FISDAP cardiology test
What prevents the death of cells due to clots
"clot-busting" thrombolytic drugs or angioplasty within the first few hours prevent damage
Transient ischemic attack
(TIA) Similarly, when blood flow to the brain is obstructed due to atherosclerosis or a small blood clot, the patient may exhibit signs of a stroke. When these stroke-like symptoms resolve on their own in less than 24 hours, the event is called a transient ischemic attack (TIA). no actual death of tissue (infarction) occurs with a TIA. However, since symptoms of a TIA can last up to 24 hours, you may not be able to differentiate between a stroke and a TIA
subdural/epidural bleeding
(a collection of blood near the skull that presses on the brain)
Sympathetic
(fight or flight) nervous system and parasympathetic(breathing rate, pulse, etc) nervous system. makes adjustments to the body to compensate for increased physical activity. The sympathetic nervous system speeds up the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscles, and constricts blood vessels in the digestive system.
Postictal state
(period following a seizure that lasts between 5 and 30 minutes, characterized by labored respirations and some degree of altered mental status). They recover quickly
Cardiac tamponade
-A collection of fluid between the pericardial sac and the myocardium is called a pericardial effusion. If the effusion becomes large enough, it can prevent the ventricles from filling with blood—a condition called cardiac tamponade or pericardial tamponade. - caused by blunt or penetrating trauma that causes hemorrhage around the heart. -Large pericardial effusions leading to cardiac tamponade can also be seen in patients with cancer and autoimmune diseases. -Cardiac tamponade occurs when blood leaks into the space between the tough fibrous membrane known as the pericardium and the outer walls of the heart, an area called the pericardial sac. As more blood or fluid accumulates in this confined space, the outer walls of the heart become compressed. ---- -Because the pericardium has a limited ability to stretch, the accumulated blood or fluid in the pericardial space eventually exerts back pressure on the outer walls of the heart, compressing the walls of the heart, and preventing the heart from completely refilling with blood. -Continued pressure within the pericardial sac obstructs the flow of blood into the heart, resulting in a decreased outflow from the heart.
Signs and symptoms of cardiac tamponade
-Beck triad( the build-up of fluid in the heart's sac, blood or air in the pericardial sac.) -the presence of jugular vein distention, muffled heart sounds, -and a narrowing pulse pressure, where the systolic and diastolic blood pressures start to merge (systolic pressure drops and the diastolic pressure rises).
What to do when administering nitroglycerin
-Ensure medication is not expired or contaminated. ---Ensure medication is prescribed for the patient. Wear gloves. -Make sure to remove the nitroglycerin patch before starting AED (wipe it off). ->The fizzing of nitro drug= potent; not fizzing=exposure to the sun decreased the potency of the drug
What is an external defibrillator vest?
-It is a vest with built-in monitoring electrodes and defibrillation pads worn by the patient that is attached to a monitor. -It uses high energy shock but you should not touch the patient if the device warns it is about to deliver a shock. -Blue gel under the large defibrillation pads indicates that the device has already delivered at least one shock
What do cardiac pacemakers do?
-Maintain regular cardiac rhythm and rate. -They deliver electrical impulses through wires in direct contact with the myocardium (myocardium is the muscle tissue of the heart). -Pacemakers are implanted under heavy muscle or fold of skin in the upper left portion of the chest .
Steps and precautions to take before defibrillating
-Make sure the electricity injures no one, -Do not defibrillate patients in pooled water but if they are on dry ground and they are soaking wet, dry them off and -quickly start AED as long as they are on dry ground, -Do not defibrillate patients touching metal, -Carefully remove the nitroglycerin patch and wipe with a dry towel before shocking to prevent ignition of the patch, -Shave hairy chest to increase conductivity, -Determine the NOI and MOI(things that caused the injury), -Perform a spinal immobilization for trauma patients , -Call for ALS in a tiered system
Medical care for chest pain or discomfort
-Proper positioning that is comfortable: They can sit up or be supine. Most prefer sitting up. -Losen tight clothing and make them comfortable. -Give oxygen early if indicated but continually reassess the oxygen saturation and patient's respiratory status.
Left ventricular assist devices (LVADs)
-Used to enhance the pumping of the left ventricle. Has an external battery pack. -These pumps may be pulsatile, meaning they pump the blood in pulsations just like the natural heart, or they may be continuous, in which case the patient will not have any palpable pulses.. -The patient or family will tell you more about the device . -Transport all LVAD supplies and battery packs to the hospital with the patient
Sign and Symptoms of cardiogenic shock
-anxiety or restlessness as the brain becomes relatively starved for oxygen. -"air hunger." -cannot breathe. -the body tries to send blood to the most important organs, such as the brain and heart, and away from less important organs, such as the skin. -pale, cool, clammy skin -the pulse rate will be higher than normal. -the heart rate usually, but not always, is greater than 120 beats/min. -the pulses may become irregular and weak. -rapid and shallow breathing, nausea and vomiting, and a decrease in body temperature.• Finally, as the heart and other organs begin to malfunction, the blood pressure will fall below normal. -Systolic blood pressure less than 90 mm Hg(decompensated shock) -It is very important though not to assume that shock is not present just because the blood pressure is normal (compensated shock)
What to check for a patient with cardiac issues in secondary assessment
-focus on cardiac and respiratory systems. -Check circulation and respiration. -check Capillary refill, pulse, skin. Also, check breathing and respirations. -Measure vital signs and use pulse oximetry.
If paramedics or another ALS service is responding to the scene, the best option usually is to
-stay where you are and continue the sequence of shocks and CPR. Administering CPR while patients are being moved or transported is usually not very effective. -The best chance for patient survival occurs when the patient is resuscitated where found, unless the location is unsafe.
Pacemakers
-watch out for pacemakers. pacemakers to maintain a regular cardiac rhythm and rate. -Pacemakers are inserted when the electrical control system of the heart is so damaged that it cannot function properly. -These battery-powered devices deliver an electrical impulse through wires that are in direct contact with the myocardium.
If you are en route with a conscious adult patient who is having chest pain and becomes unconscious, take the following steps
1. Check for a pulse. 2. Stop the vehicle. 3. If the AED is not immediately ready, perform CPR, beginning with chest compressions, until it is ready. 4. Analyze the rhythm. 5. Deliver one shock, if indicated, and immediately resume CPR. 6. Begin compressions, and continue resuscitation according to your local protocol, including transporting the patient
What are the requirements for good perfusion?
1. Heart must pump at the appropriate rate 2. Adequate volume of fluid or blood 3. The blood must be carried in a properly sized container: vessels must not be too constricted or dilated
How do I know CPR is working?
