accessory muscles and what does it mean when our patients is using them to breath?

muscles of the neck, chest, abdomen that assist during respiratory difficulty

what is atonal respirations?

* reflective gasping breaths
* an abnormal breathing pattern characterized by slow shallow gasping breaths that typically occur following cardiac arrest

where do you put the stethoscope when osculating lung sounds on the back?

under the shoulder blades towards the middle

where do you put the stethoscope when osculating lung sounds on the front?

a few inches below the collar bone but right above the nipples

where do you put the stethoscope when osculating lung sounds on their side?

in the middle axillary line

what does COPD mean?

__C__hronic __O__bstructive __P__ulmonary __D__ieases

what are the 3 OPD’S?

* chronic bronchitis
* emphysema
* anthema

what is bronchitis?

swelling and inflammation of bronchi and bronchioles and excessive muucus formation

what are the classic signs and symptoms of bronchitis?

* overweight
* productive cough (near curb ratting around)
* mild to moderate shortness of breath
* pale or cyanotic complexion
* wheezes, cracked at bases of lungs

what is emphysema?

a __progressive__ contain characterized by the __destruction of the alveoli__

what are the common signs and symptoms of emphysema?

* shortness of breath (SOB)
* large (barrel) chest appearnace
* nonproductive cough
* prolonged appearnace
* very thin appearance
* pursed lip breathing
* wheezing

what should be your treatment for chronic bronchitis and emphysema?

* oxygen
* SpO2 88-92% nasal canula 2-6 Lpm
* MDI metered nose inhaler or SVN small volume nebulizer per medial direction
* place patient in position of comfort - sitting up

what is asthma?

condition affecting the lungs characterized by __narrowing of the air passages__ and __wheezing__

what are the signs and symptoms of asthma?

* moderate to severe shortness of breath (SOB)
* wheezing
* anxiety
* nonproductive cough

what should be your treatment for asthma?

* oxygen to maintain SpO2 of 94% or above
* note-under 8 ventilate - over 28 ventilate
* **assist with meters dose inhaler or nebulizer**
* immediate transport

what is a metered dose inhaler (MDI)? what does the medication do to the bronchioles?

prescribed to patient with asthma, emphysema. chronic bronchitis

* dilates the bronchioles

what are the indications for assisting with an MDI?

* patient has S&S of respiratory distress and bronchoconstriction
* patients has prescriptions for MDI or EMR has online of offline medical direction to administer
* patients has NOT taken maximum allowed doses prior to your arrival

what are contradictions to assisting with MDI?

* alerted mental status
* no permissions has been given by medical direction
* patient has already taken maximum prescribed dose

what is a Small Volume Nebulizer SVN and what makes it different from an MDI?

* same medication that is an MDI but route is different


* delivers medication over the course of many inhalations rather than 1
* can assist with patients home nebulizer

what is hyperventilation syndrome?

temporary condition characterized by uncontrolled, rapid, deep breathing that is usually self correcting

what are the signs and symptoms of hyper ventilation syndrome?

* SOB
* anxiety
* tingling
* dizziness
* spams of fingers & feet
* chest discomfort
* **CO2 levels decrease causing muscle cramps in feet & hands**

what is the treatment for hyperventilation syndrome?

* calm the patient and get patient to slow their breathing
* remove patient from the stressful environment
* low flow oxygen per protocols (2 Lpm)

What is the epiglotitis?

infection of the epiglottis leads to swelling that can obstruct the airway

what are the signs and symptoms of the epiglottis?

* severe sore throat
* inability to swallow __drooling__ (late sign)
* difficulty or pain with speaking

what is the treatment for epiglotitis?

* oxygen
* keep patient quiet and calm
* do not agitate the airway

what is pneumonia?

* acute infectious disease of the lower respiratory tract
* causes lung inflammation & fluid of pus-filled alveoli

what is the standard care of anyone with respiratory compromise?

