12: Cardiovascular Emergencies

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12 Cardiovascular Emergencies
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Cardiovascular Emergencies

• Cardiovascular disease (CVD) claimed 931,108
  lives in the US during 2001.
• 2,551 per day
• Almost two people per minute!
• CVD accounts for 38.5 of all deaths.
• One of every 2.6 deaths

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Blood Flow Through the Heart
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Electrical System of the Heart
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Coronary Arteries
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Blood Flow
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Blood
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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.

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Atherosclerosis

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

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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

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Heart Attack

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

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Signs and Symptoms

• Sudden onset of weakness, nausea, sweating
  without obvious cause
• Chest pain/discomfort
• Often crushing or squeezing
• Does not change with each breath
• Pain in lower jaw, arms, back, abdomen, or neck
• Sudden arrhythmia with syncope
• Shortness of breath or dyspnea
• Pulmonary edema
• Sudden death

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Pain of Heart Attack

• 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

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Sudden Death

• 40 of AMI patients do not reach the hospital.
• Heart may be twitching.

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Arrhythmias
Bradycardia
Ventricular Tachycardia
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Cardiogenic Shock

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

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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.

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You are the Provider

• You are a volunteer EMT-B in a rural area. You
  are dispatched to an older man complaining of
  severe chest pain.
• ALS has been dispatched.
• You arrive to find the patient clutching his
  chest. The pain is the worst he has ever had.
• The patient has nitroglycerin but has not taken
  it yet.

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You are the Provider (continued)

• What is wrong with this patient?
• What must you know before administering any
  medication?
• What must you specifically know before assisting
  a patient with nitroglycerin?

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Scene Size-up

• Scene size-up
• General impression
• Is the patient responsive?

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Initial Assessment

• Chief complaint on responsive patients
• A chief complaint of chest discomfort, shortness
  of breath, or dizziness must be taken seriously.
  
• Airway and breathing
• Circulation

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Transport Decision

• Is the patient a life threat?
• Stable patients
• Transport in gentle manner.
• Avoid lights and siren.
• Do not let patient exert or strain self.
• Specialty facilities

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You are the Provider (continued)

• You obtain a brief history while taking the
  patients blood pressure.
• Your partner retrieves the nitroglycerin and
  obtains permission from medical control.
• Your partner administers the nitroglycerin.
• What else can you do at this time?

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Focused History and Physical Exam

• SAMPLE
• OPQRST
• Medications are important!
• Medications often prescribed for CHF
• Furosemide
• Digoxin
• Amiodarone

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Focused Physical Exam

• Cardiac and respiratory systems
• Look for skin changes.
• Lung sounds
• Baseline vital signs
• BOTH systolic and diastolic BP readings

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Communication
Relay history, vital signs, changes,
medications, and treatments.