1. If bystander CPR is in progress, assess the effectiveness of chest compressions by palpating for a carotid or femoral pulse. If compressions are effective, you should be able to feel a pulse. If you do, leave your fingers in that position and stop compressions. If you lose the pulse when compressions stop, immediately resume compressions. It is important to limit the amount of time compressions are interrupted. If the patient is responsive, do not apply the AED. 2. If the patient is unresponsive and CPR has not been started yet, begin providing chest compressions and rescue breaths at a ratio of 30 compressions to 2 breaths and a rate of 100 to 120 compressions per minute, continuing until an AED arrives and is ready for use Step 1 . It is important to start chest compressions and use the AED as soon as possible. Compressions provide vital blood flow to the heart and brain, improving the patient's chance of survival. High-quality compressions (ie, performed at the appropriate rate and depth, with no leaning on the chest during recoil, and interruptions minimized) provide the best cardiac output. 3. Turn on the AED Step 2. Remove clothing from the patient's chest area. Apply the pads to the chest: one just to the right of the breastbone (sternum) just below the collarbone (clavicle), the other on the left lower chest area with the top of the pad 2 inches to 3 inches below the armpit. Do not place the pads on top of breast tissue in women. If necessary, move the breast out of the way with the back of your hand and place the pad underneath. Ensure that the pads are attached to the patient cables (and that they are attached to the AED in some models). Plugin the pads connector to the AED. 4. Stop CPR when the AED instructs you to. 5. State aloud, "Clear the patient," and ensure that no one is touching the patient. 6. Push the Analyze button, if there is one, and wait for the AED to determine whether a shockable rhythm is present. If a shock is advised, perform chest compressions while the AED is charging. 7. If a shock is not advised, perform fve cycles (about 2 minutes) of CPR, beginning with chest compressions, and then reanalyze the cardiac rhythm. If a shock is advised, reconfirm that no one is touching the patient and push the Shock button. If at any time the AED advises to check the patient, quickly assess for a carotid or femoral pulse. This should not take longer than 5 to 10 seconds. If you feel a pulse, the patient has experienced a return of spontaneous circulation (ROSC). ROSC is defined as the return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest. Continue to monitor the patient. 8. After the shock is delivered, immediately resume CPR, beginning with chest compressions. Remember to change to a different person for chest compressions each time CPR is paused to prevent rescuer fatigue Step 3 . 9. After five cycles (about 2 minutes) of CPR, reanalyze the patient's cardiac rhythm Step 4 . Do not interrupt chest compressions for more than 10 seconds. 10. If the AED advises a shock, clear the patient, push the Shock button, and immediately resume CPR compressions. If no shock is advised, immediately resume CPR, beginning with chest compressions and remembering to change the person providing compressions. 11. Gather additional information about the arrest event. 12. After five cycles (2 minutes) of CPR, reassess the patient. 13. Repeat the cycle of 2 minutes of CPR, one shock (if indicated), and 2 minutes of CPR. 14. Transport, and contact medical control as needed Step 5
How to deal with hypertensive emergencies
1. If you suspect your patient is experiencing a hypertensive emergency, attempt to make him or her comfortable and monitor the blood pressure regularly. 2. Position the patient with the head elevated, and transport rapidly to the ED. Contact ALS. 3. If you can meet ALS halfway (if the distance to hospital is long, do it. If the distance to the hospital is short, just go to hospital)
Maintain AED by
1. Maintain as the manufacturer recommends 2. Check battery Read the operator's manual Document AED failure 3. Check equipment daily at beginning of a shift 4. Ask the manufacturer for a maintenance checklist 5. Report AED failure to the manufacturer and US food and drug administration (FDA) and follow local protocol for notifying
To safely assist the patient with nitroglycerin, follow the steps
1. Obtain an order from medical control— online or through off-line protocol. 2. Take the patient's blood pressure. Administer nitroglycerin only if the systolic blood pressure is greater than 100 mm Hg. 3. Check that you have the right medication, the right patient, and the right delivery route. Check the expiration date. Make sure the patient has no contraindications, such as having taken medication for erectile dysfunction in the past 24 hours. 4. Ask the patient about the last dose he or she took and its effects. Make sure that the patient understands the route of administration. Be prepared to have the patient lie down to prevent fainting if the nitroglycerin substantially lowers the patient's blood pressure (the patient gets dizzy or feels faint). 5. Ask the patient to lift his or her tongue. Place the tablet or spray the dose under the tongue (while wearing gloves), or have the patient do so. Have the patient lower the tongue and keep his or her mouth closed with the tablet or spray under the tongue until it is dissolved and absorbed. Caution the patient against chewing or swallowing the tablet 6. Recheck the blood pressure within 5 minutes. Record the medication and the time of administration. Reevaluate the chest pain, and note the response to the medication. If the chest pain persists and the patient still has a systolic blood pressure greater than 100 mm Hg, repeat the dose every 5 minutes as authorized by medical control. In general, a maximum of three doses of nitroglycerin is given for any one episode of chest pain
Treatment of cardiogenic shock
1. Position the patient comfortably. Some patients will be more comfortable in a semi-Fowler position (head and knees slightly elevated); however, patients with low blood pressure may not tolerate a semi-upright position but may be more comfortable and more alert in a supine position. 2. Administer high-flow oxygen. 3. Assist ventilations as necessary. 4. Cover the patient with sheets or blankets as necessary to preserve body heat. Be sure to cover the top of the patientʼs head. 5. Provide prompt transport to the ED
When would do not start CPR
1. Rigor mortis 2. decapitation of the head 3. DNR
How to apply ECG
1. Shave body hair. 2. Rub electrode site with an alcohol swab before application. 3. Attach electrodes to ECG cables before placement on skin. 4. Confirm electrode placement . Once electrodes are in place, switch on the monitor,Print sample of rhythm strip, -If strip shows artifact, confirm electrodes are firmly applied and the cable is plugged in. 5. Make sure the patient is supine or in a semi-fowlers position, feet uncrossed, relaxed position. 6a. Position the limb electrodes on the patient, on the torso if performing continuous monitoring, on the limbs if you will be acquiring a 12-lead ECG. The RA electrode goes on the right arm distal to the shoulder or on the wrist (avoid placing it directly over a bone). The LA electrode goes on the left arm at the same location as you placed the RA electrode on the right arm. The LL electrode is placed on the left leg on the thigh or ankle, although if you do not plan to obtain a 12-lead ECG tracing, this electrode is often placed on the lower left side of the abdomen (slightly lower than an AED pad would be placed). Place the RL electrode at the same location on the right side of the body as the LL electrode on the left. 6b. If you plan to obtain a 12-lead ECG tracing, place the chest leads on the chest as shown. The V1 electrode is placed on the right side of the sternum between the fourth and fifth ribs. The V2 electrode is placed on the left side of the sternum directly across from V1 . The V4 is placed next, between the fifth and sixth ribs in a straight line down from the middle of the clavicle. The V3 is then placed halfway between V2 and V4 . The V6 is placed next and is located horizontally even with V4 in a straight line down from the middle of the armpit. Finally, V5 is placed halfway between V4 and V. Label each strip
Treatment of CHF
1. Take the vital signs, and give oxygen by nonrebreathing mask with an oxygen flow of 10 to 15 L/min. -use of continuous positive airway pressure (CPAP) to move some of the fluid out of the lungs to provide better oxygenation. 2. Allow the patient to remain sitting in an upright position with the legs down. 3. Be reassuring; many patients with CHF are quite anxious because they feel as if they cannot breathe. 4. Patients who have had problems with CHF before will usually have specific medications for its treatment. Gather these medications, and take them along to the hospital. 5. Nitroglycerin may be of value in reducing pulmonary edema if the patientʼs systolic blood pressure is more than 100 mm Hg. If the patient has been prescribed nitroglycerin, and medical control or standing orders advise you to do so, you can administer it sublingually. 6. Prompt transport to the ED is essential
If nonbreathing or inadequate breathing patient is present
100% oxygen with BVM
Berry aneurysm
A hemorrhagic stroke in an otherwise healthy young person is often caused by a weakness in a blood vessel called a berry aneurysm. This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery. When the aneurysm is overstretched and ruptures, blood spurts into an area between two of the coverings of the brain called the subarachnoid space.
What to do with a patient with a defective pacemaker
A patient with a malfunctioning pacemaker should be promptly transported to the ED; repair of the problem may require surgery. When an AED is used, the patches should not be placed directly over the pacemaker. This will ensure a better flow of electricity through the patient's body.
Define premature ventricular contractions
A variety of other lethal and nonlethal dysrhythmias may follow an AMI, usually within the frst hour. In most cases, premature ventricular contractions, or extra beats in the damaged ventricle, occur.
Chest pain does not always mean
AMI
Treat angina patients like_____ patients
AMI Patients
What does AMI pain signal?
