1 Chapter 14 Cardiovascular Emergencies2 Cardiovascular Emergencies

Cardiovascular disease has been leading killer of Americans since _____________.Accounts for 1 of every 2.8 deathsCardiovascular disease (CVD) claimed 931,108 lives in the US during 2001.

2,551 per dayAlmost _______________ people per minute!

3 PreventionEMS can help reduce deaths by: Encouraging healthy life-style_______________________accessMore CPR training of laypeople_______________________access to defibrillation devicesRecognizing need for _______________________life support (ALS)

4 Physiology of the Circulatory System (1 of 2)Pulse:The wave of blood through the arteries formed when the left ventricle _______________________Can be felt where an artery passes near the skin surface and over a _______________________

5 Physiology of the Circulatory System (2 of 2)Blood pressure:Amount of force exerted against walls of arteries

_______________________: Left ventricle contracts_______________________: Left ventricle relaxes

Perfusion:Circulation of blood within an organ or tissueIf inadequate, the patient goes into _______________________

6 Pulse Points_______________________FemoralBrachial_______________________Posterior Tibial_______________________Pedis

7 Components1. _______________________(pump)2. _______________________(pipes)

2. _______________________(pipes)3. _______________________(fluid)

8 The HeartMuscular organ_______________________-the heart muscleLies directly behind the sternumHas ____________ chambers

-Left and right _______________________ (upper chambers)-Left and right _______________________ (lower chambers)

Septum--divides left and right sides9 The Heart

Has it’s own _______________________supplyHas it’s own _______________________systemThe heart is divided into 2 types of circulation:1. _______________________Circulation2. _______________________Circulation

10 Pulmonary CirculationCirculation to and from ______________________________________________side of heartUnoxygenated blood enters the right atrium from the superior vena cavaEnters the right ventricle through a valvePumped through pulmonary arteries to lungsReceives oxygen from _______________________and leaves waste products and carbon dioxide

11 Systemic CirculationCirculation to and from ______________________________________________side of heartOxygenated blood enters left atria through pulmonary veinEnters left ventricle through a valvePumped to aorta and the bodyDelivers oxygen to cells and removes _______________________

12 Cardiovascular Structure and Function13 Blood Flow Through the Heart

1. Vena Cava2. Right Atrium3. Tricuspid valve4. Right _______________________5. Pulmonic Valve6. Pulmonary Artery7. _______________________

6. Pulmonary Artery7. _______________________

14 Blood Flow Through the Heart15 Electrical System of the Heart16 Coronary Arteries17 Blood Vessels

_______________________-Carries blood away from the heart (usually oxygenated)Arteries branch into arterioles and then into capillaries_______________________-Carries blood toward the heart (usually unoxygenated)Veins branch into venules and then into _______________________

18 Blood VesselsCapillaries--Very thin vessels where the actual gas exchanges occurs

-oxygen and _______________________delivered to cells-carbon dioxide and waste picked up

Forms capillary _______________________19 Blood Components

_______________________-sticky yellowish-carries blood cells and nutrients

_______________________(red blood cells)-contain iron-gives blood it’s color-carries _______________________

20 Blood Components_______________________(white blood cells)

-fights infection_______________________

-clot formation-usually clots in 4 to 6 minutes

21 Cardiac CompromiseChest pain results from _______________________Ischemic heart disease involves decreased blood flow to the heart.If blood flow is not restored, the tissue _______________________.

22 Coronary Artery Disease (CAD)______________________________________________

23 Atherosclerosis

_______________________23 Atherosclerosis

Materials build up inside blood _______________________.This decreases or obstructs blood flow._______________________factors place a person at risk.

