Cardiac Emergencies

Jim Bennett
Paramedic and Clinical
Education Coordinator
American Medical Response
Spokane, Washington
 The Heart

-------Aorta
Pulmonary Veins---- ----Pulmonary
Arteries
Superior Vena Cava------
------Left Atrium
Right Atrium-----

-------Left ventricle
Right Ventricle----------
Inferior Vena Cava--
Cardiac Conductive System

 Heart is more than a muscle

 Specialized contractile and
conductive tissue in the
heart
 Electrical impulses
 The Conduction System
(The electrical path)

Sinoatrial
(SA) node -----
-------------Atrioventricular (AV) node

Ventricular conduction system--

Arteries

 Function – carry blood away

from the heart to the rest of the
body
 Major Arteries

----Carotid

-----Brachial

-----Radial
Femoral----------

--------Dorsalis pedis
Arterioles, Capillaries,
Venules, and Veins
 Arterioles – Smallest branch of an artery
leading to capillaries.
 Capillaries – Connection to venules.
 Venules – Smallest branch of a vein
leading to the capillaries.
 Veins – Carry blood back to the heart.
 Venae Cavae – Carries oxygen-poor
blood.
Blood Composition
 Red blood cells
 Give the blood its color
 Carry oxygen to organs
 Carry carbon dioxide away from organs
Blood composition continued…

 White blood cells – part of the

body’s defense against infections
 Plasma – fluid that carries the
blood cells and nutrients
 Platelets – essential for the
formation of blood clots
Physiology
 Pulse
 Left ventricle contracts sending a wave of
blood through the arteries
 Can be palpated anywhere an artery
simultaneously passes near the skin surface
and over a bone.
 Peripheral
 Radial
 Brachial
 Posterior tibial
 Dorsalis pedis
 Central
 Carotid
 Femoral
Physiology continued…
o Blood Pressure
o Systolic - the pressure exerted
against the walls of the artery
when the left ventricle contracts
o Diastolic – the pressure exerted
against the walls of the artery
when the left ventricle is at rest
Cardiovascular disorders
 Coronary artery disease
 Aneurysm

 Electrical malfunctions

 Mechanical malfunctions

 Angina pectoris

 Acute myocardial infarction

 Congestive heart failure

Inadequate circulation
 Shock (hypoperfusion) – a state
of profound depression of the
vital processes of the body.
Inadequate circulation
 Characterized by signs and
symptoms such as:
 Pale, cyanotic
 Cool, clammy skin
 Rapid, weak pulse
 Rapid and shallow breathing
 Restlessness, anxiety or mental dullness
 Nausea and vomiting
 Low or decreasing blood pressure
Cardiac Compromise
 May include one or all of the
following:
 Squeezing, dull pressure, chest pain
commonly radiating down the arms or
to the jaw
 Sudden onset of sweating
 Difficulty breathing
 Anxiety, irritability
 Feeling of impending doom
Cardiac compromise
continued…
 Abnormal pulse rate (may be
irregular)
 Abnormal blood pressure

 Epigastric pain

 Nausea/vomiting
Causes of cardiac compromise

 Coronary Artery Disease-narrowing

or blocked coronary arteries
 Aneurysm-weakened sections in the
arterial walls
 Electrical malfunctions-an irregular,
or absent, heart rhythm
 Mechanical malfunctions-mechanical
pump failure
Causes continued…
 Angina Pectoris- a pain in the chest
 Acute myocardial infarction- heart
muscle that dies due to oxygen
starvation
 Congestive heart failure-excessive
fluid build-up
 Hypertensive Crisis- High blood
pressure
Emergency Care
Case Study
You respond to a complaint of chest pain.
As you enter the apartment, your partner
rolls her eyes. The patient is an obese 37
yo/fe. She is breathing rapidly and crying,
and you note a cast on her right lower leg.
You find: BP-108/68mmHg, P-124/min, 02
sats-92%, breath sounds show clear
bilaterally. She rates her chest pain at
8/10 radiating down her left arm.
What type of equipment
needs to be taken to the side
of every cardiac patient?
Equipment should include…
 Oxygen
 Oxygen adjuncts