AMI pain signals the actual death of cells in the heart muscle. If cells of the heart die, they cannot be revived which means they become scar tissue and become a burden to the beating heart
Cardiogenic shock is most commonly found in
AMI that affects the inferior and posterior regions of the left ventricle of the heart because this provides the circulation to the majority of the body
When does heart muscle begin to die?
About 30 minutes after blood flow is cut off, some heart muscle cells begin to die. After about 2 hours, as many as half of the cells in the area can be dead; in most cases, after 4 to 6 hours, more than 90% will be dead.
What happens after the right ventricle contracts?
After contraction of the right ventricle, blood flows into the pulmonary artery and the pulmonary circulation in the lungs, where the blood is oxygenated.
En route and later you should
Alert the ED staff about the status of your patient's condition and your estimated time of arrival. Follow the instructions of medical control. Describe the patient's condition to the ED staff on arrival.
Contraindications of aspirin
Allergic, Already had enough, Has a history of internal bleeding such as stomach ulcers, If they have a history of internal bleeding such as stomach ulcers, contact medical control before giving the patient aspirin
Hypoglycemia
Always check the blood glucose level in patients with altered mental status if allowed by your local protocol
Where is AMI more likely to occur?
An AMI is more likely to occur in the larger, thick walled left ventricle, which needs more blood and oxygen than the right ventricle.
What is an aortic aneurysm
An aortic aneurysm is a weakness in the wall of the aorta. The aorta dilates at the weakened area, which makes it susceptible to rupture
Define aortic aneurysm
An aortic aneurysm is a weakness in the wall of the aorta. The aorta dilates at the weakened area, which makes it susceptible to rupture.
Complications of electrical injuries and treatment
An electric current passing through the body delivers a shock. In this chapter, shock (hypoperfusion) describes a state of collapse and failure of the cardiovascular system. When the circulation of blood in the body becomes inadequate, the oxygen and nutrient needs of the cells cannot be met
CHF happens because
Any condition that weakens the pumping strength of the heart may cause CHF and this often happens between the first few hours and the first few days after a heart attack.
The arteries are also affected by aging by
Arteriosclerosis (hardening of the arteries) can develop, affecting perfusion of the tissues. There is an increased chance of heart attack or stroke due to decreased blood flow or plaque formation (atherosclerosis) in the narrowed arteries.
Atherosclerosis and age
As a person ages, more of this fatty material is deposited; the lumen, or the inside diameter of the artery, narrows. As the cholesterol deposits grow, calcium deposits can form as well. The inner wall of the artery, which is normally smooth and elastic, becomes rough and brittle with these atherosclerotic plaques. Damage to the coronary arteries may become so extensive that they cannot accommodate increased blood flow during times of maximum need.
What happens if there is no impulse from the sinoatrial node
As long as impulses come from the sinoatrial node, the other myocardial cells will contract when the impulse reaches them. If no impulse arrives, however, the other myocardial cells are capable of creating their own impulses and stimulating a contraction of the heart, although at a generally slower rate.
The heart, like other major organs, will show the effects of aging by
As the heartʼs muscle mass and tone decrease, the amount of blood pumped out of the heart per beat decreases. The residual (reserve) capacity of the heart is also reduced; therefore, when the vital organs of the body need additional blood flow, the heart cannot meet the need. When blood flow to the tissues is decreased, the organs suffer. If blood flow to the brain is inadequate, the patient may report weakness, fatigue, or dizziness and may experience syncope (fainting). The heart muscle is stimulated by electricity and has its own electrical system. Under normal conditions, electrical impulses travel throughout the heart, resulting in the contraction of the heart muscle and the pumping of blood from the heartʼs chambers. With aging, the electrical system can deteriorate, causing the heartʼs contraction to weaken or, if blood flow to the heart muscle is affected, extra beats to form. With decreased strength of contraction, the heartbeat is weaker and blood flow to the tissues is reduced. If extra beats are produced, the patientʼs heart rhythm will be irregular. Although some irregular heart rhythms are not harmful, others can be lethal.
What are the effects of aspirin?
Aspirin (acetylsalicylic acid) prevents clots from forming or getting bigger.
If there is pulmonary edema?
BVM or CPAP
Amount of aspirin to give
Baby aspirin comes in 81 mg chewable tablets. The recommended dose is 162 mg or 2 tablets to 324 mg or 4 tablets. Make sure patient is not allergic to aspirin before you give it to them
What is the most effective thing for CHF
CPAP is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique. Be aware of the indications and contraindications of CPAP and be competent in utilizing this equipment.
How does CPR help the patient
CPR helps patients in cardiac arrest because it prolongs the period during which defibrillation can be effective.
In the case of asystole and pulseless electrical activity
CPR should be performed immediately after AED analysis after it tells you that "shock is not advised"
What are capillaries
Capillaries are tiny blood vessels about one cell thick that connect arterioles to venules. Capillaries, which are found in all parts of the body, allow the exchange of nutrients and waste at the cellular level. As the blood passes through the capillaries, it gives up oxygen to the tissues and picks up carbon dioxide and other waste products to be removed from the body
How is cardiac output increased?
Cardiac output is increased by increasing the heart rate or stroke volume.
2. American Heart Association (AHA) Basic Life Support current guidelines
Check papers
Define coronary artery bypass graft
Chest or leg blood vessel is sewn from the aorta to a coronary artery beyond the point of obstruction
What to do for ALS and post arrest care(after cardiac arrest):
Continue ventilation. Maintain oxygen saturation. Assure BP is above 90 mmHg. Maintain glucose levels. Provide rapid transport to the right emergency room
Drugs for erectile dysfunction
Drugs used for erectile dysfunction include sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra), and vardenafil (Levitra, Staxyn).
Signs and symptoms of a cardiac dysrhythmia
Dyspnea, SVT (heart rate above 150), irregular heartbeat and atrial fibrillation, too slow
When are EMTs usually called in angina patients
EMS usually becomes involved when stable angina becomes unstable, such as when a patient whose pain is normally relieved by sitting down and taking one nitroglycerin tablet has taken three tablets with no relief.
How can EMS reduce cardiovascular deaths?
Encouraging healthy lifestyle, Early access to medical care More CPR training of laypeople Increased use of evolving technology in dispatch and response Public access to defibrillation devices Recognizing the need for advanced life support (ALS) The use of cardiac specialty centers when they are available
What to do if there is emergency medical care for chest pain or discomfort
Ensure proper position of comfort, if oxygen is indicated, give oxygen. Administer low dose (baby) aspirin and give nitroglycerin
What can be disrupted by angina pectoris?
Even with angina, because the oxygen supply to the heart is diminished, the electrical system can be compromised, and the person is at risk for significant cardiac rhythm problems.
EMT goal with AED
Few systems will achieve the ultimate goal: shocking 100% of patients within 1 minute of the call.
How is thromboembolism caused
For reasons that are still not completely understood, a brittle plaque will sometimes develop a crack, exposing the inside of the atherosclerotic wall. Acting like a torn blood vessel, the ragged edge of the crack activates the blood-clotting system, just as when an injury has caused bleeding. In this situation, however, the resulting blood clot will partially or completely block the lumen of the artery. If it does not occlude the artery at that location, the blood clot may break loose and begin floating in the blood, becoming what is known as a thromboembolism.
Heart rate
Heart rate is the number of times the heart contracts in 1 minute.
Where is hemorrhagic stroke common?
Hemorrhagic stroke commonly occurs in people experiencing stress or exertion. The people at highest risk for hemorrhagic stroke are those with very high blood pressure or long-term untreated elevated blood pressure. Many years of high blood pressure weaken the blood vessels in the brain. If a vessel ruptures, the bleeding in the brain will increase the pressure inside the cranium. Also, genetic weakness of the artery walls can form an aneurysm which can also cause hemorrhagic stroke in young people.
