Chapter 17: Cardiovascular Emergencies

Overview

• Focus on cardiovascular emergencies as covered in the "Emergency Care and Transportation of the Sick and Injured, 12th Edition."
• Topics include:
  • Anatomy and physiology of the cardiovascular system
  • Pathophysiology of respiration and perfusion
  • Signs and symptoms of common cardiac conditions
  • Usage of AEDs
  • General care for cardiac emergencies

Cardiovascular Disease

• Leading cause of death in the U.S. since 1900s, accounting for 1/3 of deaths.
• EMS can help reduce deaths through:
  • Promoting healthy lifestyles
  • Encouraging early medical care access
  • Increasing CPR training
  • Evolving dispatch technology
  • Public access to defibrillation
  • Advanced life support and cardiac specialty centers

Anatomy and Physiology

• Heart Function: Pumps blood, supplying oxygenated blood to tissues.
• Heart Structure:
  • Divided into left and right sides.
  • Each side has an atrium (upper chamber) and ventricle (lower chamber).
  • Aorta: Main artery, delivers blood from the left ventricle.
• Heart's Electrical System:
  • Controls heart rate via sinus node.
  • Automaticity: Heart's ability to contract without nerve stimulus.
  • Conduction system: SA node to AV node to Bundle of His to Purkinje fibers.
• Autonomic Nervous System: Balances sympathetic and parasympathetic activities.
• Coronary Arteries: Supply blood to the heart muscle, originating near the aorta.
• Arteries and Veins:
  • Various arteries supply different body regions.
  • Vena cava returns deoxygenated blood to the heart.

Blood Components

• Red Blood Cells: Carry oxygen, remove CO2.
• White Blood Cells: Fight infection.
• Platelets: Assist in blood clotting.
• Plasma: Fluid component of blood.

Pathophysiology

• Ischemia: Reduced blood flow leading to decreased oxygen supply.
• Atherosclerosis: Plaque buildup causing artery narrowing.
• Thromboembolism: Clot blocking blood flow, leading to myocardial infarction (heart attack).
• Risk Factors:
  • Controllable: Smoking, high BP, high cholesterol, diabetes, lack of exercise, obesity.
  • Uncontrollable: Age, family history, ethnicity, male gender.

Cardiac Conditions

• Angina Pectoris: Chest pain due to reduced oxygen supply.
• Acute Myocardial Infarction (AMI): Death of heart tissue due to blood flow obstruction.
• Dysrhythmias: Irregular heart rhythms like tachycardia, bradycardia, ventricular fibrillation.
• Cardiogenic Shock: Heart's inability to pump adequate blood.
• Congestive Heart Failure (CHF): Heart failure causing fluid buildup in lungs.
• Hypertensive Emergencies: Severe elevation in blood pressure.
• Aortic Aneurysm: Weakness in aorta wall leading to potential rupture.

Emergency Treatment

• Patient Assessment:
  • Scene safety, nature of illness, primary assessment.
  • Investigate chief complaints, history taking, secondary assessments.
  • Use OPQRST for pain assessment.
• Medical Interventions:
  • Positioning for comfort.
  • Administer oxygen, aspirin, nitroglycerin as required.
  • Use AED if indicated in cardiac arrest.

Advanced Interventions

• Heart Surgeries and Devices:
  • Bypass surgeries, angioplasty, stents.
  • Pacemakers, implantable defibrillators, LVADs.
• Automated External Defibrillator (AED):
  • Analyzes heart rhythm, advises shock if needed.
  • Enhances survival in cardiac arrest if used promptly.

Chain of Survival

• Early recognition and EMS activation.
• Immediate high-quality CPR.
• Rapid defibrillation.
• Advanced life support.
• Post-arrest care and recovery.

Conclusion

• Cardiovascular emergencies require prompt assessment and treatment.
• Understanding anatomy, conditions, and interventions can improve patient outcomes.
• Continuous training and protocol adherence are vital for effective response.