CARDIAC EMERGENCIES Angina, AMI, CHF and AED

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CARDIAC EMERGENCIES Angina, AMI, CHF and AED
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OVERVIEW

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

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THREE FAMILIAR CARDIAC CONDITIONS

• Angina Pectoris
• Acute Myocardial Infarction
• Congestive Heart Failure

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ANGINA PECTORIS

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

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ACUTE MYOCARDIAL INFARCTION (AMI)

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

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AMI
Time is Muscle!
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CONGESTIVE HEART FAILURE (CHF)

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

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CHF
Right side- blood returns from body
Left side- blood returns from lungs
Right Heart Failure Ascites / Edema Leave legs
dangling
Left Heart Failure Rales in lungsExpect SOB
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EMERGENCY MEDICAL CARE Pulseless

• Patient 12 yrs old - CPR with AED
• Patient

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EMERGENCY MEDICAL CAREResponsive

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

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QUESTION

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

?
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AUTOMATED EXTERNAL DEFIBRILLATION - AED

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

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AUTOMATED EXTERNALDEFIBRILLATION

• Implementation of early defibrillation
  programsincreases survival outcomes

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AUTOMATED EXTERNALDEFIBRILLATORS

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

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RHYTHMS

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

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INAPPROPRIATE SHOCKS

• Human error
• Mechanical error

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SHOCKABLE RHYTHMS

• Ventricular fibrillation
• Ventricular tachycardia

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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

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AED - CARDIC PT

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

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• Attach device to patient
• White to the Right
• Red to the Ribs

• Turn on power
• Stop CPR and clear patient
• Initiate rhythm analysis

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• 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
shock
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• 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

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• 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
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• CPR and VOMITING

Perform Sellick whenever possible
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ON GOING- TRANSPORTATION

• 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

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• 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 pronouncementaccording to protocol
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The Care and Feeding of DEFIBRILLATORS

• Regular maintenance is necessary
• Daily operators shift checklist dailybatteries,
  cables, patches, operation
• Failure is related to improper maintenance,
  usually battery failure

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MEDICATION ASSISTANCEFOR ANGINA

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

Spray Tablet Patch Paste
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INDICATIONS

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

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CONTRAINDICATIONS

• Hypotension or systolic B/P below 100 mm/Hg
• Viagra
• Head injury
• Infants and children
• Patient has met dose total(call med control)

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DOSE

• Patients med?
• Check expiration date

• One dose
• Repeat in 3 - 5 minutes
• Maximum of 3 doses

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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

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ACTION and SIDE EFFECTS

• Relaxes blood vessels
• Decreases workload of the heart

• Hypotension
• Headache
• Pulse rate changes