24 ArteriosclerosisCoronary artery wall becomes hard and stiff due to _______________________deposits“Hardening of the Arteries”Causes coronary arteries to loose their elastic nature_______________________blood flowCauses _______________________

25 Major Risk Factors of Coronary Artery DiseaseUncontrollableAgeSexRace_______________________

26 Minor Risk Factors of Coronary Artery Disease_______________________Inactivity_______________________Personality

27 Coronary Artery Disease28 Coronary Artery Disease29 Angina Pectoris

Pain in chest that occurs when the heart does not receive enough oxygenTypically _______________________or squeezing painRarely lasts longer than ___________-______________ minutesCan be difficult to differentiate from heart _______________________

30 Angina PectorisSigns/Symptoms1. Squeezing/crushing chest _______________________2. Pain may _______________________to shoulders, arms, neck, jaw, upper back, or upper abdomen3. Pain may be in area of _______________________only4. Possible shortness of breath (SOB)

31 Angina Pectoris5. Pain associated with the “3 E’s”

31 Angina Pectoris5. Pain associated with the “3 E’s”

-_______________________-Eating -_______________________

6. Pain seldom lasts for more than 10-15 minutes7. Pain normally relieved by:

-rest-_______________________

32 Angina PectorisFollowing an angina attack, there is NO residual _______________________to the myocardium

33 Angina PectorisTwo Forms of Angina1. _______________________Angina

-Pain _______________________in duration and frequency-Pain relieved by predictable amounts of rest and nitroglycerin

2. _______________________Angina-Change occurs in usual patterns-30% go on to infarct within 3 months

34 Treatment of Angina PectorisTreat all first time angina and unstable angina as a myocardial _______________________. When in doubt, manage _______________________chest pain as a myocardial infarction

35 Acute Myocardial InfarctionAcute Myocardial Infarction (AMI)--_______________________Attack_______________________of the myocardium due to inability of diseased coronary arteries to allow adequate perfusionOnce myocardium tissue dies, it will not _______________________

36 Myocardial Infarction IncidenceMI is the _______________________cause of death in the US1 to 1.5 million Americans will have a MI this year. Of these, about 600,000 will die.350,000 will die in the first _____________ hours after symptoms begin, without ever reaching the hospital!!

37 Acute Myocardial Infarction (AMI)Pain signals _______________________of cells.Opening the coronary artery within the first hour can

Pain signals _______________________of cells.Opening the coronary artery within the first hour can _______________________damage.Immediate _______________________is essential.

38 Pain of AMIChest Pain is “_______________________sign” of an AMIOccurs in 85% of AMIsMay or may not be caused by _______________________Does not resolve in a few minutesCan last from 30 minutes to several hoursMay not be relieved by rest or _______________________

39 Pain of AMIMay be crushing, squeezing, tight, heavyMay radiate to neck, _______________________, shoulders, arm, upper back, or even abdomenMay occur in areas of radiation onlyMay vary in intensity, unaffected by swallowing, coughing, deep breathing, or _______________________15% have “silent AMI”

40 Signs/Symptoms of AMIChest painShortness of breath (SOB)Weakness, dizziness, faintingNausea, _______________________Pallor, diaphoresis (sweating)Feeling of impending _______________________Pulmonary _______________________

41 Signs/Symptoms of AMIChanges is pulse, BP, or respirations are _______________________diagnostic of an AMIEarly recognition is _______________________50% of deaths occur in first ___________ hours. But the average person waits 3 hours before seeking help

42 Sudden Death40% of AMI patients do not reach the hospital.Death is due to _______________________ (irregular heart rhythm)Heart may be _______________________.

43 Arrhythmias_______________________ Ventricular _______________________

_______________________ Ventricular _______________________

44 Arrhythmias_______________________ TachycardiaVentricular Fibrillation_______________________

45 Treatment of Cardiac Chest Pain (1 of 3)1. _______________________ Pt, High concentration of oxygen2. Give _______________________ 3. Reassure/calm patient4. Obtain brief history and perform physical exam5. Give _______________________

46 Treatment of Cardiac Chest Pain (2 of 3)6. If patient has history of angina with changes in pattern, _______________________ immediately.7. Transport in semi-sitting position if BP is normal, supine if BP is low.8. Do NOT allow patient to _______________________ to ambulance.9. Don’t use lights and _______________________ if patient is awake, alert, and breathing without distress.

