EKG Ch 10

Emergency Situations

Key Concepts

  • Emergency Identification:

    • The first sign of an emergency may be changes in the EKG.

    • A myocardial infarction (MI) patient may not show the typical severe signs or symptoms; some signs may not be heart-related.

  • EKG Changes Requiring Immediate Attention:

    • ST Segment Depression: Indicates ischemia (decreased oxygen in heart tissue due to blockages).

    • ST Segment Elevation: Indicates ST elevation myocardial infarction (STEMI).

  • Coronary Artery Blockages:

    • Causes decreased oxygen in heart tissue.

    • Treatment may involve cardiac catheterization or open-heart surgery to bypass the clogged arteries.

  • Non-ST Elevation Myocardial Infarction (NSTEMI):

    • Some heart attacks may not show ST segment changes but still cause severe symptoms, diagnosed via blood tests for heart muscle damage.

    • Treatment may include cardiac catheterization or open-heart surgery.

  • Heart Rhythm Monitoring:

    • EKG technicians should monitor for changes in heart rate and rhythm, and recognize lethal dysrhythmias:

    • Third-degree heart block

    • Agonal rhythm

    • Pulseless electrical activity

    • Asystole

    • These arrhythmias prevent adequate blood flow and need immediate recognition and treatment.

Proper Emergency Notification

  • Emergency Procedures:

    • Technicians should know employer policies for patient emergencies.

    • In hospitals, technicians call the operator to announce codes over the intercom (e.g., "Code Blue" for cardiac arrest).

    • Responsibilities defined for each healthcare worker during emergencies, often handled by a rapid response team (code team).

  • Emergency Codes (Table 10-1):

    • Code Red: Fire

    • Code Gray: Combative patient

    • Code Pink: Child or infant abduction

    • Code Blue: Cardiac arrest

Quick EKG Reference

  • EKG Changes to Report Immediately:

    • ST Segment Elevation: > 1 mm above isoelectric line.

    • ST Segment Depression: > 2 mm below isoelectric line.

    • New-Onset Dysrhythmia: Report sudden changes immediately.

  • Lethal Dysrhythmias:

    • Ventricular Tachycardia: Rapid rate with no P waves, wide bizarre QRS complexes.

    • Ventricular Fibrillation: Chaotic disorganized rhythm, no recognizable waves or complexes.

  • Additional Lethal Dysrhythmias:

    • Third-degree heart block: no relation between P waves and QRS complexes.

    • Agonal rhythm: wide QRS and minimal activity.

    • Pulseless electrical activity: electrical activity present but no pulse.

    • Asystole: no electrical activity, no pulse.

Emergency Medical Services (EMS) Response

  • Notification of EMS:

    • Call 911 providing:

    • Nature of emergency, number of patients, and treatments being provided.

    • Location and a callback number.

    • Indicate if CPR is in progress so sufficient responders are sent.

  • Patient Information to Gather for EMS:

    • Name, date of birth, signs/symptoms, medical history, medications, allergies, next of kin.

    • If permitted, copies of patient records can be sent.

Patient Care During Emergencies

Care of a Conscious Patient

  • Assisting a Conscious Patient:

    • Help patient sit or lie down, reassuring to conserve energy until EMS arrives.

    • Administer oxygen if permitted and trained.

    • Closely observe for worsening condition.

    • Monitor cardiac rhythm; repeat 12-lead EKG as necessary.

Care of an Unconscious Patient

  • Response if Patient Loses Consciousness:

    • Call for help and 911 immediately.

    • Check for a carotid pulse: locate near larynx and slide fingers to side of the neck.

    • If a pulse is found, place patient in recovery position (lateral recumbent).

    • If no pulse is found, begin CPR after no more than 5-10 seconds of checking.

Ventilation Assistance

  • Using Bag Valve Mask (BVM):

    • Administer breaths at a rate of 10-12 breaths per minute, ensuring chest rise with each breath.

    • Use supplemental oxygen if available, setting at 15 liters per minute (LPM).

Cardiopulmonary Resuscitation (CPR) and Defibrillation

  • CPR:

    • Maintains blood circulation and oxygen delivery during cardiac arrest or ventricular fibrillation.

    • Cells can die without oxygen in under 10 minutes.

  • Automated External Defibrillator (AED):

    • Delivers electric shock to correct ventricular fibrillation.

    • Operates with visual/audio prompts for users.

    • Rescuer must check for ‘shock advised’ whenever indicated.

    • CPR must resume afterward.

Stroke Recognition and Response

  • Signs of Stroke:

    • F.A.S.T. Method for Stroke:

    • Face: Check for drooping.

    • Arms: Check for numbness or weakness.

    • Speech: Slurred or unable to speak.

    • Time: Report timing of symptoms.

  • Risk Factors:

    • Atrial fibrillation, high blood pressure, diabetes, high cholesterol contribute to the risk of stroke.

Medications in Cardiac Emergencies

  • Common Medications:

    • Oxygen: Increases availability to heart muscle and blood.

    • Aspirin: Reduces clotting; should be chewed for faster efficacy in suspected MI.

    • Nitroglycerin: Dilates arteries, enhancing blood flow; must monitor the patient closely post-administration.

Nonmedical Emergencies

  • Types of Nonmedical Emergencies:

    • Weather-related events: tornadoes, earthquakes, floods.

    • Human-created events: acts of terrorism, active shooter situations.

  • Disaster Response Guidelines:

    • Remain calm and know exit routes and emergency equipment locations.

    • Know specific guidelines based on facility training.

  • DISASTER GUIDELINES:

    • For Fire: Follow RACE (Remove, Activate, Contain, Extinguish).

    • For Tornadoes: Seek shelter away from windows, away from outside walls.

    • For Power Outages: Use backup medical equipment as necessary.

    • For Hurricanes: Stay updated and evacuate if advised.

    • For Earthquakes: Drop, cover, and hold on.

    • For Active Shooter Situations: Follow facility protocol, secure if possible, call 911.

Conclusion

  • EKG technicians should be knowledgeable about emergency guidelines and procedures for both medical and nonmedical emergencies

  • Participation in training drills is crucial for effective response to real emergencies.

  • Understanding the implications of cardiac conditions and medications enhances the technician’s ability to assist effectively in emergencies relevant to patient care.