Many emergencies may involve problems with the heart and its functions. You’ll need to know both appropriate terms and actions to make the most of those few minutes you may have to save a life. This study guide outlines what you’ll need to know in this area in order to answer related questions correctly. Refer to your textbook for more information about all the terms listed until you are thoroughly familiar with them and their related procedures.
The cardiovascular system consists of arteries, veins, capillaries, and the heart. Knowledge of this system and how it works, including its potential dysfunctions and diseases, is critical to patient management in emergencies.
The primary function of the cardiovascular system is to ensure the flow of oxygenated blood throughout the body. Using the atrium, ventricles, and aorta, the system is precise in delivery. The veins carry blood to the heart and the arteries carry blood from the heart throughout the body. In the process of this delivery, by-products are carried to the systems that function to rid the body of waste, such as the urinary or digestive systems.
Terms/Concepts to Know: atrium,ventricles, aorta, parts of the heart, main function of upper and lower heart chambers, blood flow pathway, automaticity, autonomic, sympathetic and parasympathetic nervous system
Circulation is the system of flow from the heart to the other tissues of the body and back again. For the system to function optimally, there must be an adequate volume of blood, patent valves, and functional vessels that dilate to allow blood flow.
Terms/Concepts to Know: myocardium, stroke volume, dilation, coronary arteries, aortic valve, automaticity, sympathetic and parasympathetic nervous system, cardiac output
Diseases or dysfunction of the heart and/or the vessels are common. The Center for Disease Control and Prevention (CDC) states that 1 in 4 americans suffer from heart disease.
Atherosclerosis is a cardiac disease where buildup of plaque forms around the inner walls of the blood vessels. This buildup causes obstruction of blood flow, vessel dilation, and contraction.
Terms/Concepts to Know: occlusion, lumen, ischemia, thromboembolism, acute myocardial infarction, cardiac arrest
Acute coronary syndrome is a description of a conglomeration of symptoms brought on by myocardial ischemia. There are two categories in which these symptoms are labeled.
This disease process can be painful, although not life threatening. The pain is caused by decreased oxygen flow or arterial spasm, and it may be present during stress or physical exertion. The pain is typically located in the mid-chest area and is described by patients as a squeezing, pressure sensation, much like reflux or GERD symptoms. There may also be jaw and/or arm pain and nausea. Angina does not cause heart cell death; however, it can cause arrhythmias and serve as a precursor or warning to initiate preventive measures.
The key identifiers of AMI symptoms include acute onset of nausea, sweating, chest pressure or squeezing, arm, jaw, lower back, and/or abdominal pain. Some patients experience other diverse symptoms and some patients have no symptoms prior to onset. The pain is derived from arterial blockage, which can cause irreversible cell death. Sudden death can occur as a result of an AMI.
Terms/Concepts to Know: nitroglycerin regime, syncope, signs and symptoms of ACS, difference between angina pectoris and acute myocardial infarction, symptom differential between gender and age population
Low cardiac output creates decreased oxygenation to the body. This low output keeps the heart from performing at full pressure/force to send adequate amounts of oxygenated blood throughout the body. Over time, this condition can impair organ functions.
Terms/Concepts to Know: signs and symptoms of cardiogenic shock, time frame for cardiogenic shock to occur after AMI
In congestive heart failure, the heart’s pumping mechanism is weaker, resulting in slower blood flow throughout the heart and in turn the entire body. This lack of pumping action creates fluid stasis around the heart and congestion in the lungs.
Terms/Concepts to Know: function of the left ventricle and atria, pulmonary and dependent edema
Hypertension is defined as acute or chronic high blood pressure outside of the normal range. Identification of classic signs and symptoms that create hypertensive emergencies is key to accurate and timely treatment. The ideal blood pressure, according to the American Heart Association, is 120/80.High blood pressure is defined as 140/90 or higher. An EMT should be familiar with three common hypertensive emergencies: AMI, aortic aneurysm, and dissecting aortic aneurysm.
Terms/Concepts to Know: cardiac process for systolic and diastolic readings,normal bp pressure ranges for adults, possible signs and symptoms of hypertensive emergency, aortic aneurysm, differentiate symptoms of AMI and dissecting aortic aneurysm,
Cardiac assessment is critical no matter what the environment. In an emergency situation accuracy, timing of treatment, and medication regimens are extremely important for the best patient outcomes.
Gather as much information as possible, starting with information from the 911 call. Observation of the environment and information from the patient and/or witnesses regarding the incident are also helpful. Ensure the environment is stable and safe and always use universal precautions. Avoid making assumptions or letting the information you obtained pigeon-hole your thinking. Use the scene assessment to gather baseline information regarding environment, incident onset, and the pattern and duration of signs and symptoms.
Terms/Concepts to Know: key components of scene assessment
The initial patient observation should include the basic CPR Airway Breathing Circulation (ABC) assessment. Depending on the symptoms and status, timely actions should be set in motion. Ensure there is an automated external defibrillator (AED) and oxygen in place, with Advanced Life Support (ALS) backup, if possible.
Terms/Concepts to Know: AED, CPR process
At this point in the process, it is assumed that life-threatening factors are being monitored and controlled. During the scene assessment, some of the patient history may have been obtained. It is important to stay calm and speak to the patient and witnesses in a clear, concise, and calm tone. Clarify and fill in important medical and medication history at this juncture. Obtain and pinpoint details of associated and currently occurring signs and symptoms, as well as pertinent comorbid conditions and a history of similar events.
Terms/Concepts to Know: common symptoms of respiratory versus cardiac symptoms, key questions for the alert patient during a cardiac emergency, OPQRST mnemonic for pain assessment
The primary assessment information is part of the foundation for the more specific, hands-on secondary assessment. Focus on the key and currently active symptoms to guide further evaluation of the respiratory, circulatory, and cardiovascular systems. Observe and assess skin condition, color, temperature, turgor, capillary refill, etc. Monitor vital signs, including blood pressure, respirations, oxygen saturation, pulse, and pain level. Auscultate lungs and heart, paying attention to key signs and symptoms of cardiovascular and respiratory complications.
Terms/Concepts to Know: procedure for observing and assessing heart and lungs
This is the time to prepare for transportation and communication with emergency room team. The reassessment, which is basically the same as the primary assessment, focuses on current status, with attention to any status changes in the primary complaint/concern. Focus on improvements or lack thereof with adjustments to treatment regimes as appropriate. Ensure that documentation is complete and accurate, with interventions and times included.
Terms/Concepts to Know: determination of frequency of vital signs