cardiac and respiratory emergencies
DESCRIPTION
CARDIAC AND RESPIRATORY EMERGENCIES. MOSHE WEIZBERG, MD. BEEP!!!. ANY ES UNITS AVAILABLE CHEST PAIN DIFFICULTY BREATHING You gotta know these cold. CARDIAC. CHEST PAIN CHF ARRHYTHMIAS. TACHYCARDIA. Usually due to underlying condition May be due to arrhythmia - PowerPoint PPT PresentationTRANSCRIPT
CARDIAC AND CARDIAC AND RESPIRATORY RESPIRATORY EMERGENCIESEMERGENCIES
MOSHE WEIZBERG, MDMOSHE WEIZBERG, MD
BEEP!!!BEEP!!! ANY ES UNITS AVAILABLEANY ES UNITS AVAILABLE CHEST PAIN DIFFICULTY BREATHINGCHEST PAIN DIFFICULTY BREATHING
You gotta know these coldYou gotta know these cold
CARDIACCARDIAC
CHEST PAINCHEST PAIN CHFCHF ARRHYTHMIASARRHYTHMIAS
TACHYCARDIATACHYCARDIA
Usually due to underlying conditionUsually due to underlying condition May be due to arrhythmiaMay be due to arrhythmia >150 more likely to be arrhythmia>150 more likely to be arrhythmia
TACHYCARDIATACHYCARDIA
Treat underlying conditionTreat underlying condition Arrhythmia may require specific Arrhythmia may require specific
treatmenttreatment
BRADYCARDIABRADYCARDIA
More concerningMore concerning Inadequate cardiac outputInadequate cardiac output May lead to hypotensionMay lead to hypotension
BRADYCARDIABRADYCARDIA
OxygenOxygen Monitor BP closelyMonitor BP closely TransportTransport Definitive management depends on Definitive management depends on
causecause
CHEST PAINCHEST PAIN
MI/ANGINAMI/ANGINA PULMONARY EMBOLISMPULMONARY EMBOLISM AORTIC DISSECTIONAORTIC DISSECTION PNEUMOTHORAXPNEUMOTHORAX
CHEST PAINCHEST PAIN
MI/ANGINAMI/ANGINA– Most commonMost common
PULMONARY EMBOLISMPULMONARY EMBOLISM AORTIC DISSECTIONAORTIC DISSECTION PNEUMOTHORAXPNEUMOTHORAX
MIMI
Blockage in a coronary arteryBlockage in a coronary artery Inadequate blood flow to that area of Inadequate blood flow to that area of
the heartthe heart Inadequate oxygenation to that area Inadequate oxygenation to that area
of the heartof the heart Necrosis of myocardial cellsNecrosis of myocardial cells
MI RISK FACTORSMI RISK FACTORS
AgeAge GenderGender HypertensionHypertension HypercholesterolemiaHypercholesterolemia SmokingSmoking Family historyFamily history
MI SYMPTOMSMI SYMPTOMS
Chest painChest pain– Pressure, tightnessPressure, tightness– ““something is sitting on my chest”something is sitting on my chest”– Radiates to left arm, neckRadiates to left arm, neck
Shortness of breathShortness of breath Nausea/vomitingNausea/vomiting Dizziness/lightheadednessDizziness/lightheadedness
MI SIGNSMI SIGNS
AnxiousAnxious DiaphoreticDiaphoretic Ashen grayAshen gray Vital signs can be completely normalVital signs can be completely normal Levine’s signLevine’s sign Lungs for CHFLungs for CHF
MI TREATMENTMI TREATMENT
OxygenOxygen Assist with nitroglycerinAssist with nitroglycerin
– If systolic >120If systolic >120– Vasodilation Vasodilation
ASPIRINASPIRIN
Decreases mortality by 23%Decreases mortality by 23% Platelet inhibitionPlatelet inhibition
ASPIRINASPIRIN
IndicationsIndications– If >35 y/o or cardiac historyIf >35 y/o or cardiac history
DoseDose– 162 mg (2 baby aspirin)162 mg (2 baby aspirin)
ASPIRINASPIRIN
ContraindicationsContraindications– Aspirin allergyAspirin allergy– Recent GI bleedRecent GI bleed– Bleeding disorderBleeding disorder– On coumadinOn coumadin
MI TREATMENTMI TREATMENT
Monitor vital signsMonitor vital signs– Can develop V-fibCan develop V-fib
TransportTransport
MI WARNING SIGNSMI WARNING SIGNS
HypotensionHypotension CHFCHF Persistent painPersistent pain
ANGINAANGINA
Brief episode of chest painBrief episode of chest pain Goes awayGoes away Partial blockage in a coronary arteryPartial blockage in a coronary artery Much more commonMuch more common Treat the sameTreat the same
