Drill of the Month Developed by Gloria Bizjak Recognizing and Managing Acute Coronary Syndrome

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3 Recognizing and Managing Acute Coronary Syndrome Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: Define acute coronary syndrome and related terms. Define acute coronary syndrome and related terms. List causes of acute coronary syndrome. List causes of acute coronary syndrome. List general risk factors of acute coronary syndrome. List general risk factors of acute coronary syndrome. List general symptoms of acute coronary syndrome. List general symptoms of acute coronary syndrome. Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

Drill of the Month4 Recognizing and Managing Acute Coronary Syndrome Overview: Definitions Definitions Causes Causes Risk Factors Risk Factors Symptoms Symptoms Assessment and care Assessment and care

Drill of the Month5 Acute Coronary Syndrome: Definitions Acute coronary syndrome Acute coronary syndrome –Umbrella term: includes group of clinical symptoms of AMI –Includes angina and heart attack –Chest or anginal pain and other symptoms  Low oxygen levels to heart  Caused by plaque build-up

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7 Acute Coronary Syndrome: Definitions Acute coronary syndrome Acute coronary syndrome –Includes several signs and symptoms  Chest and epigastric pain/discomfort  Radiating pain to arm, shoulders, jaw  Difficulty breathing/shortness of breath  Sudden onset of sweating, nausea, vomiting NOTE: Any type of chest discomfort or signs and symptoms of acute coronary syndrome is serious and needs immediate treatment

Drill of the Month8 Acute Coronary Syndrome: Definitions Specific terms Specific terms –Acute: Sudden onset w/severe, sharp pain (compare to chronic) –Syndrome: Group of symptoms characteristic of disease/disorder –Myocardial: Referring to the heart muscle –Ischemia: Decrease of blood supply

Drill of the Month9 Acute Coronary Syndrome: Definitions Specific terms Specific terms –Angina: Severe constricting pain w/the sensation of choking/suffocating –Heart attack: Blockage of a coronary artery causing tissue damage/death –Plaque: Deposits of fatty material (lipids) on arterial wall

Drill of the Month10 Acute Coronary Syndrome: Causes Causes: Plaque Causes: Plaque –Made up of lipids, accumulates in arteries –Narrows arteries and blocks blood flow –Build-up and narrowing is ‘coronary artery disease’ –Pain from restricted blood flow causes angina –Breaks away from arterial wall, blocks artery or causes a clot resulting in heart attack

Plaque Drill of the Month11

Drill of the Month12 Acute Coronary Syndrome: Risk Factors Risk factors: Gender and age Risk factors: Gender and age –Men (commonly) –Women 15 years post menopausal –Increased age

Drill of the Month13 Acute Coronary Syndrome: Risk Factors Risk factors: Medical Risk factors: Medical –Diabetes mellitus (DM) –Hypertension –Hyperlipidemia: Includes fats, oils, waxes, sterols, nucleic acids, triglycerides –Hypercholesterolemia: Cholesterol is a lipid –Prior cerebrovascular accident: Over 7% of patients with ACS had prior stroke

Drill of the Month14 Acute Coronary Syndrome: Risk Factors Risk factors: Medical Risk factors: Medical –Inherited metabolic disorders –Connective tissue disease: Commonly known diseases include—  Autoimmune diseases, such as lupus, rheumatoid arthritis  Inherited diseases, such as Marfan’s Syndrome  Scurvy and other

Drill of the Month15 Acute Coronary Syndrome: Risk Factors Risk factors: Other Risk factors: Other –Smoking history –Metamphetamine use –Occupational stress

Drill of the Month16 Acute Coronary Syndrome: Symptoms Symptoms Symptoms –Chest discomfort  May radiate to arm, shoulders, jaw, back  May feel like crushing pain, muscle ache, toothache –Anginal pain –Shortness of breath (SOB) w/exertion –Shortness of breath when lying down (orthopnea)

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Drill of the Month18 Acute Coronary Syndrome: Symptoms Symptoms Symptoms –Paroxysmal nocturnal dyspnea  Waking in the middle of the night w/long-lasting SOB –Patient stands at window to catch his/her breath –Patient sleeps on stacked pillows to elevate head/chest –Patient sleeps in recliner

Drill of the Month19 Acute Coronary Syndrome: Symptoms Symptoms Symptoms –Difficulty breathing –Sudden sent of diaphoresis, nausea, vomitting –Palpitations –Anxiety

