Chapter 17: Cardiovascular Emergencies General Knowledge
-Indicates fluid is being moved into lungs from circulatory system
"Wet" lung sounds
What does the sympathetic nervous system do?
-accelerates the heart rate -increased respiratory rate and depth -dilates blood vessels in the muscles -constricts blood vessels in the digestive system
What does the parasympathetic nervous system do?
-slows the heart and respiratory rates -constricts blood vessels in the muscles -dilates blood vessels in the digestive system
Complications of a heart attack
-sudden death -cardiogenic shock -congestive heart failure
What is in plasma?
-water -salts -nutrients -proteins
According to the American Heart Association, how many lives has cardiovascular disease claimed in the U.S. in 2016?
840,768 (30.6% of all deaths, or 1 in 3 deaths)
Thrombolytic medicine
A clot-busting medication used in treating AMI
Shock
A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.
Pink, frosty sputum
A sign of pulmonary edema or left side CHF
atrioventricular (AV) node
A small mass of specialized cardiac muscle fibers, located in the wall of the right atrium of the heart, that receives heartbeat impulses from the sinoatrial node and directs them to the walls of the ventricles.
Sinoatrial (SA) node
A specialized area of cardiac tissue, located in the right atrium of the heart, which initiates the electrical impulses that determine the heart rate; often termed the pacemaker for the heart.
Hypertension
A systolic above 130 mm Hg or diastolic above 80 mm Hg
-Fast and delivers the most important treatment for a patient in VF -Easy to operate -Shock can be given remote, through adhesive defibrillation pads -pad area larger than paddles thus more efficient
Advantages of AEDs
percutaneous transluminal coronary angioplasty (PTCA)
Aims to dilate, rather than bypass, the coronary artery
Semiautomatic AED
Analyzes patient's cardiac rhythm, determines if shock is needed, advises operator to deliver shock by pushing button
-Shortness of breath -Nausea -Sweating
Angina is often associated with?
Pulse
Beat of the heart as felt through the walls of the arteries.
Systolic Pressure
Blood pressure in the arteries during contraction of the ventricles.
Mechanic Chest Compressor
Can be used on transport
-exposed to light/heat -expired
Can cause nitro to fail
7-10% decrease each minute until defibrillation
Cardiac arrest patient's chances of survival until defibrillation
What has been the leading killer in the U.S. since 1900?
Cardiovascular disease
Inferior Venae Cavae
Carries blood from the abdomen, pelvis, and legs back to the right atrium
superior venae cavae
Carries blood from the head and arms back to the right atrium
Red blood cells
Carries oxygen to the body's tissue and removes carbon dioxide
Near to none
Chances of survival for patient wiath asystole heart rhythms
Pulmonary circulation
Circulation of blood between the heart and the lungs
Acute myocardial infraction
Classic heart attack
-Sudden Death -Cariogenic Shock -Congestive heart failure
Consequences of AMI
-Cigarette smoking -High blood pressure -Elevated Cholesterol level -Elevated blood glucose level (diabetes) -Lack of exercise -Obesity
Controllable "Risk factors" for AMIs:
Automatic AED
Delivers shock without the operator pressing a button; Not many left
Furosemide
Diuretic; increase the strength of hear contractions
Septum
Divides the right and left chambers of the heart
-sildenafil (Viagra) -Tadalafil (Cialis) -Avanafil (Stendhal) -Vardenafil (Levite, staxyn)
Drugs used for erectile dysfunction
Right-sided heart failure
Edema in lower extremities. Can lead to swelling of feet and legs Lower blood pressure
-voltage -current -impedance
Factors involved in defibrillation
Where is cardiogenic shock most often found?
Following an AMI the affects the inferior and posterior region of the left ventricle
AED failing to deliver shock when needed
Greatest legal risk when it comes to using an AED
Baseline
Horizontal line between all waves
"Like someone is standing on my chest"
How do patients often describe angina?
Within 5 minutes for most patients
How fast does nitro typically work?
30 minutes
How long does is take for heart muscle cells to die without adequate oxygen?
20-60 seconds
How long does it take for an external defibrillator vest to recognize and shock a patient?
A year or longer for 10% of victims
How long does it typically take to recover from cardiac arrest
3-8 minutes and rarely longer that 15 minutes
How long does the pain from angina typically last?