 Suction equipment

 Equipment to assess vital signs

 Defibrillator
What are the treatment
priorities ?
Treatment Priorities
 ABC’s
 Oxygen

 Vital signs

 Nitroglycerin

 Rapid Transport
What assessment
information do you need to
obtain next ?
Assessment
 Onset
 Provocation

 Quality

 Radiation

 Severity

 Time
Assessment continued…
 Signs and symptoms
 Allergies

 Medications

 Past medical history

 Last meal

 Events leading up to the illiness

Medication

oNitroglycerin
Medication Name
 Generic Name  Trade Name
 Nitroglycerin  Nitrostat ™
 Nitrolingual ®
Spray
Acute Coronary Syndromes
(Chest Pain)
 Primary ABCD Survey
 Body Substance Isolation
procedure
 Assess responsiveness

 Open airway

 Assesses pulse

 Attaches monitor
Acute Coronary Syndromes
(Chest pain) continued…

 Secondary Survey
 Obtains vital signs
 Places Patient on 02 at appropriate
rate
 Initiates IV line

 Performs targeted history, OPQRST,

SAMPLE
Acute Coronary Syndromes
(Chest Pain) continued...

 Treatment
 Administers 325mg Aspirin
 Administers Nitro 0.4mg SL then Q
5 minutes X2, (if B/P > 100 Systolic &
pain not relieved)
 Know contraindications
 Hypotension

 Suspected increased intracranial

pressure
 Viagra or Levitra within past 24 hours
& Cialis within past 96 hours
 Test Questions
1. The blood vessels include arteries, capillaries, and
A. Veins
B. SA node
C. AV node
D. Ventricles

2. Cardiac compromise refers to:

A. The heart’s ability to function properly
during a respiratory emergency.
B. Any kind of problem with the heart.
C. The right atrium’s receiving blood from
the body’s veins.
D. The left ventricle’s receiving blood from
the pulmonary veins.
3. What is the maximum number of (0.04 sublingual
nitroglycerin) doses that can be given to a patient with
chest pain that has stable vital signs?
A. There is no maximum (as long as vitals
are stable)
B. 2 doses
C. 4 doses
D. 3 doses

4. Whenever you are managing a patient with chest

pain, you should:
A. Attach electrode pads to the patient
B. Treat the situation as a cardiac emergency
C. Analyze the patient’s heart rhythm
D. Give the patient nitroglycerin
5. Cardiac compromise may include all of the
following signs or symptoms EXCEPT:
A. Difficulty breathing
B. Warm, dry skin
C. Nausea or vomiting
D. Epigastric pain

6. An important consideration of managing any

patient with chest pain is that he or she may:
A. Deteriorate into cardiac arrest.
B. Need automated external defibrillation.
C. Require positive pressure ventilation.
D. Need oxygen administration and chest
compressions.
7. Before administering a second dose of nitroglycerin to a
patient, you must:
A. Perform CPR for 1 minute.
B. Request authorization from medical
control.
C. Provide supplemental oxygen via nasal
cannula.
D. Check the patient’s pupils for excess
dilation.

8. Fluid buildup in the lungs caused by inadequate

pumping of the heart is known as:
A. Pulmonary edema
B. Angina pectoris
C. Arrhythmia
D. Thrombus
9. A malfunction of the heart’s electrical system will
generally result in an:
A. Embolism
B. Occlusion
C. Aneurysm
D. Arrhythmia

10. The pulmonary valve prevents blood from

returning to the:
A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left Atrium
Wrapping it up…

Questions or Comments

Renee Anderson
andersr@inhs.org
509-232-8155
Fax: 509-232-8344