EMT: CARDIAC and CIRCULATION, EMT Chapter 18- cardiac emergencies, emtbcardio2

Acute coronary syndrome (ACS)

Any condition brought on by a sudden reduction or blockage of blood flow to the heart.

Congestive Heart Failure

Congestive Heart Failure is often a complication with a heart attack.

Perfusion

Constant flow of oxygenated blood to the tissues

And adults heart typically beats with a ratio of 60-100 bests each minute. What each minute of heart beats called?

Cycles

Acute Myocardial Infarction

Often called a Heart Attack. The condition in which a portion of the myocardium dies as a result of oxygen starvation.

ischemia

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

What is angina pectoris?

chest pain caused by insufficient blood flow to the myocardium; typically due to CAD; pain usually increases upon exerction

Indications for administering Aspirin

chest pain, ability to swallow

Angina Pectoris

pain in chest due to lack of blood flow to myocardium muscle

Who is a typical cardiac arrest victim?

A male in his 60's

Nitroglycerin

A medication that diatlates the blood vessels

Bradycardia

a slow heart rate, less than 60 beats/minutes.

temporary loss of consciousness caused by a fall in blood pressure

syncope

stroke volume

the volume of blood ejected with each ventricular contraction

postictal

(occurring) after a seizure or attack

List following signs and symptoms of cardiac compromise

-Feeling of impending doom -Squeezing, chest pain or dull pressure that may radiate down the arm or to the jaw. -Sudden onset of diaphoresis (sweating) -Anxiety and irritability -Difficulty breathing -Irregular or abnormal pulse rate -Abnormal blood pressure -Epigastric pain -Nausea and/ or vomiting

Fluid and Electrolyte Imbalances What are three different fluid compartments of the body?

-Intravascular -Intracellular -Extracellular

Inadequate Circulation What is shock (hypoperfusion)? How is it characterized by a signs and symptoms?

-It is a profound depression of the body's vital processes. -It is characterized by signs and of paleness, cyanosis, cool clammy skin, shallow and rapid bathing, rapid but weak pulse, mental dullness, restlessness, and anxiety. -There is also a drop in blood volume.

What are the three types of cardiac polarity?

-Polarization -Depolarization -Repolarization

What is Acute Myocardial infarction (MI)?

-There will be actual death to a region of the cardiac muscle from lack of oxygenated blood flow. -This can be from a blocked coronary arteries.

dosage for nitroglycerin

0.4 mg every 5 minutes. max 3 doses

Nitroglycerin can be administered under the conditions that..

1. Authorization by medical direction 2. Patients physician prescribed the medication 3. Blood pressure is greater then 100 systolic

Non-shockable rhythms

1. Aystole 2. PEA

tachycardia: above __ bpm

100

Signs and symptoms of Acute Coronary Syndrome

1. Difficulty breathing 2. Sudden onset of sweating with nausea and vomiting 3. Pain in the chest or upper abdomen

Management of a patient with ACS

1. Place the patient in position of comfort (Fowler) 2. Administering high O2 via Non-reb mask 3. Assist the patient of nitro if medical direction authorizes

Shockable rhythms

1. V-Fib 2. Pulseless ventricular tachycardia 3. Ventricular tachycardia

Dysrhythmia

A disturbance in the heart rate and rhythm

Hypertension, or high blood pressure, usually means a reading over __ / __

140 / 90

If the down time is more than 4 minutes, __ minutes of CPR needs to be done before applying the AED

2

After __-__ minutes of inadequate blood flow and reduced oxygen, the heart tissue begins to die

20-30

Maximum number of doses of Nitro

3 doses

when traveling to the hospital with an unconscious patient, check the pulse every __ seconds

30

If the down time is __ minutes or less, the AED needs to be readied and applied

4

bradycardia hr: below __ bpm

60

normal adult HR: __-__ bpm

60-100

low blood pressure, or hypotension, usually means a reading less than __ / __

90 / 60

What is an acute myocardial infarction?

A HEART ATTACK; death of a portion of the myocardium due to a lack of O2; CAD USUALLY the underlying issue

Cardiac Arrhythmia -Ectopic beat

A beat that originates outside of the heart's pacemaker (SA node.)

Acute Coronary Syndrome

A blanket term used to represent and symptoms related to lack of oxygen in the heart muscle. Also called Cardiac Compromise.

Pulse-less Electrical Activity (PEA)

A condition in which the heart has an electrical rhythm but is not generating a pulse

Cardiac Arrhythmia -Premature ventricular contraction (PVC)

A contraction of ventricles that occurs early.

Thrombus

A stationary blood clot along the wall of the blood vessel

Cardiac Arrhythmia -Ventricular flutter

A ventricular rate of 15o-300 beats per minute (considered life-threatening).

AED Use

AED says "analyzing" do not touch patient.

