review. inferior and superior vena cave ra tricuspid valve pulmonic valve pulmonary artery lungs...
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Review
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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
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RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
P wave- PR interval- QRS complex - ST segment- TwaveNormal 0.12 – 0.20 morphology normal isoelectric presentUpright <0.12 secondsOnly before each QRS
= NSR
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RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
Any deviation from the normal electricalrhythm of the heart
= Dysrhythmia
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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
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RELATIONSHIP OF THE ECG TO ELECTRICAL EVENTS IN THE HEART
The absence of cardiac electrical activity
= arrhythmia
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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
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CARDIAC EMERGENCIES
What’s next:• Bringing It Home• Cardiac arrest lecture• Mega code practice and scenarios• Exams
writtenMega code
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BRINGING IT HOME
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Cardiac Anatomy and Physiology• Flow of blood through the heart and cardiac
conductive system• Composition of Blood
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Composition of the Blood
• Plasma• Red blood cells• White blood cells• Platelets
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Flow of bloodArteries – arterioles - veinules - veins
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Major Blood Vessels• Superior Vena Cava• Carotid Arteries• Jugular Veins• Aorta• Femoral Artery• Inferior Vena Cava• Brachial Arteries
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Circulation of Blood between:• Heart and lungs• Heart and rest of the body
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• Mechanical and Electrical functions of the heart in relation to pulse and blood pressure
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• Shock
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Cardiac CompromiseAcute 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.
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Cardiac Compromise:• Any kind of problem with the heart
• May lead to a high index of suspicion for possible: MI
AnginaCHF
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Signs and Symptoms of Cardiac Compromise:• Dyspnea• Pain, pressure or discomfort• Palpations• Sweating• N & V• Anxiety
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• Abnormal Pulse• Blood Pressure:
Hypotensive: <90/systolicHypertensive: >150/systolic or
>90/diasolic• Chest Pain
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Causes of Cardiac Compromise:• CAD
AtherosclerosisArteriosclerosis
Hardening of the arteries from Ca++ deposits
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• Restriction of blood through the arteryThrombus; clot and debris from plaque
Occlusion: Thrombus cuts off blood flow
Embolism: Thrombus that moves to occlude the flow of blood beyond the blockage
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Risk Factors:• Heredity• Age• HTN• Obesity• Lack of exercise• Elevated cholesterol and triglycerides• Smoking
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• Common SymptomChest Pain
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• Aneurysm
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Electrical Malfunctions of the Heart• Dysrhythmia
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Mechanical Malfunctions of the Heart• Pump Failure
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Angina PectorisChest Pain
• Difference between Angina & MI• NTG
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• AMISudden death is considered a cardiac arrest
within 2 hrs. of symptomsRisk Factors• CAD• Chronic respiratory problems• Unusual exertion• Severe emotional stress
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Treatment• Fibrinolytics• Angioplasty or Catheterization• ASA regimen
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CHFLeft sided heart failure/ Right sided failure soon follows
Causes:• Diseased heart valves• HTN• COPD• As a complication of an MI
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Pulmonary Edema• Rales• Blood tinged sputum• Pedal Edema• Abdominal Distension
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Signs and symptoms of CHFCARDIOGENIC SHOCK
• Tachycardia• Dyspnea• Normal to elevated B/P• Cyanosis• Diaphoresis• Cool Clammy skin
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• Pulmonary Edema• Anxiety or confusion due to hypoxia• Pedal edema• JVD (late sign)• ABD distension
Enlarged liver and spleen• Medication History
Lasix
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PATIENT CARE• POC• O2• Identify Priority Patient
No history of cardiac problemsHx but no NTGHypotensive
• Transport: Thoughtful, calm, caring fashion
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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
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• Remember usual protocol is 1 does q 5 minutes to 3 doses.
• CHECK BLOOD PRESSURE BEFORE ADMINISTERING
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CARDIAC EMERGENCIES
LET’SPLAY