CHEST PAINCHEST PAIN MI/ANGINAMI/ANGINA
PULMONARY EMBOLISMPULMONARY EMBOLISM AORTIC DISSECTIONAORTIC DISSECTION PNEUMOTHORAXPNEUMOTHORAX
PULMONARY EMBOLISMPULMONARY EMBOLISM
Clot in pulmonary arteryClot in pulmonary artery Begins as DVTBegins as DVT HypoxiaHypoxia Necrosis of lung tissueNecrosis of lung tissue Decreased cardiac outputDecreased cardiac output
PE RISK FACTORSPE RISK FACTORS
Cancer Cancer Prolonged immobilizationProlonged immobilization
– Casted legCasted leg– Airplane flightAirplane flight
PregnancyPregnancy Recent surgeryRecent surgery Hypercoagulable stateHypercoagulable state
PE SYMPTOMSPE SYMPTOMS
Sudden deathSudden death Abrupt onset SOBAbrupt onset SOB Chest painChest pain
– PleuriticPleuritic
PE SIGNSPE SIGNS
Appearance variableAppearance variable TachycardiaTachycardia TachypneaTachypnea BP may be normalBP may be normal When severe – hypotensionWhen severe – hypotension
PE SIGNSPE SIGNS
Clear lungsClear lungs Swollen legSwollen leg
PE TREATMENTPE TREATMENT
OxygenOxygen TransportTransport CT scanCT scan HeparinHeparin
PE WARNING SIGNSPE WARNING SIGNS
Respiratory distressRespiratory distress HypotensionHypotension
CHEST PAINCHEST PAIN MI/ANGINAMI/ANGINA PULMONARY EMBOLISMPULMONARY EMBOLISM
AORTIC DISSECTIONAORTIC DISSECTION PNEUMOTHORAXPNEUMOTHORAX
AORTIC DISSECTIONAORTIC DISSECTION
AortaAorta– Large blood vesselLarge blood vessel
Tear in aortaTear in aorta Massive hemorrhageMassive hemorrhage John RitterJohn Ritter
DISSECTION RISK FACTORSDISSECTION RISK FACTORS
Prolonged hypertensionProlonged hypertension SmokingSmoking Post-partumPost-partum Marfan’s syndromeMarfan’s syndrome
– Abe LincolnAbe Lincoln
DISSECTION SYMPTOMSDISSECTION SYMPTOMS
Abrupt onset chest painAbrupt onset chest pain Radiates to backRadiates to back Described as tearing sensationDescribed as tearing sensation
DISSECTION SIGNSDISSECTION SIGNS
Look sickLook sick TachycardiaTachycardia HypertensionHypertension Unequal pulsesUnequal pulses
DISSECTION TREATMENTDISSECTION TREATMENT
OxygenOxygen NO ASPIRINNO ASPIRIN Rapid transportRapid transport SurgerySurgery High mortalityHigh mortality
DISSECTION WARNING DISSECTION WARNING SIGNSSIGNS
HypotensionHypotension
CHEST PAINCHEST PAIN MI/ANGINAMI/ANGINA PULMONARY EMBOLISMPULMONARY EMBOLISM AORTIC DISSECTIONAORTIC DISSECTION
PNEUMOTHORAXPNEUMOTHORAX– Pulmonary sectionPulmonary section
CHFCHF
Left ventricle failsLeft ventricle fails Pressure backs up to lungsPressure backs up to lungs Leakage of fluid into lungsLeakage of fluid into lungs Pulmonary edemaPulmonary edema Trying to breathe air through fluidTrying to breathe air through fluid
CHF CAUSESCHF CAUSES
IschemiaIschemia– MIMI
Prolonged hypertensionProlonged hypertension Excessive salt intakeExcessive salt intake Didn’t take medsDidn’t take meds
CHF SYMPTOMSCHF SYMPTOMS
SOBSOB CongestionCongestion Drowning Drowning
CHF SIGNSCHF SIGNS
Look sickLook sick DiaphoreticDiaphoretic Laboring to breatheLaboring to breathe Difficulty speakingDifficulty speaking Gurgling respirationsGurgling respirations
CHF SIGNSCHF SIGNS
TachycardiaTachycardia TachypneaTachypnea Hypertension Hypertension
CHF SIGNSCHF SIGNS
Rales bilaterally Rales bilaterally JVDJVD Pedal edemaPedal edema
CHF TREATMENTCHF TREATMENT
Sitting positionSitting position– Gravity brings fluid downGravity brings fluid down
OxygenOxygen
CHF TREATMENTCHF TREATMENT
Monitor respiratory statusMonitor respiratory status Monitor mental statusMonitor mental status
– If decreasing If decreasing may need to assist may need to assist ventilations with BVMventilations with BVM
Rapid transportRapid transport
CHF WARNING SIGNSCHF WARNING SIGNS
