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					Cardiac Emergencies
Chapter 17

+++ Review Cardiovascular medications +++
Hearts function and anatomy
Blood flow through the heart - Vena cava – CO2 - R atrium – CO2 - R ventricle – CO2 - Pulmonary artery – CO2 - Pulmonary Vein – O2 - L atrium – O2 - L ventricle – O2 - Aorta – O2 - Body Chambers - Atria – Supply blood to the ventricles - Ventricles – Left ventricle has the thickest and most muscular walls Coronary arteries – Supply oxygenated blood to the heart (myocardium) Carotid arteries – Supply oxygenated blood to the head Superior/Inferior vena cava – Returns deoxygenated blood from the head and body Subclavian arteries – Conduction system - Sinus node - Atrioventricular node th Impulse is slowed for 1/10 of a second to allow filling of the ventricles - Right & Left Bundle branches (ventricles) Blood components - Red blood cells Most numerous cells Carry O2 to the cells and remove CO2/waste - White blood cells Fight infection - Platelets Help with clotting - Plasma Fluid that the cells float in Makes up over half the volume of the blood Pulse points - Carotid – Neck - Femoral – Groin - Brachial – Inside of the upper arm - Radial – Thumb side of the wrist - Posterior tibial – Inside of the ankle - Dorsalis pedis – Top of the foot

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Atherosclerosis
- A disorder in which calcium and cholesterol build up and form a plaque inside the walls of blood vessels

Acute Myocardial Infarction (AMI) – heart attack
Caused by the blockage of an artery supplying blood to the myocardium Risk Factors

Signs/symptoms

Treatment

Vitals o Reassess every 5 minutes or whenever condition changes Physical exam History o OPQRST o SAMPLE

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Angina Pectoris
- A symptom of atherosclerotic coronary artery disease Risk factors - Same as for AMI Signs/symptoms - Same as for AMI Treatment – Same as for AMI

AMI – vs. - angina pectoris
Acute Myocardial Infarction
- May or may not be caused by exertion - Pain may or may not go away with rest and/or nitro - Pain does not go away in a few minutes

Angina
- Usually caused by exertion or activity - Pain disappears with rest and/or nitro

Consequences of AMI Sudden death Cardiac rhythms seen prior to arrest Ventricular fibrillation (V-fib)

Tachycardia - Heart rate >100 Bradycardia - Heart rate <60 Ventricular Tachycardia (V-tach)

Congestive Heart Failure (CHF)
- Ventricles of heart are unable to keep up with blood flow from atria Signs/symptoms

Treatment

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Cardiogenic shock
- Heart lacks the power needed to circulate blood Signs/symptoms

Treatment

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FYI
Heart operations
Coronary Artery Bypass Graft (CABG) - A blood vessel from the chest or leg is sewn directly from the aorta to a coronary artery beyond the point of obstruction Percutaneous Transluminal Coronary Angioplasty (PTCA) - A balloon is inserted into a vein (usually at the groin) and placed at the narrowed portion of the coronary artery. The balloon is inflated then deflated and removed. Stent - Sometimes placed into a coronary artery following PTCA to keep the artery open Pacemakers - Battery powered devices placed into the heart when the natural electrical control system is so damaged that it does not function properly - Deliver an electrical impulse through wires, which are connected directly to the myocardium - Usually located under the skin in the upper left chest but may be located anywhere in the chest or upper ABD - Malfunction is usually caused by a dead battery or if the wires become detached - Treat them as you would any other patient Automatic Implantable Cardiac Defibrillator (AICD) - Placed in patients who have survived cardiac arrest or who have an extremely high risk of ventricular fibrillation - Continuously monitor the heart rhythm and shock the patient as needed - The shock will not harm anyone in contact with the patient - Usually located in the L upper ABD but may be located anywhere in the chest or upper ABD - Treat them as you would any other patient

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