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Chapter 11

Chapter 11. Cardiovascular Emergencies. Objectives (1 of 6). Describe the structure and function of the cardiovascular system. Describe the emergency care of the patient experiencing chest pain/discomfort. List the indications for automated external defibrillation (AED).

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Chapter 11

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  1. Chapter 11 Cardiovascular Emergencies

  2. Objectives (1 of 6) • Describe the structure and function of the cardiovascular system. • Describe the emergency care of the patient experiencing chest pain/discomfort. • List the indications for automated external defibrillation (AED). • Define the role of rescuer in the emergency cardiac care system.

  3. Objectives (2 of 6) • Discuss the position of comfort for patients with various cardiac emergencies. • Establish the relationship between airway management and the patient with cardiovascular compromise. • Predict the relationship between the patient experiencing cardiovascular compromise and basic life support.

  4. Objectives (3 of 6) • Discuss the fundamentals of early defibrillation. • Explain the importance of prehospital ACLS intervention if it is available. • Explain the importance of urgent transport to a facility with ACLS if it is not available in the prehospital setting.

  5. Objectives (4 of 6) • Discuss the procedures that must be taken into consideration for standard operations of the various types of automated external defibrillators. • Discuss the importance of coordinating ACLS trained providers with personnel using automated external defibrillators. • Explain the role medical direction plays in the use of automated external defibrillation.

  6. Objectives (5 of 6) • Recognize the need for medical direction of protocols to assist in the emergency medical care of the patient with chest pain. • Defend the reasons for obtaining initial training in automated external defibrillation and the importance of continuing education.

  7. Objectives (6 of 6) • Demonstrate the assessment and emergency medical care of a patient experiencing chest pain/discomfort. • Practice completing a prehospital care report for patients with cardiac emergencies.

  8. Blood Flow Through the Heart

  9. Electrical System of the Heart

  10. Coronary Arteries

  11. Cardiac Compromise • Chest pain results from ischemia. • Ischemic heart disease involves decreased blood flow to the heart. • If blood flow is not restored, the tissue dies.

  12. Materials build up inside blood vessels. This decreases or obstructs blood flow. Risk factors place a person at risk. Atherosclerosis

  13. Angina Pectoris • Pain in chest that occurs when the heart does not receive enough oxygen • Typically crushing or squeezing pain • Rarely lasts longer than 15 minutes • Can be difficult to differentiate from heart attack

  14. Acute Myocardial Infarction (AMI) • Pain signals death of cells. • Opening the coronary artery within the first hour can prevent damage. • Immediate transport is essential.

  15. Signs and Symptoms of AMI • Sudden onset of weakness, nausea, and sweating • Chest pain or discomfort • Pain in lower jaw, arms, or back • Sudden fainting • Pulmonary edema • Sudden death

  16. Physical Findings of Cardiac Compromise (1 of 2) • Pulse rate increases. • Blood pressure may be normal or falling. • Respirations are usually normal. • General appearance • Frightened • Nausea, vomiting, cold sweat

  17. Physical Findings of Cardiac Compromise (2 of 2) • Ashen gray skin • Swollen neck veins with acute CHF • Feeling of impending doom

  18. Pain of AMI • May or may not be caused by exertion • Does not resolve in a few minutes • Can last from 30 minutes to several hours • May not be relieved by rest or nitroglycerin

  19. Cardiac Arrest • Greatest risk within hours or days of AMI • Usually due to abnormal heart rhythm: • Ventricular fibrillation—most common • Ventricular tachycardia • Asystole

  20. Cardiogenic Shock • Heart lacks power to force blood through the circulatory system. • Onset may be immediate or not apparent for 24 hours after AMI.

  21. Pulmonary Edema • Occurs when undamaged right ventricle continues to function normally. • Damaged left ventricle unable to function normally. • Blood accumulates in lungs and fluid pools in alveoli.

  22. Congestive Heart Failure • CHF occurs when ventricles are damaged. • Heart tries to compensate. • Increased heart rate • Enlarged left ventricle • Fluid backs up into lungs or body as heart fails to pump.

  23. Emergency Care of AMI Patients (1 of 2) • Arrange access to ALS care. • Arrange access to defibrillation. • Reassure the patient and perform initial assessment. • Administer high-flow oxygen. • Measure and record vital signs.

