Cardiovascular Emergencies - Chapter 19 PDF

8/22/2024 Slid e1 CHAPTER 19 CARDIOVASCULAR EMERGENCIES  8/22/2024 Slid OVERVIEW e2 Review of the Circulatory System Anatomy Physiology Cardiac Compromise...

8/22/2024 Slid e1 CHAPTER 19 CARDIOVASCULAR EMERGENCIES  8/22/2024 Slid OVERVIEW e2 Review of the Circulatory System Anatomy Physiology Cardiac Compromise Assessment Emergency Medical Care  8/22/2024 Slid OVERVIEW e3 Automated External Defibrillator Overview of the Automated External Defibrillator Advantages of the Automated External Defibrillator Operation of the Automated External Defibrillator Postresuscitation Care Automated External Defibrillator Maintenance Automated External Defibrillator Skills  8/22/2024 Slid e4 THE CIRCULATORY SYSTEM  8/22/2024 Slid THE CIRCULATORY SYSTEM e5 The heart pumps blood to the body organs through the cardiovascular system This process is so vital to life that any interruption for more than a few minutes can mean death to the individual  8/22/2024 Slid THE CIRCULATORY SYSTEM e6 Heart Blood vessels Arteries Veins Capillaries Blood  8/22/2024 Slid THE HEART e7 Structure and function Atrium Ventricle Right Right Receives blood from the veins of the body Receives blood from the right atrium and the heart Pumps oxygen-poor blood to the lungs Pumps oxygen-poor blood to the right ventricle Left Left Receives blood from the left atrium Receives blood from the pulmonary veins (lungs) Pumps oxygen-rich blood to the body Pumps oxygen-rich blood to left ventricle THE HEART  8/22/2024 Slid THE HEART e9 Structure and function Valves prevent backflow of blood  8/22/2024 Slid THE HEART e 10 Structure and function Cardiac conductive system Heart is more than a muscle Specialized contractile and conductive tissue in the heart Electrical impulses create coordinated contraction Automaticity The ability of cardiac muscle cells to generate their own impulses  8/22/2024 CONDUCTIVE SYSTEM 11  8/22/2024 Slid BLOOD VESSELS e 12 Arteries Arterioles Capillaries Venules Veins  ARTERIES 8/22/2024 Slid Carry blood away from the heart to the rest of the body e 13 Major arteries Coronary Vessels that supply the heart with blood Aorta Major artery originating from the heart, lying in front of the spine in the thoracic and abdominal cavities Pulmonary Artery originating at the right ventricle; carries oxygen-poor blood to the lungs Carotid Major artery of the neck Femoral Major artery of the thigh Radial Major artery of the lower arm Brachial An artery of the upper arm Posterior tibial Dorsalis pedis ARTERIES  8/22/2024 Slid ARTERIOLES e 15 The smallest branches of an artery leading to the capillaries  8/22/2024 Slid CAPILLARIES e 16 Tiny blood vessels that connect arterioles to venules Found in all parts of the body Allow for the exchange of nutrients and waste at the cellular level CAPILLARIES  8/22/2024 Slid VENULES e 18 The smallest branches of a vein leading to the capillaries  8/22/2024 Slid VEINS e 19 Vessels that carry blood back to the heart Major veins Pulmonary vein Carries oxygen-rich blood from the lungs to the left atrium Venae cavae Superior Inferior Carries oxygen-poor blood back to the right atrium VEINS  THE BLOOD 8/22/2024 Slid e 21 Red blood cells Give the blood its color Carry oxygen to organs Carry carbon dioxide away from organs White blood cells Part of the body’s defense against infections Plasma Fluid that carries the blood cells and nutrients Hematocrit: total number of cells in the blood. Normal 35-45% Platelets Essential for the formation of blood clots  8/22/2024 PULSE Slid e 22 Left ventricle contracts, sending a wave of blood through the arteries Can be palpated anywhere an artery simultaneously passes near the skin surface and over a bone Peripheral Radial Brachial Posterior tibial Dorsalis pedis Central Carotid Femoral PULSE  8/22/2024 Slid BLOOD PRESSURE e 24 A measure of the pressure exerted against the walls of the arteries during contraction and relaxation of the heart Systolic Pressure exerted against the walls of the artery when the left ventricle contracts Diastolic Pressure exerted against the walls of the artery when the left ventricle is at rest  8/22/2024 Slid PERFUSION e 25 The process of delivering oxygenated blood to the organs and removing waste products and carbon dioxide Cellular respiration  8/22/2024 Slid PERFUSION e 26 Shock (hypoperfusion): hemodynamic: Widespread inadequate tissue perfusion  8/22/2024 Slid SHOCK e 27 Signs and symptoms Pale or cyanotic skin Cool or cold skin Rapid weak pulse Altered mental status Rapid breathing Nausea and vomiting Low or decreasing blood pressure A LATE SIGN!  8/22/2024 Slid e 28 CARDIAC COMPROMISE  