Chapter 14 emt

Minimum pressure for nitro

100 systolic

Primary: if not breathing

100% oxygen via bag mask

Treating cardiovascular emergencies

ABCs High flow oxygen If unconscious: determine if cpr needed, and AED. If ok locally, aspirin or nitro.

How does cardiogenic shock tie into these heart issues

AMI is typical cause; but any heart issue can cause it. heart just isn't pumping enough so lack of perfusion.

What is AMI?

AMI, or heart attack, occurs when heart tissue downstream of a blood clot suffers from a lack of oxygen and, within 30 minutes, begins to die.

basic heart function

Atria receives incoming blood, and ventricles pump outgoing blood. One-way valves keep blood flowing in the proper direction. Aorta, body's main artery, receives blood ejected from left ventricle.

To administer nitro

Be ready for patient to fiaint; place tablet under the tongue. Keep mouth shut. No chewing. Rechceck blood pressure within 5. If chest pressure reamins and blood pressure > 100, than administer again in 5 minutes Usually 3 doses is max DO NOT DELAY FOR for nitro; do en route.

When does CHF occur, as in, what is occurring with heart?

CHF occurs when damaged heart muscle cannot pump blood. It results in shortness of breath, fluid in lungs, or legs. It is left side of heart. It can be due to AMI. They refer to it as left-sided. Pulmonary edema is a form of CHF.

What to do if CHF?

CPAP

what is angina pectoris

Chest pain from lack of oxygen *for a brief time.* Brought on by stress, exercise, cold weather. Usually goes away with rest (3 to 5 minutes) or nitro. Pain can radiate to arm, jaw.

Signs, symptoms of angina pectoris

Crushing chest pain "someone sitting on my chest" Usually less than 15, usually less than say 5 Pain can radiate

ami, cardiac compromise other symptoms

Fear, nausea, poor circulation Faster, irregular, or bradycardic pulse Decreased, normal, or elevated BP Normal or rapid and labored respirations Patients express feelings of impending doom.

what is congestive heart failure?

Heart fails; left ventricle Congestive since lungs congest (pulmonary edema is one form) Fluids accumulate Doesn't seem like death... shortness of breath; edema.

When pediatric AED?

In an unresponsive child less than 8 years and weighing less than 55 lb, perform defibrillation with special pediatric pads.

When in CPR sequence do you transport?

NO ALS OR Patient regains pulse OR 6 to 9 shocks delivered OR AED gives 3 consecutive messages of no shock

How is angina often treated by patients

Nitro, sitting down, etc. They may be able relieve the pain themselves.

How does ami differ from angina?

Not always due to exertion Lasts 30 minutes to several hours Not always relieved by rest or nitroglycerin More severe pain

If a patient with an implanted pacemaker is in cardiac arrest, the EMT should:

Place AED pads at least one inch away

Signs, symptoms of AMI

Sudden onset, no obvious cause Same chest pain as angina Radiation Pink sputum (possibly pulmonary edema). shortness of breath DIAPHORESIS

Symptoms of hypertensive emergencies?

Sudden, severe headache Strong, bounding pulse Ringing in the ears Nausea and vomiting Dizziness Warm skin (dry or moist) Nosebleed AMS Pulmonary edema

What are hypertensive emergencies?

Systolic pressure greater than 160 mm Hg

what is systolic pressure

The max pressure generated by left ventricle Top number in the reading What we feel as pulse

How do you treat CHF?

Treat a patient with CHF by monitoring vital signs. Give oxygen via nonrebreathing face mask. Allow the patient to remain sitting up.

signs symptoms of aortic aneurysm

Very sudden chest pain Comes on full force Different blood pressures (??)

All of the following are common signs and symptoms of cardiac ischemia, EXCEPT: headache. chest pressure. shortness of breath. anxiety or restlessness.

a

if blood clot lodges in coronary artery

acute myocardial infarction (AMI) results

Signs of cardiogenic shock are:

altered loc; restlessness; anxiety; pale, clammy skin; increased pulse rate; rapid, shallow breathing; and decreased blood pressure.

While palpating the radial pulse of a 56-year-old man with chest pain, you note that the pulse rate is 86 beats/min and irregular. you conclude has:

arrythmia

what is thrombo-embolism

blood clot moving

what is stroke volume

blood ejected each contraction

when to do nitro?

complaint similar to normally experienced angina or cardiac pain BP greater than 100 mmHg systolic no more than three doses total (5 minutes apart) must be patient's prescription patient must be sitting or lying down no Viagra or Levitra within past 24 hours or Cialis within past 48 hours AND GIVE THEM OXYGEN!

What is cardiac arrest

complete cessation of cardiac activity absence of carotid pulse

what is ischemia

decreased blood flow

Using AED the "don'ts"

don't touch patient don't do CPR while using equipment no motion not if with pulse (don't try to fix someone)

Signs, symptoms of CHF

fatigue cough dyspnea pulmonary edema (a severe form of CHF) tachypnea agitation and confusion hypertension swollen feet or lower legs

what is myocardium

heart muscle

History taking

investigate chief complaint ask about any recent trauma SAMPLE if conscious Onset provocation/palliation quality of pain region/radiation Severity Time: how long it lasts; is it intermittent

How do you treat angina patients

like ami patients (don't try to differentiate them)

what is asystole?

no heart electrical activity long period of ischemia almost always death

Is congestive heart failure the heart stopping?

no. that's cardiac arrest. chf is damaged heart symptoms. shortness of breath; fluid in lungs; fluid in feet.

Basic treatment If difficulty breathing

oxygen via non rebreathing

AED and nitro patch

remove, wipe dry

When not to do AED

responsive In the unresponsive infant, begin CPR. Do not apply AED to moving a patient. Do not apply AED to *responsive* patients with rapid heart rates.

what does defibrillator do?

restore heart rhythm

details of blood flow

right atrium (unoxygenated); right ventricle; lungs; left atrium; mitral valve; left ventricle; aortic valve.

treating pulmonary edema

suction, air, transport. chest pain typically gets nitro, aspirin.

pulmonary edema presents

think rales (listen to chest), and then usual chest things; coughing up blood; worse when lying down.

Treating hypertensive emergency

transport quickly

What to do with aortic aneurysm

transport rapidly

cardiac output

volume in one minute

What is aortic aneurysm?

weakness in wall, susceptible to rupture Dissecting aneurysm occurs when inner layers of aorta become separated (Table 14-1). Primary cause: uncontrolled hypertension