Define hemorrhagic stroke
Hemorrhagic stroke occurs as a result of bleeding inside the brain. According to the American Stroke Association, hemorrhagic strokes account for 13% of all strokes
When do you not wait for ALS to arrive?
If AED is available use it without the permission of ALS, Analyze using AED if the patient is unresponsive or does not have a pulse , Notify ALS of cardiac arrest , Do not delay defibrillation , Follow local protocol for coordination
Define acute myocardial infarction (AMI)
If a blockage occurs in a coronary artery, the condition is known as an acute myocardial infarction (AMI). a classic heart attack
If pacemaker malfunctions when the battery wears out
If a pacemaker does not function properly, as when the battery wears out, the patient may experience syncope, dizziness, or weakness because of an excessively slow heart rate. The pulse ordinarily will be less than 60 beats/min because the heart is beating without the stimulus of the pacemaker and without the regulation of its own electrical system, which may be damaged.
ROSC
If at any time the AED advises to check the patient, quickly assess for a carotid or femoral pulse. This should not take longer than 5 to 10 seconds. If you feel a pulse, the patient has experienced a return of spontaneous circulation (ROSC). ROSC is defined as the return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest. Continue to monitor the patient.
Dependent edema
If the right side of the heart is damaged, fluid collects in the body, often showing up as swelling in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. Can happen suddenly or slowly over months.
What are the contraindications of nitroglycerin?
If the systolic blood pressure is less than 100 mm Hg, do not give more medication. Other contraindications include the presence of a head injury, use of erectile dysfunction drugs within the previous 24 to 48 hours the maximum prescribed dose of nitroglycerin has already been given (usually three doses).
How can you know that there is cardiac arrest?
If there no carotid pulse. Can be treated with CPR and an external defibrillator
Infarction means
Infarction means the death of tissue
Cardiogenic shock
Is often caused by a heart attack. It is when the heart lacks the power to force enough blood through the circulatory system. Can occur immediately or 24 hours after AMI. The various signs and symptoms of cardiogenic shock are produced by the improper functioning of the body's organs. There is inadequate oxygen to body tissues causing organs to malfunction. It is important to recognize the shock in its early stages
What does automated external defibrillation do
It analyzes electrical signals from the heart by identifying ventricular fibrillation. It administers a shock to the heart when needed.
The left ventricle can be damaged
Just as the pumping function of the left ventricle can be damaged by coronary artery disease, it can also be damaged by diseased heart valves or chronic hypertension
How to treat hypotension
Lay them down supine and elevate the legs, call for ALS, rapid transport
How do we manage the return of spontaneous circulation (ROSC)
Monitor respiration, Provide oxygen via BCM at 10-12 breaths per minute or 1 per 6 seconds, Maintain oxygen saturation between 95% and 99%, Assess blood pressure, See if the patient can follow simple commands: such as "Squeeze my fingers.", If ALS is not on scene or en route, immediately begin transport to the closest appropriate hospital depending on local protocol
Define myocardial ischemia
Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries).
What are the side effects of nitroglycerine?
Nitroglycerin also dilates blood vessels in other parts of the body and can sometimes cause low blood pressure and/or a severe headache. Burning sensation. Other side effects include changes in the patient's pulse rate, including tachycardia or bradycardia
What forms is nitroglycerine available in?
Nitroglycerin comes in several forms— as a small white tablet, placed sublingually (under the tongue); as a spray, also taken sublingually; and as a skin patch applied to the chest.
What are the effects of nitroglycerine?
Nitroglycerin may help to relieve the pain of angina. Nitroglycerin relaxes the muscle of blood vessel walls, dilates coronary arteries, increases blood flow and the supply of oxygen to the heart muscle, and decreases the workload of the heart. Nitroglycerin also dilates blood vessels in other parts of the body and can sometimes cause low blood pressure and/or a severe headache.
Steps of electrical impulses in the heart
Normal electrical impulses begin in the sinus node, which is in the upper part of the right atrium and is also known as the sinoatrial (SA) node. The impulses travel across both atria, stimulating them to contract. Between the atria and the ventricles, the impulses cross a bridge of special electrical tissue called the atrioventricular (AV) node. Here, the signal is slowed for about one- to two-tenths of a second to allow blood time to pass from the atria to the ventricles. The impulses then exit the atrioventricular node and spread throughout both ventricles via the bundle of His, the right and left bundle branches, and the Purkinje fibers, causing the ventricular muscle cells to contract
Parasympathetic versus sympathetic
Normally, these two systems balance each other, but in times of stress, the sympathetic nervous system gains primary control, whereas in times of relaxation, the parasympathetic system takes control.
How does AMI pain differ from angina pain
Not always due to exertion. Lasts 30 minutes to several hours. Not always relieved by rest or nitroglycerin
When does congestive heart failure happen?
Often occurs a few days following heart attack. Failure of the heart occurs when the ventricular heart muscle is so permanently damaged that it can no longer keep up with the return flow of blood from the atria. It is called "congestive" heart failure because the lungs become congested with fluid once the left side of the heart fails to pump the blood effectively.
Common AED operator errors
Operator errors include: 1. failing to apply the AED to a patient in cardiac arrest, 2. not pushing the analyze or shock buttons when the machine advises you to do so, 3. or pushing the power button instead of pushing the shock button when a shock is advised.
What are the advantages of AED use
Quick delivery of shock , It is easy to operate, ALS providers do not need to be on the scene, Remote, adhesive pads are safe to use , Because it has a larger pad area, it has more efficient shocks , Don't use next to metal or in water. Dry off the patient.
■ Tachycardia.
Rapid beating of the heart, 100 beats/min or more.
■ Ventricular tachycardia.
Rapid heart rhythm, usually at a rate of 150 to 200 beats/min. The electrical activity starts in the ventricle instead of the atrium. This rhythm usually does not allow adequate time between beats for the left ventricle to fill with blood. Therefore, the patient's blood pressure may fall, and the pulse may be lost altogether. The patient may also feel weak or light-headed or may even become unresponsive. In some cases, existing chest pain may worsen or chest pain that was not there before the onset of the dysrhythmia may develop. Most cases of ventricular tachycardia will be sustained and may deteriorate into ventricular fibrillation.
What does blood consist of?
Red blood cells: carry oxygen White blood cells: fight infection Platelets: which help the blood to clot Plasma: which is what the fluid cells float in
Hypotensive
Remove nitroglycerin patch before administering AED, If they are hypotensive, no nitroglycerin, If there is no obvious sign but they are hypotensive, this might be a sign of cardiogenic shock or decompensation, Maybe a sign of pneumonia, If pregnant, put on the left side when transporting so that the patient does not become hypotensive, Weak peripheral pulse or even weak central pulse. Immediate transportation and oxygen. Low blood sugar
What different parts of the body do arteries supply oxygen to via blood?
