12. Cardiac CompromiseCardiac Compromise
Rapid or slow pulse withRapid or slow pulse with
no apparent causeno apparent cause
Palpitation or flutteringPalpitation or fluttering
sensation in chestsensation in chest
Suspect and treat for ifSuspect and treat for if
patient has:patient has:
13. Cardiac CompromiseCardiac Compromise
Suspect and treat for ifSuspect and treat for if
patient has:patient has:
Pain, pressure, or discomfortPain, pressure, or discomfort
in chest or upper abdomenin chest or upper abdomen
Difficulty breathingDifficulty breathing
14. Cardiac CompromiseCardiac Compromise
Sudden onset of sweating,Sudden onset of sweating,
nausea, and vomitingnausea, and vomiting
Anxiety, irritabilityAnxiety, irritability
Suspect and treat for ifSuspect and treat for if
patient has:patient has:
15.
16. ANGINA PECTORIS
• The heart has to work
harder because of a disease
or a clot and the heart can
not get enough oxygen
18. Causes of Cardiovascular Compromise --Causes of Cardiovascular Compromise --
AtherosclerosisAtherosclerosis
19. Coronary Artery Disease
• Narrowing of the
coronary
arteries caused
by the
buildup of
cholesterol-
containing plaque
20. Postmortem specimen of large artery with
minimal atherosclerotic changes
Marked atherosclerotic changes which cause
turbulent blood flow and blood flow restriction
28. Causes of Cardiovascular Compromise --Causes of Cardiovascular Compromise --
Acute Myocardial InfarctionAcute Myocardial Infarction
AREA OF
INFARCT
43. VARIATION
• Women tend
to have an
M.I. more
frequently in
the autumn
& winter
• Men do not
have this
pattern
TAN YELLOW = DEADTAN YELLOW = DEAD
MUSCLE TISSUEMUSCLE TISSUE
44. INCREASED LIKELIHOOD
OF VAGUE SYMPTOMS
• Hypertension
(HTN)
• Diabetes
• Risk for M.I.
4 to 6 times
greater for
diabetic
45. ““I CALLED EMSI CALLED EMS
FOR YOU.FOR YOU.
YOU’RE GOINGYOU’RE GOING
TO HAVE ATO HAVE A
HEART ATTACKHEART ATTACK
IN ABOUTIN ABOUT
10 MINUTES.”10 MINUTES.”
65. TIME
• When did the pain start?
• What were you doing when it
started?
• Have you ever experienced
a similar pain before?
66. Place patient in position of comfort;Place patient in position of comfort;
givegive
high-concentration oxygen byhigh-concentration oxygen by
nonrebreather mask.nonrebreather mask.
67. SAMPLE HISTORY
• S = Symptoms
• A = Allergies
• M = Medications
• P = Past history
• L = Last meal
• E = Events
85. SUPPLIED AS:
• Tablet in air tight brown
bottle
• Nitroglycerine is
deactivated in sunlight
86. RATE / ROUTE / DOSE:
• 0.4 mg (1/150 grain)
• Sublingually
• Repeated every 5 minutes
• Maximum 3 doses
• Onset – 1 to 3 minutes
• Duration – 30 min.
87. INFORMATION:
• Unstable and rapidly
deteriorates when exposed
to light, air, or temperature
extremes
• Needs to be stored in a
dark, room-temperature
area
88. ‘HE GETS CONFUSED
WHEN HE TRIES TO
PUT HIS TOUPEE
AND NITRO PATCHES
ON AT THE SAME
TIME.”
89. INFORMATION:
• Tablets taste bitter and may
sting the tongue
• If the tablet does not have a
bitter taste, it may have lost
its strength
• Check the expiration date
90. “YOU MIGHT FEEL
A SLIGHT
BURNING
SENSATION
UNDER YOUR
TONGUE FROM
THE NITRO.”
91. INFORMATION:
• Hypotension caused by nitro is
usually reversible with proper
positioning and volume infusion
• Patients should always be
sitting down or lying down prior
to administration
92. “HEY, MARK … DID YOU
KNOW THAT OUR RIG’S
NITRO SPRAY LOOKS
A LOT LIKE BREATH
FRESHENER?”
