540 likes | 847 Views
Bunch of Heart Stuff. Chemeketa Community College EMT-Paramedic Program. Objectives. Left Ventricular Failure Right Ventricular Failure Pulmonary Edema Cor Pulmonale Acute Pulmonary Embolism EKG’s. Left Ventricular Failure. Affects over 2% of US pop. Disproportionate # of EMS calls
E N D
Bunch of Heart Stuff Chemeketa Community College EMT-Paramedic Program
Objectives • Left Ventricular Failure • Right Ventricular Failure • Pulmonary Edema • Cor Pulmonale • Acute Pulmonary Embolism • EKG’s
Left Ventricular Failure • Affects over 2% of US pop. • Disproportionate # of EMS calls • #1 Dx of inpatients >65 • Incidence of CHF doubles per decade of life • Mortality Rate with CHF • 8 times for men • 5 times for women
Left Ventricular Failure • The failure of the LV to effectively pump forward • Synonymous with CHF • Acute CHF • Rapid • Chronic CHF • Slow • Midnight Shoppers
LVF • Common Causes • Systemic HTN • Afterload • Coronary Artery Disease • Arteriosclerosis/Atherosclerosis • Ischemia • Local/temporary occlusion
LVF • Common Causes • Infarction • Permanent, necrosis • Cardiomyopathy • Diseased heart muscle tissue • ETOH • Enlargement
LVF • Causes • Volume overload • Bag of Potato Chips • Severe anemia • Hypoxemia
LVF • Fluid will collect in LA • Small & Relatively incapable • Pulmonary Vasculature Fills • Pulmonary Congestion Occurs • Pulmonary Edema 2nd to LVF
LVF S/S • Generalized Weakness • Fatigue • Chest Pain • May be masked by respiratory complaint • Anxiety • Dyspnea
LVF S/S • Tachypnea • Orthopnea • Paroxysmal Nocturnal Dyspnea • Elevation of pulmonary venous & cap pressures • Wakening from sleep • Decrease in exercise tolerance
LVF S/S • Rales • Wheezes • Reflex Airway Spasm • Cardiac Asthma • Rhonchi (Larger airway) • Dull percussion at lung bases
LVF S/S • Productive Cough • Foamy-Blood-tinged sputum • Cyanosis • B/P • Initial HTN
LVF S/S • Pulse • Rapid • Possible Dysrhythmia • Location of infarct • Diaphoresis
Right Ventricular Failure • Causes • #1 Cause of RVF is LVF • Stenosis: • Pulmonary valve • Mitral Valve • Pulmonary Vascular HTN • RV AMI
RVF – Who Cares • Inability of RV to pump forward • Overwhelmed by venous return • Backflow in systemic circulation
RVF – S/S • Tachycardia • Venous Congestion • Engorged Liver, spleen • JVD • Peripheral Edema • Dependent Edema • Pitting Edema • Sacral (Bedridden)
RVF-S/S • Ascites • Accumulation of serous fluid in peritoneal cavity – Taber’s 19th • Pleural Effusion • Peripheral Cyanosis • Tachy if isolated RVF • Right sided hypertrophy • X-ray
RVF – S/S • Clubbing of fingers • Dx: Chronic Hypoxia with RHF • Most of the other LVF S/S also • CP • SOB • Tachypnea • Anxiety • Etc…
Cor Pulmonale • Cause of RVF • Pulmonary Parenchymal or vascular disease • CP is a disease process • Case Scenario Explanation
Cor Pulmonale – Case • 58 yo male • Hx of Chronic bronchitis or emphysema • Typical S/S of bronchitis • Progression • Deterioration of Pulmonary capillaries • Alveolar Fibrosis • Chronic Hypoxemia
Cor Pulmonale – Case • Progression caused: • Increase in pulmonary artery pressures • Result RV afterload increase • RV ill equipped • RV Enlarges (Hypertrophy) • Chronic RH HTN leads to RVF
Cor Pulmonale – Case • Patient displays all signs of: • RVF • Initial causative pulmonary condition • Voila’
Treatment of RVF & LVF • CHF a circumstance not a Dx • Treatment objectives • Decrease myocardial: • Workload • Oxygen demand • Increase force & efficiency of contraction • Reduce fluid retention
Tx • Decrease Workload • No Physical activity • Sitting upright • Oxygen • Pt may tolerate BVM • Morphine
Tx • Vasodilatory Therapy (Nitrates) • AMI reperfusion • Container expansion reduces preload • Increase Contractility • Shock algorithm directs • Dopamine • Dobutamine • Norepinephrine
Tx • Reduce Fluid Retention • Diuretics • Lasix • Bumex
Acute Pulmonary Embolism Chemeketa Community College Paramedic Program
Defined • Blood clot lodged in pulmonary artery • Blocks pulmonary artery flow • Supplied area ceases to function • Decreased gas exchange • V/Q mismatch
Defined • Typically forms in deep veins of thighs • Can also be fat or air
History • Anticoagulation therapy • Heparin – 1930s • Streptokinase – 1930 • Urokinase – 1951 • 1960s – Large study of clot resolution • Recently TPA
Incidence • Unknown, range from 50,000-100,000/yr • Higher than diagnosed, most diagnosed postmortem • 8% death rate with heparin tx • 1/3 will die within 1 hour
Risk Factors • Deep vein thrombosis • Prolonged immobilization • Surgery • Trauma • Pelvic or femur fractures • Late pregnancy
Risk Factors • Thrombophlebitis • Certain meds • Oral contraceptives • Atrial fibrillation • Smoking • Unknown
Increasing Frequency • Older population • Malignancies • More sedentary • Heart failure • COPD • Surgical procedures
Presentation • Variable and Non-specific • Dyspnea • Pleuritic chest pain • Syncope • Hemoptysis • RHF • Tachycardia
Presentation • No physical findings significantly accurate • Deep venous thrombosis in proximal lower ext. helpful for Dx • Only about ½ source known
Why doesn’t lung tissue die from emboli like heart muscle? • Lung has two blood supplies • Pulmonary and Bronchial • Share capillary beds
Pre-hospital Treatment • Good Physical Exam and History • Index of suspicion • Airway • High flow O2 • IV • Rapid Transport
Treatment ??? • Heparin • Thrombolytic agents • Streptokinase • TPA • Catheter fragmentation • Catheter embolectomy • Open-chest embolectomy
Definitive Diagnosis • ???? • Angiographic • V/Q scan (venous/perfusion mismatch) • Operative • Multiple sources of evidence
Pneumonia Herpes Zoster Pleurisy COPD Rib fracture Asthma Angina MI Pneumothorax Pancreatitis Hepatitis Salicylate OD Bronchitis Hyperventilation Lung carcinoma Sepsis TB Muscle pain Costochondritis CA Pericarditis CHF Percardial tamponade Differential Diagnosis
Watch Out • Extraordinarily difficult to diagnose • Watch out for hyperventilation • Young women
Group Projects! Work in Pairs and find the answers
List As Many Drugs As You Can That Will Dilate Blood Vessels. • Name the source • Describe why they work