EMR ch14

Emergency Medical ResponderEmergency Medical ResponderFirst on SceneFirst on Scene

CHAPTER

TENTH EDITION

Copyright © 2016, 2011, 2009by Pearson Education, Inc.

All Rights ReservedEmergency Medical Responder: First on Scene, 10/eChristopher J. Le Baudour | J. David Bergeron

Caring for Cardiac Emergencies

14



NORMAL HEART FUNCTION



Figure 14.3 The coronary arteries supply blood to the heart muscle (myocardium).



Figure 14.1 Major anatomy of the heart including blood flow through the chambers.



Figure 14.2 The heart’s conduction pathway, highlighted in green.



CARDIAC COMPROMISE



Cardiac Compromise

• Cardiac Compromise Symptoms Chest discomfort Diaphoresis Dyspnea Nausea/vomiting Anxiety/irritability Abnormal pulse Abnormal blood pressure Feeling of impending doom



Angina Pectoris

• Angina pectoris (angina) is pain in the chest.

• Decreased oxygenated blood supply in the coronary arteries leads to an increased oxygenated blood demand in the heart muscle. Exertion Partial blockage Spasm

continued on next slide



Angina Pectoris

• Signs and symptoms of angina are nearly identical to a heart attack.

• No actual damage to the heart muscle• Patients with angina history typically

carry nitro. • Treatment for angina and myocardial

infarction (heart attack) is the same.



Myocardial Infarction

• Myocardial infarction (MI) Myo, muscle Cardial, heart Infarction, tissue death

• Blockage or narrowing of the coronary arteries leads to a permanent decrease in oxygenated blood supply.

• Without oxygenated blood, the tissue of the heart begins to die.




• Typical signs and symptoms Pain, pressure, tightness, or heaviness

to the chest/upper abdomen Pain or discomfort behind the sternum Pain radiating to the shoulders or arms Pain to the back, neck, jaw or upper

abdomen




• Atypical signs and symptoms "Flu-like" signs and symptoms such as

nausea and vomiting Indigestion Feeling of general weakness




• Large amounts of tissue death or damage over an important electrical pathway may lead to cardiac arrest.

• Patients in cardiac arrest are unresponsive, not breathing, and have no pulse.



Figure 14.4 Both myocardial infarction and angina can present with symptoms of chest pain. Treat all cases of chest pain as a true cardiac emergency.



Heart Failure

• Congestive heart failure (CHF) Weakened heart muscle is unable to

pump blood efficiently and manage normal blood volume.• Chronic due to cardiac diseases• Sudden after a myocardial infarction




Heart Failure

• Congestive heart failure (CHF) Fluid backs up within the circulatory

system.• Lungs• Lower extremities



Heart Failure

• Signs and Symptoms of Heart Failure Shortness of breath Chest pain/discomfort Rapid pulse rate Pedal edema (swollen ankles) Jugular Vein Distention (JVD) Pale, moist skin Altered mental status



Figure 14.5a Signs of heart failure include bulging neck veins.




Figure 14.5b Signs of heart failure include swollen ankles (pedal edema).



EMERGENCY CARE FORCARDIAC COMPROMISE



Emergency Care for Cardiac Compromise

• Emergency Care Take appropriate Standard Precautions. Perform a primary assessment and

support the ABCs as necessary. If allowed, provide oxygen per local

protocols. • SpO2 should read between 95–100%.





• Emergency Care Determine chief complaint.• Onset• Provocation• Quality• Region and radiate• Severity• Time




• Emergency Care Provide emotional support and reassure

the patient. Allow the patient to maintain a position

of comfort, usually sitting up. Obtain vital signs.




• Emergency Care Assist the patient with the prescribed

dose of nitroglycerin, if your protocols permit. Consult medical direction.

Continue to monitor vital signs.



Nitroglycerin Medication Form – Tablet



Nitroglycerin Medication Form – Sublingual Spray




• Medications Aspirin• Analgesic• Clot inhibitor• Prescribed daily for angina • Beneficial for patients exhibiting signs

and symptoms of an MI• Assist patient according to protocol.



SUMMARY



Summary

• A healthy heart is the core of the cardiovascular system.

• Blood flows through the heart in a precise way.

• Electrical impulses flow along the conduction pathway.

• There are key signs and symptoms of cardiac compromise.




Summary

• Angina results from a diminished supply of oxygenated blood to the heart.

• Myocardial infarction occurs when a portion of the heart dies due to inadequate blood supply.

• Congestive Heart failure (CHF) is caused by a weakened heart that can no longer pump blood efficiently.




Summary

• Care for cardiac compromise includes: The ABCs Supplemental oxygen Obtaining a thorough medical history Keeping the patient at rest Monitoring vital signs

• Initiate ALS transport if available.



REVIEW QUESTIONS



Review Questions

1. Describe the normal flow of blood through the heart.

2. What are some vague symptoms of MI that may be seen in women or the elderly?

3. What is the appropriate assessment and care for a patient experiencing cardiac compromise?



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EMR ch14

Healthcare

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