Acute Myocardial Infarction

AKA: Heart attack - A condition in which a portion of the myocardium dies as a result of oxygen starvation

In this type of cardiac emergency, rest and/or nitro may only partially relieve the symptoms or may have no relief at all

AMI

What is the problem? Signs and symptoms: chest discomfort anxiety dyspnea impending doom diaphorea nausea and/or emesis weakness light-headedness or dizziness

AMI

Cardiac Arrhythmia -Asystole

Absence of a heart rate (flat line)

Chest Pain

Administer Oxygen

AED Single Shock

After a single shock from an AED, and patient regains pulse, place patient in recovery position.

Hypertension (HTN) What is it?

Also called high blood pressure (HGP), hypertension is reading of anything above 14o mmHg systolic pressure or above 90 mmHg diastolic pressure.

Hypoperfusion

Also known as shock. Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen.

Dysrhthmia

An irregular or abnormal heart rythm

Coronary Artery Diseases

Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure

What is Angina Pectoris?

Angina is transient chest pain that results from a lack of oxygen to the heart muscle. -This can occur at rest or during physical activity or stress. -It resolves with rest, oxygen, and nitroglycerine. -It only lasts around 5-15 minutes, and does not cause permanent heart damage.

Patient Assessment and Management

Any patient with chest pain or any cardiac emergency should be transported as high priority. The EMT-B should consider medications such as nitroglycerine ands aspirin per standard EMS protocol and with approval of the medical director. Also, consider us of continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BIPAP) for patient in heart failure.

Cardiac Arrhythmia -Premature atrial contraction (PAC)

Atrial contraction that occurs early.

Cardiac Arrhythmia -Atrial flutter

Atrial rate of 250-350 beats per minute that produces a "saw tooth" pattern

Cardiac Arrhythmia -Atrial fibrillation

Atrial rate of 350-500 beats per minute

Cardiac Arrhythmia -Paroxysmal atrial tachycardia (PAT)

Atrial tachycardia that occurs and subsides suddenly.

Embolism

Blockage of a vessel by a clot or foreign material brought to sight by the blood current

Occlusion

Blockage, as of an artery by fatty deposits

Damage to Left Ventricle

Blood backs up into the pulmonary circulation and the lungs. Pulmonary Edema.

Describe the flow of blood through the heart

Blood enters the heart through the right atrium from the venae cava. Blood then travels through the TRIcuspid valve into the right Ventricle. From the Right Ventricle blood is pumped through the pulmonary artery to be oxygenated by the lungs. After Oxygenation, blood travels back to the heart through the pulmonary vein where it will enter the left atrium, then into the left ventricle. After it has passed through the left ventricle, it will be pumped into the aorta to perfuse the rest of the body.

Coronary Arteries

Blood vessels that supply the myocardium

How is fluid volume deficit corrected?

By administration of IV fluids, use of antidiarrheal medications and treatment of the electrolyte imbalance, if necessary.

How does fluid excess occur?

By overhydration, where fluid intake and retention exceeds the body's requirements. The goal of treatment is to correct electrolyte imbalances if present, eliminate the underlying cause of the overload, and restore fluid balance. Care interventions include stabilizing and monitoring for complications.

symptoms of acute coronary syndrome

CHEST PAIN: "crushing, dull, or squeezing", radiates to arms, upper abdomen, jaw; dyspnea (differentiate that heart is problem); anxiety; feeling of impending doom; sweating; sometimes abnormal pulse; sometimes abnormal BP

signs: swollen ankles from dependent edema high BP rapid heart rate and respirations crackles (rales) sometimes, the pink sputum and dyspnea of pulmonary edema

CHF

with this, the damaged heart muscle can no longer pump blood efficiently, the lungs fill with fluid (pulmonary edema), breathing becomes difficult, hr increases, and left ventricle enlarges.

CHF

Congestive Heart Failure (CHF of HF) What is it?

CHF occurs when ventricles are not able to adequately pump blood or handle the blood pumped in them.

Left Heart Failure

Can cause Right Heart Failure

Sudden Death

Cardiac Arrest that occurs within 2 hours of the onset of symptoms. -Patient may have no prior symptoms

What are cardiac arrhythmias?

Cardiac arrhythmias are irregular heart activities.

What is acute coronary syndrome also called?

Cardiac compromise

Artery

Carries blood away from the heart

Viens

Carry blood to the heart

Best known heart problem symptom

Chest Pain

Identify Stroke

Cincinnati Prehospital Stroke Scale Facial Droop Arm Drift Slurred Speech Altered Mental Status

Coronary Artery Disease

Conditions that narrow or block the arteries of the heart. Coronary artery disease is often the result of buildup of fatty deposits on the inner walls of the arteries.