5 cycles of compression (approx. 2 minutes)
How long is a typically CPR cycle?
Approximately 1/3
How man people do not seek medical care during an AMI?
As many as 1/2
How many cells in the heart area can die within two hours of a AMI?
4 L/min
How much air to administer via nasal cannula
15 L/min
How much air to administer via nonrebreather mask
100% oxygen
How much oxygen to administer via bag-valve mask
Every 5 minutes
How often should you reassess an unstable patient?
More than 90%
In most cases, after 4-6 hours into an AMI, ________ of heart cells will die
Ischemic heart disease
Inadequate oxygen supply to the heart muscles due to impaired blood flow to the heart
Pulseless electric activity
Indicates there no electric activity remains
Long surgical scar on the chest
Indicator a patient has had a bypass graft operation
Rapid defibrillation
Link that most common determinant for survival in chain of survival
Dark red blood cells
Low on oxygen
Metoprol
Lowers blood pressure
-Monitor for spontaneous respiration -provide oxygen via bag-mask device at 10 breath/min -maintain an oxygen saturation between 95% and 99% -Assess BP -See if he/she can follow simply commands
Management of ROSC
"Key-hole" surgery technique
May not produce a large scar
Mean arterial pressure (MAP)
Measures the average blood pressure and is displayed when a noninvasive blood pressure is measured
Severe headache
Most common side affect of a hypertension emergency
Bright red blood cells
Oxygenated
What system is in control during times of relaxation?
Parasympathetic nervous system
Peripheral pulse
Pulses felt in the extremities
Central pulses
Pulses near the trunk of the body, like carotid and femoral
-Have you ever had a heart attack? -Have you been told that you have a heart problem? -Have you been diagnosed with angina, heart failure, or heart valve disease? -Have you ever had high blood pressure? -Have you ever been diagnosed with an aneurysm? -Do you have any respiratory disease such as emphysema or chronic bronchitis -Do you have diabetes or have you ever had any problems with your blood sugar? -Have you ever had kidney disease? -Do you have any risk factors for coronary artery disease, such as smoking, high blood pressure, or high cholesterol? -Is there a family history of heart disease -Do you currently take any medications
Questions specially for cardiovascular emergencies:
QRS complexes
Represents one contraction of the ventricles
Sudden Death
Result of cardiac arrest where the hear fails to generate effective blood flow
-Be aware of the surface on which the patient is lying -What is the age of the patient -Does the patient have a medical patch in the area the AED pad will be place? -Does the patient have an implanted pacemaker or internal defibrillator in the same area the AED pads will be place?
Safety tips for using an AED
-Low blood pressure -severe headache -change in pulse rate
Side effects of Nitro
-Very sudden chest pain located in the anterior part of the chest or in the back between the shoulder blades -exhibits different blood pressures between arms -diminished pulse in the lower extremities
Signs and symptoms of a dissecting aortic aneurysm
-Strong bounding pulse -ringing in the ears -nausea and vomiting -dizziness -warm skin (dry or moist) -nosebleed -altered mental status -sudden development of pulmonary edema
Signs and symptoms of a hypertension emergency
-Sudden onset of weakness, nausea, and sweating without an obvious case -Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath -pain, discomfort, or pressure in the lower jaws, arms, back, abdomen, or neck -Irregular heartbeat and syncope -Shortness of breath, or dyspnea -Nausea/vomiting -Pink frothy sputum (indicating possible edema) -sudden death
Signs and symptoms of an AMI
1. Recognition of early warning sides 2. Immediate CPR with emphasis on high-quality chest compressions 3. Rapid defibrillation 4. Basic and advance EMS 5. ALS and post arrest care 6. Recovery
Six links to the chain of survival
Anioplasty
Sugical repair of vessle; balloon inserted in clogged artery inflated to flatten fatty deposits against walls of artery
Brachial Artery
Supplies blood to each arm
Left and right iliac arteries
Supplies blood to the groin, pelvis, and legs
Radial and ulnar arteries
Supplies blood to the lower arms and hands
Anterior and posterior tibial arteries and peroneal artery
Supply blood to lower legs and feet
What system is in control during times of stress?
Sympathetic nervous system
-syncope -dizziness -weakness
Symptoms a patient may experience if his/her pacemaker isn't working properly
Stroke volume
The amount of blood ejected from the heart in one contraction.
