Chapter 20: Cardiac Emergencies
Topics
● Cardiac Anatomy and Physiology
● Acute Coronary Syndrome
● Cardiovascular Disorders
Cardiac Anatomy and Physiology
● Review of the cardiovascular system:
○ Composition of the blood
○ Flow of blood through the chambers of the heart
○ Flow of blood through arteries, veins, arterioles, venules, and capillaries
○ Circulation of blood between heart and lungs, and between heart and the rest of
body
● Only job of the heart is to pump blood
○ Generation and distribution of electrical charge
○ Mechanical response to create rhythmic and unceasing pumping action
○ Requires constant supply of oxygen and nutrients
Acute Coronary Syndrome
● Sometimes called cardiac compromise
● Refers to any time the blood supply to the cells of the heart is blocked or disrupted
● Heart muscles cells go without oxygen, causing cell death
● Hypoxic condition of the heart is called ischemia
● Cells die quickly without adequate blood supply
● Chest discomfort is best-known symptom
○ Can be described as pressure, squeezing, or aching
● Radiates to the jaw, neck, either arm, or upper abdomen
● Dyspnea is another common finding in older patients and women
● Other symptoms
○ Nausea and/or vomiting
○ Snycope
○ Sudden onset of sweating
○ Abnormal pulse (tachycardia/bradycardia)
○ Abnormal blood pressure
○ Anxiety, feeling of impending doom
Patient Assessment
● Acute coronary syndrome
○ Perform primary assessment
○ Explore chief complaint
○ Use OPQRST to get history of present illness
○ Obtain past medical history
○ Take baseline vital signs
● Signs and symptoms of ACS
, ○ Pain, pressure, or discomfort in the chest, jaw, neck, arms, or upper abdomen
○ Difficulty breathing
○ Palpitations
○ Sudden onset of sweating and nausea or vomiting
○ Syncope
○ Anxiety
○ Unusual generalized weakness
○ Abnormal pulse
○ Abnormal blood pressure
● Physical examination
○ Grabbing or clutching the center of the chest
○ Sweating
○ Pale or gray skin
○ Anxiousness or restlessness
○ Acute pulmonary edema
○ Swollen ankles and feet
○ Medic alert jewelry indicating cardiac problems
● 12-lead ECG
○ Speed up process of recognizing electrocardial findings
○ Intrepretation is outside scope of EMT
○ EMT can place leads and acquire print tracing
○ EMT can transmit ECG to destination hospital
● Preparing a patient for an ECG
○ Place electrodes on chest
○ Electrodes need secure contact with the skin
○ Remove clothing and jewelry
○ Remove sweat and dead skin cells
○ Remove hair
● 12-lead ECG Placement
○ Step 1- Place limb leads
○ Step 2- Place V1 and V2 leads
○ Step 3- Place V4 and V3 leads
○ Step 4- Place V5 and V6 leads
Care of the Patient with Acute Coronary Syndrome
● Fundamental Principles of Care
○ Place patient in position of comfort
○ Determine if oxygen should be administered
■ Respiratory failure, agonal breaths, or apneic should receive
high-concentration oxygen via ventilations
■ Low oxygen saturations receive high-concentration oxygen via mask or
nasal cannula
■ No significant distress and oxygen saturation of at least 94 percent should
not receive oxygen
Topics
● Cardiac Anatomy and Physiology
● Acute Coronary Syndrome
● Cardiovascular Disorders
Cardiac Anatomy and Physiology
● Review of the cardiovascular system:
○ Composition of the blood
○ Flow of blood through the chambers of the heart
○ Flow of blood through arteries, veins, arterioles, venules, and capillaries
○ Circulation of blood between heart and lungs, and between heart and the rest of
body
● Only job of the heart is to pump blood
○ Generation and distribution of electrical charge
○ Mechanical response to create rhythmic and unceasing pumping action
○ Requires constant supply of oxygen and nutrients
Acute Coronary Syndrome
● Sometimes called cardiac compromise
● Refers to any time the blood supply to the cells of the heart is blocked or disrupted
● Heart muscles cells go without oxygen, causing cell death
● Hypoxic condition of the heart is called ischemia
● Cells die quickly without adequate blood supply
● Chest discomfort is best-known symptom
○ Can be described as pressure, squeezing, or aching
● Radiates to the jaw, neck, either arm, or upper abdomen
● Dyspnea is another common finding in older patients and women
● Other symptoms
○ Nausea and/or vomiting
○ Snycope
○ Sudden onset of sweating
○ Abnormal pulse (tachycardia/bradycardia)
○ Abnormal blood pressure
○ Anxiety, feeling of impending doom
Patient Assessment
● Acute coronary syndrome
○ Perform primary assessment
○ Explore chief complaint
○ Use OPQRST to get history of present illness
○ Obtain past medical history
○ Take baseline vital signs
● Signs and symptoms of ACS
, ○ Pain, pressure, or discomfort in the chest, jaw, neck, arms, or upper abdomen
○ Difficulty breathing
○ Palpitations
○ Sudden onset of sweating and nausea or vomiting
○ Syncope
○ Anxiety
○ Unusual generalized weakness
○ Abnormal pulse
○ Abnormal blood pressure
● Physical examination
○ Grabbing or clutching the center of the chest
○ Sweating
○ Pale or gray skin
○ Anxiousness or restlessness
○ Acute pulmonary edema
○ Swollen ankles and feet
○ Medic alert jewelry indicating cardiac problems
● 12-lead ECG
○ Speed up process of recognizing electrocardial findings
○ Intrepretation is outside scope of EMT
○ EMT can place leads and acquire print tracing
○ EMT can transmit ECG to destination hospital
● Preparing a patient for an ECG
○ Place electrodes on chest
○ Electrodes need secure contact with the skin
○ Remove clothing and jewelry
○ Remove sweat and dead skin cells
○ Remove hair
● 12-lead ECG Placement
○ Step 1- Place limb leads
○ Step 2- Place V1 and V2 leads
○ Step 3- Place V4 and V3 leads
○ Step 4- Place V5 and V6 leads
Care of the Patient with Acute Coronary Syndrome
● Fundamental Principles of Care
○ Place patient in position of comfort
○ Determine if oxygen should be administered
■ Respiratory failure, agonal breaths, or apneic should receive
high-concentration oxygen via ventilations
■ Low oxygen saturations receive high-concentration oxygen via mask or
nasal cannula
■ No significant distress and oxygen saturation of at least 94 percent should
not receive oxygen
