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FCA 0211 - Cardiac

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Redwood Memorial Hospital, PreHospital Care, Field Care Audit, Lecture on Cardiac Issues and new AHA Guidelines and goals. Presented 02/16/11

Redwood Memorial Hospital, PreHospital Care, Field Care Audit, Lecture on Cardiac Issues and new AHA Guidelines and goals. Presented 02/16/11

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  • Transcript

    • 1. Affairs of the Heart Veronica Bonales, M.D. CEP Emergency Physician Redwood Memorial Hospital
    • 2. Affairs of the Heart
    • 3. Affairs of the HeartAnatomy of heart and electrical systemHeart problems - ArrythmiasHeart problems - IschemiaMega Code with new AHA Guidelines
    • 4. Heart Anatomy
    • 5. Heart Anatomy
    • 6. Heart Anatomy
    • 7. Heart Anatomy
    • 8. Heart Anatomy
    • 9. Heart Anatomy
    • 10. Heart Anatomy
    • 11. Heart Anatomy
    • 12. Heart Anatomy
    • 13. Heart Anatomy
    • 14. Heart Anatomy
    • 15. Heart Tissues Cardiac Myocytes Specialized Intrinsic Rhythm
    • 16. Heart Anatomy
    • 17. Heart Anatomy
    • 18. Heart Anatomy
    • 19. Heart Anatomy
    • 20. Heart Anatomy
    • 21. Intrinsic RhythmSA Node - 100 beats per minute (70 normal)AV Node - 40 - 60 beats per minutePurkinje Fibers - 30 - 40 beats per minute
    • 22. Fight or Flight / Rest and DigestSympathetic and Parasympathetic NervousSystem - on SA Node Sympathetic Norepinephrine (beta-1 receptors) Parasympathetic Vagus Nerve (ACh)
    • 23. Balance
    • 24. Cardiac Filling
    • 25. Cardiac Filling
    • 26. When Good Hearts Go Bad
    • 27. Heart Problems - ArrhythmiasRateRhythm
    • 28. Normal Sinus
    • 29. Heart Problems - Rate
    • 30. Heart Problems - RateToo fastToo slowNot beating at all
    • 31. Heart Problems - RhythmRegularIrregular
    • 32. Heart Problems - RhythmRegularIrregular
    • 33. Atrial Fibrillation
    • 34. 3rd Degree Heart Block
    • 35. 3rd Degree Heart Block
    • 36. Atrial Flutter
    • 37. Ventricular Tachycardia
    • 38. Torsades de Pointes
    • 39. Ventricular Fibrillation
    • 40. Cardiac Drugs
    • 41. DrugsAspirin FurosemideAtropine LidocaineAdenosine MorphineAmiodarone NitroglycerinEpinephrine Oxygen
    • 42. DrugsAspirin FurosemideAtropine LidocaineAdenosine MorphineAmiodarone NitroglycerinEpinephrine Oxygen
    • 43. Sympathetic and Parasympathetic NervousSystem - on SA Node Sympathetic Norepinephrine (beta-1 receptors) Parasympathetic Vagus Nerve (ACh)
    • 44. Atropineincreases firing of the sinoatrial node (SA) andconduction through the atrioventricular node (AV) ofthe heart, opposes the actions of the vagus nerve,blocks acetylcholine receptor sites
    • 45. Atropineincreases firing of the sinoatrial node (SA) andconduction through the atrioventricular node (AV) ofthe heart, opposes the actions of the vagus nerve,blocks acetylcholine receptor sites x
    • 46. AdenosineBlocks the AV node
    • 47. AdenosineBlocks the AV node x
    • 48. AmiodaroneBeta blocker, prolongs action potential viasodium channels and potassium channels
    • 49. AmiodaroneBeta blocker, prolongs action potential viasodium channels and potassium channels x
    • 50. EpinephrineWorks at ACh junctions
    • 51. EpinephrineWorks at ACh junctions
    • 52. LidocaineBlocks sodium channels
    • 53. LidocaineBlocks sodium channels x
    • 54. LidocaineBlocks sodium channels x x
    • 55. Heart Problems - Ischemia
    • 56. Coronary Anatomy
    • 57. Coronary Anatomy
    • 58. The Heart Electric
    • 59. EKG Regions
    • 60. STEMI
    • 61. STEMI
    • 62. LM
    • 63. LM LCx
    • 64. LADLM LCx
    • 65. LADLM LCx
    • 66. Angiography Opening the lesion
    • 67. EMS called to office building with reportof “man down.” Found 54 y.o. male patientin PEA arrest. CPR & ACLS for 35minutes & pronounced at scene.
    • 68. MEGA Code
    • 69. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.
    • 70. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.911 call - Family reports patient “passed out” in car.Pulled over to side of the road and family performingCPR.
    • 71. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.911 call - Family reports patient “passed out” in car.Pulled over to side of the road and family performingCPR.FD is first on scene.... What do you do?