Which ventricle is thicker and why?
The left ventricle is thicker because it pumps blood to the entire body
Afterload
The pressure the left ventricle pumps against
scar tissue
The thick, collagenous tissue that forms at an injury site
Cardiac Output
The volume of blood ejected from the left side of the heart in one minute.
-A well-functioning Heart -an adequate volume of fluid or blood -Blood must be carried in a proper sized container
Three components of good perfusion
-pulse regained (ROSC) -No pulse, and AED indicates that no shock is advised -No pulse, and AED indicates that shock is advised
Three outcomes of defibrillation
-Make him/her comfortable -monitor blood pressure regularly -transport to ED as quickly and safely as possible -Position patient with head elevated
Treatment for Hypertension emergency
-Rest -Supplemental oxygen -nitroglycerin
Treatments to alleviate Angina
The right and left bundle branches
Two pathways in the interventricular septum that carry the impulses toward the apex of the heart
atria
Two upper chambers of the heart
-Small white tablet (sublingual) -Spray (sublingual) -Patch (absorb through chest)
Types of Nitro
-Old age -Family History of atherosclerosis coronary artery disease -race -ethnicity -male sex
Uncontrollably "Risk Factors" for AMIs:
Stroke or dissecting aortic aneurysm
Untreated hypertensive emergencies can lead to?
-May or may not be caused by exertion but can occur at any time, sometimes when a person is sitting quietly or even sleeping -It does not resolve in a few minutes; rather it can last between 30 minutes and several hours -It may or may not be relieved by rest or nitroglycerin
Ways AMI pain differs from Angina
-Speed of defibrillation -when the monitor can record it -the quality of CPR (including times on pauses)
What AED related reviews should involve
-Better Public Awareness -Early Access to medical care -Increased numbers of laypeople trained in CPR -Increased use of evolving technology in dispatch and cardiac arrest response -public access to defibrillator devices -Recognization of the need for ALS services -use of cardiac specialty centers when they are available
What are some way to reduce the number of lives claimed by cardiovascular emergencies?
-relaxes the muscles of blood vessel walls -dilates coronary arteries -increase blood flow And supply of oxygen to heart muscles -decrease workload of heart
What does Nitro do?
150 or 180 beats/min
What does an AED consider VT?
Death of cells in the heart muscle
What does the pain from an AMI signal?
Blue Gel
What indicates a shock has been delivered via external defibrillator vest?
Silent Myocardial Infraction
What is AMI without its classic chest pain symptoms called?
-Preload -After-load -Contractility
What is Stroke volume affected by?
>180 mm Hg Systolic pressure
What is considered a hypertension emergency
Cardiac Output= Heart Rate x Stroke Volume
What is the formula for cardiac output?
coronary artery disease
What is the number one cause of death in the U.S. for men and women?
Heart Disease
What is the number one killer of women in the U.S.?
45-64 Years
What is the peak age range for AMIs?
162 to 324 mg per dose
What is the recommended does of aspirin for cardiac issues
81-mg
What is the typical dose of aspirin?
To shock 100% of patients within a minute
What is the ultimate goal for AEDs?
Fizzing sensation
What should patients experience after putting nitro tablet under tongue?
Patients who require/are waiting for a heart transplant
When are LVADS used?
Late 1970 and early 1980s
When did AEDs start to appear?
When the heart's need for oxygen exceeds it's supposed; usually during periods of physical or emotional stress
When does Angina Pectoris typically occur?
Within 2 minutes of onset of cardiac arrest
When does defibrillation work best?
The Myocardium is so profoundly damaged that it can no longer keep up with the return of flow of blood from the atria
When does heart failure occur?
Immediately
When should patients with chest pain be transported?
-Patient regains a pulse -Six to nine shocks have been delivered (or as directed by local protocol) -AED gives three consecutive message (separated by 2 minutes of CPR) that no shock is advised on a pulseless patient (or as directed by local protocol)
When should you transport a patient in cardiac arrest?
-pulseless -not breathing (apneic) -Unresponsive
When to apply an AED
1960s
When was CPR introduced?
Midpoint of chest, under the sternum; can radiate to jaw, arms (frequently the left arm), midpoint of back, or epigastrium
Where is Angina typically felt?
-The larger, thick-walled left ventricle
Where is a AMI most likely to occur?
