Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak Recognizing and Managing Acute Coronary Syndrome

2. Recognizing and Managing Acute Coronary Syndrome Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • Define acute coronary syndrome and related terms. • List causes of acute coronary syndrome. • List general risk factors of acute coronary syndrome. • List general symptoms of acute coronary syndrome. • Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Recognizing and Managing Acute Coronary Syndrome Overview: • Definitions • Causes • Risk Factors • Symptoms • Assessment and care Drill of the Month

4. Acute Coronary Syndrome: Definitions • Acute coronary syndrome • Umbrella term: includes group of clinical symptoms of AMI • Includes angina and heart attack • Chest or anginal pain and other symptoms • Low oxygen levels to heart • Caused by plaque build-up Drill of the Month

5. Acute Coronary Syndrome: Definitions • Acute coronary syndrome • Includes several signs and symptoms • Chest and epigastric pain/discomfort • Radiating pain to arm, shoulders, jaw • Difficulty breathing/shortness of breath • Sudden onset of sweating, nausea, vomiting NOTE: Any type of chest discomfort or signs and symptoms of acute coronary syndrome is serious and needs immediate treatment Drill of the Month

6. Acute Coronary Syndrome: Definitions • Specific terms • Acute: Sudden onset w/severe, sharp pain (compare to chronic) • Syndrome: Group of symptoms characteristic of disease/disorder • Myocardial: Referring to the heart muscle • Ischemia: Decrease of blood supply Drill of the Month

7. Acute Coronary Syndrome: Definitions • Specific terms • Angina: Severe constricting pain w/the sensation of choking/suffocating • Heart attack: Blockage of a coronary artery causing tissue damage/death • Plaque: Deposits of fatty material (lipids) on arterial wall Drill of the Month

8. Acute Coronary Syndrome: Causes • Causes: Plaque • Made up of lipids, accumulates in arteries • Narrows arteries and blocks blood flow • Build-up and narrowing is ‘coronary artery disease’ • Pain from restricted blood flow causes angina • Breaks away from arterial wall, blocks artery or causes a clot resulting in heart attack Drill of the Month

9. Acute Coronary Syndrome: Risk Factors • Risk factors: Gender and age • Men (commonly) • Women 15 years post menopausal • Increased age Drill of the Month

10. Acute Coronary Syndrome: Risk Factors • Risk factors: Medical • Diabetes mellitus (DM) • Hypertension • Hyperlipidemia: Includes fats, oils, waxes, sterols, nucleic acids, triglycerides • Hypercholesterolemia: Cholesterol is a lipid • Prior cerebrovascular accident: Over 7% of patients with ACS had prior stroke Drill of the Month

11. Acute Coronary Syndrome: Risk Factors • Risk factors: Medical • Inherited metabolic disorders • Connective tissue disease: Commonly known diseases include— • Autoimmune diseases, such as lupus, rheumatoid arthritis • Inherited diseases, such as Marfan’s Syndrome • Scurvy and other Drill of the Month

12. Acute Coronary Syndrome: Risk Factors • Risk factors: Other • Smoking history • Metamphetamine use • Occupational stress Drill of the Month

13. Acute Coronary Syndrome: Symptoms • Symptoms • Chest discomfort • May radiate to arm, shoulders, jaw, back • May feel like crushing pain, muscle ache, toothache • Anginal pain • Shortness of breath (SOB) w/exertion • Shortness of breath when lying down (orthopnea) Drill of the Month

14. Acute Coronary Syndrome: Symptoms • Symptoms • Paroxysmal nocturnal dyspnea • Waking in the middle of the night w/long-lasting SOB • Patient stands at window to catch his/her breath • Patient sleeps on stacked pillows to elevate head/chest • Patient sleeps in recliner Drill of the Month

15. Acute Coronary Syndrome: Symptoms • Symptoms • Difficulty breathing • Sudden sent of diaphoresis, nausea, vomitting • Palpitations • Anxiety Drill of the Month

16. Acute Coronary Syndrome: Symptoms • Possible findings on examination • Rales • Jugular vein distention (JVD) • Hypertension or hypotension Drill of the Month

17. Acute Coronary Syndrome: Assessment and Care • Assessment: Perform General Patient Care (Maryland Protocols) • Size up scene; gather info • Perform initial assessment • Perform focused history, physical exam • History of present illness—OPQRST questions • SAMPLE history • Baseline vital signs Drill of the Month

18. Acute Coronary Syndrome: Assessment and Care • Assessment: Perform General Patient Care (Maryland Protocols) • Follow treatment protocols • Communicate with hospital, other response personnel • Disposition: determine priority and mode of transport Drill of the Month

19. Acute Coronary Syndrome: Assessment and Care • Emergency care • Place patient in position of comfort • Patients with SOB or difficulty breathing: sitting up • Hypotensive patients: lying down • Patients with both: let them decide position or change position • Give a high concentration of oxygen • Be prepared for respiratory or cardiac arrest Drill of the Month

20. Acute Coronary Syndrome: Assessment and Care • Emergency care • Transport immediately if: • This is patient’s first episode—no cardiac history • Patient has cardiac history but no nitroglycerine • Patient’s systolic blood pressure is less than 100 mm Hg Drill of the Month

21. Acute Coronary Syndrome: Assessment and Care • Emergency care • Assist patient in taking own nitroglycerine (Refer to Nitroglycerine protocol) • Repeat • 3-5 minutes with persistent chest pain • If BP is greater than 90 mm Hg (consult if BP drops more than 20 mm HG) • If pulse is greater than 60 bpm Drill of the Month

22. Acute Coronary Syndrome: Assessment and Care • Emergency care • Assist patient in taking own nitroglycerine (Refer to Nitroglycerine protocol) • Doses • Maximum 3 doses (medical consult for additional) • 3 doses include patient taken and EMT assisted NOTE: CONTRAINDICATED if patient has taken erectile dysfunction meds w/i 48 hours (medical consult) ViagraTM, LevitraTM, CialisTM Drill of the Month

23. Acute Coronary Syndrome: Assessment and Care • Emergency care • Assess for shock signs/symptoms • Provide care for shock • Monitor the airway • Reassess vital signs every 5 minutes Drill of the Month

24. Recognizing and Managing Acute Coronary Syndrome Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • Define acute coronary syndrome and related terms. • List causes of acute coronary syndrome. • List general risk factors of acute coronary syndrome. • List general symptoms of acute coronary syndrome. • Describe and demonstrate assessment and care of a patient suspected of having acute coronary syndrome. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

25. Recognizing and Managing Acute Coronary Syndrome Review: Define the following terms: • Acute coronary syndrome • Acute • Syndrome • Ischemia • Myocardial • Angina • Heart attack • Plaque Drill of the Month

26. Recognizing and Managing Acute Coronary Syndrome Review • Acute Coronary Syndrome • List causes of acute myocardial syndrome • Name the risk factors of acute myocardial syndrome • Describe the symptoms of acute myocardial syndrome • Explain the assessment and care of acute myocardial syndrome Drill of the Month