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EMT NOTES

Cardiovascular Emergencies (Chapter 14)



  • Heart disease is leading cause of death in US

  • in 2005, approximately 35.3% of all deaths were due to heart disease in America.  

  • automaticity-special characteristic of cardiac muscle cells that allows them to contract spontaneously without a stimulus from a nerve source

  • myocardium-heart muscle

  • stroke volume-volume of blood ejected with each ventricular contraction

  • cardiac output-volume of blood that passes through heart in 1 minute = heart rate x stroke volume

  • ischemia-decreased blood flow to heart

  • occlusion-blockage (eg. occlusion of artery)

  • difficult to distinguish between chest pain from angina or myocardial infarction (MI).  Therefore, all chest pain should be treated as MI.  

  • fast action is critical in an MI.  The faster the care is given, the less cells die from lack of oxygen.  Dead cells cannot be repaired and become scar tissue that burdens the heart. 
    • Approximately 40% of al patients with an MI do not reach the hospital alive

  • syncope-fainting

  • dyspnea-shortness of breath

  • not all patients who are having an MI recognize it or experience pain.  About a third of patients never seek medical attention.

  • Any complaint of chest discomfort is a serious matter-you should assume the worst.

  • Document patient's description of chest pain, in his/her own words

  • asystole- absence of all heart electrical activity.  Without CPR, asystole usually occurs in several minutes in MI patients.  Asystole causes death. 

  • in any adults with syncopal episodes (fainting), consider cardiac event.

  • Aspirin should be given ASAP to cardiac patients if no allergies are present
    • makes platelets less "sticky," reducing platelet aggregation and preventing clot from increasing in size

  • Only one way to tell if patient has actually had a heart attack- by using EKG and/or blood test for certain enzymes.

  • AED placement-patient's upper right chest and lower left abdomen  

  • Early defibrillation is critical–for each minute that goes by after a cardiac event that care is not given, a person is 10% less likely to survive. 

  • Indicators for high flow oxygen from nonrebreather (any one of these factors):
    • SpO2 (from pulse oximeter) <94%
    • shortness of breath
    • labored breathing

  • if none of these factors are present, administer 4L Oxygen with nasal cannula

  • Medications:
    • Nitroglycerin vasodilates
    • Nitroglycerin and Aspirin can be administered together
    • If both are available, give Aspirin first
    • Aspirin should be chewed and swallowed, while Nitroglycerin should be placed under the tongue