Louis
Where the manubrium meets the body of the sternum
The lower left ventricle
Which ventricle provides circulation to a majority of the body's organs?
Patients experience Pulmonary Edema
Who would benefit from CPAP
Coronary Bypass graft
a blood vessel from the chest or leg is sewn directly from the aorta to a coronary artery beyond the point of obstruction
Bundle of His
a bundle of modified heart muscle that transmits the cardiac impulse from the atrioventricular node to the ventricles causing them to contract
Cholesterol
a fatty substance that travels through the blood and is found in all parts of the body
Angioplasty
a method of surgically unblocking a narrowed or blocked artery (this can be done by using a balloon or laser)
Bilevel positive airway pressure
a mode of ventilator assistance that delivers air to assist with the individual's ability to control breathing for both inspiration and expiration by alternating the amount of pressure
electrocardiogram
a record of the electrical activity of the myocardium
Epigastrium
abdominal region above the stomach
Pulmonary Edema
accumulation of fluid in the lungs
Aspirin
acetylsalicylic acid; helps with blood clots
Dissecting aortic aneurysm
aneurysm caused when blood gets between and separates the layers of the aortic wall
AED
automated external defibrillator
Platelets
blood clotting
Left-sided heart failure
causes an accumulation of fluid in the lungs also known as pulmonary edema
Cardiac Arrest
cessation of heart activity
Stable Angina
chest pain that occurs when a person is active or under severe stress
Unstable Angina
chest pain that occurs while a person is at rest and not exerting himself/herself
Angina Pectoris
chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle
CHF
congestive heart failure
CPAP
continuous positive airway pressure
P Wave
contraction of the atria
-Less than 100 mm Hg systolic blood pressure -head injury -use of erectile dysfunction drugs within past 24-48 hours -max does of nitro already given (usually three does)
contraindications of nitro
Aorta Rupture
dead
resting pressure
diastolic
coronary artery disease
disease of the arteries surrounding the heart
Premature Ventricular Contractions
extra beats in a damaged ventricle.
Purkinje fibers
fibers in the ventricles that transmit impulses to the right and left ventricles, causing them to contract
White blood cells
fight disease and infection
Asystole
flat line
Umbilicus
navel
Nitroglycerin
nitrate drug used in the treatment of angina
Nitrostat
nitroglycerin
What does the cardiac cycle consist of?
one complete systole and one complete diastole for both atria and vent
Deoxygenated
oxygen poor
Oxygenated
oxygen rich
Right side of heart:
receives deoxygenated blood from the body and pumps it to the lungs
The left side of the heart:
receives oxygenated blood from the lungs and pumps it to the body
Contractility
refers to how hard the myocardium contracts for a given preload
Preload
related to the amount of blood returning to the right ventricle and therefore ultimately to the left ventricle
T Wave
repolarization of ventricles
Impedance
resistance to the flow of energy
Venules
small vessels that gather blood from the capillaries into the veins
Arterioles
small vessels that receive blood from the arteries
Right and left femoral arteries
supply blood to lower extremities
Left and Right Carotid Arteries
supply blood to the head and neck
Right and Left Subclavian Arteries
supply blood to the upper extremities
automatic implantable cardioverter-defibrillator (AICD)
surgically implanted electrical device that continuously monitors and corrects potentially fatal arrhythmias by delivering low-energy shocks to the heart; also called implantable cardioverter defibrillator (ICD)
cardiac pacemaker
surgically placed mechanical device connected to stimulating leads (electrodes) on or within the heart, programmed to help maintain normal heart rate and rhythm
"Fight-or-flight" system
sympathetic nervous system
Cardiac Denial
the act of denying AMI related symptoms due to fear of death and potential symptoms may be serious
pulmonary artery
the artery carrying blood from the right ventricle of the heart to the lungs for oxygenation.
Plasma
the fluid in which other parts of the blood are suspended
Diastolic Pressure
the pressure in the arteries when the heart is at rest
External Defibrillator Vest
this is a vest with built in monitoring electrodes and defibrillation pads which is worn by the patient under their clothing.
Capillaries
tiny blood vessels that connect arteries and veins
Left Ventricular Assist Devices (LVADS)
used to enhance the pumping of the left ventricle
Stent
wire-mesh tube used to keep arteries open
12-lead ECG tracing
yields much of the information needed to identify cardiac conditions