Defibrillation

Defibrillation is used for emergency treatment for patients who are in ventricular fibrillation, a form of irregular heartbeat. Also called v. fib, this arrhythmia is characterized by rapid electrical impulses. Defibrillation involves administering and electric shock to the heart with the purpose of reestablishing a normal rhythm. CPR is often performed along with defibrillation. The automated external defibrillator (AED) is a computer-controlled device that requires little manipulation for use. EMT-B providers can use the AED to administer life-saving treatment. The semi-automatic AED involves placement of patches and leads, so the sure can analyze the rhythm. To administer a hock, only a push of a button is necessary. The fully automatic AED is quicker, and usually the preferred device.

Patients with a heart problems may complain of..

Difficulty breathing, mild chest discomfort, and pain in the center of the chest

Coronary Artery Disease

Diseases that affect the arteries of the heart

V-fib

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

Extracellular Compartment

Fluid outside a cell in the interstitial space or transcellular areas (peritoneal, pleural, cerebrospinal, and synovial).

What is an electrocardiogram?

EKG or ECG are noninvasive tests that record the electrical activity of the heart and detect cardiac dysrhythmias -It is important to reassure a patient that there will be no electrical shock.

What are electrolytes?

Electrolytes are substances that exist in the human body, dissolve in solution, and have electrically charged atoms or ions. When there is fluid loss, the body loses electrolytes.

What is edema?

Excess fluid in the interstitial spaces, from cardiac or liver failure, or localized, from burns or traumatic injury.

Storke Assessment

Facial Assessment Ask patient to grimace to smile

Cardiac Arrhythmia -Tachycardia

Fast heartbeat (more than 100 beats per minute)

The iliac becomes the ____ artery as it enters the leg thru the groin, which then becomes the ____ artery at the knee.

Femoral; Tibial (anterior/front and posterior/back)

Intravascular Compartment

Fluid inside a blood vessel.

Intracellular Compartment

Fluid inside a cell.

the heart's electrical system controls __

HR

Cardiac output

Heart rate X volume of blood ejected w/ each contraction. This is the vol of blood that passes thru the heart in 1 min/amt of blood pumped out of left ventricle in 1 min and is the best measure of the output of the heart.

What is homeostasis?

Homeostasis is the medical term that indicates relative stability of the internal body fluid balance. -When there is a fluid volume deficit, it is dehydration

Contractility

How hard the heart squeezes

Preload

How much blood is returned to the heart prior to the contraction.

Types of shock

Hypovolemic-severe bleeding causes loss of pressure, which makes it hard on the heart to perfuse adequately. Loss of pressure also means LOSS OF OXYGEN Distributive-Loss of blood vessel tone. Smooth muscle has lost its ability to control its diameter. Causes low pressure. Cardiogenic- Heart fails in its ability to pump blood. Electrical problem or mechanical problem. Obstructive- Blood flow is physically blocked. Stops blood flow to vital organs.

What is dehydration caused by?

Inadequate fluid intake, fluid shifts between compartments, increased fluid loss from perspiration, diarrhea, and ketoacidosis, renal failure, chronic illness, and chronic malnutrition.

Shock

Inadequate perfusion of blood throughout the body. Otherwise known as HYPOPERFUSION.

Lumen

Inside diameter of an artery or other hollow structure

Hypoxia

Insufficiency of oxygen in the body's tissue.

Ischemia

Insufficient O2 supply that deprives tissues of nutrients, resulting from partial blockage of blood flow; potentially reversible.

Cardiac Dysrrhythmia

Irregular heartbeat. Improper beating of the heart, too fast or too slow

Repolarization

Is the recovery of the cells.

Polarity

It is the electrical status of cardiac muscle cells in an attempt to maintain electronegativity inside the cells for distribution of ions, such as potassium, sodium, and chloride.

Polarization

It is the resting of the cardiac muscles cells, depolarization is changing and contracting of these cells.

Damage to the _______ Ventricle causes the backup of blood into the lungs.

Left

Recovery Position Left Side

Left Lateral Recumbent

What causes pulmonary edema? What are symptoms?

Left Ventricular failure, the blood backs up into the lungs. -Symptoms include dyspnea, chest pain, leg and food swelling, and difficulty breathing lying down (orthopnea).

The symptoms of angina and MI are similar, what separates them?

MI pain typically does not go away after a few minutes. -EMS provider should treat PT's with chest pain as if he or she is having an MI.

Nitroglycerine use

Most protocols allow EMT-B providers to administer nitroglycerine tables or sublingual sprays for persons who have chest pain and who have a doctor's prescription. Before giving this drug, determine what doses that PT took before you arrived. Most protocols require you to contact medical director if the patient does not have a prescription. After giving the nitroglycerine, The PT should be monitored for changes in blood pressure and LOC. If the patient experiences a systolic BP of less than 100, place him or her in the Trendelenburg position and reassess.

Acute Coronary Syndrome (ACS) What are symptoms of ACS caused from?