Right and left carotid Right and left subclavian Brachial Radial and ulnar Right and left iliac Right and left femoral Anterior and posterior tibial and peroneal
Arteries supply oxygen to different parts of the body
Right and left carotid Right and left subclavian Brachial Radial and ulnar Right and left iliac Right and left femoral Anterior and posterior tibial and peroneal
What do you do if there is cardiac arrest(pulse is absent) during transport
Stop the vehicle, Begin CPR but if AED is available start with AED, Call for ALS support, Analyze rhythm: AED cannot analyze as the car is moving, Deliver shock, if indicated, and resume CPR, Continue resuscitation per local protocol
What are 3 serious consequences of AMI
Sudden death,Cardiogenic shock , and Congestive heart failure
Define the signs and symptoms of AMI
Sudden onset of weakness, nausea, and sweating without an obvious cause ■ Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath ■ Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck ■ Irregular heartbeat and syncope (fainting) ■ Shortness of breath, or dyspnea ■ Nausea/vomiting ■ Pink, frothy sputum (indicating possible pulmonary edema) ■ Sudden death
What defines hypertensive emergencies
Systolic pressure is greater than 180 mmHg. A rapid rise in systolic pressure. There is a sudden and severe headache. Other signs and symptoms include: strong bounding pulse, ringing in the ears, nausea and vomiting, dizziness, warm skin (dry or moist), nosebleed. Altered mental status and sudden development of pulmonary edema. If untreated, it can lead to stroke or dissecting aortic aneurysm. It is important to transport patients quickly and safely because it Can lead to stroke or aortic aneurysm
Define asystole
The absence of all heart electrical activity reflects a long period of ischemia, nearly all patients will die. unstable ventricular tachycardia or ventricular fibrillation will eventually lead to asystole, the absence of all heart electrical activity.
What is intracranial pressure
The blood from a ruptured blood vessel irritates the tissues of the brain and can cause increased intracranial pressure, resulting in severe headache pain. This type of pain may initially be localized and then become more diffuse as the irritation in the meninges spreads.
How does blood return from the lungs?
The blood then returns to the heart through the pulmonary veins. The left side of the heart receives oxygen-rich (oxygenated) blood from the lungs through the pulmonary veins. Blood enters the left atrium and then passes into the left ventricle. The left ventricle is more muscular than the right ventricle because it must pump blood into the aorta to supply all the other arteries of the body.
What does one cardiac cycle consist of?
The cardiac cycle consists of one systolic and one diastolic time period
■ Ventricular fibrillation (V fib).
The disorganized, ineffective quivering of the ventricles. No blood is pumped through the body, and the patient usually becomes unconscious within seconds. The only way to convert this dysrhythmia is to defibrillate the heart. To defibrillate means to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore a normal rhythmic beat. If a defibrillator is not immediately available, CPR must be initiated until the defibrillator arrives.
What happens right before CHF
The heart rate increases, and the left ventricle enlarges in an effort to increase the amount of blood pumped each minute. When these adaptations can no longer make up for the decreased heart function, CHF eventually develops.
What does the heart's electrical system control?
The heart's electrical system controls heart rate and coordinates the atria and ventricles
The left coronary artery
The left coronary artery supplies blood to the left atrium and left ventricle and divides into two major branches, just a short distance from the aorta.
Define the controllable AMI risk factors
The major controllable factors are cigarette smoking, high blood pressure, elevated cholesterol level, elevated blood glucose level (diabetes), lack of exercise, obesity.
What is systolic blood pressure
The max pressure generated by the left ventricle contracting during the time period called systole
What is the difference between AMI and dissecting aneurysms?
The pain from an AMI is often preceded by other symptoms— nausea, indigestion, weakness, and sweating—and tends to come on gradually, getting more severe with time and often described as "pressure" rather than "stabbing." By contrast, the pain of a dissecting aortic aneurysm usually comes on full force from one minute to the next. More like stabbing. A patient with a dissecting aortic aneurysm also may exhibit a difference in blood pressure between arms or diminished pulses in the lower extremities. Transport without delay
Parasympathetic nervous system?
The parasympathetic nervous system directly opposes the sympathetic nervous system. The parasympathetic nervous system slows the heart and respiratory rates, constricts blood vessels in the muscles, and dilates blood vessels in the digestive system.
When do begin transport during a cardiac arrest?
The patient regains a pulse (ROSC), 6-9 shocks are delivered, AED gives three consecutive messages (every 2 minutes of CPR) advising no shock
What is diastolic blood pressure
The pressure against artery walls while the left ventricle is at rest: period called diastole
What controls cardiac contractions?
The rate of cardiac contractions can be increased or decreased by the autonomic nervous system. The heart also has the ability to increase or decrease the volume of blood it pumps with each contraction based on the autonomic nervous system response
Signs and symptoms of dissecting aortic aneurysm
The signs and symptoms of a dissecting aortic aneurysm include very sudden chest pain located in the anterior part of the chest or in the back between the shoulder blades or trauma
Common AED errors
The three most common errors in using certain AEDs 1. are failure of the machine to shock V fib; 2. applying the AED to a patient who is moving, squirming, or being transported; 3. turning off the AED before analysis or shock is complete
■ Bradycardia.
The unusually slow beating of the heart, 60 beats/min or less.
What do you do when doing CPR with an external defibrillator vest?
The vest should remain in place while CPR is being performed unless it interferes with compressions
AED shocks only
There are two shockable rhythms in cardiac arrest: ventricular fibrillation (v-fib) and pulseless ventricular tachycardia (pulseless V-tach)
What are arterioles and capillaries?
They are smaller vessels
Aorta arteries
Two major arteries branching from the upper aorta supply blood to the head and arms. The right and left carotid arteries supply the head and brain with blood. The right and left subclavian arteries (under the clavicles) supply blood to the upper extremities. As the subclavian artery enters each arm, it becomes the brachial artery, the major vessel that supplies blood to each arm. Just below the elbow, the brachial artery divides into two major branches: the radial and ulnar arteries, supplying blood to the lower arms and hands. At the level of the umbilicus, the descending aorta divides into two main branches called the right and left iliac arteries, which supply blood to the groin, pelvis, and legs. As the iliac arteries enter the legs through the groin, they become the right and left femoral arteries. At the level of the knee, the femoral artery divides into the anterior (front) and posterior (back) tibial arteries and the peroneal artery, supplying blood to the lower legs and feet.
Venules
Venules are the smallest branches of veins. After traveling through the capillaries, oxygen-poor blood enters the system of veins, starting with the venules, on its way back to the heart. The veins become larger and larger and eventually form the two large venae cavae: the superior vena cava and the inferior vena cava.
Ischemic stroke is
When blood flow to a particular part of the brain is stopped by a blockage (blood clot) inside a blood vessel, the result is an ischemic stroke.
Subarachnoid hemorrhage
When the aneurysm is overstretched and ruptures, blood spurts into an area between two of the coverings of the brain called the subarachnoid space. These types of strokes are called subarachnoid hemorrhages. Fatal if not treated.
Define angina pectoris
When, for a brief time, heart tissues are not getting enough oxygen, the pain is called angina pectoris, or angina.
AED during transport
You may deliver additional shocks at the scene or en route with the approval of medical control. Keep in mind that AEDs cannot analyze the rhythm while the vehicle is in motion; nor is it as safe to defibrillate in a moving ambulance. Therefore, you should come to a complete stop if more shocks are needed. Be sure to memorize the protocol of your EMS system
What is the mechanism of action for nitroglycerin?
You should take the patient's blood pressure within 5 minutes after each dose.
What happens to cause a hemorrhagic stroke
a blood vessel ruptures and the accumulated blood then forms a blood clot, which compresses the brain tissue next to it. The compression prevents oxygenated blood from getting into the area, and the brain cells begin to die. Cerebral hemorrhages are often fatal
Mild dyspnea vs. serious breathing problems:
a nasal cannula may be all that is needed, whereas patients with more serious respiratory difficulty may require a nonrebreathing mask. Give oxygen to get SPO2 levels that are between 95%-99%. Respiratory distress (8 or below or 26 or above shallow breathing is distress). Administer baby aspirin and nitroglycerin if the local protocol allows.
What is the pulse
a pulse is felt when blood passes through an artery during systole
Aneurysm
a swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall, may then develop
What does the autonomic nervous system control
a system in the brain that controls the functions of the body that do not require conscious thought, such as the heartbeat, respirations, dilation and constriction of blood vessels, and digestion of food.