Worsening respiratory distressWorsening respiratory distress Decreasing mental statusDecreasing mental status
ARRHYTHMIASARRHYTHMIAS
Electrical wires in heartElectrical wires in heart OverdriveOverdrive Supraventricular vs ventricularSupraventricular vs ventricular
ARRHYTHMIA CAUSESARRHYTHMIA CAUSES
IschemiaIschemia Heart diseaseHeart disease CaffeineCaffeine Stimulants Stimulants Congenital Congenital
ARRHYTHMIA SYMPTOMSARRHYTHMIA SYMPTOMS
PalpitationsPalpitations– Abrupt onsetAbrupt onset
Light-headednessLight-headedness Syncope Syncope
ARRHYTHMIA SIGNSARRHYTHMIA SIGNS
TachycardiaTachycardia Blood pressure can be normalBlood pressure can be normal Hypotension is a bad signHypotension is a bad sign
ARRHYTHMIA TREATMENTARRHYTHMIA TREATMENT
OxygenOxygen Monitor heart rateMonitor heart rate Monitor blood pressureMonitor blood pressure Monitor mental statusMonitor mental status Transport Transport
ARRHYTHMIA WARNING ARRHYTHMIA WARNING SIGNSSIGNS
HypotensionHypotension Worsening mental statusWorsening mental status
RESPIRATORYRESPIRATORY
SOBSOB ASTHMAASTHMA COPDCOPD PNEUMONIAPNEUMONIA PTXPTX
SHORTNESS OF BREATHSHORTNESS OF BREATH
CardiacCardiac RespiratoryRespiratory
SHORTNESS OF BREATHSHORTNESS OF BREATH
CardiacCardiac– CHFCHF– Pulmonary EmbolismPulmonary Embolism– MIMI
SHORTNESS OF BREATHSHORTNESS OF BREATH
RespiratoryRespiratory– Asthma exacerbationAsthma exacerbation– COPD exacerbationCOPD exacerbation– PneumoniaPneumonia– Pneumothorax Pneumothorax
SHORTNESS OF BREATHSHORTNESS OF BREATH
Recognize the sick patientRecognize the sick patient Labored respirationsLabored respirations Accessory muscle useAccessory muscle use Speak full sentencesSpeak full sentences Mental statusMental status
ASTHMAASTHMA
Reactive airwaysReactive airways Inflammation Inflammation Mucous plugsMucous plugs BronchospasmBronchospasm
ASTHMAASTHMA
ChildhoodChildhood Young adultYoung adult Rare in elderlyRare in elderly
– New wheezing likely not asthmaNew wheezing likely not asthma
ASTHMA EXACERBATIONASTHMA EXACERBATION
ExerciseExercise ColdCold Ran out of medicinesRan out of medicines
ASTHMA SYMPTOMSASTHMA SYMPTOMS
CoughCough DyspneaDyspnea WheezingWheezing
ASTHMA SIGNSASTHMA SIGNS
Appearance variableAppearance variable– Stable to severe distressStable to severe distress
ASTHMA SIGNSASTHMA SIGNS
Vital signs variableVital signs variable– Usually tachypneicUsually tachypneic– May be tachycardicMay be tachycardic– Blood pressure should be normalBlood pressure should be normal
May be elevatedMay be elevated
ASTHMA SIGNSASTHMA SIGNS
LungsLungs– TachypneaTachypnea– Labored respirationsLabored respirations– WHEEZINGWHEEZING
bronchospasmbronchospasm
ASTHMA TREATMENTASTHMA TREATMENT
OxygenOxygen Nebulized albuterolNebulized albuterol Transport Transport
ALBUTEROLALBUTEROL
ββ22 agonist agonist BronchodilationBronchodilation Side effectsSide effects
– Tachycardia (Tachycardia (ββ1 1 effects)effects)
– JiterrinessJiterriness– Lightheadedness Lightheadedness
ALBUTEROLALBUTEROL
IndicationsIndications– >1y/o>1y/o– Previous history of asthmaPrevious history of asthma
Up to 3 dosesUp to 3 doses
WARNING SIGNSWARNING SIGNS
Respirations slowingRespirations slowing Decreasing breath soundsDecreasing breath sounds TiredTired
COPDCOPD
Chronic obstructive pulmonary Chronic obstructive pulmonary diseasedisease
ChronicChronic ObstructiveObstructive
COPDCOPD
Older patientsOlder patients SmokingSmoking
COPD EXACERBATIONSCOPD EXACERBATIONS
Upper respiratory infectionsUpper respiratory infections Ran out of meds Ran out of meds
COPD SYMPTOMSCOPD SYMPTOMS
Similar to asthma exacerbationsSimilar to asthma exacerbations CoughCough
– PhlegmPhlegm DyspneaDyspnea
– May be worse with exertionMay be worse with exertion WheezingWheezing