47 Treatment of Cardiac Chest Pain (3 of 3)10. Monitor vital signs every _____________ minutes11. Request ALS Backup

-90% of deaths occur from _______________________ .-Arrhythmias can be treated with early drug therapy.

12. _______________________ examine for pedal edema and listen to lung sounds

48 Cardiogenic ShockHeart lacks power to force _______________________ through the circulatory system.Onset may be immediate or not apparent for 24 hours after AMI.Failure of the _______________________ and circulatory systemLow BP_______________________ : Irregular heart beats

49 Congestive Heart FailureCongestive Heart Failure (CHF)--Inability of the heart to _______________________ blood out as fast as it enters.Can be left-sided or right-sidedUsually begins with _______________________ -sided failure.

50 Congestive Heart FailureCauses of CHF

50 Congestive Heart FailureCauses of CHFCoronary Artery Disease (______________)Chronic _______________________ MIValvular heart disease

51 Congestive Heart FailurePathophysiology_______________________ ventricle failsBlood backs up into _______________________ _______________________ increases in capillary bedsFluids forced out of capillary beds into the alveoli causing pulmonary edema; fluid in the lungs

52 Congestive Heart FailureSigns/SymptomsDyspnea on _______________________ Paroxysmal nocturnal dyspnea_______________________ -dyspnea lying down_______________________ -rapid pulse rate (>100 bpm)

53 Congestive Heart FailureSigns/Symptoms (Cont.)_______________________ -rapid breathingNoisy, labored breathing_______________________ , wheezingPink, frothy _______________________

54 Congestive Heart FailureRight sided failure most commonly caused by _______________________ sided failure.Blood backs up into systemic circulation

-_______________________ neck veins-fluid in abdominal cavity-_______________________ edema-fluid in feet and ankles

55 Congestive Heart FailureTreatmentSit patient up with _______________________ downHi concentration of oxygenAssist _______________________ as neededMonitor vital signs every 5 to 10 minutesRequest _______________________ backup

56 Hypertensive Emergencies (1 of 2)

Request _______________________ backup56 Hypertensive Emergencies (1 of 2)

Systolic pressure greater than ____________ mm HgCommon symptoms include altered mental status and pulmonary edema.If untreated, can lead to _______________________ or dissecting aortic aneurysm.Common symptoms

Sudden, severe _______________________ Strong, bounding _______________________ Ringing in the ears

57 Hypertensive Emergencies (2 of 2)Common symptoms

Nausea and vomiting_______________________ Warm skin (dry or moist)_______________________

Normally, there is no pre-hospital care for hypertension at the EMT-B levelRapid transport, contact _______________________ backup

58 Aortic AneurysmAortic aneurysm is _______________________ in the wall of the aorta.Susceptible to _______________________ Dissecting aneurysm occurs when inner layers of aorta become separatedPrimary cause: uncontrolled _______________________

59 S/S of Aortic AneurysmVery _______________________ chest painComes on full forceDifferent blood pressures between _______________________ May complain of _______________________ painTransport patients quickly and safely.

60 Physical Findings of Cardiac Compromise Pulse rate increases and may be _______________________ .Blood pressure may be _______________________ or falling.Respirations are usually normal.General appearance

Frightened_______________________ , vomiting, cold sweat

61 Approach to the Patient with Chest Pain (1 of 2)_______________________ the patient and perform initial assessment.Administer _______________________ .Measure and record vital signs.

Administer _______________________ .Measure and record vital signs.Place the patient in a position of _______________________ .

62 Approach to the Patient with Chest Pain (2 of 2)Obtain history and physical exam._______________________ about the chest painAssist with administration of prescribed nitroglycerin._______________________ promptly.Report to medical control en route.

63 Heart SurgeriesCoronary artery bypass _______________________ (CABG) AngioplastyCardiac _______________________

64 Internal Cardiac PacemakersMaintains a regular heart _______________________ and rateDo not place _______________________ patches over pacemaker.

65 Automatic Implantable Cardiac DefibrillatorsMonitor heart _______________________ and deliver shocks as needed.Low _______________________ will not affect rescuers.