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Agenda Sean add whatever you want Next phase of scenario prep – Final exam – Practical final Run Reports – Will send out Google doc to fill out Lecture.

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Presentation on theme: "Agenda Sean add whatever you want Next phase of scenario prep – Final exam – Practical final Run Reports – Will send out Google doc to fill out Lecture."— Presentation transcript:

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2 Agenda Sean add whatever you want Next phase of scenario prep – Final exam – Practical final Run Reports – Will send out Google doc to fill out Lecture code – - = MI – - = Angina

3 Angina vs. MI Causes – MI: complete blockage of the blood supply to the heart muscle – Angina: decrease in blood supply to the heart Symptoms – MI: chest pain with damage to the heart Severe, steady, crushing pain Radiates to the left neck Weak, rapid pulse Hypotension Low grade fever – Angina: best pain with no damage to the heart Tightness or pressure in the chest Severity – MI: may cause permanent damage irreversible damage prevented if blood supply restored within 20 min Symptoms persist after 15 minutes and not relieved by nitro – Angina: symptoms relieved by rest or nitro within minutes

4 Medications Administration criteria (DICE) – Drug/Dosage – Integrity/Indications (right patient?) – Clarity/Contraindications – Expiration Date Nitroglycerin – Take BP before administration and 5 minutes after administration Why? – May cause hypotension due to vasodilation – Indications Symptoms of chest pain Systolic BP >100mm/Hg – Contraindications Patient does not meet indication or criteria for administration Patient has taken 3 doses before EMS arrival within the last 5 minutes Last dose was < 5 minutes ago Systolic blood pressure < 100mm/Hg Administration of Sildenafil citrate (Viagra7) or similar medication within 36 hours

5 Medications Preparation/administration – Tablet Remove from container and check if in tact Place under pt’s tongue Instruct patient to allow tablet to dissolve, not swallow – Spray One spray delivers 0.4 mg of nitro sublingually

6 Reassessment Repeat every 5 minutes – AKA primary assessment – Vital signs – Relevant part of a secondary assessment

7 Cause Onset of pain Location History What makes it better or worse? Things to think about in the field …

8 Onset Was it… Sudden? Gradual? Lasts Minutes? Lasts Hours? Varies?

9 Quality Does the chest feel like it is spasming? Is there a sharp pain when inhaling? Is there any tightness/heaviness? Can the pain be pinpointed? Is the pain not easy to pinpoint? Is there a burning sensation? Does the pain feel “tearing”?

10 Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm

11 Things to consider about pt Hx Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis – HTN, angina

12 Signs/Symptoms? Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

13 What makes it worse? Breathing Position of comfort (sitting, laying down, or just moving in general) Stress/anxiety

14 What makes it better? Rest/little movement Position of comfort Antacids Medications

15 Angina Onset of Pain Sudden Gradual Lasts Minutes Lasts Hours Varies

16 Angina Quality of Pain Sharp pain upon inhalation Spasm Tight/heavy Sharp/Burning TEARING / EXCRUCIATING

17 Angina Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm VAGUE

18 Angina History Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis – HTN, angina

19 Angina Signs and Symptoms Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

20 What Makes Angina Worse? Breathing Position (sitting, laying down, or just moving in general) Stress/anxiety

21 What Makes Angina Better? Rest/little movement Position of comfort Antacids Medications

22 MI Onset Sudden Gradual Lasts Minutes Lasts Hours Varies

23 Quality of MI Does the chest feel like it is spasming? Is there a sharp pain when inhaling? Is there any tightness/heaviness? Can the pain be pinpointed? Is the pain not easy to pinpoint? Is there a burning sensation? Does the pain feel “tearing”?

24 MI Location Below the sternum Center of chest Lateral chest Lower part of the chest Radiates to jaw, neck, back of arm

25 MI History Age of patient Has this happened before? Is there any trauma involved? Is there any high level stress going on in pt’s life? Is the patient having an emotional episode (ex. Breakup – yes, EMSC has dealt with this before) Previous diagnosis – HTN, angina

26 MI Signs and Symptoms Shortness of breath (dyspnea – know this term for final) Diaphoresis Nauseous Syncopal episode or weakness

27 What Makes MI Worse? Breathing Position (sitting, laying down, or just moving in general) Stress/anxiety

28 What Makes MI Better? Rest/little movement Position of comfort Antacids Medications

29 See you next week!!

30 References Carroll, Laurie, RN, and Will Grundy. “Cardiac Differential Diagnosis”. Lecture.


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