Myocardial ischemic. -This syndrome includes both angina pectoris and acute myocardial infarcti9on (heart attack)

Cardiac Medications

Nitroglycerin Aspirin

nonshockable rhythms

PEA asystole

Angina Pectoris

Pain in the chest, which occurs when - the blood supply to the heart is reduced - a portion of the heart muscles is not receiving enough oxygen

Angina Pectoris

Pain in the chest. In this condition coronary artery disease has narrowed the arteries that supply the heart. Occurring when blood supply to the heart is reduced and a portion of the heart muscle is not recieving enough oxygen.

Right Sided Heart Failure

Pedal Edema

If a patient with a pacemaker needs to be deliberated, the EMT should....

Place the pad several inches away from the pacemaker battery.

Left Sided Heart Failure

Pulmonary Edema

AED Indications

Pulseless Not Breathing Unresponsive

Left Ventricle

Pumps oxygenated blood to the body.

Which arteries supply blood to the hands?

Radial and ulnar arteries

Cardiac Arrest Treatment

Rapid CPR and early application of an AED. Maintain open airway, apply high concentration of oxygen, non rebreather mask.

V-tach

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

Ventricular tachycardia (V-Tach)

Rapid heartbeat -if rapid enough it will not allow the hearts chambers to fill with enough blood between beats to produce blood flow sufficient enough to meet the body's needs

Anatomy of the Heart

Right Atrium to Right Ventricle Left Atrium to Left Ventricle

Swollen ankles and coughing up pink sputum may cause you to suspect that the patient is experiencing...

Right heart failure

What causes jugular venous distention (JVD) and leg/food edema?

Right ventricular failure, the blood backs up into the venous system.

ROSC Return of Spontaneous Circulation

Roll patient onto left side Suction airway if indicated Maintain open airway

electrical conduction system

SA node, AV node, Bundle of His, Purkinje fibers

Cardiogenic Shock

Shock or lack of perfusion brought on by inadequate pumping action of the heart. Often the result of a heart attack or congestive heart failure.

Dyspnea

Shortness of breath, labored or difficulty breathing.

Dyspnea

Shortness of breath; labored or difficulty breathing

Cardiac Arrhythmia -Bradycardia

Slow heartbeat (less than 60 beats per minute)

Coronary arteries

Start just above the aortic valve. Supplies blood to the right ventricle and to the inferior wall of the left ventricle.

Cardiac Output

Stroke Volume x Heart Rate

Subclavian arteries

Supply blood to upper extremities and become the brachial arteries once they reach the arm.

Right and left carotid arteries

Supply the head and brain w/ blood

Edema

Swelling resulting from a build-up of fluid in the tissues

Congestive Heart Failure Signs and Symptoms

Tachycardia (Fast Pulse) Dyspnea Cyanotic (Blue or Gray skin color) Diaphretic ( Profuse Sweating) Pulmonary Edema (White or Pink septum) Pedal Edema Anxiety or confusion

Acute Myocardial Infarction Signs and Symptoms

Tachycardia, Diaphretic, clear lung sounds, radiating pain

Nitroglycerin

Taken by patient's who have chest pain of cardiac origin. Dilates the blood vessels

Afterload

The amount of pressure the heart has to pump against in order to force blood out of the system

What does the descending aorta branch into?

The common iliac arteries, which supply blood to the groin, pelvis, and legs.

Aneurysm

The dilation, or ballooning, of a weakened section of the wall of an artery

parasympathetic nervous system

The division of the autonomic nervous system that calms your body, conserving energy.

Congestive Heart Failure Definition

The failure of the heart to efficiently, leading to excessive blood or fluids in the lungs, the body, or both. The fluid buildup is called Edema.

Congestive Heart Failure (CHF)

The failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body, or both

Infarction

Tissue death

Ischemia

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

Ventricular Fibrillation (VF)

The most serious cardiac rhythm disturbance

Which artery supplies the feet?

The peroneal artery

Return of Spontaneous Circulation (Rosc)

The return of a pulse and effective blood flow to body in a patient who previously had cardiac arrest

Stroke Volume

The volume of blood ejected with each ventricular contraction

How do kidneys play a role in electrolyte balance?

They regulate fluid, with the quantity of fluid determined by the amount of water ingested and the amount of waste excreted.

bradycardia

a slow heart rate, less than 60 beats/min

AED First Arrives

Turn it on and place pads on patient.

Cardiac Arrhythmia -Ventricular fibrillation

Uncoordinated ventricular contractions (quivering of the heart).

shockable rhythms

V-Fib V-Tach

AED Shockable Rhythms

V-Tach V-Fib

Nitroglycerin Causes

Vasodilation and increased oxygen supply to the heart.

Stroke volume

Vol of blood pumped out by the left ventricle in one cardiac cycle/with each contraction. It's affected by preload, afterload, and contractility. Preload is related to venous return to the rt atrium. Afterload is associated w/ systemicc vascular resistance, which is a function of the constriction of the systemic bv's. Contractility refers to how forcefully the heart contracts.