COPD SIGNSCOPD SIGNS
Variable appearanceVariable appearance– Stable to sickStable to sick
Vital signsVital signs– TachypneaTachypnea– Pulse usually normalPulse usually normal– BP usually normalBP usually normal
COPD SIGNSCOPD SIGNS
Lung examLung exam– TachypneaTachypnea– Labored respirationsLabored respirations– Wheezing Wheezing
COPD TREATMENTCOPD TREATMENT
OxygenOxygen Monitor respiratory statusMonitor respiratory status Monitor mental statusMonitor mental status TransportTransport
WARNING SIGNSWARNING SIGNS
Decreasing respirationsDecreasing respirations Decreasing mental statusDecreasing mental status Getting tired Getting tired
PNEUMONIAPNEUMONIA
Infection in the lung tissueInfection in the lung tissue Bacteria, white blood cells, Bacteria, white blood cells,
inflammatory cells in the lunginflammatory cells in the lung Interfere with air exchangeInterfere with air exchange
PNEUMONIA SYMPTOMSPNEUMONIA SYMPTOMS
Gradual onset SOBGradual onset SOB FeverFever Generalized weaknessGeneralized weakness Cough productive of green/brown Cough productive of green/brown
sputumsputum
PNEUMONIA SIGNSPNEUMONIA SIGNS
Usually tachypneicUsually tachypneic May be tachycardicMay be tachycardic BP normal unless septicBP normal unless septic LungsLungs
– Rhonchi on one sideRhonchi on one side
PNEUMONIA vs CHFPNEUMONIA vs CHF
Difficult to differentiateDifficult to differentiate Fever suggests pneumoniaFever suggests pneumonia History of CHF suggests CHFHistory of CHF suggests CHF Can coexistCan coexist
– Pneumonia can exacerbate CHFPneumonia can exacerbate CHF
PNEUMONIA TREATMENTPNEUMONIA TREATMENT
Young healthy adultYoung healthy adult– If hemodynamically stable and not If hemodynamically stable and not
hypoxic, can manage as O/Phypoxic, can manage as O/P
PNEUMONIA TREATMENTPNEUMONIA TREATMENT
Most of our patientsMost of our patients– ElderlyElderly– ComorbiditiesComorbidities– Diagnosis may be unclearDiagnosis may be unclear
PNEUMONIA TREATMENTPNEUMONIA TREATMENT
OxygenOxygen Monitor vital signsMonitor vital signs
– Respiration rate, BPRespiration rate, BP Transport Transport
WARNING SIGNSWARNING SIGNS
Worsening respiratory distressWorsening respiratory distress Dropping blood pressureDropping blood pressure
– SepsisSepsis Decreasing mental statusDecreasing mental status
– Hypoxia, sepsisHypoxia, sepsis
PNEUMOTHORAXPNEUMOTHORAX
Collapsed lungCollapsed lung Air accumulates around lungAir accumulates around lung TraumaTrauma Blebs Blebs AsthmaticsAsthmatics COPD patientsCOPD patients
PNEUMOTHORAX PNEUMOTHORAX SYMPTOMSSYMPTOMS
Abrupt onset SOBAbrupt onset SOB Chest painChest pain
– PleuriticPleuritic Severity depends on sizeSeverity depends on size
PNEUMOTHORAX SIGNSPNEUMOTHORAX SIGNS
Usually tachypneicUsually tachypneic Pulse may be normalPulse may be normal BP normal unless tensionBP normal unless tension Decreased breath sounds on one sideDecreased breath sounds on one side
TENSION PNEUMOTHORAXTENSION PNEUMOTHORAX
Pneumothorax compresses trachea Pneumothorax compresses trachea to opposite sideto opposite side
Decreased venous returnDecreased venous return Decreased cardiac outputDecreased cardiac output HypotensionHypotension Life threatening emergencyLife threatening emergency
TENSION PNEUMOTHORAX TENSION PNEUMOTHORAX SIGNSSIGNS
Absent breath sounds on one sideAbsent breath sounds on one side Tracheal deviationTracheal deviation Hypotension Hypotension
PNEUMOTHORAX PNEUMOTHORAX TREATMENTTREATMENT
OXYGENOXYGEN TransportTransport Air must be drainedAir must be drained
כלכל המקייםהמקיים נפשנפש אחתאחת מישראלמישראל
כאילוכאילו קייםקיים עולםעולם מלאמלא KEEP UP THE AMAZING KEEP UP THE AMAZING
WORK!!!WORK!!!