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