8/22/2024 Slid CARDIAC COMPROMISE e 29 Ischemia A condition of reduced oxygen to body tissues and cells  8/22/2024 Slid CARDIAC COMPROMISE e 30 Atherosclerosis A condition in which cholesterol and cellular debris form a plaque inside the arteries, narrowing the area that the blood flows through  8/22/2024 31 CARDIAC COMPROMISE Normal artery Artery clogged with plaque  8/22/2024 Slid CARDIAC COMPROMISE e 32 Angina Chest pain caused by reduced oxygen to the heart due to inadequate blood supply through the coronary arteries  8/22/2024 Slid CARDIAC COMPROMISE e 33 Myocardial infarction A condition in which a part of the heart muscle dies as a result of no blood supply and prolonged lack of oxygen  CARDIAC COMPROMISE 8/22/2024 34 MYOCARDIAL INFARCTION  8/22/2024 Slid CARDIAC COMPROMISE e 35 Congestive heart failure A condition in which the heart fails to pump efficiently, causing fluid to back up into the lungs and venous system  8/22/2024 Slid CARDIAC COMPROMISE e 36 Signs and symptoms Squeezing, dull pressure; chest pain commonly radiating down the arms or to the jaw Sudden onset of sweating (this in and of itself is a significant finding) Difficulty breathing (dyspnea) Anxiety, irritability Feeling of impending doom Abnormal pulse rate (may be irregular) Abnormal blood pressure Epigastric pain Nausea/vomiting  8/22/2024 Slid ASSESSMENT e 37 Initial assessment Focused history and physical exam OPQRST Physical exam SAMPLE history  8/22/2024 Slid e 38 EMERGENCY MEDICAL CARE  8/22/2024 Slid EMERGENCY MEDICAL CARE e 39 Priorities in management Oxygen Positioning Nitroglycerin Basic life support  EMERGENCY MEDICAL CARE Place the patient in a position of comfort Administer high-flow oxygen  8/22/2024 Slid EMERGENCY MEDICAL CARE e 41 Administration of nitroglycerin reduces the workload of the heart  8/22/2024 Slid NITROGLYCERIN e 42 Indications Signs and symptoms of cardiac chest pain Patient has physician-prescribed nitroglycerin spray or sublingual tablets EMT-B has permission from medical direction physician  8/22/2024 Slid NITROGLYCERIN e 43 Contraindications Patient has systolic blood pressure less than 100 mm Hg Patient does not have own nitroglycerin Patient has head injury or is not mentally alert Patient has already taken maximum prescribed dosage  8/22/2024 Slid NITROGLYCERIN e 44 Assisting the patient with nitroglycerin Obtain order from medical direction either online or offline Perform focused assessment for cardiac patient Take blood pressure—above 100 mm Hg systolic Contact medical control if no standing orders  8/22/2024 Slid NITROGLYCERIN e 45 Assisting the patient with nitroglycerin Ensure right medication, right patient, right route, patient alert Check expiration date of nitroglycerin Question patient on last dose, administration, effects, and ensure understanding of route of administration Ask patient to lift tongue and place tablet or spray dose under tongue (while wearing gloves) or have patient place tablet or spray under tongue  8/22/2024 Slid NITROGLYCERIN e 46 Assisting with nitroglycerin Have patient keep mouth closed with tablet under tongue (without swallowing) until dissolved and absorbed Recheck blood pressure within 2 minutes Record activity and time Perform reassessment  8/22/2024 Slid NITROGLYCERIN e 47 Assisting with nitroglycerin Reassessment strategies Monitor blood pressure Ask patient about effect on pain relief Seek medical direction before readministering Record reassessments  8/22/2024 Slid NITROGLYCERIN e 48 Mechanism of action Relaxes vascular smooth muscle to increase coronary blood flow Decreases blood return to heart, thus lessens heart’s workload  8/22/2024 Slid NITROGLYCERIN e 49 Side effects Lowers blood pressure Headache Pulse rate may drop Burning sensation on or under tongue  8/22/2024 Slid BASIC LIFE SUPPORT REVIEW e 50 If available, request ALS backup One-person CPR Two-person CPR  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 51  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 52 Defibrillation is the primary intervention that makes the greatest difference in survival of cardiac arrest patients in ventricular fibrillation. AUTOMATED EXTERNAL DEFIBRILLATION The chain of survival  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 54 Many EMS systems have demonstrated increased survival outcomes of cardiac arrest patients experiencing ventricular fibrillation This increased survival was after early defibrillation programs were implemented and when all of the links in the chain of survival were present  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 55 Analysis of cardiac rhythms Defibrillator computer microprocessor