1. Review

2. Inferior and Superior Vena Cave  RA Tricuspid Valve  Pulmonic Valve  Pulmonary Artery  Lungs {oxygenation} Pulmonary Vein  Left Atrium  Mitral Valve  Left Ventricle  Aortic Valve Circulation Sodium Enters; Potassium leaves  Depolarization

3. RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
P wave- PR interval- QRS complex - ST segment- Twave
Normal – morphology normal isoelectric present
Upright <0.12 seconds
Only before
each QRS
= NSR

4. RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
Any deviation from the normal electrical
rhythm of the heart
= Dysrhythmia

5. RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
Causes of dysrhythmias:
MI, ischemia, necrosis
Autonomic nervous system imbalance
Distension of the chambers
notably in the arteries secondary to CHF
Blood gas abnormalities i.e. hypoxia and abnormal pH
Electrolyte imbalances
Trauma {cardiac contusion}
Drug effects and drug toxicity
Electrocution
Hypothermia
CNS damage
Idiopathic events: arising spontaneously or from an obscure or unknown cause
Normal occurances
Idiopathic: arising spontaneously or from an obscure or unknown cause

6. RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
The absence of cardiac electrical activity
= arrhythmia

8. RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
ANALYZING RATE
ECG strip method or 60 second method
“300” method or triplicate method
R-R method

9. CARDIAC EMERGENCIES What’s next: Bringing It Home
Cardiac arrest lecture
Mega code practice and scenarios
Exams
written
Mega code

10. BRINGING IT HOME

11. Cardiac Anatomy and Physiology
Flow of blood through the heart and cardiac conductive system
Composition of Blood

13. Composition of the Blood
Plasma
Red blood cells
White blood cells
Platelets
Plasma; watery salty fluid that make up over half the volume of blood. Red and white blood cells and platelets are carried in the plasma
Red Blood Cells, Erythrocytes; Gives blood its color, carries o2 to the tissues and co2 away from the tissues
White blood cells; Fight infection
Platelets; clotting

14. Flow of blood
Arteries – arterioles - veinules - veins

15. Major Blood Vessels
Superior Vena Cava
Carotid Arteries
Jugular Veins
Aorta
Femoral Artery
Inferior Vena Cava
Brachial Arteries

16. Circulation of Blood between:
Heart and lungs
Heart and rest of the body

17. Mechanical and Electrical functions of the heart in relation to pulse and blood pressure

18. Shock

19. Cardiac Compromise
Acute Coronary Syndrome
Syndrome: In medicine and psychology, the term syndrome refers to the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others.

20. Any kind of problem with the heart
Cardiac Compromise:
Any kind of problem with the heart
May lead to a high index of suspicion for possible: MI
Angina
CHF

21. Signs and Symptoms of Cardiac
Compromise:
Dyspnea
Pain, pressure or discomfort
Palpations
Sweating
N & V
Anxiety

22. Abnormal Pulse
Blood Pressure:
Hypotensive: <90/systolic
Hypertensive: >150/systolic or >90/diasolic
Chest Pain

23. Causes of Cardiac Compromise:
CAD
Atherosclerosis
Arteriosclerosis
Hardening of the arteries from Ca++ deposits

24. Restriction of blood through the artery
Thrombus; clot and debris from plaque
Occlusion: Thrombus cuts off blood flow
Embolism: Thrombus that moves to occlude the flow of blood beyond the blockage

25. Risk Factors:
Heredity
Age
HTN
Obesity
Lack of exercise
Elevated cholesterol and triglycerides
Smoking

26. Common Symptom
Chest Pain

27. Aneurysm

28. Electrical Malfunctions of the Heart
Dysrhythmia

29. Mechanical Malfunctions of the Heart
Pump Failure

30. Angina Pectoris
Chest Pain
Difference between Angina & MI
NTG

31. AMI
Sudden death is considered a cardiac arrest within 2 hrs. of symptoms
Risk Factors
CAD
Chronic respiratory problems
Unusual exertion
Severe emotional stress

32. Treatment
Fibrinolytics
Angioplasty or Catheterization
ASA regimen

33. CHF
Left sided heart failure/ Right sided failure soon follows
Causes:
Diseased heart valves
HTN
COPD
As a complication of an MI

34. Pulmonary Edema
Rales
Blood tinged sputum
Pedal Edema
Abdominal Distension

35. Signs and symptoms of CHF
CARDIOGENIC SHOCK
Tachycardia
Dyspnea
Normal to elevated B/P
Cyanosis
Diaphoresis
Cool Clammy skin

36. Pulmonary Edema
Anxiety or confusion due to hypoxia
Pedal edema
JVD (late sign)
ABD distension
Enlarged liver and spleen
Medication History
Lasix

37. PATIENT CARE
POC O2
Identify Priority Patient
No history of cardiac problems
Hx but no NTG
Hypotensive
Transport: Thoughtful, calm, caring fashion

38. ASSIST with NTG
Clinical signs and symptoms must be present
Right med, route, dose, form, patient
Pulse rate >50 and <100
Protocol
Systolic B/P >110
Has not taken Viagra or such within 48 to 72 hrs.
Medical Control

39. Remember usual protocol is 1 does q 5 minutes to 3 doses.
CHECK BLOOD PRESSURE BEFORE ADMINISTERING

40. CARDIAC EMERGENCIES
LET’S
PLAY