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12: Cardiovascular Emergencies. Cardiovascular Emergencies. Cardiovascular disease (CVD) claimed 931,108 lives in the US during 2001. 2,551 per day Almost two people per minute! CVD accounts for 38.5% of all deaths. One of every 2.6 deaths. Blood Flow Through the Heart.
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Cardiovascular Emergencies • Cardiovascular disease (CVD) claimed 931,108 lives in the US during 2001. • 2,551 per day • Almost two people per minute! • CVD accounts for 38.5% of all deaths. • One of every 2.6 deaths
Cardiac Compromise • Chest pain results from ischemia • Ischemic heart disease involves decreased blood flow to the heart. • If blood flow is not restored, the tissue dies.
Materials build up inside blood vessels. This decreases or obstructs blood flow. Risk factors place a person at risk. Atherosclerosis
Angina Pectoris • Pain in chest that occurs when the heart does not receive enough oxygen • Typically crushing or squeezing pain • Rarely lasts longer than 15 minutes • Can be difficult to differentiate from heart attack
Heart Attack • Acute myocardial infarction (AMI) • Pain signals death of cells. • Opening the coronary artery within the first hour can prevent damage. • Immediate transport is essential.
Signs and Symptoms • Sudden onset of weakness, nausea, sweating without obvious cause • Chest pain/discomfort • Often crushing or squeezing • Does not change with each breath • Pain in lower jaw, arms, back, abdomen, or neck • Sudden arrhythmia with syncope • Shortness of breath or dyspnea • Pulmonary edema • Sudden death
Pain of Heart Attack • May or may not be caused by exertion • Does not resolve in a few minutes • Can last from 30 minutes to several hours • May not be relieved by rest or nitroglycerin
Sudden Death • 40% of AMI patients do not reach the hospital. • Heart may be twitching.
Arrhythmias Bradycardia Ventricular Tachycardia
Cardiogenic Shock • Heart lacks power to force blood through the circulatory system. • Onset may be immediate or not apparent for 24 hours after AMI.
Congestive Heart Failure • CHF occurs when ventricles are damaged. • Heart tries to compensate. • Increased heart rate • Enlarged left ventricle • Fluid backs up into lungs or body as heart fails to pump.
You are the Provider • You are a volunteer EMT-B in a rural area. You are dispatched to an older man complaining of severe chest pain. • ALS has been dispatched. • You arrive to find the patient clutching his chest. The pain is the worst he has ever had. • The patient has nitroglycerin but has not taken it yet.
You are the Provider (continued) • What is wrong with this patient? • What must you know before administering any medication? • What must you specifically know before assisting a patient with nitroglycerin?
Scene Size-up • Scene size-up • General impression • Is the patient responsive?
Initial Assessment • Chief complaint on responsive patients • A chief complaint of chest discomfort, shortness of breath, or dizziness must be taken seriously. • Airway and breathing • Circulation
Transport Decision • Is the patient a life threat? • Stable patients • Transport in gentle manner. • Avoid lights and siren. • Do not let patient exert or strain self. • Specialty facilities
You are the Provider (continued) • You obtain a brief history while taking the patient’s blood pressure. • Your partner retrieves the nitroglycerin and obtains permission from medical control. • Your partner administers the nitroglycerin. • What else can you do at this time?
Focused History and Physical Exam • SAMPLE • OPQRST • Medications are important! • Medications often prescribed for CHF: • Furosemide • Digoxin • Amiodarone
Focused Physical Exam • Cardiac and respiratory systems • Look for skin changes. • Lung sounds • Baseline vital signs • BOTH systolic and diastolic BP readings
Communication Relay history, vital signs, changes, medications, and treatments.