Stoke Volume

Volume of blood ejected in a single squeeze of the heart

Administering Oxygen

When the EMS provider confirms a patient is experiencing cardiac compromise, he or she should administer oxygen after placing the patient in a comfortable position. The oxygen can be given through a nonrebreather mask at a rate of 15 liters per minute.

What is considered to be a hypertensive crisis? What are signs of this?

When the blood pressure is either over 160 systolic or over 94 diastolic. -Ringing or the ears (tinnitus), headache, nausea/vomiting, nosebleed, and dizziness

Bradycardia

When the heart rate is slow, usually below 60 beats per minute

How does third-spacing of fluid occur?

When there is accumulation and trapped Extracellular fluid in a body space, such as joint cavities, the pleural spaces, or within soft tissues.

could vitals still be in a normal range but a heart problem still be present?

YES

acute coronary symdrome

a blanket term used to represent any symptoms related to lack of oxygen in the heart muscle

occlusion

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

Occlusion

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

thromboembolism

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

Thromboembolism

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

sudden death

a cardiac arrest that occurs within two hours of the onset of symptoms, the patient may have no prior symptoms of coronary artery disease

thrombus

a clot formed of blood and plaque attached to the inner wall of an artery or vein

asystole

a condition in which the heart has ceased generating electrical impulses

ventricular tachycardia

a condition in which the heart rate is quite rapid, if rapid enough, it will not allow the heart's chambers to fill enough blood between beats to produce blood flow sufficient enough to fill the body's needs

ventricular fibrillation

a condition in which the heart's electrical impulses are disorganized, preventing the heart muscle from contracting properly

pulseless electrical activity

a condition in which the heart's electrical rhythm remains relatively normal, but the mechanical pumping activity fails to follow the electric activity, resulting in cardiac arrest

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

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.

What is Coronary Artery Disease?

a condition that narrows/blocks coronary arteries, often from fatty deposit build up on inner walls of arteries

Atherosclerosis

a disorder in which a cholesterol and calcium build up inside the walls of blood vessels, forming plaque, which eventually leads to partial or complete blockage of blood flow.

atheroslerosis

a disorder in which cholesterol and calcium build up inside the walls of blood vessels, eventually leading to partial or complete blockage of blood flow

Congestive Heart Failure (CHF)

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

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

dystrhythmia

a disturbance in heart rate or rhythym

Syncope

a fainting spell or transient a loss of consciousness,often caused by an interruption of blood flow to the brain.

syncope

a fainting spell or transient loss of consciousness

Acute Myocardial Infarction (AMI)

a heart attack; death of heart muscle following obstruction of blood flow to it. Acute in this context means "new" or "happening right now".

acute myocardial infarction (AMI)

a heart attack; death of heart muscle following obstruction of blood flow to it. acute in this context means new or happening right now

ischemia

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

Cardiac Output

a measure of the volume of blood circulated by the heart and 1 min., calculated by multiplying the stroke line of the heart rate.

cardiac output

a measure of the volume of blood circulated by the heart in one minutes, calculated by multiplying the stroke volume by the heart rate

tachycardia

a rapid heart rate, more than 100 beats/min

ventricular tachycardia

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

Ventricular Tachycardia

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.

Tachycardia

a rapid heartbeat, more than 100 beats/minute.

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. This can be a severe complication of large acute myocardial infarction, as well as other conditions.

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 large acute myocardial infarction

cardiac arrest

a state in which the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest, even if muscular and electrical activity continues in the heart

acute coronary syndrome

a term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction

Acute Coronary Syndrome

a term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction.

Is the vena cava a vein or an artery?

a vein

aortic aneurysm

a weakness in the wall of the aorta that makes it susceptible to rupture

Aortic Aneurysm

a weakness in the wall of the aorta that makes it susceptible to rupture.

pericardial effusion

accumulation of fluid in pericardial cavity

pedal edema

accumulation of fluid in the feet or angles

pulmonary edema

accumulation of fluid in the lungs

pedal edema

accumulation of fluids in the feet or ankles

CPR

actions taken to revive a person by keeping the person's heart and lungs working

sympathetic nervous system

activates body during emergency situations (fight or flight response)

What is the problem? Signs and symptoms: angina pectoris dyspnea syncope anxiety or irritability diaphorea referred pain

acute coronary syndrome

this, which is also called "cardiac compromise," is often the result of coronary artery disease and is used as a blanket term for any time the heart may not be getting enough oxygen

acute coronary syndrome

this condition, which usually results from coronary artery disease, is typically the result of severe narrowing or complete occlusion of the coronary arteries

acute myocardial infarction (AMI or heart attack)

Asystole

also known as flatline, is a state of no electrical activity from the heart and therefore no blood flow. It results in cardiac arrest.

