Acute Coronary Syndrome Paramedic Refresher Transcript PDF

Acute Coronary Syndrome -- Paramedic Refresher Transcript Hey y\'all. I\'m Cecil Fairchild with iMed, and in this module, we\'re going to discuss one of my favorite topics in EMS: the recognition and management of acute coronary syndromes. I want to start us off by pointing out something. In this...

Acute Coronary Syndrome -- Paramedic Refresher Transcript Hey y\'all. I\'m Cecil Fairchild with iMed, and in this module, we\'re going to discuss one of my favorite topics in EMS: the recognition and management of acute coronary syndromes. I want to start us off by pointing out something. In this lesson, we\'re going to talk a little bit about cardiac electrophysiology, obtaining and interpreting 12-lead EKGs, as well as the management of acute coronary syndromes and a few other cardiac emergencies. This course is not going to make you an expert. I\'ve only got an hour to give you a 10,000-foot view. You should continue to seek ongoing education and really dive into this. In this course, we\'re going to review the basics of 12-lead acquisition and interpretation, then we\'ll talk about STEMI and STEMI imposters. I\'m a firm believer that to really understand something, you can\'t just say, \"I know A is true because my instructor told me.\" It\'s like saying, \"I\'m giving this patient medication A because that\'s what the protocol says.\" It\'s crucial to understand the underlying principles, anatomy, and physiology of everything we do. In cardiology, this is especially true. We're going to briefly review cardiac anatomy, physiology, and electrophysiology so you can better understand what's happening when your patient experiences an acute coronary syndrome and you get a 12-lead. Let's start with the cardiac conduction system and how it works. All cardiac muscle cells have the property of automaticity. This means every cardiac muscle cell can generate its own electrical impulse and fire itself off. This is vital because the heart must keep pumping even if it loses outside stimulation. It's like the body's backup system. The cardiac conduction impulses originate from the sinoatrial node, or SA node, at the top of the right atrium. It's the primary pacemaker of the heart, firing at a regular heart rate of 70-100 beats per minute. When the SA node fires, conduction travels through intraatrial and internodal pathways, reaching the atrioventricular (AV) junction. The AV junction is the first backup pacemaker if the SA node fails, firing at a slower rate of 40-60 beats per minute. Impulses then travel from the AV junction through the bundle of His, splitting into the left and right bundle branches, and into the Purkinje fibers to innervate the ventricles. If all else fails, the Purkinje fibers can act as a backup pacemaker, firing at 20-40 beats per minute, resulting in an idioventricular rhythm. Understanding this conduction cycle is crucial. Any disruption in this process affects cardiac function and output, leading to emergencies. For instance, electrolyte imbalances or blockages can disrupt ion movement, impacting depolarization and causing arrhythmias or STEMIs. Now, let's talk about 12-lead EKG acquisition. Accurate placement of electrodes is essential, as they act like cameras showing different parts of the heart. Improper placement gives inaccurate images, making diagnosis difficult. Always follow correct placement guidelines for V1 through V6 and limb leads. When interpreting a 12-lead EKG, never rely solely on the computer-generated interpretation. These are often inaccurate. Analyze the EKG yourself, focusing on each lead\'s morphology and patterns. Look for ST-segment elevation, which indicates STEMI, characterized by elevation greater than 1mm in two or more contiguous leads. Also, understand reciprocal changes, which are opposite findings in leads looking at opposite parts of the heart. Lastly, be aware of STEMI imitators and always strive for accuracy in your assessment. Understanding the underlying physiology, conduction system, and EKG interpretation is essential for effective patient care.