Percutaneous transluminal coronary angioplasty
a tiny balloon is inflated inside a narrowed coronary artery. The balloon is then deflated, and the tube is removed from the body. Sometimes, a metal mesh cylinder called a stent is placed inside the artery instead of or after the balloon. The stent is left in place permanently to help keep the artery from narrowing again.
What is AMI?
acute myocardial infarction
If clot lodges in the coronary artery,
acute myocardial infarction (AMI) results
If the patient is having chest pain and their oxygen saturation is less than 95%,
administer oxygen at 4 L/min via a nasal cannula. If they do not improve quickly, increase the oxygen concentration.
Automaticity
allows spontaneous contraction without stimulus from a nerve source
All patients in cardiac arrest should be analyzed with (on the scene)
an AED
Define cardiogenic shock
an acute physiological condition caused by the inability of the heart to pump sufficient blood for the needs of the body.
When can CHF occur
anytime after MI, in the setting of a heart valve damage or a consequence of having high blood pressure for a long time
Level of vessels
aorta, arteries, smaller and smaller vessels called arterioles, and eventually enter the capillaries
Vital signs should be assessed
at least every 5 minutes or anytime significant changes in the patient's condition occur
When to reassess vital signs
at least every 5 minutes or when conditions change
Angina pectoris is most often a symptom of
atherosclerotic(calcium and cholesterol) coronary(in the coronary artery) artery disease
What does AED stand for?
automated external defibrillation
What control involuntary activities
autonomic nervous system control in voluntary activities that stimulates the sinoatrial node
Early defibrillation
because only a few cardiac arrest patients survive outside a hospital without a rapid sequence of events and chain of survival. AEDs have resuscitated people with cardiac arrests due to v-fib
Subclavian artery
becomes brachial artery as it supplies blood to each arm
If unresponsive and not breathing
begin CPR
What causes ischemic stroke
blockage from thrombosis or embolus as well as the byproduct of atherosclerosis. This blockage may be due to thrombosis, where a clot forms at the site of blockage, or an embolus, where the blood clot forms in a remote area (such as a diseased heart) and then travels to the site of the blockage. As with coronary artery disease, atherosclerosis in the blood vessels is often the cause of ischemic stroke
What is thromboembolism
blood clot floating through blood vessels. Blood clots happen when the body tries to fix a vessel but the clot that the body forms after trauma may float around and block the lumen/vessel. The tissue downs stream of a blood clot will have hypoxia. If blood flow is resumed in a short time, the hypoxic tissues will recover. However, if too much time goes by before blood flow is resumed, the hypoxic tissues will die
Embolus
blood clot forms in a remote area and travels to the site of the blockage in the brain.
Coronary arteries are
blood vessels that supply blood to the heart muscle
What can atherosclerosis cause
can cause complete occlusion of the arteries also as age increases so do fatty material inside the artery
What connects arterioles and venules
capillaries
Death of a heart muscle can cause
cardiac arrest
If there is no pulse
cardiac arrest
Sudden death is the result of
cardiac arrest, in which the heart fails to generate effective blood flow. Although you cannot feel a pulse in someone experiencing cardiac arrest, the heart may still be twitching, though erratically. The heart is using up energy without pumping any blood. Such an abnormality of heart rhythm is ventricular dysrhythmia, known as ventricular fibrillation
The inferior (lower) vena cava
carries blood from the abdomen, kidneys, and legs back to the right atrium.
The superior (upper) vena cava
carries blood from the head and arms back to the right atrium.
What happens if perfusion fails
cells die and later patient death occurs
If AED advises no shock and the patient has a pulse
check the patient's breathing. If the patient is breathing adequately, give oxygen via a nonrebreathing mask, adjusting the flow as soon as pulse oximetry gives a reading and transport.
If you are traveling to the hospital with an unconscious patient
check the pulse at least every 30 seconds
In some older patients with angina or AMI, particularly people with diabetes,
chest pain is absent, and the clinical picture can be confused with other, noncardiac conditions. These patients may present with a chief complaint of syncope (fainting), fatigue, or shortness of breath.
Where does chest pain usually stem from?
chest pain usually stems from ischemia
Thrombosis
clot forms at the site of the blockage
Define thrombolytic medication
clot-busting medication
Define cardiac arrest
complete cessation of cardiac activity
If the patient does not have prescribed nitroglycerin and you do not have permission from medical control to administer nitroglycerin,
complete your patient assessment and prepare to transport.
If there is dizziness or fainting spells
consider the possibility of a spinal injury from a fall
Atherosclerosis
coronary heart disease where cholesterol and calcium plugs up the coronary arteries. This may cause occlusion in the coronary arteries and the carotid artery in the neck. an atherosclerotic plaque in the carotid artery in the neck ruptures. A blood clot forms over the crack in the plaque. Sometimes, it grows large enough to completely block all blood flow through that artery. The parts of the brain supplied by the artery are deprived of oxygen and stop functioning. The plaques can also travel to the brain and cause cerebral embolism and block blood flow.
The effects of angina pectoris are
crushing or squeezing pain('someone is standing on my chest). The pain is usually in the mid-portion of the chest under the sternum although it can radiate to the jaw, arms, left arm, midportion of the back or the epigastrium, or the upper middle region of the abdomen. does not lead to death or permanent heart damage should be taken as a serious warning sign. The pain usually lasts from 3 to 8 minutes, rarely longer than 15 minutes. It may be associated with shortness of breath, nausea, or sweating. It usually disappears promptly with rest, supplemental oxygen, or nitroglycerin (NTG), all of which decrease the need or increase the supply of oxygen to the heart
Define ischemia
decreased blood flow to one or more portions of the heart. Decreased blood flow. Because of a partial or complete blockage of blood flow through the coronary arteries, heart tissue fails to get enough oxygen and nutrients. The tissue soon begins to starve and, if blood flow is not restored, eventually dies. Ischemic heart disease, then, is a disease involving a decrease in blood flow to one or more portions of the heart muscle.
Defibrillation
defibrillate means to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore a normal rhythmic beat. restores cardiac rhythms and can save lives. Initial CPR until a defibrillator is available
Patients with diabetes caveat
diabetes patients can experience reduced circulation to the hands and feet, which makes peripheral pulses harder to detect. It also puts the hands and feet at particular risk for infection and ulceration.
When the myocardium is demanding more oxygen
dilation of the coronary arteries happens
The increased oxygen demand of the myocardium itself is supplied by
dilation or widening, of the coronary arteries, which increases blood flow
Iliac arteries
enter legs through the groin and become the right and left femoral arteries which divide into the anterior and posterior tibial arteries and peroneal artery at the knees which supply blood to lower legs and feet
Stroke in left hemisphere
exhibit speech disorder called aphasia where they cannot understand or produce speech. Some patients will have trouble understanding speech but will be able to speak clearly.What day is today?" The patient may respond with an inappropriate answer such as, "Green." The speech is clear, but it does not make sense
Older people and women may call AMI
fatigue
If the first shock of AED or CPR is not started
few patients benefit from defibrillation when more than 10 minutes elapse before administration of the first shock or if CPR is not performed in the first 2 to 3 minutes.
Define asystole
flatline or no electrical activity
If the right side of the heart is damaged
fluid collects in the body, often showing up as swelling in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. However, chronic dependent edema may indicate underlying heart disease even in the absence of pain or other symptoms. Since the right side of the heart supplies the preload for the left side of the heart, right heart failure can result in an inadequate supply of blood to the left ventricle resulting in a drop in systolic blood pressure. It is important to realize that some patients may present with signs of both left-sided and right-sided heart failure because left-sided failure often leads to right-sided failure.