93. DRUG INTERACTION:
• May produce additive
hypotension effects in the
presence of alcohol, beta-
adrenergic blockers, and
calcium channel blockers
105. MORPHINE ACTIONS
• Powerful CNS depressant
• Depresses sensory area of
cerebral cortex
• Depresses pain impulse
transmission at spinal cord
level by interacting with
opioid receptors
106. MORPHINE ACTIONS
• Painful stimuli continue to be
received but are no longer
interpreted as pain
• Decreases systemic vascular
resistance
• This aids in reducing oxygen
requirements of the heart
107. “WOULD YOU LIKE A LITTLE
SOMETHING FOR THE PAIN
MR. WILKINSON?”
108. MORPHINE ACTIONS
• Increases the capacity of
venous circulation
• Pools blood
• Decreases blood return to the
heart
• Reduces O2 consumption
• Relieves lung congestion
119. NALOXONE (NARCAN):
• Classification:
• Narcotic antagonist
• Indications:
• Overdose of known or
suspected natural or synthetic
narcotics
• Coma of unknown etiology
120. NALOXONE ACTIONS:
• Competes with narcotic drugs
opiate receptors in CNS.
• This competitive action
displaces narcotic analgesics
from their receptor sites
125. NARCAN INFORMATION:
• Use caution in administering
to patients with:
• Supraventricular arrhythmias
• Head injury
126. NARCAN INFORMATION:
• Use caution in administering to
patients with:
• Increased ICP
• Seizure disorder
• Narcan can cause seizures
127. NARCAN INFORMATION:
• Duration of Narcan is shorter
than narcotics, repeat doses
may be necessary
• Use caution in administering to
addicted patients because
Narcan can precipitate
withdrawal syndrome
128. NARCAN INFORMATION:
• Patients may become violent if
they become conscious
following administration of
narcotics for a narcotics
overdose
• Give enough Narcan to correct
respiratory depression only
129. SOB:
• 78 y/o male seated upright in
obvious distress
• Speaks 3 to 4 words in a row
• Swelling to legs
• Crackles ¾ of lungs
• Hx. Emphysema & heart trouble
• What do you suspect?
130.
131. CONGESTIVE HEART
FAILURE (CHF):
• The heart can no longer
pump effectively causing
blood to back up into the
lungs and other parts of the
body
150. LASIX - ACTIONS:
• Furosemide is a potent
diuretic
• Inhibits primary
reabsorption of sodium and
chloride in proximal and
distal tubules as well as
the loop of Henle
154. LASIX – ACTIONS:
• Causes vasodilation
• This reduces left
ventricular preload and
pulmonary congestion
• Venous dilation starts
within 2 – 5 min.
155. LASIX – ACTIONS:
• Onset of action IV:
• Within 5 min.
• Duration = 2 hours
• Metabolized by liver
• Excreted by kidneys
unchanged
162. LASIX - PRECAUTIONS:
• Dehydration & blood
volume depletion can
result from long term use
of potent diuretics & can
contribute to circulatory
collapse
163.
164. LASIX - PRECAUTIONS:
• Potassium depletion is
common and may pose a
serious threat to the pt. with
acute heart disease as well
as the pt. on digitalis
therapy
• Hyperosmolity may occur
167. LASIX - INFORMATION:
• Onset of
diuresis after IV
administration
starts within
minutes
• Reaches a peak
within 30
minutes
• Lasts 2 hours
168. LASIX - INFORMATION:
• The venous dilatation starts
within 2 to 5 minutes
resulting in almost
immediate alleviation of
some symptoms
169. SYNCOPAL EPISODE:
• Dispatched to a 37 year old female who
became dizzy & fell while changing a
light bulb
• Hit her head and is c/o tenderness to
neck & headache
• Starts to c/o SOB
170. SYNCOPAL EPISODE:
• B/P = 200/116
• Pulse = 130 & regular
• Resp. = 28 & shallow
• Slight wheezes in lower lobes
• Hx. – Diabetes & heart attack 2 years
ago
171. SYNCOPAL EPISODE:
• As start to backboard pt., she doubles
over & starts to cough
• Continues coughing & very short of
breath
• Now has rales & pink sputum
• Glucose level = 146
172. SYNCOPAL EPISODE:
• What tx. is appropriate?
• Enroute resp rate decreases to 6 per
minute
• At hospital – continued tx. for CHF &
later undergoes open heart surgery for
severe coronary artery disease
173.
