1. Chapter 12 Cardiovascular Emergencies

2. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 2 Describe the structure and function of the heart. Describe the care for patients experiencing chest pain. Identify the indications for using an AED. Define the role of the EMT-B in the emergency cardiac care system. Objectives (1 of 6)

3. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 3 Discuss the position of comfort for patients with cardiac compromise. Establish the relationship between airway management and cardiac compromise. Discuss fundamentals of early defibrillation. Objectives (2 of 6)

4. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 4 Explain importance of ACLS intervention. Discuss various types of AEDs. State the need for assuring no pulse prior to attaching an AED. Discuss circumstances resulting in inappropriate shocks. Objectives ( 3 of 6)

5. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 5 Discuss advantages and disadvantages of AEDs. List the steps for using an AED. Differentiate between single- and multi- rescuer care with an AED. Explain why pulses are not checked between shocks when using an AED. Objectives ( 4 of 6)

6. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 6 Discuss the importance of post- resuscitation care. Discuss the importance of completing the AED checklist. Discuss the role AHA plays in the use of AEDs. Objectives ( 5 of 6)

7. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 7 List the indications for the use of nitroglycerin. State contraindications and side effects for the use of nitroglycerin. Define the functions of all controls on an AED. Objectives ( 6 of 6)

8. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 8 Blood Flow Through the Heart

9. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 9 Electrical System of the Heart

10. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 10 Coronary Arteries

11. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 11 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.

12. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 12 Atherosclerosis Materials build up inside blood vessels. This decreases or obstructs blood flow. Risk factors place a person at risk.

13. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 13 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

14. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 14 Acute Myocardial Infarction (AMI) Pain signals death of cells. Opening the coronary artery within the first hour can prevent damage. Immediate transport is essential.

15. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 15 Pain of AMI 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

16. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 16 Sudden Death 40% of AMI patients do not reach the hospital. Heart may be twitching.

17. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 17 Arrhythmias Bradycardia Ventricular Tachycardia

18. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 18 Cardiogenic Shock Heart lacks power to force blood through the circulatory system. Onset may be immediate or not apparent for 24 hours after AMI.

19. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 19 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.

20. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 20 Signs and Symptoms of AMI Sudden onset of weakness, nausea, and sweating Chest pain or discomfort Pain in lower jaw, arms, or back Sudden fainting Pulmonary edema Sudden death

21. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 21 Physical Findings of Cardiac Compromise (1 of 2) Pulse rate increases. Blood pressure may be normal or falling. Respirations are usually normal. General appearance Frightened Nausea, vomiting, cold sweat

22. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 22 Physical Findings of Cardiac Compromise (2 of 2) Ashen gray skin Swollen neck veins with acute CHF Feeling of impending doom

23. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 23 Approach to the Patient with Chest Pain (1 of 2) Reassure the patient and perform initial assessment. Administer oxygen. Measure and record vital signs. Place the patient in a position of comfort.

24. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 24 Approach to the Patient with Chest Pain (2 of 2) Obtain focused history and physical exam. Ask about the chest pain using OPQRST. Assist with administration of prescribed nitroglycerin. Transport promptly. Report to medical control en route.

25. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 25 Nitroglycerin Forms Pill, spray, skin patch Effects Relaxes blood vessel walls Dilates coronary arteries Reduces workload of heart

26. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 26 Nitroglycerin Contraindications Systolic blood pressure of less than 100 mm Hg Head injury Patient age less than 15 years Maximum dose taken in past hour

27. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 27 Assisting with Nitroglycerin (1 of 2) Obtain order from medical direction. Take patient’s blood pressure. Check that you have right medication, patient, and delivery route. Check expiration date. Find out last dose taken and effects. Be prepared to lay the patient down.

28. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 28 Assisting with Nitroglycerin (2 of 2) Administer tablet or spray under tongue. Have patient keep mouth closed until tablet dissolves or is absorbed. Recheck blood pressure. Record each activity and time of application. Perform reassessment. May repeat dose in 3 to 5 minutes.

29. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 29 Heart Operations Coronary artery bypass graft (CABG) Angioplasty Cardiac pacemaker

30. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 30 Automatic Implantable Cardiac Defibrillators (1 of 2) Maintains a regular heart rhythm and rate Do not place AED patches over pacemaker.

31. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 31 Automatic Implantable Cardiac Defibrillators (2 of 2) Monitor heart rhythm and deliver shocks as needed. Low electricity will not affect rescuers.

32. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 32 Automated External Defibrillation (AED) AEDs come in two forms: Automated Semiautomated A specialized computer recognizes heart rhythms that require defibrillation.

33. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 33 AED Use Problems Battery is dead. Patient is moving. Patient is responsive and has a rapid pulse.

34. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 34 AED Advantages ALS providers do not need to be on scene. Remote, adhesive defibrillator pads are used. Efficient transmission of electricity

35. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 35 Non-Shockable Rhythms Asystole Pulseless electrical activity

36. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 36 Rationale for Early Defibrillation Early defibrillation is the third link in the chain of survival. A patient in ventricular fibrillation needs to be defibrillated within 2 minutes.

37. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 37 Using an AED (1 of 3) Assess responsiveness, pulse, and breathing. Deliver breaths and begin CPR. Turn on AED. Apply pads. Stop CPR.

38. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 38 Using an AED (2 of 3) Clear patient. Analyze rhythm. If no shock advised, continue CPR. If shock advised, deliver up to three shocks. Check pulse and breathing after shocks delivered.

39. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 39 Using an AED (3 of 3) If patient begins breathing, give oxygen, and transport. If patient is not breathing, ventilate and transport. If there is no pulse, continue CPR for 1 minute. Re-analyze. Deliver three more shocks if needed. Transport and call medical control.

40. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 40 After AED Shocks Check pulse. No pulse, no shock advised No pulse, shock advised If a patient is breathing independently: Administer oxygen. Check pulse. If a patient has a pulse but breathing is inadequate, assist ventilations.

41. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 41 Transport Considerations Keep AED attached. Check pulse frequently. Transport: When patient regains pulse After delivering six shocks After receiving three consecutive “no shock advised” messages Stop ambulance to use an AED.

42. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 42 Cardiac Arrest During Transport (1 of 2) Check unconscious patient’s pulse every 30 seconds. If pulse is not present: Stop the vehicle. Perform CPR until AED is available. Analyze rhythm. Deliver shock(s). Continue resuscitation according to local protocol.

43. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 43 Cardiac Arrest During Transport (2 of 2) If patient becomes unconscious during transport: Check pulse. Stop the vehicle. Perform CPR until AED is available. Analyze rhythm. Deliver up to three shocks. Continue resuscitation according to local protocol.

44. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 44 Safety Considerations Make sure the electricity injures no one. Do not defibrillate a patient lying in pooled water. Dry a soaking wet patient’s chest first. Do not defibrillate someone who is touching metal that others are also touching. Remove nitroglycerin patches.

45. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 45 AED Maintenance Read operator’s manual. Check AED and battery at beginning of each shift. Get a checklist from the manufacturer. Report any failures to the manufacturer and the FDA..

46. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 46 Medical Direction Should approve protocols Should review AED usage Should review speed of defibrillation Should provide review of skills every 3 to 6 months

47. 12: Cardiovascular Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 47 Cardiovascular System Changes with Age Decreased pumping of heart Electrical system changes Atherosclerosis Decreased peripheral circulation (diabetes) AMI without pain