  24. Place the patient in a position of comfort and minimize outside distractions. Obtain focused history and physical exam. Ask about the chest pain using OPQRST. Arrange for prompt transport. If cardiac arrest occurs, administer CPR. Emergency Care of AMI Patients (2 of 2)

  25. Nitroglycerin • Forms • Pill, spray, skin patch • Effects • Relaxes blood vessel walls • Dilates coronary arteries • Reduces workload of heart

  26. CPR on the Ski Hill (1 of 2) • Procedure recommended by the NSP Medical Committee: • Start CPR as soon as possible. • Administer O2 as soon as possible. • Use an AED as soon as it arrives. • Continue CPR in the toboggan en route.

  27. CPR on the Ski Hill (2 of 2) • Utilize a “leap frog” technique on steep or uneven terrain. • Do not delay transport and wait for O2 or an AED. • Use the AED as soon as it arrives. • Be realistic about survival expectations.

  28. Heart Operations • Coronary artery bypass graft (CABG) • Angioplasty • Cardiac pacemaker

  29. Maintains a regular heart rhythm and rate Do not place AED patches over pacemaker. Automatic Implantable Cardiac Defibrillators (1 of 2)

  30. Monitor heart rhythm and deliver shocks as needed. Low electricity will not affect rescuers. Automatic Implantable Cardiac Defibrillators (2 of 2)

  31. Automated External Defibrillation (AED) • AEDs come in two forms: • Automated • Semiautomated • A specialized computer recognizes heart rhythms that require defibrillation.

  32. AED Use Problems • Battery is dead. • Patient is moving. • Patient is responsive and has a rapid pulse.

  33. AED Advantages • ALS providers do not need to be on scene. • Remote, adhesive defibrillator pads are used. • Efficient transmission of electricity

  34. Non-Shockable Rhythms • Asystole • Pulseless electrical activity

  35. Rationale for Early Defibrillation • Early defibrillation is the third link in the chain of survival. • A patient in ventricular fibrillation needs to be defibrillated within 2 minutes.

  36. Using an AED (1 of 3) • Assess responsiveness, pulse, and breathing. • Deliver breaths and begin CPR. • Turn on AED. • Apply pads. • Stop CPR.

  37. Using an AED (2 of 3) • Clear patient. • Analyze rhythm. • If no shock advised, continue CPR. • If shock advised, deliver up to three shocks. • Check pulse and breathing after shocks delivered.

  38. Using an AED (3 of 3) • If patient begins breathing, give oxygen, and transport. • If patient is not breathing, ventilate and transport. • If there is no pulse, continue CPR for 1 minute. • Re-analyze. • Deliver three more shocks if needed. • Transport and call medical control.

  39. After AED Shocks • Likely scenarios: • Regained a pulse. • No pulse, no shock advised • No pulse, shock advised • If a patient is breathing independently: • Administer oxygen. • Check pulse. • If a patient has a pulse but breathing is inadequate, assist ventilations.

  40. Transport Considerations • Keep AED attached. • Check pulse frequently. • Transport: • When patient regains pulse • After delivering six shocks • After receiving three consecutive “no shock advised” messages • Stop and secure the toboggan when using an AED.

  41. Cardiac Arrest During Transport (1 of 2) • Check unconscious patient’s pulse every 30 seconds. • If pulse is not present: • Stop and secure the toboggan. • Perform CPR until AED is available. • Analyze rhythm. • Deliver shock(s). • Continue resuscitation according to local protocol.

  42. Cardiac Arrest During Transport (2 of 2) • If patient becomes unconscious during transport: • Check pulse. • Stop and secure the toboggan. • Perform CPR until AED is available; do not delay transport while waiting for an AED. • Analyze rhythm. • Deliver up to three shocks. • Continue resuscitation according to local protocol.

  43. Safety Considerations • Make sure the electricity injures no one. • Do not defibrillate a patient lying in pooled water. • Dry a soaking wet patient’s chest first. • Do not defibrillate someone who is touching metal that others are also touching. • Remove nitroglycerin patches.

  44. AED Maintenance • Read operator’s manual. • Check AED and battery at beginning of each shift. • Get a checklist from the manufacturer. • Report any failures to the manufacturer and the FDA.

  45. Medical Direction • Should approve protocols • Should review AED usage • Should review speed of defibrillation • Should provide review of skills every 3 to 6 months

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