Coumadin is used to prevent heart attacks, strokes, and blood clots in veins and arteries.

also warfarin

Signs and Symptoms of Shock

altered mental status cool clammy pale skin increased heart rate increased respiratory rate sweating delayed Cap Refill

hypertensive emergency

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

Hypertensive Emergency

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

Cardiopulmonary resuscitation (CPR)

chest compressions and artificial ventilation

arrhythmis

an irregular or abnormal heart rhythm

In shock, hypoperfusion causes less o2 to be delivered to tissues, leading to cells beginning to engage in _____ respiration, which results in increased lactic acid production

anaerobic

If chest pain has been relieved with rest or nitroglycerin, you should suspect the pain was caused by

angina

chest pain that results when the heart does not get enough oxygen

angina pectoris

this symptom is particularly associated with the progression of coronary artery disease

angina pectoris

What is acute coronary syndrome?

any time the heart may not be getting enough O2

the largest artery in the body

aorta

blood exits the left ventricle through the ______ valve

aortic

When these symptoms are present, you should suspect what cardiac emergency is taking place?: tearing chest pain different BP in each arm absent radial pulse

aortic dissection

a tear in the innermost layer of the aorta, causing blood to collect between the layers and restrict blood flow

aortic dissection

these connect arteries to capillary beds and regulate blow from the heart

arteriole

complete absence of electrical activity, with no pulse

asystole (flatline)

the ability of cardiac muscle cells to contract without stimulation from the nervous system

automaticity

After 3 shocks of the AED the EMT should

begin to transport the patient with high quality CPR

oxygenated blood enters the left ventricle from the left atrium through the _______ valve

bicuspid

embolism

blockage of a vessel by a clot brought to site by blood current

embolism

blockage of a vessel by the clot or foreign material brought to the site by the bloodstream

occlusion

blockage of artery by fatty deposit

occlusion

blockage, as of an artery by fatty deposits

this is when the patient's heart has stopped, and respirations have become inadequate or absent

cardiac arrest

sudden death

cardiac arrest that occurs within 2 hours of onset of symptoms

This type of shock is associated with compromised heart function - impaired heart function prevents wastes and nutrients from being able to move around the body efficiently

cardiogenic

when observing the following, you may suspect what type of shock?: history or knowledge of weakened heart muscles (prior AMI) very fast or very slow heart rate

cardiogenic

symptoms: restlessness anxiety pale, clammy skin tachycardia low bp

cardiogenic shock

Pulmonary embolism / signs and symptoms

caused by a blockage in the pulmonary artery chest pain, pedal edema in one leg Risk factors include long sedentary periods

Left side heart failure

causes fluid backup in the lungs typically presents with pulmonary edema and respiratory distress

Right side heart failure

causes fluid backup within the body presents with pedal edema and JVD

What are the indications for administering nitroglycerin?

chest pain, history of cardiac problems, prescribed NTG, pt has NTG, medical direction authorizes administration

Perfusion

circulation of blood within an organ or tissue in adequate amounts to meet current needs of the cells.

thrombus

cloth formed of blood attached to inner wall of an artery or vein

acute myocardial infarction

condition in which a part of the myocardium dies as a result of oxygen starvation, often referre to as a heart attack

the epicardium is largely made from _____ tissue

connective

angina pectoris is caused by a partial blockage in the _____ arteries, causing a decrease in available oxygen to myocardial tissue

coronary

a buildup of plaque and cholesterol form plaque inside heart vessels, eventually causing a narrowing that could result in a complete occlusion.

coronary artery disease

Infarction

death of a body tissue, usually caused by interruption of blood flow.

infarction

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

Infarct

death of tissue due to lack of oxygen (no blood going to tissue)

acute myocardial infarction (AMI)

death to part of myocardium due to lack of oxygen

lucas device

delivers manual compressions

post cardiac arrest care

determining appropriate destination for patient

______, the elderly, and women are more prone to present with non-typical symptoms when having a heart attack - including a "silent MI" in which no chest discomfort is experienced. They may only complain of shortness of breath, nausea, epigastric pain, light-headedness, or weakness

diabetics

medical term for sweating

diaphoria

coronary arteries and veins are filled during ______

diastole

this is the term for ventricular relaxation

diastole

aneurysm

dilation of a weakened section of the wall of an artery

defibrillation

dilevery of an electrical shock to stop fibrillation of the heart and restore a normal heart beat

coronary artery disease

diseases that affect arteries of the heart

ventricular fibrillation

disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest

Ventricular Fibrillation

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

dyshythmia

disturbance in heart rate and rhythm

how long the patient has been in cardiac arrest

down time

Crushing chest pain may also be described as...

dull, squeezing, heavy

D.O.E

dyspnea on exerction

Electrical malfunctions of the heart

dysrhythmia, bradycardia, tachycarda

abnormal heart rhythms

dysrhythmias

damage to the both sides of the heart in heart failure will lead to

edema in lung and extremities

defibrilation

electric shock to restore normal heart rhythm

This is the smooth inner surface lining the heart's cavities

endocardium

congestive heart failure

failure of heart to pump blood efficiently

cause of CAD

fatty deposit build up in inner walls of arteries

results of congestive heart failure

fluids in lungs and (or) body

What happens when a thrombus breaks loose?

forms an embolism - thats bad shit bruh

What does electrocardiography involve?

heart activity.