evaluates the patient’s rhythm and confirms the presence of a rhythm for which a shock is indicated Detects shockable rhythms AUTOMATED EXTERNAL DEFIBRILLATION Ventricular fibrillation AUTOMATED EXTERNAL DEFIBRILLATION Ventricular tachycardia  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 58 Overview of automated external defibrillators Types of automated external defibrillators Fully automated—defibrillator operates without action by EMT-Basic, except to turn on power Semi-automated defibrillator uses a computer voice synthesizer to advise EMT-Basic as to the steps to take based on its analysis of the patient’s cardiac rhythm  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 59 Accuracy of devices in rhythm analysis has been high, both in detecting rhythms that need shocks and rhythms that do not need shocks Analysis is dependent on properly charged defibrillator batteries  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 60 Inappropriate delivery of shocks Human error Mechanical error  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 61 Attach defibrillator to only unresponsive, pulseless, non-breathing patients to avoid delivering inappropriate shocks Defibrillator advises shocks for ventricular tachycardia when the rate exceeds a certain value, for example, above 180 beats/min  8/22/2024 Slid AUTOMATED EXTERNAL e 62 DEFIBRILLATION Interruption of CPR No CPR performed at times shocks are delivered No person should be touching patient when rhythm is being analyzed and when shocks are delivered Chest compressions and artificial ventilations are stopped when the rhythm is being analyzed and when shocks are delivered Defibrillation is more effective than CPR; stopping CPR during the process is more beneficial to patient outcome CPR may be stopped for up to 90 seconds if three shocks are necessary Resume CPR only after up to the first three shocks are delivered  8/22/2024 Slid AUTOMATED EXTERNAL DEFIBRILLATION e 63 Advantages Speed of operation Defibrillation is “hands off” Safer method Better electrode placement Has larger pad surface area Provokes less anxiety in EMT-Basic  OPERATION OF THE AED Take infection control precautions en route to scene Arrive on scene and perform initial assessment Stop CPR if in progress Verify pulselessness and apnoea  OPERATION OF THE AED Have partner resume CPR Turn on defibrillator power  OPERATION OF THE AED Attach device Begin narrative if machine has tape recorder  OPERATION OF THE AED Stop CPR Clear patient Initiate analysis of rhythm  OPERATION OF THE AED Machine advises shock Deliver shock OPERATION OF THE AED  8/22/2024 Slid OPERATION OF THE AED e 70 If no ACLS personnel are on scene, transport patient when: Pulse regained After 6-9 shocks delivered (varies by region) Three consecutive messages of “no shock advised” (separated by 1 minute of CPR)  8/22/2024 Slid e 71 OPERATION OF THE AED One EMT operates the AED and the other EMT performs CPR Open the airway and confirm arrest Defibrillation comes first Do not do anything that delays shocks The first shock should be delivered within 60 seconds  8/22/2024 Slid e 72 OPERATION OF THE AED State “clear patient” before defibrillation Make sure everyone is clear  8/22/2024 Slid e 73 OPERATION OF THE AED En route to receiving facility Continue shocks as long as AED advises Sets of three shocks with 1 minute of CPR between Stop vehicle to analyze the rhythm Additional shocks as directed by medical direction physician  8/22/2024 Slid POST RESUSCITATION CARE e 74 After AED protocol is completed, the patient may: Have pulses Have no pulse with machine indicating “no shock indicated” Have no pulse with machine indicating shock  8/22/2024 Slid POST RESUSCITATION CARE e 75 If pulses return Consider awaiting ALS backup if appropriate Transport the patient Continue to keep defibrillator device on patient en route Perform focused assessment and reassessment en route  8/22/2024 Slid DEFIBRILLATOR MAINTENANCE e 76 The most common cause of defibrillator failure is poor maintenance Use a maintenance checklist  8/22/2024 Slid AED SKILLS e 77 Maintenance of AED skills Practice skills regularly Have events reviewed by medical director or representative  8/22/2024 Slid SUMMARY e 78 Review of the Circulatory System Anatomy Physiology Cardiac Compromise Assessment Emergency Medical Care  8/22/2024 Slid SUMMARY e 79 Automated External Defibrillator Overview of the Automated External Defibrillator Advantages of the Automated External Defibrillator Operation of the Automated External Defibrillator Post resuscitation Care Automated External Defibrillator Maintenance Automated External Defibrillator Skills