What are the early signs of intracranial pressure?
headache, vomiting, altered mental status, and seizures
What is the formula for the cardiac output
heart rate multiplied by volume ejected with each contraction (stroke volume)
Patients with bleeding in the brain have the signs of
high blood pressure (high blood pressure can cause bleeding or be a compensatory response to the bleeding). Blood pressure increases as the body attempts to force more oxygen to the area of the brain where the damage is occurring. A trend of increasing blood pressure is an important sign. Blood pressure may then taper off and return to normal. Significant drops in blood pressure may also occur as the patient's condition worsens. Therefore, it is important to monitor the blood pressure for changes in these patients
Things that mimic strokes
hypoglycemia, postictal states, and subdural/epidural bleeding
When should AED be administered?
if the patient is pulseless, not breathing (apneic), and unresponsive
What is needed after AMI pain signals
immediate transportation, thrombolytic drugs, angioplasty
Where is peripheral pulses felt?
in the extremities or radial and the posterior tibial, are called peripheral pulses,
Aphasia
inability to produce or understand speech. Other patients will be able to understand the question but cannot produce the right sounds to provide an answer. Cause paralysis on the right side of the body.
In congestive heart failure
increased heart rate and enlargement of left ventricle no longer make up for decreased heart function. Lungs become congested with fluid and may cause dependent edema
What are the two types of vena cava
inferior and superior
Reassess your
interventions to see whether they are helping and whether the patient's condition is improving.
Dysrhythmia
is heart rhythm abnormalities. Although you cannot feel a pulse in someone experiencing cardiac arrest, the heart may still be twitching, though erratically.
Pulseless electrical activity
is not shockable by AED because Pulseless electrical activity refers to a state of cardiac arrest that exists despite an organized electrical complex. In both cases, CPR should be initiated as soon as possible beginning with chest compressions
Define cardiac output
is the volume of blood that passes through the heart in one minute
EMT/ALS goal
is to continue ventilation at less than 12 breaths/min to achieve an ETCO2 of 35 to 40 mm Hg; maintaining oxygen saturation between 94% and 99%; assuring blood pressure is above 90 mm Hg; and maintaining glucose levels in the patient who is hypoglycemic. It also includes cardiopulmonary and neurologic support at the hospital as well as other advanced assessment techniques and interventions when indicated.
What is the most common stroke
ischemic (80% of all strokes)
Define two main types of strokes
ischemic and hemorrhagic
When there is unstable angina
it is in response to fewer stimuli than normal. Unstable angina is characterized by pain or discomfort in the chest of coronary origin that occurs in response to progressively less exercise or fewer stimuli than ordinarily required to produce angina. Can lead to AMI.
When there is stable angina
it is relieved by rest or nitroglycerin. Stable angina is characterized by pain in the chest of coronary origin that is relieved by the things that normally relieve it in a given patient, such as resting or taking nitroglycerin.
Define automatic implantable cardiac defibrillators
it monitors heart rhythm and shocks as needed for patients who survive cardiac arrest due to ventricular fibrillation.
Defibrillation works best if
it takes place within 2 minutes of the onset of the cardiac arrest.
The superior and inferior venae cavae
join at the right atrium of the heart, where blood is eventually returned into the pulmonary circulation for oxygenation. Used blood comes through the venae cava. .
Coronary artery disease is the
leading cause of death in US
Symptoms of ischemic stroke
loss of movement on the side of the body opposite the side where the occlusion has occurred
Define angioplasty
medications or angioplasty (mechanical clearing of the artery)
Who is more likely to deny AMI?
middle-aged men
Myocardium
muscle tissue of the heart
Acute coronary syndrome (ACS) is a group of systems caused by:
myocardial ischemia. Can lead to CHF
Where is the central pulse felt
near the body's trunk. femoral and carotid pulses are known as central pulses.
Do not delay transport to assist with the administration of
nitroglycerin. The drug can be given en route.
Dissecting aneurysm
occurs when the inner layers of the aorta become separated, allowing blood (at high pressures) to flow between the layers.
Who does not experience pain during AMI?
older people, women, and people with diabetes. Some may call it indigestion
Define the tricuspid valve
one-way valve that keeps blood from flowing backward into the right atrium
Cerebrovascular accident (CVA)
or stroke is an interruption of blood flow to an area within the brain that results in the loss of brain function. In the context of a total lack of oxygen, brain cells stop functioning and begin to die within minutes
Chest scar
patients who have had open-heart procedures may or may not have chest scar but you need to treat a chest pain patient that has the procedure the same as you do with those that have never had heart surgery. It shows that they have had AMI or angina in the past but did not get angioplasty or coronary artery stent. Assume they have had it because sometimes patients that go under surgery do not have scars. Still use AED.
If there is sudden cardiac arrest
perform CPR and AED
If the patient has no pulse,
perform five cycles (approximately 2 minutes) of CPR beginning with chest compressions. After 2 minutes of CPR, reanalyze the patient's cardiac rhythm. If the AED advises to shock, deliver one shock followed immediately by CPR, beginning with chest compressions. Repeat these steps if needed.
If the patient has no pulse and the AED advises no shock,
perform five cycles (approximately 2 minutes) of CPR, beginning with chest compressions. After five cycles (2 minutes) of CPR, reanalyze the patient's cardiac rhythm. If no shock is advised, continue CPR. Transport the patient, and contact medical control as needed
Pulmonary edema
positive pressure ventilation with BVM or CPAP
Dysrhythmia can include
premature ventricular contractions, tachycardia, bradycardia, and ventricular tachycardia
If AED advises no shock and the patient has a pulse but is not breathing adequately
provide artificial ventilation with a BVM or pocket mask device attached to 100% oxygen and transport. Ensure that proper airway techniques are used at all times.
Apply AED to
pulseless, unresponsive patients while staying clear of a patient when AED is analyzing the heart rhythm and delivering shocks. ONLY stop CPR when AED is analyzing and delivering shocks
Vena cavae
return deoxygenated blood to the heart
What is a shock
shock is present when the body tissues do not get enough oxygen, causing the body organs to malfunction
15-20 minutes no pulse/CPR
start CPR and call medical directors to see when to terminate
Transport in a
stress relieving manner
Define stroke volume
stroke volume is the volume of blood ejected with each ventricular contraction. How much blood is pumped when the left ventricle contracts
Notable symptoms of a ruptured aneurysm
sudden onset, severe headache, typically described by the patient as the worst headache he or she has ever had. The headache is caused by the irritation of blood on the brain tissue after the artery swells and ruptures.
Signs of hemorrhagic stroke
sudden, severe headache, 'worst pain the patient has ever had', seizures, altered mental status, vomiting, increased intracranial pressure
The right coronary artery
supplies blood to the right atrium and the bottom part of the left ventricle
Right and left carotid arteries
supply the head and brain with blood
What are the two parts of the autonomic nervous system?
sympathetic and parasympathetic
Although the technology is very reliable, pacemaker malfunction can cause
syncope, dizziness, or weakness due to an excessively slow heart rate. If this occurs transport patients promptly.
Hypertension
systolic greater than 140 mmHg or diastolic greater than 90 mmHg
Define uncontrollable AMI risk factors
that cannot be controlled are older age, family history of atherosclerotic coronary artery disease, race, ethnicity, male(sex)
What do the atria do?
the atria receive incoming blood
Define aorta
the body's main artery, it receives blood ejected from the left ventricle
Ischemia
the brain will develop ischemia if there is a reduction in blood supply that results in inadequate oxygen being supplied to the brain cells. This causes those cells to stop functioning properly. If normal blood flow is restored to that area of the brain in time, the cells will not die and the patient may regain full use and control of the body part.