The Cardiovascular System is composed of...

heart and blood vessels

inadequate ejection of blood from the ventricles, as BP rises can be caused by damage sustained during a AMI, or uncontrolled high BP leads to cardiogenic shock

heart failure

acute coronary syndrome (ACS) (cardiac compromise)

heart muscles not getting enough oxygen

tachycardia

heart rate is fast

bradycardia

heart rate is slow

ventricular fibrillation (V-Fib)

heart's electrical impulses are disorganized

ventricular tachycardia (V-Tach)

heartbeat is too rapid (chambers can refill fast enough- not enough blood to body)

pulseless electrical activity (PEA)

hearts electrical rhythm is normal but the mechanical pumping is not

a sudden increase in blood pressure

hypertensive crisis

when blood pressure is too low, the body make get an inadequate supply of blood, resulting in ______

hypoperfusion

when observing the following, you may suspect what type of shock?: trauma and/or blood loss severe emesis or diarrhea

hypovolemic

This type of shock is caused by inadequate blood volume. The blood circulating is insufficient to deliver o2 and nutrients to the body

hypovolemic shock

Contraindications for aspirin

inability to swallow, allergy to aspirin, history of asthma, pt has already taken other anti-clotting medications

What is congestive heart failure?

inadequate pumping of the heart

death of a body tissue, usually caused by inadequate blood supply

infarction

agonal breathing

irregular, gasping breaths

agonal breathing

irregular, gasping breaths that precede apnea and death

angina pectoris ischemia or infarction?

ischemia

lack of blood supply to tissue

ischemia

what is an infarction?

lack of blood flow to tissue usually as a result of a thrombus or embolus

Ischemia

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

positioning for a patient that has regained a pulse and is moaning?

lateral recumbent (recovery) position

bradycardia heart rate

less than 60 bpm

the ventricles are the _____ chambers of the heart

lower

The left atrium and ventricle are fed by the _____

lungs

nitroglycerin

medication that dilates blood vessels

the increased lactic acid production associated with shock leads to a severe ______ _____ and increased CO2 levels in the blood. Patients who can compensate increase their breathing volume and depth, thereby increasing their minute volume

metabolic acidosis

another name for the bicuspid valve is the _____ valve

mitral

tachycardia heart rate

more than 100 bpm

during periods of exercise or stress, the _______ requires more oxygen

myocardium

this thick, muscular middle layer of the heart performs the pumping action

myocardium

coronary artery disease (CAD)

narrowing or blocking of arteries.

This type of shock is associated with injury of the nervous system

neurogenic

can AEDs analyze an electrical rhythm while a vehicle is in motion?

no

is it safe to defibrillate in a moving ambulance

no

apnea

no breathing

asystole

no electrical impulses in heart (flatline)

when it is unknown when the patient went down

non-witnessed arrest

This type of shock is associated with blocked blood flow back to or through the heart

obstructive

when observing the following, you may suspect what type of shock?: severe lung collapse (tension pneumothorax) pericardial effusion pulmonary embolism

obstructive

What is a thrombus?

occulsion of blood flow caused by formation of a clot on rough inner surface of diseased artery

Atrium

one of two (right and lef upper chambers of the heart. The right atrium receives blood from the vena cava and delivers it to the right ventricle. The left atrium receives blood from the pulmonary veins and delivers it to the left ventricle.

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.

Where to place 4 lead ekg electrodes?

one on each extremity, be consistent with on placing proximally/distally

angina pectoris

pain in the chest that occurs when blood supply to the heart is reduced and a portion of the blood muscle is not receiving enough oxygen

What is the usual progression of CHF?

patient sustains AMI, myocardium of LV dies, blood back up into pulmonary circulation and lungs, L heart failure can then cause R heart failure

this affixes the heart to the mediastinum

pericardium

damage to the right side of the heart in heart failure will lead to

peripheral edema (fluid or swelling in the extremities)

treatment of acute coronary syndrome

position of comfort, apply O2 as needed, TRANSPORT, obtain + transmit a 12-lead EKG

Blood leaving the lungs and entering the left atrium pass through the _____ vein, which is the only vein in the body carrying oxygenated blood

pulmonary

________ arteries and veins supply the heart muscle and tissue, and are the only place in the heart that can have an occlusion, leading to a MI

pulmonary

after entering the right ventricle through the tricuspid valve, blood passes through the ______ valve to enter the _______ artery, which is the only artery that moves deoxygenated blood away from the heart -- to the lungs

pulmonary

manifests as crackles or rales in the base of both lungs

pulmonary edema

damage to the left side of the heart in heart failure will lead to

pulmonary edema (fluid in the lungs)

