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CARDIAC EMERGENCIES

Angina, AMI, CHF and AED

OVERVIEW
Common Cardiac Problems Emergency Care Automated External Defibrillation Post Resuscitation Care Defibrillator Maintenance Medications

THREE FAMILIAR CARDIAC CONDITIONS


Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure

ANGINA PECTORIS
Chest pain No permanent damage Signs and symptoms
Dyspnea Nausea Sweating Weakness Squeezing

ACUTE MYOCARDIAL INFARCTION (AMI)


Oxygen cant reach the heart Death of heart muscle Signs and symptoms
Radiating pain Dyspnea Indigestion Weakness or fatigue

AMI Time is Muscle!

CONGESTIVE HEART FAILURE (CHF)


Failure to pump blood effectively Results in systemic edema or pulmonary edema and rales

CHF
Right sideblood returns from body Left sideblood returns from lungs

Right Heart Failure


Ascites / Edema *Leave legs dangling

Left Heart Failure


Rales in lungs *Expect SOB

EMERGENCY MEDICAL CARE Pulseless


Patient > 12 yrs old - CPR with AED Patient < 12 yrs old or < 90 lbs - CPR

EMERGENCY MEDICAL CARE Responsive


Perform initial assessment Focused HX and PE Place patient in position of comfort Cardiac - c/o pain or discomfort
100% oxygen Assess vitals

QUESTION
O nset P rovocation Q uality R adiation S everity T ime

AUTOMATED EXTERNAL DEFIBRILLATION - AED


The winning combination: Early access Early CPR Early defibrillation Early ACLS

AUTOMATED EXTERNAL DEFIBRILLATION


Implementation of early defibrillation programs increases survival outcomes

AUTOMATED EXTERNAL DEFIBRILLATORS


Fully automated - operates without any action once in place Semi-automated - requires EMT to utilize action buttons

RHYTHMS
AED evaluates and confirms shockable rhythm High accuracy Dependent on properly charged batteries

INAPPROPRIATE SHOCKS
Human error Mechanical error

SHOCKABLE RHYTHMS
Ventricular fibrillation

Ventricular tachycardia

NOTE
Stop CPR, BVM or any pt contact during analysis or when shocking If you dont stop the fibrillation it will eventually stop on its own. Its called death. Weirdness_ EMT on board must have MD orders- Joe Blow with a public AED does not

AED - CARDIC PT
Take BSI techniques Perform initial assessment Stop CPR -verify pulselessness Resume CPR REMOVE ANY NITRO PATCHES

Attach device to patient


White to the Right Red to the Ribs

Turn on power Stop CPR and clear patient Initiate rhythm analysis

analyse

If AED advises shock


Deliver shock and reanalyze rhythm If AED advises shock, deliver 2nd shock and reanalyze If AED advises shock, deliver 3rd shock and check pulse
Do not defibrillate on top of a pacemaker - keep 2-3 clearance

analyse analyse

shock shock

If pulse, repeat ABCs Airway Clear?


If breathing adequately- rate? Provide 100% oxygen and transport If not breathing adequately, ventilate with 100% oxygen and transport

If no pulse, resume CPR for one minute


Repeat cycle of three stacked shocks Transport

NOTE: Do not touch patient during rhythm analysis or shock delivery Resume CPR after only three shocks if hypothermic

CPR and VOMITING

Perform Sellick whenever possible

Unconscious, reassess ABCs every 30 seconds If patient becomes pulseless, stop the rig
Cannot analyze while in motion Not safe to defibrillate in moving ambulance

ON GOINGTRANSPORTATION

Monitor patient and do the following:


Continue chest compressions if required Ventilate with oxygen, advanced airways, and suctioning Leave the AED in place REPEAT ABCs Frequently Consider pronouncement according to protocol

The Care and Feeding of

DEFIBRILLATORS
Regular maintenance is necessary Daily operators shift checklist daily
batteries, cables, patches, operation

Failure is related to improper maintenance, usually battery failure

MEDICATION ASSISTANCE
FOR ANGINA

Generic - nitroglycerin Trade - Nitro-stat, Nitro-bid, etc.

Spray Tablet
Patch Paste

INDICATIONS
Exhibits S/S of chest pain BP >100 systolic Physician prescribed to pt Authorization by medical direction

CONTRAINDICATIONS
Hypotension or systolic B/P below 100 mm/Hg Viagra < 24 hours*- females too! Head injury Infants and children Patient has met dose total (call med control)

DOSE
Patients med? Check expiration date One dose Repeat in 3 - 5 minutes Maximum of 3 doses

ADMINISTRATION
Have patient sit or lie down Place tablet sublingually Recheck B/P within 2 minutes Record activity, time and reasses

Repeat with each dose

ACTION and
SIDE EFFECTS
Relaxes blood vessels Decreases workload of the heart

Hypotension Headache Pulse rate changes