* give oxygen
* give nebulizer or inhaler
* position of comfort (sitting up)

BVM ventilations are needed when a patients respiratory rate RR is less than __ *times per minute for greater than* *__* times per minute

less than 8 and greater than 28

what is altered mental status (AMS)?

a decreases in the patient’s alertness and responsiveness to his or her surroundings

a person who is alert and oriented x 4 or A&0x4 is oriented to these 4 things:

* who they are (person)
* where they are (place)
* time of day (time)
* their current situation (event)

a patient that is only able to tell you who they are and where they are but unsure of the other 2 criteria, is said to be A & 0 x ___

2

a patient that is unresponsive may not be able to maintain their own _______

airway

for any patient with altered mental status: it is good practice to check their _________.__ _____________ _____________

blood glucose levels. (if protocols allow)

what is a seizure?

sudden, abnormal burst of electrical activity in the brain that causes a sudden change in mental status or behavior

what is convulsions?

uncontrolled muscular contractions

what is the difference between tone muscle activity and clonic muscle activity?

tonic: stiffening of the entire body including arms & legs during generalized seizure

clonic:jerking action of the muscles during a generalized seizure

what is epilepsy?

brain disorder that causes seizures

what are the 5 of the many common causes of a seizure?

* high fever
* hyper or hypoglycemia (blood sugar)
* head injury or stroke
* stress/anxiety
* pregnancy complications (eclampsia)

what are the characteristics of a generalized seizure?

type of seizure character by a loss of conciousness and tonic - clonic muscle activity - usually lasts less than 1 minute

what is status elipticus and why is it considered life-threatening?

life threatening condition that occurs when patients have very long seizures or seizures that repeat one after another

* brain can become dangerously hypoxic

what is the pesticidal stage of a seizure?

phase of a seizure following convulsions

* patients will be tired, weak and may not be fully awake

what are the characteristics of a partial seizure?

characterized by temporary loss of awareness with no dramatic body movements

what is the cause of a febrile seizure?

* **caused by high fever**
* most common from ages 6 months to 6 years old

what are the steps you should take to provide emergency medical care for a patient having a seizure?

* protect the patient from injury- move objects away from them
* DO NOT RESTRAIN or put anything in their mouth
* protect their head
* perform a primarily assessment - ABC’s
* after convulsions, place patient in recovery postion
* provide care for any injuries that may have occurred

what is a stroke/CVA (cerebrovascular accident)?

a condition that occurs when an area of the brain does not receive an adequate supply of blood

what is the difference between a hemorrhagic stroke and an ischemic stroke?

Hemorrhagic: bleeding- area in the brain from a rupture or burst

Ischemic: blockage- caused by an embolus or a clot

what is the term used to describe short, intermittent strokes caused by small clots that are characterized by symptoms that usually disappear within 1 hour?

Transient ischemic attacks (TIA)

* same emergency care for TIA is the same for stroke

what are the 6 common symptoms of a stroke?

* facial droop (one side)
* weakness on one side of the body
* difficulty with speech or vision
* altered mental status
* severe headache
* confusion

what does the letter F mean in FAST and how do we address it?

Facial droop- give me a big toothy grin

what does the letter A mean in FAST and how do we address it?

Arm drift-

* have your patient close their eyes
* grab their hands and hold them out in front (palms up)
* tell them to hold them out for 10 seconds

what does the letter S mean in FAST and how do we address it?

Speech- “you can’t teach an old dog new tricks”

what does the letter T mean in FAST and how do we address it?

Time- make sure you determine onset time

how often do you reassess a FAST?

every 5 minutes

once you suspect a stroke, how would you care for your patient?

* Get a full history, meds etc.
* Do not give more oxygen than the patient needs to maintain an Sp02 of 94%
* Monitor ABC’s - protect the airway
* Establish time patient was normal
* Time- time is brain
* clot blusters can be given within 3 hours of onset (4.5 hours for some)
* Baseline vitals
* Transport