Cardiology
Usually left coronary artery is the cause of heart attack, but happens to right as well. Pooling in legs are typically sign of right side. CHF usually results in fluid in lungs.
Atria receive blood, ventricles pump out blood.
Electrical Impulses start at the SA Node. Passes through AV Node which helps delay the electrical (redstone repeater, delays signal). AV Node can take over if SA Node fails, but can only maintain 40-60 bpm vs SA 60-100.
Ischemia is low blood flow to the heart, infarction is the damage as a result of the ischemia.
Atherosclerosis is the buildup of calcium and cholesterol in the arteries.
Unstable Angina: Occurs in the absence of a significant increase in oxygen demand.
Stable Angina: Occurs in response to exercise or activity that increases demand on the heart muscle.
AMI Symptoms: Caused by blocked coronary artery? Weakness, nausea, sweating; chest pain, pressure, discomfort; lower jaw, arm, back, abdomen, or neck pain; irregular heartbeat and syncope; shortness of breath; vomiting; pink, frothy sputum; sudden death.
AMI pain differs from angina pain. Not always due to exertion, lasts 30 mins to several hours, not always relieved by rest or nitro.
AMI and cardiac compromise 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.
Dysrhythmia: Heart rhythm abnormalities. Premature ventricular contractions. Tachycardia, bradycardia, ventricular tachycardia, ventricular fibrillations. Tachycardia: 100+, Supraventricular 140+
Hypertensive Emergencies: Systolic over 180. Common symptoms are nausea, vomiting, dizziness, warm skin, nosebleed, altered mental status, sudden pulmonary edema.
Aortic aneurysm is weakness in the wall of the aorta; susceptible to rupture.
Dissecting aneurysm occurs when inner layers of aorta become separated. Primary cause: Uncontrolled hypertension. Bleeding occurs between those layers, eventually ballooning. Very sudden chest pain, 10/10 really quick; ripping tearing sensation; different bp on each arm; pain comes in full force. Moving them must be careful to not pop it. Different to tell apart AMI and dissecting aneurysm. For brain aneurysm: Main complaint for brain aneurysm is a thunderclap headache. “Feels like someone is grabbing their face” or “squeezing their brain.”
Aspirin: Prevents blood clots from forming or getting bigger. 81mg chewing tablets. Recommended dose: 162 mg (2 tablets) to 324 mg (4 tablets). Only push for cardiac chest pain. Contraindications: Not A&O 4, Need to be 18+, wheezing/asthma, active bleed. Do not need to call medical control for Aspirin.
Nitroglycerin: Vasodilator, opening arteries to help blood flow to heart. Indications: Cardiac chest pain. HAS to be prescribed to the patient. Need medical control permission. Above 100 systolic. Can’t exceed 3 doses per day. Contraindications: Not alert, below 100 systolic, not prescribed, max dose taken, on ED meds.
Cardiac Monitoring: Shave if needed to apply electrodes, place them on corners of body. V1 V2 go on sternum nipple level. V6 go to the side right below nipple level. V3-V5 go between V2 and V6 under breast. When electrodes are on turn it on.
Cardiac Pacemakers: Maintain regular cardiac rhythm. Very reliable, inside the body. Malfunction can cause syncope.
Implantable AEDs: Used by some patients who have survived cardiac arrest due to ventricular fibrillation. Electricity low enough not to hurt EMTs.
External Defibrillator Vest: Vest with buildin monitoring electrodes and defib pads worn by the patient. Attached to a monitor, uses high energy shocks. Do not touch patient if warned of shock.
LVADs Left ventricular assist devices: Used to enhance pumping of the left ventricle. Most common ones have an internal pump and external batter.
When pulse is back (return of spontaneous circulation): Monitor respirations. BVN 10 breathes per mind. Maintain sp02. Assess bp. See if patient can follow simple commands. Immediately begin transport if ALS is not en route.
Chest Injuries:
Cervical and thoracic vertebrae (below C5 can result in paralysis). Above C3 can cause loss in ability to breathe.
4 sided occlusive dressing in open wounds. Don’t wrap neck in bandages for obvious reasons. Leave broken bones sticking out, wrap around it. Don’t remove impaled object unless absolutely necessary, if you do pack the wound with gauze to replace the object and wrap.
Signs and symptoms of injuries to chest: Pain at the site of injury, localized pain aggravated or increased with breathing, bruising to chest wall, crepitus with palpation of the chest, penetrating injury, difficulty breathing (dyspnea), hemoptysis (coughing up blood), flail chest/paradoxical motion, cyanosis, low SpO2, rapid, weak pulse and low bp.
Pneumothorax: Commonly called collapsed lung. Accumulation of air in the pleural space. Blood passing through the collapsed portion for the lung is not oxygenated. Diminished, absent, or abnormal breath sounds.
Simple Pneumothorax: Compensating. 1 Lung (muffled)
Tension Pneumothorax: Decompensated. 2 Lungs affected. JVD, Trachea deviation, Altered
Flutter Valve and 1 Way valve is the same (in terms of chest seal).
Hemothorax: Blood collects in the pleural space around the lung and prevents it from expanding. Similar to pneumothorax but instead of air it’s blood. Shock without any obvious external bleeding or apparent reason for shock. Decreased breath sounds on that side.
Hemopneumothorax: Presence of air and blood in the pleural space.
Cardiac Tamponade: Protective membrane (pericardium) around the heart fills with blood of fluid, causing heart to be unable to pump an adequate amount of blood. Use Beck’s Triad: Muffled heart sounds, narrow pulse pressure (less than 25), JVD; Altered LOC.
Pulmonary Contusion: Lung wall bruise. Should always be suspected in patient with a flail chest, usually causes pulmonary edema. Supplemental oxygen and positive pressure ventilation as needed.
Traumatic Asphyxia: Distended neck veins, cyanosis in the face and neck, and hemorrhage in the sclera of the eye. Just ventilate them. Not really favorable outcomes.
Blunt Myocardial Injury: Bruising of the heart muscle, heart may be unable to maintain adequate blood pressure. S: Irregular pulse rate, chest pain or discomfort.
Commotio Cordis: Blunt hit to the chest (usually on heart) that disrupts the hearts conduction and leads to cardiac arrest. Usually AED brings them back.