Comprehensive Emergency Medical Services Notes on Cardiovascular Emergencies

National EMS Education Standard Competencies

  • Pathophysiology - Apply understanding of respiration and perfusion to assess and manage patients, including recognizing signs of inadequate circulation and oxygenation.

  • Medicine - Use knowledge to provide emergency care based on assessment of acutely ill patients, integrating various medical principles and techniques to stabilize their conditions.

  • Cardiovascular Competencies - Anatomy, signs, symptoms, and management of cardiovascular emergencies, including thorough understanding of risk factors leading to cardiac events.

    • Chest pain

    • Cardiac arrest

Overview of Cardiovascular Emergencies

  • Leading Cause of Death - Cardiovascular disease has been the leading cause of death since 1900 in the USA, accounting for approximately 697,000 deaths in 2020, which is about 1 in every 3 deaths. Common conditions include heart attacks, strokes, and other heart-related issues.

  • Role of EMS - Reduce deaths through:

    • Encouraging healthy lifestyles, such as regular exercise and dietary recommendations.

    • Early medical care access via emergency services to ensure quick transport to treatment centers.

    • CPR training for the public, which empowers bystanders to act during emergencies.

    • Use of defibrillation devices in public spaces, making these life-saving tools readily available.

    • Recognizing need for advanced life support, including the use of medications and advanced airway management techniques.

Anatomy and Physiology of the Heart

  • Heart Function - The heart functions as a muscular pump, pushing oxygen-enriched blood to tissues while also assisting in the removal of carbon dioxide and metabolic wastes.

    • Divided into left and right sides:

      • Atria: The upper chambers that receive incoming blood from the body and lungs.

      • Ventricles: The lower chambers that pump blood out to the arteries, with the left ventricle delivering oxygenated blood to the body and the right ventricle pumping deoxygenated blood to the lungs.

  • Electrical System - Controls heart rate and coordinates contractions through electrical impulses. The conductive pathway begins at the SA node, causing atrial contraction, and spreads through the AV node and bundle branches to the ventricles, allowing synchronized pumping.

  • Coronary Arteries - Essential for supplying blood to heart muscle.

    • Two main arteries: Right coronary artery and left coronary artery, which branch into smaller vessels to ensure significant blood flow to all heart tissues.

Pathophysiology of Cardiovascular Disorders

  • Ischemia and Acute Myocardial Infarction (AMI) - Ischemia is the condition where blood flow to the heart muscle is significantly reduced, leading to decreased oxygen supply and potential tissue death. Major causes include:

    • Atherosclerosis - A condition characterized by the build-up of fatty deposits, calcium, and cholesterol in the coronary arteries, narrowing the vessels and restricting blood flow.

    • Thromboembolism - A floating blood clot can obstruct coronary arteries, potentially causing a heart attack if it lodges into a narrowed area.

Signs and Symptoms of AMI

  • Common Symptoms - Patients may present with weakness, nausea, and sweating. Additional signs include:

    • Chest pain or pressure, which may radiate to the arm, back, jaw, or neck.

    • Shortness of breath, which may occur before or along with chest discomfort.

    • Possible pink, frothy sputum, indicating pulmonary edema due to heart failure.

Management of Cardiac Emergencies

  • Emergency Medical Care for Chest Pain - Ensure patient comfort and provide supplemental oxygen as indicated. Actions include:

    • Administer low-dose aspirin (162-324 mg) to help prevent clotting and further heart damage.

    • Prepare for assisting with nitroglycerin administration, recognizing contraindications such as low blood pressure (BP <100 mm Hg) or recent use of erectile dysfunction medication.

    • Nitroglycerin works by relaxing vascular smooth muscle, leading to increased blood flow and reduced myocardial oxygen demand.

Emergency Response Procedures

  • Scene Size-Up - Evaluate the scene for safety and identify the nature of the illness through bystanders’ input and the context, gathering information about potential hazards or crowd challenges.

  • Primary Assessment - Assess responsiveness (AVPU scale), airway patency, breathing effectiveness, and circulation (pulse check). The decision to transport should consider the presence of life threats and local protocols.

Advanced Care: AED and CPR

  • Use of Automated External Defibrillator (AED) - This essential device for patients in cardiac arrest analyzes heart rhythm and delivers a shock if indicated. The Chain of Survival emphasizes:

    • Early recognition of cardiac arrest.

    • Immediate initiation of CPR to maintain blood flow.

    • Rapid defibrillation to restore normal heart rhythm.

    • Access to advanced care through emergency medical services.

Post-Cardiac Arrest Care

  • Management for Return of Spontaneous Circulation (ROSC) - Following ROSC, maintain a patent airway and ensure proper oxygenation. Monitor vital signs and neurologic status, assessing responsiveness, and transport the patient to an appropriate facility quickly if necessary.

Key Takeaways for Exam

  • A thorough understanding of cardiac anatomy and physiology is critical for recognizing and responding to cardiovascular emergencies.

  • Be familiar with signs and symptoms of ischemic heart disease and AMI, as early identification can significantly improve outcomes.

  • Master emergency response protocols, specifically around the use of AEDs, nitroglycerin, and CPR techniques.

  • Recognize the importance of CPR and timely interventions as key factors that improve outcomes for patients experiencing cardiac events.