AED is only applied to someone without a ______

pulse

organized rhythm, with no pulse

pulseless electrical activity (PEA)

chain of survival

recognition & activation, early CPR, rapid defibrillation, effective advanced life support, post cardiac arrest care

how to resolve angina attack

rest, nitroglycerin

effect of CAD

restricts blood flow

positioning for a patient with chest pain?

semi fowler position

This type of shock is associated with severe infection

septic

a life-threatening condition that occurs when the body is not getting enough blood flow (hypoperfusion)

shock

dyspnea

shortness of breath, labored breathing or diffuculty breathing

dyspnea

shortness of breath, labored breathing, difficulty breathing

Ischemia

starvation of oxygen to tissues

dependen edema

swelling in part of the body closest to the ground, caused by a collection of fluid in the tissues; a possible sign of CHF

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.

edema

swelling resulting from a build up of fluid in the tissue

edema

swelling resulting from a build up of fluid in the tissues

This is the term for ventricular contraction

systole

contraindications for administering Nitrogylcerin

systolic BP is <90-100 (NTG lowers BP), taken Viagra or any similar ED drug w/n the past 48-72 hours

Signs and Symptoms of CHF?

tachycardia, dyspnea + cyanosis, normal/elevated BP, diaphoresis, pulmonary edema, anxiety/confusion, pedal edema, engorged + pulsating neck signs (a V late sign), enlarged liver and spleen

automaticity

the ability of cardiac muscle cells to contract without stimulation from the nervous system

Automaticity

the ability of cardiac muscle cells to contract without stimulation from the nervous system.

Posterior

the back surface of the body; the software from you in the standard anatomic position.

coronary arteries

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

Coronary Arteries

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

blood entering the right atrium from the vena cava comes from...where?

the capillary beds of the body

Asystole

the complete absence of any electrical cardiac activity, appearing as a straight line or almost straight line on an ECG strip.

asystole

the complete absence of heart electrical activity

aneurysm

the dilation or balloning of a weakened section of the wall of an artery

congestive heart failure

the failure of the heart to pump efficiently which leads to excess fluid in the lungs, body, or both

perfusion

the flow of blood through the body tissues and vessels

cardiovascular system

the heart and blood vessels

myocardium

the heart muscle

Myocardium

the heart muscle.

lumen

the inside diameter of an artery or other follow structure

Aorta

the main artery that receives blood from the left trenchcoat and delivers it to all other arteries that can carry blood to the tissues of the body.

Aortic Valve

the one-way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta;one of four heart valves.

sympathetic nervous system

the part of the autonomic nervous system that controls active functions such as responding to fear; fight or flight

parasympathetic nervous system

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

automatic nervous system

the part of the nervous system that controls the involuntary activities of the body such as the heart rate, blood pressure, and digestion of food

Autonomic Nervous System

the part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion and sweating.

defibrillate

to shock a fibrillating (chaotically beating) heart with specialized electrical current in an attempt to restore a normal, rhythmic beat

Defibrillate

to shock of celebrating (chaotically beating) heart with specialized electrical current and attempt to restore a normal rhythmic beat.

angina pectoris

transient (short lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle

Angina Pectoris

transient (short-lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle.

AED is not recommended for _____ patients

trauma

The ______ valve separates the right atrium from the right ventricle

tricuspid

the atria are the _____ chambers of the heart

upper

AED will only shock the ____ rhythm

v-fib

The AED can mistake _____ for v-fib, which is why it is only applied to a pulseless patient

v-tach

nitroglycerin causes _____, opening the narrow coronary vessels and relieving the symptoms of angina pectoris

vasodilation

distributive shock

vasodilation increase vascular compartment size till bp decrease results in warm skin

the right atrium and ventricle are fed by the superior and inferior ____`

vena cava

disorganized rhythm that produces no pulse or cardiac output - the heart is just quivering

ventricular fibulation (V-Fib)

a very fast heart rhythm - so fast it does not refill properly, cardiac output is greatly decreased (causing inadequate perfusion). Will degenerate into v-fib if not corrected

ventricular tachycardia (V-Tach)

these connect capillary beds to veins and regulate blow to the heart

venules

Another name for the epicardium

visceral pericardium

What is an aneurysm?

weakened sections of blood vessels begin to dilate and "balloon" up; can be life threatening if burst

tachycardia

when the heart rate is fast, above 100 beats per minute

bradycardia

when the heart rate is slow, usually below 60 beats per minute

Dilation

widening of a tubular structure such as a coronary artery.

when someone saw the patient lose consciousness

witnessed arrest

The 5 elements in the chain of survival

• Immediate recognition of cardiac arrest and activation of the emergency response system • Early CPR • Rapid defibrillation • Effective advanced life support • Integrated post-cardiac arrest care