    • 72. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.911 call - Family reports patient “passed out” in car.Pulled over to side of the road and family performingCPR.FD is first on scene.... What do you do? *AHA - change from ABC to CAB
    • 73. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.911 call - Family reports patient “passed out” in car.Pulled over to side of the road and family performingCPR.FD is first on scene.... What do you do? *AHA - change from ABC to CAB *Patients should receive CPR until an AED is available
    • 74. AHA: CPR should be fast (>100) and deep (>2 inches) Rotate compressor every 2 minutes No ventilation for first 18 sec (30 compressions) If no advanced airway 30:2 ratio
    • 75. FD applies AED; shock advised. One shock given withROSC. EMS arrives at this point. What do you do?
    • 76. FD applies AED; shock advised. One shock given withROSC. EMS arrives at this point. What do you do?
    • 77. EMT’s place patient in back of ambulance and see this onmonitor....
    • 78. EMT’s place patient in back of ambulance and see this onmonitor....
    • 79. EMT’s place patient in back of ambulance and see this onmonitor....“Andy, Andy, are you ok? Patient is unresponsive. Nopulse. What do you do?
    • 80. PEA Arrest
    • 81. PEA Arrest CPR for 2 minutes
    • 82. PEA Arrest CPR for 2 minutes Epinephrine every 3 minutes
    • 83. PEA Arrest CPR for 2 minutes Epinephrine every 3 minutes Consider advanced airway (passive O2 via mask with an open airway showed improved survival)
    • 84. PEA Arrest CPR for 2 minutes Epinephrine every 3 minutes Consider advanced airway (passive O2 via mask with an open airway showed improved survival) 8 - 10 breaths per minute, continuous CPR
    • 85. Coronary Artery Perfusion Pressure9 strokes
    • 86. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    • 87. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    • 88. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    • 89. Then on the monitor you see this....
    • 90. Then on the monitor you see this....
    • 91. Then on the monitor you see this....Now what?
    • 92. Ventricular tachycardia Shock CPR for 2 minutes
    • 93. Then on the monitor you see this....
    • 94. Then on the monitor you see this....
    • 95. Then on the monitor you see this....Now what?
    • 96. Ventricular fibrillation
    • 97. Ventricular fibrillation Shock
    • 98. Ventricular fibrillation Shock CPR for 2 minutes
    • 99. Ventricular fibrillation Shock CPR for 2 minutes Another drug....?
    • 100. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    • 101. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    • 102. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    • 103. Reversible Causes:
    • 104. Reversible Causes: Hypovolemia
    • 105. Reversible Causes: Hypovolemia Hypoxia
    • 106. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis)
    • 107. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis) Hypo/Hyper K+
    • 108. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    • 109. Reversible Causes: Hypovolemia Tension PTx Hypoxia H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    • 110. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    • 111. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Hypothermia
    • 112. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Thrombosis, PE Hypothermia
    • 113. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Thrombosis, PE Hypothermia Thrombosis, Coronary
    • 114. Amiodarone 300mg loading dose given withROSC.Now what?
    • 115. Amiodarone 300mg loading dose given withROSC.Now what?
    • 116. Amiodarone 300mg loading dose given withROSC.Now what?
    • 117. AHA Post Cardiac Arrest Goals - control body temperature to optimize survival & neurological recovery - Tx of ACS (Cath Lab Activation)
    • 118. Patient arrives in hospital E.D. Therapeutic hypothermiastarted with cold saline in the field. Patient placed oncooler. EKG showed STEMI. Cath Lab activated andpatient underwent angiography which showed LAD lesion.Stented in the Cath Lab and went to CCU whererewarmed about 24 hours later. Extubated andeventually went to cardiac rehab.
    • 119. Questions...??