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

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  • FCA 0211 - Cardiac

    1. 1. Affairs of the Heart Veronica Bonales, M.D. CEP Emergency Physician Redwood Memorial Hospital
    2. 2. Affairs of the Heart
    3. 3. Affairs of the HeartAnatomy of heart and electrical systemHeart problems - ArrythmiasHeart problems - IschemiaMega Code with new AHA Guidelines
    4. 4. Heart Anatomy
    5. 5. Heart Anatomy
    6. 6. Heart Anatomy
    7. 7. Heart Anatomy
    8. 8. Heart Anatomy
    9. 9. Heart Anatomy
    10. 10. Heart Anatomy
    11. 11. Heart Anatomy
    12. 12. Heart Anatomy
    13. 13. Heart Anatomy
    14. 14. Heart Anatomy
    15. 15. Heart Tissues Cardiac Myocytes Specialized Intrinsic Rhythm
    16. 16. Heart Anatomy
    17. 17. Heart Anatomy
    18. 18. Heart Anatomy
    19. 19. Heart Anatomy
    20. 20. Heart Anatomy
    21. 21. Intrinsic RhythmSA Node - 100 beats per minute (70 normal)AV Node - 40 - 60 beats per minutePurkinje Fibers - 30 - 40 beats per minute
    22. 22. Fight or Flight / Rest and DigestSympathetic and Parasympathetic NervousSystem - on SA Node Sympathetic Norepinephrine (beta-1 receptors) Parasympathetic Vagus Nerve (ACh)
    23. 23. Balance
    24. 24. Cardiac Filling
    25. 25. Cardiac Filling
    26. 26. When Good Hearts Go Bad
    27. 27. Heart Problems - ArrhythmiasRateRhythm
    28. 28. Normal Sinus
    29. 29. Heart Problems - Rate
    30. 30. Heart Problems - RateToo fastToo slowNot beating at all
    31. 31. Heart Problems - RhythmRegularIrregular
    32. 32. Heart Problems - RhythmRegularIrregular
    33. 33. Atrial Fibrillation
    34. 34. 3rd Degree Heart Block
    35. 35. 3rd Degree Heart Block
    36. 36. Atrial Flutter
    37. 37. Ventricular Tachycardia
    38. 38. Torsades de Pointes
    39. 39. Ventricular Fibrillation
    40. 40. Cardiac Drugs
    41. 41. DrugsAspirin FurosemideAtropine LidocaineAdenosine MorphineAmiodarone NitroglycerinEpinephrine Oxygen
    42. 42. DrugsAspirin FurosemideAtropine LidocaineAdenosine MorphineAmiodarone NitroglycerinEpinephrine Oxygen
    43. 43. Sympathetic and Parasympathetic NervousSystem - on SA Node Sympathetic Norepinephrine (beta-1 receptors) Parasympathetic Vagus Nerve (ACh)
    44. 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. 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. 46. AdenosineBlocks the AV node
    47. 47. AdenosineBlocks the AV node x
    48. 48. AmiodaroneBeta blocker, prolongs action potential viasodium channels and potassium channels
    49. 49. AmiodaroneBeta blocker, prolongs action potential viasodium channels and potassium channels x
    50. 50. EpinephrineWorks at ACh junctions
    51. 51. EpinephrineWorks at ACh junctions
    52. 52. LidocaineBlocks sodium channels
    53. 53. LidocaineBlocks sodium channels x
    54. 54. LidocaineBlocks sodium channels x x
    55. 55. Heart Problems - Ischemia
    56. 56. Coronary Anatomy
    57. 57. Coronary Anatomy
    58. 58. The Heart Electric
    59. 59. EKG Regions
    60. 60. STEMI
    61. 61. STEMI
    62. 62. LM
    63. 63. LM LCx
    64. 64. LADLM LCx
    65. 65. LADLM LCx
    66. 66. Angiography Opening the lesion
    67. 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. 68. MEGA Code
    69. 69. 54 yo with hx of multiple medical problems riding in carwith family on Sunday afternoon, going home after lunch.
    70. 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. 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. 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. 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. 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. 75. FD applies AED; shock advised. One shock given withROSC. EMS arrives at this point. What do you do?
    76. 76. FD applies AED; shock advised. One shock given withROSC. EMS arrives at this point. What do you do?
    77. 77. EMT’s place patient in back of ambulance and see this onmonitor....
    78. 78. EMT’s place patient in back of ambulance and see this onmonitor....
    79. 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. 80. PEA Arrest
    81. 81. PEA Arrest CPR for 2 minutes
    82. 82. PEA Arrest CPR for 2 minutes Epinephrine every 3 minutes
    83. 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. 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. 85. Coronary Artery Perfusion Pressure9 strokes
    86. 86. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    87. 87. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    88. 88. Epinephrine x 2 (*no atropine), intubated with minimalinterruption of chest compressions (*<10 sec), wave-formcapnography in place...
    89. 89. Then on the monitor you see this....
    90. 90. Then on the monitor you see this....
    91. 91. Then on the monitor you see this....Now what?
    92. 92. Ventricular tachycardia Shock CPR for 2 minutes
    93. 93. Then on the monitor you see this....
    94. 94. Then on the monitor you see this....
    95. 95. Then on the monitor you see this....Now what?
    96. 96. Ventricular fibrillation
    97. 97. Ventricular fibrillation Shock
    98. 98. Ventricular fibrillation Shock CPR for 2 minutes
    99. 99. Ventricular fibrillation Shock CPR for 2 minutes Another drug....?
    100. 100. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    101. 101. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    102. 102. Ventricular fibrillation Shock CPR for 2 minutes Another drug....? Amiodarone & treat reversible causes
    103. 103. Reversible Causes:
    104. 104. Reversible Causes: Hypovolemia
    105. 105. Reversible Causes: Hypovolemia Hypoxia
    106. 106. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis)
    107. 107. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis) Hypo/Hyper K+
    108. 108. Reversible Causes: Hypovolemia Hypoxia H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    109. 109. Reversible Causes: Hypovolemia Tension PTx Hypoxia H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    110. 110. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Hypo/Hyper K+ Hypothermia
    111. 111. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Hypothermia
    112. 112. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Thrombosis, PE Hypothermia
    113. 113. Reversible Causes: Hypovolemia Tension PTx Hypoxia Tamponade H+ (Acidosis) Toxins Hypo/Hyper K+ Thrombosis, PE Hypothermia Thrombosis, Coronary
    114. 114. Amiodarone 300mg loading dose given withROSC.Now what?
    115. 115. Amiodarone 300mg loading dose given withROSC.Now what?
    116. 116. Amiodarone 300mg loading dose given withROSC.Now what?
    117. 117. AHA Post Cardiac Arrest Goals - control body temperature to optimize survival & neurological recovery - Tx of ACS (Cath Lab Activation)
    118. 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. 119. Questions...??

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