**COMBINED * * BLOCK 3 & 4 review + Skills + BLOCK 6

NTG

nitroglycerin

What skin sign are you likely to observe in a cardiac 911?

pale cool moist or diaphoretic

define VFIB

ventricular fibrillation - It is the most frequent cause of sudden cardiac death.

ALOC

altered level of consciousness

Purkinje fibers

specialized conductive fibers located within the walls of the ventricles tertiary pacemaker if SA and AV nodes fail they kick in @ a much slower HR (very bad) if purkinje fibers fail then we go into cardiac arrest

Define ischemia

Damaged cell tissue due to a lack of oxygen.

Define syncope

fainting

What is NALOXONE?

NARCAN an opioid OD intervention medicine

occlusion

A blockage, usually of a tubular structure such as a blood vessel.

What is the most common cause of sudden death in children?? *** bonus*** Name another big killer of kids

#1 : Airway and Breathing 911 ***Sepsis

AV node

(atrioventricular node) region of the heart between the right atrium and right ventricle from which electrical impulses spread to the ventricles during a heartbeat if SA node fails the AV node takes over, @ a somewhat slower HR (not good) secondary pacemaker

HTN

(hypertension 140-150+ systolic or 90+ diastolic)

What are the BP ranges for hypertension?

(hypertension 140-150+ systolic or 90+ diastolic)

S&S of R sided heart failure

- JVD - pedal edema

** BONUS ** Name 2 reasons to avoid North Africa

- sunburn - Tunisian fat-tailed scorpion (A. australis)

Define ECG aka EKG

-Electrocardiogram -THE GRAPHIC RECORDING OF THE ELECTRICAL CHANGES (DEPOLARIZATION FOLLOWED BY REPOLARIZATION) OCCURING DURING THE CARDIAC CYCLE.

what's the dose of NTG?

.4mg

what's the maximum dose of NTG

.4mg x 3 / episode

How many cardiac emergencies are fatal per year? When do they usually become lethal?

500,000 people die per year 250,000 in the first hour

CAD

coronary artery disease

What is the dose for aspirin to help with cardiac 911?

81mg x 2-4

thromboembolism

A blood clot that has formed within a blood vessel and is floating within the bloodstream.

dissecting aneurysm

A condition in which the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressures) to flow between the layers.

congesitve heart failure (CHF)

A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs.

syncope

A fainting spell or transient loss of consciousness.

ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete bloackage of blood flow; potentially reversible because permanent injury has not yet occurred.

Cardiac Output (CO)

A measure of the volume of blood circulated by the heart in 1 minute, calculated by multiplying the stroke volume by the heart rate.

tachycardia

A rapid heart rate, more than 100 beats/minute.

Ventricular tachycardia (V-tach)

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

Name 5-7 OPQRST S/S's of AMI (hint: 0o / 2p/ Q/ 3r / ST )

Acute Myocardial Infarction S/S P - Provoke* -maybe nothing P - Palliation* -nothing by the EMT Q - Crushing, Pressure, "Vice-like" R - Region -Substernal or midsternal R - Radiation -Upper thorax R - Reoccurrence -possible history, possibly first time S - Severity -mod to severe **may be "silent"can be atypical in woman, diabetics and elderly T* -more than 30 minutes (unlike angina)

Define angina

Acute severe chest pain Pressure or tightness, usually in the chest but can be in the arm shoulder or jaw

Glucose (INDICATIONS) Glucose (CONTRAINDICATIONS)

Ind. = hypoglycemia Contra = ALOC, can't follow simple instructions

hypertensive emergency

An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm.

dysrhythmia

An irregular or abnormal heart rhythm.

inferior

The part of the body or any body part nearer to the feet.

CO = ____ x ____.

CO = HR x SV

What is the most common cause of sudden death in adults?

Cardiac arrest

superior

The part of the body or any body part nearer to the head.

infarction

Death of a body tissue, usually caused by interruption of its blood supply.

Define hypoperfusion

Decrease of oxygen-rich blood to tissues widespread inadequate blood flow

ventricle fibrillation

Disorganized, ineffective quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest.

EMT's can carry and administer... _______ and ___________.

Glucose and Oxygen

CO = ____ x SV.

HR heart rate

sometimes the first sign of cardiovascular disease is _________.

High Blood Pressure

What position is indicated for L side heart failure?

High Fowler's

What does aspirin do to help a cardiac 911?

IT IS AN ANTI-PLATELET it makes the platelets less sticky, it stops clots from getting bigger aka blood thinner

What does NTG do?

It is a vasodilator. It opens blood vessels.

Define: JVD

Jugular Vein Distension

S/S of left sided heart failure

L= Lungs -dyspnea -cough - restlessness - tachycardia - rales

What do you do for a P with dizziness?

Lie them down , consider shock position

** Bonus** What is Rob's favorite song by Natalia Clavier?

Lumen https://open.spotify.com/track/10eR5CedA1idilta1h46NH?si=itIhSYJ4TSiCdM8ft6pd8w

S/S of Cardiac Disease (name 4-6)

N/V Diaphoresis Dyspnea (SOB) Irregular Pulse Weakness Hypotension (*see also SHOCK) / hypertension

EMT's can assist patients in administering...

