A Change Of Heart
Cardiac Emergencies by: Madeline Gierkey
Cardiac Anatomy and Physiology
Blood Flow
- S/I venae cava~right atrium~tricuspid valve~right ventricle~pulmonary valve~pulmonary artery~lungs~pulmonary vein, left atrium~bicuspid valve~left ventricle~aortic valve~aorta~arteries~capillaries~cells in body~veins~
Heart Anatomy
- superior vena cava, aorta, right atrium, pulmonary valve, tricuspid valve, right ventricle, inferior vena cava, left atrium, aortic valve, mitral valve, left ventricle, endocardium, myocardium, pericardium
Cardiac Conduction System
- SA node fires
- Excitation spreads through atrial myocardium
- AV node fires
- Excitation spreads down AV bundle
- Purkinjie fibers distribute excitation through ventricular myocardium
Angina Pectoris
Pain in the chest occurring when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough oxygen. Treatment for this condition is typically administering Nitroglycerin, a medication that dilates the blood vessels.
Acute Myocardial Infarction
The condition in which a portion of the myocardium dies as a result of oxygen starvation; often called heart attack by laypersons. Often brought on by narrowing or occlusion of the coronary artery, also coronary artery disease. Some factors such as, chronic respiratory problems, unusual exertion, or severe emotion stress can cause a AMI. Treatment of an AMI typically consist of fibrinolytics, balloon angioplasty, beta blockers, and aspirin.
Congestive Heart Failure
The failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body, or both. It is the complication of an AMI and leads to edema, including pulmonary edema and pedal edema. If left untreated it can lead to left and right heart failure. The treatment for this is limited considering most patients who have CHF are normally already medicated with diuretics and other medications that help decrease the workload of the heart.
Cardiac Arrest
The cessation of electrical heart function. The patient assessment of someone experiencing cardiac arrest includes performing the primary assessment of the patient and verifying pulseless, apnea, or agonal breathing of patient within 10 seconds while also looking for external blood loss. Then have person resume CPR while performing secondary assessment and obtaining PMH without interfering or slowing defibrillation or chest compressions. Patient care includes the whole process of acquiring and implementing AED use. Do not stop resuscitation efforts until given orders to do so by physician or medical direction, until circulation returns, or someone steps in to take over compressions for you.
BLS CPR
- BLS CPR includes checking the carotid pulse of the patient and determining if they have a pulse. Checking their breathing and noticing any sounds and signs of difficulty breathing. If patient has signs of life then you proceed in the A-B-C sequence by opening airway with appropriate maneuver, then evaluating breathing and circulation. If there are no signs of life then you proceed in C-B-A sequence by doing 30 chest compressions followed by 2 breaths, repeating. Once more help arrives on scene, it is appropriate to delegate someone to administer breaths with a BVM while the other partner does compressions, all while someone is setting up the AED. This level of CPR is indicated when someone goes into cardiac arrest.
Special Considerations for AED Use
- 1 EMT operates the AED while another does CPR. This prevents distraction for other EMT.
- CPR must include high quality compressions
- Defibrillation comes first, do NOT hook up oxygen or do anything that delays analysis of rhythm or defib.
- Must be familiar with model/version of AED
- All contact w/ pt. must be avoided during analysis of rhythm
- state, "clear!", and be sure everyone is clear of pt. before shock is administered
- check the batteries and carry a spare for the defibrillators
- if you have delivered 3 shocks and have no ALS backup, prepare the pt. for transport. you can deliver additional shocks on scenepr en route if medical dispatch approves.
- may have to stop vehicle while analyzing rhythm while en route but check protocols
- pulse checks should not occur during rhythm analysis
- If patient goes back into cardiac arrest the steps are to:
- If you are en route, stop the vehicle
- Have someone else start CPR if the AED is not immediately ready
- Analyze the rhythm
- deliver shock if indicated
- Continue with two shocks separated by 2 minutes (5 cycles) of CPR or as your local protocol directs
"How Will I Use This Information In This Chapter In My Future?"
- This information can be utilized and applied to several situations in my future. For example, at the hospital I can have more background knowledge to apply to patients with cardiac conditions and what medications they take and why they take them and how it works with their bodies. I know how to do effective CPR and what sequence to follow depending on if the patient is showing signs of life. I know to consult the protocols while en route and dealing with a patient who has fallen back into cardiac arrest. I could also use this information if I happen to encounter a pedestrian who is experience cardiac malfunction or arrest while in public.