Define atherosclerosis
the buildup of calcium and cholesterol(fatty material) form a plaque inside the walls of blood vessels, obstructing flow and interfering with their ability to dilate or contract
Perfusion is
the constant flow of oxygenated blood to tissues
Where do coronary arteries start?
the coronary arteries start at the first part of the aorta, just above the aortic valve. The aortic valve is in the midline of the heart. Straight middle.
What is blood pressure
the force of circulating blood against the artery walls
What is the myocardium?
the heart muscle
Angina pectoris occurs when
the heart's need for oxygen exceeds the supply. When the increased oxygen demand goes away (eg, the person stops exercising), the pain typically goes away. Or can happen from a spasm of an artery. A large meal or sudden fear may also trigger an attack. When the increased oxygen demand goes away (eg, the person stops exercising), the pain typically goes away.
Define lumen
the inside diameter of the artery
What does the myocardium need to pump blood?
the myocardium must have a continuous supply of oxygen and nutrients to pump blood
If no impulse arrives,
the other cells are capable of creating their own impulses and stimulating a contraction
If impulses come from the SA node,
the other myocardial cells with contract
Stroke in the Right hemisphere
the patient will have trouble moving the muscles on the left side of the body. Usually, the patient will understand language and be able to speak, but the words may be slurred and hard to understand. patients with right hemisphere strokes may be completely oblivious to their problems. If you ask these patients to lift their left arms and they cannot, they will lift their right arms instead. Patients will seem to have forgotten that their left arms even exist. This symptom is called neglect.
CPR prolongs
the period during which defibrillation can be effective
Define systole
the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries.
What supplies blood to the lower arms and hands?
the radial and ulnar arteries
What are the two parts of the coronary arteries?
the right and left coronary artery
What does the right side of the heart receive?
the right side of the heart receives oxygen-poor blood from veins. Blood from the vena cava enters the right atrium which fills the right ventricle trough the tricuspid valve.
What do the ventricles do?
the ventricles pump outgoing blood
What helps stop AMI?
thrombolytic medication or angioplasty
What happens if blood blow is not restored
tissue dies
EMT goal during resuscitation is
to shorten interval with CPR until defibrillation
If a person wearing a device that has already delivered a shock should be
transported to the hospital for further evaluation
How do you treat patients with Automatic implantable cardiac defibrillators
treat chest pain patients with these devices like other patients having an AMI
What drug has to be given within the first few hours after a stroke
treatment with tissue plasminogen activator (tPA), but this drug must be given within the first few hours after a stroke; ideally within the first hour of arrival in the ED to have the best chance of reversing the symptoms. Note the time of symptom onset and transport to a stroke center
What causes dissecting aneurysm
uncontrolled hypertension.
How to do cardiac monitoring
use ECG to monitor
Automatic implantable cardiac defibrillators are
used by patients who have survived cardiac arrest due to ventricular fibrillation
What is the name of the smallest branches of veins
venules
When do you remove a nitroglycerin patch
when a person is hypotensive or in cardiac arrest
What happens when oxygen levels are decreased but not absent?
when oxygen levels are decreased, but not absent, because an insufficient amount of blood is getting through, brain cells may be damaged more slowly. It may take several hours or more for brain cells to die in this situation. When brain cells die or are injured, severe disability may result.
A dissecting aneurysm occurs
when the inner layers of the aorta become separated, allowing blood (at high pressures) to flow between the layers.
When does the myocardium demand more oxygen?
when there is physical exertion or stress, the myocardium requires more oxygen. The heart must increase cardiac output to meet the increased metabolic requirements of the body.
Reassessment will also determine
whether further interventions are indicated or contraindicated
Chain of survival,
which is the sequence of events that must happen for a patient with cardiac arrest to have the best chance of survival, includes: 1. recognition of early warning signs and immediate activation of EMS, 2. immediate high-quality CPR, 3. rapid defibrillation, basic and advanced EMS, and 4. ALS and postarrest care. Seconds count at every stage.
Signs and symptoms of CHF
• The patient finds it easier to breathe when sitting up.. • patient is agitated. • Chest pain may or may not be present. • The patient often has distended neck veins that do not collapse even when the patient is sitting. • The patient may have swollen ankles from dependent edema (backup of fluid). • The patient generally will have high blood pressure, a rapid heart rate, and rapid respirations. • The patient will usually be using accessory breathing muscles of the neck and ribs, reflecting the additional hard work of breathing. • Skin is usually pale or cyanotic and sweaty. • The fluid surrounding small airways may produce rales (crackles), best heard by listening to either side of the patientʼs chest, about midway down the back. In severe CHF, these soft sounds can be heard even at the top of the lung.
Signs and symptoms of a stroke
■ Facial drooping ■ Sudden weakness or numbness in the face, arm, leg, or one side of the body ■ Decreased or absent movement and sensation on one side of the body ■ Lack of muscle coordination (ataxia) or loss of balance ■ Sudden vision loss in one eye; blurred or double vision ■ Difficulty swallowing (a primary reason for good airway management in a patient with a stroke) ■ Decreased level of responsiveness ■ Speech disorders ■ Aphasia; difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken words (receptive aphasia) ■ Slurred speech (dysarthria) ■ Sudden and severe headache ■ Confusion ■ Dizziness ■ Weakness ■ Combativeness ■ Restlessness ■ Tongue deviation ■ Coma
AMI and cardiac compromise physical findings
■ General appearance.... The patient often appears frightened. There may be nausea, vomiting, and a cold sweat. The skin is often pale or ashen gray because of poor cardiac output and the loss of perfusion, or blood flow through the tissue. Occasionally, the skin will have a bluish tint, called cyanosis ■ Pulse.... Generally, the pulse rate increases as a normal response to pain, stress, fear, or actual injury to the myocardium. Because dysrhythmias are common in an AMI, you may feel an irregularity or even a slowing of the pulse. The pulse may also be dependent on the area of the heart that has been affected by the AMI. Damage to the inferior area of the heart often presents with bradycardia. ■ Blood pressure.... Blood pressure may fall as a result of diminished cardiac output and diminished capability of the left ventricle to pump. However, most patients with an AMI will have a normal or, possibly, elevated blood pressure. ■ Respiration.... The respiratory rate is usually normal unless the patient has CHF. In that case, respirations may become rapid and labored with a higher likelihood of cyanosis and possibly frothy sputum. A complaint of difficulty breathing is common with cardiac compromise, so even if the rate seems normal, look at the work of breathing, and treat the patient as if a respiratory compromise were present .■ Mental status... Patients with AMIs often experience confusion or agitation and sometimes experience an almost overwhelming feeling of impending doom. If a patient tells you, "I think I am going to die," pay attention
SAMPLE for cardio
■ Have you ever had a heart attack? ■ Have you been told that you have heart problems? - Have you ever been diagnosed with angina, heart failure, or heart valve disease? - Have you ever had high blood pressure? - Have you ever been diagnosed with an aneurysm? - Do you have any respiratory diseases such as emphysema or chronic bronchitis? - Do you have diabetes or have you ever had any problems with your blood sugar? - Have you ever had kidney disease? ■ Do you have any risk factors for coronary artery disease, such as smoking, high blood pressure, or high-stress lifestyle? - Is there a family history of heart disease? - Do you currently take any medications?
Pain of AMI
■ It may or may not be caused by exertion but can occur at any time, sometimes when a person is sitting quietly or even sleeping. ■ It does not resolve in a few minutes; rather, it can last between 30 minutes and several hours. ■ It may or may not be relieved by rest or nitroglycerin
If the AED protocol is complete, one of the following is likely
■ Pulse is regained (ROSC). ■ No pulse, and the AED indicates that no shock is advised. ■ No pulse, and the AED indicates that a shock is advised.