Nitroglycerin, Epinephrin Auto-Injector, maybe: NALOXONE (NARCAN) Bronchodilator MDI?? MEDICATION ADMINISTRATION

Name 5-7 OPQRST S/S's of Angina Pectoris

O - immediate P - provocation - • exertion • increased HR P - palliation - • NTG • Rest • o2 Q - Crushing pressure "vice-like" R - region - substernal / midsternal R - radiation upper thorax left arm, left jaw/nack R - reoccurrence - possible esp. if Rx NTG . S - mod to severe , may be "silent" can be atypical in women diabetics and people over 70 T - *** under 30 minutes , usually 5-15 min. with rest (unlike AMI)

ventricle

One of two (right and left) lower chambers of the heart. The left ventricle receives blood from the left atrium (upper chamber) and delivers blood to the aorta. The right ventricle receives blood from the right atrium and pumps it into the pulmonary artery.

Oxygen - O2 (CONTRAINDICATIONS)

Pulse Ox Goal is already met: 94-98% sat 88-92% COPD patients

Define congestive heart failure (CHF)

Pump insufficiency; inability of heart to pump enough blood to keep up with demand of body

What should we do with a P with angina pectoris first?

Put them at rest, lay down or High Fowlers decrease HR

CO = HR x _____.

SV (stroke volume)

Acute Dissecting Aortic Aneurysm

Separation of the arterial wall of the aorta.

Epinephrin Auto-Injector (INDICATIONS)

Severe anaphylaxis with symptoms of either shock and/or respiratory distress

Who is most likely to have a silent heart attack? (3)

Severity of pain may be "silent" // atypical in - - women - diabetics and - P over 70

cardiogenic shock

Shock caused by inadequate function of the heart, or pump failure. A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

Define shock position

Shock position. ... The shock position is the position of a person who is lying flat on his or her back with the legs elevated approximately 8-12 inches. This is used when a patient is showing signs of shock. The shock position is also used for patients experiencing heat related emergencies and suspected cardio compromise . .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Shock position - Wikipedia https://en.wikipedia.org/wiki/Shock_position

dependent edema

Swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure.

posterior

The back surface of the body; the side away from you in the standard anatomic position.

coronary arteries

The blood vessels that carry blood and nutrients to the heart muscle.

perfusion

The flow of blood through body tissues and vessels.

myocardium

The heart muscle.

lumen

The inside diameter of an artery or other hollow structure.

sympathetic nervous system

The part of the autonomic nervous system that controls active functions such as responding to hear (also known as the "fight-or-flight" system).

stroke volume

The volume of blood ejected with each ventricular contraction.

defibrillate

To shock a fibrillating (chaotically beating) ehart with specialized electric current in an attempt to restore a normal, rhythmic beat.

Define Vtach

Ventricular tachycardia Ventricular tachycardia (V-tach or VT) is a type of regular and fast heart rate that arises from improper electrical activity in the ventricles of the heart. Ventricular tachycardia - Wikipedia https://en.wikipedia.org/wiki/Ventricular_tachycardia

V-tach

Ventricular tachycardia (an increased ventricular heart rate).

** BONUS ** What is the world's most venomous scorpion?

Who FAT-TAILED SCORPIONS (genus) When 2018 The most venomous scorpions are the fat-tailed scorpions belonging to the genus Androctonus. Several of these species rival each other in terms of the strength of their venom. Tunisian fat-tailed scorpion (A. australis) - IV LD50 of 260 µg/kg (a fatal dose of 18.2 mg for a 70-kg adult) *responsible for 80% of stings and 90% of deaths from scorpion stings in North Africa. **discovered in 1758. ***The term LD50 represents the dose of venom that proves lethal to 50% of a test population.

dilation

Widening of a tubular structure such as a coronary artery.

what is 53BASH? (Describe the 6 parts)

a mnemonic for NTG contras "53 BASH" 5 - Last dose was < 5 minutes ago 3 -NTE 3/day, 0 NTG if P has taken 3 doses already B - BP - Systolic blood pressure < 100mm/Hg A - ALOC (Altered Level of Consciousness) S - SEXUAL enhancing/ erectile dysfunction drugs within 48 - 72 hours (Viagra, Cialis, Levitra) H - Head/facial trauma

Define Fowler's Position

a semi-sitting position; the head of the bed is raised between 45 and 60 degrees

ACS

acute coronary syndrome

AMI

acute myocardial infarction

Define rales

an abnormal rattling sound in unhealthy lungs aka crackling lung sounds

What OTC drug might you consider in a cardiac emergency (in addition to NTG)??

aspirin

Name 1 relative contra of Aspirin?

asthma (relative contra, not in LA cty)

Define perfusion

blood flow and oxygen delivery to body tissues

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

EEG

electroencephalogram shows brain's electrical activity by positioning electrodes over the scalp

How often will you re-assess a cardio 911 P?

every 5 minutes

Define pulmonary edema

excess fluid in the lung "swelling of lung"

Tachycardia

fast heart rate

Name 2-4 important factors to Management of cardiac compromise

increase o2 decrease o2 demand ( decrease workload ; don't let them walk, stand, jumping jacks etc) minimize / prevent further damage time lost = heart muscle lost ( act fast!! )

SA node

primary pacemaker of the heart, located in the right atrium - ((sinoatrial node))

Define cardiogenic shock

pump failure, occurs when heart is so inefficient that it cannot sustain adequate circulation.

parasympathetic nervous system

rest and digest system The part of the autonomic nervous system that controls vegetative functions such as digestion of food and relaxation.

(ROSC)

return of spontaneous circulation The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.

Define hematology

study of blood

coronary vessels

supply the heart muscle with its blood supply

Name 5 - 12 risk factors for Acute Coronary Syndromes

unmodifiable (4) - age - sex - race - family history Modifiable (8) - hypertension (high BP) - diet - obesity - smoking - alcohol (excessive) - stress - high blood sugar - physical inactivity