Drill of the Month20 Acute Coronary Syndrome: Symptoms Possible findings on examination Possible findings on examination –Rales –Jugular vein distention (JVD) Late sign –Hypertension or hypotension

Drill of the Month21 Acute Coronary Syndrome: Assessment and Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Size up scene; gather info –Perform initial assessment –Perform focused history, physical exam  History of present illness—OPQRST questions  SAMPLE history  Baseline vital signs

Drill of the Month22 Acute Coronary Syndrome: Assessment and Care Assessment: Perform General Patient Care (Maryland Protocols) Assessment: Perform General Patient Care (Maryland Protocols) –Follow treatment protocols –Communicate with hospital, other response personnel –Disposition: determine priority and mode of transport

Drill of the Month23 Acute Coronary Syndrome: Assessment and Care Emergency care Emergency care –Place patient in position of comfort  Patients with SOB or difficulty breathing: sitting up  Hypotensive patients: lying down  Patients with both: let them decide position or change position –Give a high concentration of oxygen –Be prepared for respiratory or cardiac arrest

Drill of the Month24 Acute Coronary Syndrome: Assessment and Care Emergency care Emergency care –Transport immediately if:  This is patient’s first episode—no cardiac history  Patient has cardiac history but no nitroglycerine  Patient’s systolic blood pressure is less than 100 mm Hg

Drill of the Month25 Acute Coronary Syndrome: Assessment and Care Emergency care Emergency care –Assist patient in taking own nitroglycerine (Refer to Nitroglycerine protocol)  Repeat –3-5 minutes with persistent chest pain –If BP is greater than 90 mm Hg (consult if BP drops more than 20 mm HG) –If pulse is greater than 60 bpm

Drill of the Month26 Acute Coronary Syndrome: Assessment and Care Emergency care Emergency care –Assist patient in taking own nitroglycerine  Doses –Maximum 3 doses (medical consult for additional) –3 doses include patient taken and EMT assisted NOTE: CONTRAINDICATED if patient has taken erectile dysfunction meds w/i 48 hours (medical consult) ViagraTM, LevitraTM, CialisTM Adcirca, Revatio

Acute Coronary Syndrome: Assessment and Care ASPIRIN ASPIRIN Maryland Protocol p 206 Maryland Protocol p 206 a) Pharmacology a) Pharmacology (1) Platelet inhibitor (1) Platelet inhibitor (2) Anti-inflammatory (2) Anti-inflammatory b) Pharmacokinetics b) Pharmacokinetics Blocks platelet aggregation Blocks platelet aggregation Drill of the Month27

ASPIRIN Acute Coronary Syndrome c) Indications c) Indications Chest pain when acute myocardial infarction is suspected. Chest pain when acute myocardial infarction is suspected. d) Contraindications d) Contraindications Known hypersensitivity Known hypersensitivity Drill of the Month28

ASPIRIN Acute Coronary Syndrome Adverse Effects Adverse Effects (1) Heartburn (1) Heartburn (2) Nausea and vomiting (2) Nausea and vomiting (3) Wheezing (3) Wheezing f) Precautions f) Precautions GI bleeding and upset GI bleeding and upset g) Dosage g) Dosage (1) Adult: 324 mg or 325 mg chewed (1) Adult: 324 mg or 325 mg chewed (2) Pediatric: Not indicated (2) Pediatric: Not indicated Drill of the Month29

Drill of the Month30 Acute Coronary Syndrome: Assessment and Care Emergency care Emergency care –Assess for shock signs/symptoms –Provide care for shock –Monitor the airway –Reassess vital signs every 5 minutes

Drill of the Month31 Recognizing and Managing Acute Coronary Syndrome Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: Define acute coronary syndrome and related terms. Define acute coronary syndrome and related terms. List causes of acute coronary syndrome. List causes of acute coronary syndrome. List general risk factors of acute coronary syndrome. List general risk factors of acute coronary syndrome. List general symptoms of acute coronary syndrome. List general symptoms of acute coronary syndrome. Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

Drill of the Month32 Recognizing and Managing Acute Coronary Syndrome Review: Define the following terms: –Acute coronary syndrome –Acute –Syndrome –Ischemia –Myocardial –Angina –Heart attack –Plaque

Drill of the Month33 Recognizing and Managing Acute Coronary Syndrome Review Acute Coronary Syndrome Acute Coronary Syndrome –List causes of acute myocardial syndrome –Name the risk factors of acute myocardial syndrome –Describe the symptoms of acute myocardial syndrome –Explain the assessment and care of acute myocardial syndrome