174. HIATAL HERNIA
• Sliding of part of the stomach
into the chest cavity
• Slides through a natural hole
in the diaphragm where the
esophagus passes through to
the stomach
175.
176. ABDOMINAL PAIN
• Dispatched to 68 y/o female
c/o moderate abdominal pain
• Feels weak & nauseous
• Hx. – HTN
• Note pulsating mass to
abdomen
• What do you suspect?
186. TUNICA MEDIA
• Middle layer
• Thickest of the 3 layers
• Composed of elastic
tissue & smooth muscle
187. TUNICA MEDIA
• Allows blood vessels to
expand & contract in
response to changes in
blood pressure and tissue
demand
188. TUNICA ADVENTITIA
• Outer layer
• Consists of elastic & fibrous
connective tissue
• Provides strength to
withstand high blood pressure
189. LUMEN
• Cavity or channel within a tubular
organ
• Size or diameter changes with the
size of the organ
• Changes in the size of the lumen
in arteries play an important role
in regulating blood pressure
193. S & S:
• Often C/O
tearing pain to
the back
• May have
decreased or
absent pulse
in one
extremity
• Hypotension
194.
195. CHEST PAIN
• Dispatched to a possible heart
• 67 year old man sitting in a
chair holding onto his chest
• Appears gray in color
• What should you do?
• Put the pt. on oxygen as you
assess vital and sample history
196. CHEST PAIN
• What information do you need?
• Chest pain X 20 min. that
started while watching TV
• Pressure in the right side of
the chest going to the
shoulder
• 5 on a scale of 1 – 10
197. CHEST PAIN
• Similar to pain from heart
attack last year
• Took 1 Nitro with no relief
• Pulse = 148 and irregular
• Respirations = 22 and shallow
• B/P = 152/86
• Skin = cool, moist, & pale
198. CHEST PAIN
• Denies palpitations
• Mild SOB
• Some nausea but no
vomiting
• Has a bag of meds but no
allergies
• What do you do?
199. CHEST PAIN
• At hospital
diagnosed
with
dissection
& thrombus
of left
coronary
artery
Coronary angiogram of left
coronary artery = total
occlusion & dissection of
left anterior descending
artery
Left anterior
descending
artery
Left main
artery
Left
circumflex
artery
200. REVIEW:
• Chest pain from a decreased oxygen
supply is called:
• Angina
• Chest pain when a portion of the heart
muscle dies is:
• Myocardial infarction
201. REVIEW:
• A weakened section of the artery that
bulges outward is:
• Aneurysm
• What is the acronym for questions that
should be asked about chest pain?
• OPQRST
202. REVIEW:
• What do each of the letters stand for?
• O = Onset
• P = Pain
• Q = Quality
• R = Radiation
• S = Severity
• T = Time
203. REVIEW:
• What are the 4 rights for medication
administration?
• Right patient; Right drug; Right dose;
Right route
• How is nitroglycerine classified?
• Vasodilator
204. REVIEW:
• What are the indications for nitro?
• Cardiac ischemia; Angina; CHF
• What are contraindications for nitro?
• Hypotension; Viagra
• What are common side effects
• Hypotension; Headache
205. REVIEW:
• What is the rate, route, & dose of nitro?
• 0.4 mg. sl q 5 min. Maximum of 3 doses
• What is the rate, route, & dose of ASA?
• 162 mg. Chewable
• What is the rate, route, & dose of
morphine?
• 2 mg. Slow IV repeated as needed
maximum 10 mg
206. REVIEW:
• What is the most severe side effect of
morphine?
• Respiratory depression
• What drug counteracts morphine?
• Narcan (Naloxone)
• What is the rate, route, & dose of Lasix?
• 80 to 120 mg. IV over 1 minute
207. REVIEW:
• Dyspnea, rales, & pink frothy sputum
are classic signs of:
• Left heart failure
• What meds are used for CHF?
• Nitro, Lasix, Morphine
• Abrupt diffuse or severe abdominal pain
and a pulsating mass are s& s of:
• AAA
208. REVIEW:
• What is the name of the inner lining of
blood vessels?
• Tunica intima
• What is the term for the channel in a
tubular organ?
• Lumen
209. REVIEW:
• Severe stabbing back pain,
hypotension, & decreased pulses in one
lower extremity may indicate:
• Dissecting aorta