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CARDIAC AND RESPIRATORY EMERGENCIES

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

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CARDIAC AND RESPIRATORY EMERGENCIES

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  1. CARDIAC AND RESPIRATORY EMERGENCIES MOSHE WEIZBERG, MD

  2. BEEP!!! • ANY ES UNITS AVAILABLE • CHEST PAIN DIFFICULTY BREATHING • You gotta know these cold

  3. CARDIAC • CHEST PAIN • CHF • ARRHYTHMIAS

  4. TACHYCARDIA • Usually due to underlying condition • May be due to arrhythmia • >150 more likely to be arrhythmia

  5. TACHYCARDIA • Treat underlying condition • Arrhythmia may require specific treatment

  6. BRADYCARDIA • More concerning • Inadequate cardiac output • May lead to hypotension

  7. BRADYCARDIA • Oxygen • Monitor BP closely • Transport • Definitive management depends on cause

  8. CHEST PAIN • MI/ANGINA • PULMONARY EMBOLISM • AORTIC DISSECTION • PNEUMOTHORAX

  9. CHEST PAIN • MI/ANGINA • Most common • PULMONARY EMBOLISM • AORTIC DISSECTION • PNEUMOTHORAX

  10. MI • Blockage in a coronary artery • Inadequate blood flow to that area of the heart • Inadequate oxygenation to that area of the heart • Necrosis of myocardial cells

  11. MI RISK FACTORS • Age • Gender • Hypertension • Hypercholesterolemia • Smoking • Family history

  12. MI SYMPTOMS • Chest pain • Pressure, tightness • “something is sitting on my chest” • Radiates to left arm, neck • Shortness of breath • Nausea/vomiting • Dizziness/lightheadedness

  13. MI SIGNS • Anxious • Diaphoretic • Ashen gray • Vital signs can be completely normal • Levine’s sign • Lungs for CHF

  14. MI TREATMENT • Oxygen • Assist with nitroglycerin • If systolic >120 • Vasodilation

  15. ASPIRIN • Decreases mortality by 23% • Platelet inhibition

  16. ASPIRIN • Indications • If >35 y/o or cardiac history • Dose • 162 mg (2 baby aspirin)

  17. ASPIRIN • Contraindications • Aspirin allergy • Recent GI bleed • Bleeding disorder • On coumadin

  18. MI TREATMENT • Monitor vital signs • Can develop V-fib • Transport

  19. MI WARNING SIGNS • Hypotension • CHF • Persistent pain

  20. ANGINA • Brief episode of chest pain • Goes away • Partial blockage in a coronary artery • Much more common • Treat the same

  21. CHEST PAIN • MI/ANGINA • PULMONARY EMBOLISM • AORTIC DISSECTION • PNEUMOTHORAX

  22. PULMONARY EMBOLISM • Clot in pulmonary artery • Begins as DVT • Hypoxia • Necrosis of lung tissue • Decreased cardiac output

  23. PE RISK FACTORS • Cancer • Prolonged immobilization • Casted leg • Airplane flight • Pregnancy • Recent surgery • Hypercoagulable state

  24. PE SYMPTOMS • Sudden death • Abrupt onset SOB • Chest pain • Pleuritic

  25. PE SIGNS • Appearance variable • Tachycardia • Tachypnea • BP may be normal • When severe – hypotension

  26. PE SIGNS • Clear lungs • Swollen leg

  27. PE TREATMENT • Oxygen • Transport • CT scan • Heparin

  28. PE WARNING SIGNS • Respiratory distress • Hypotension

  29. CHEST PAIN • MI/ANGINA • PULMONARY EMBOLISM • AORTIC DISSECTION • PNEUMOTHORAX

  30. AORTIC DISSECTION • Aorta • Large blood vessel • Tear in aorta • Massive hemorrhage • John Ritter

  31. DISSECTION RISK FACTORS • Prolonged hypertension • Smoking • Post-partum • Marfan’s syndrome • Abe Lincoln

  32. DISSECTION SYMPTOMS • Abrupt onset chest pain • Radiates to back • Described as tearing sensation

  33. DISSECTION SIGNS • Look sick • Tachycardia • Hypertension • Unequal pulses

  34. DISSECTION TREATMENT • Oxygen • NO ASPIRIN • Rapid transport • Surgery • High mortality

  35. DISSECTION WARNING SIGNS • Hypotension

  36. CHEST PAIN • MI/ANGINA • PULMONARY EMBOLISM • AORTIC DISSECTION • PNEUMOTHORAX • Pulmonary section

  37. CHF • Left ventricle fails • Pressure backs up to lungs • Leakage of fluid into lungs • Pulmonary edema • Trying to breathe air through fluid

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