This document provides guidance on assessing and managing cardiac emergencies as an EMT. It discusses signs of cardiac compromise, administering nitroglycerin, performing CPR, and using an automated external defibrillator (AED). Key points covered include indications for nitroglycerin use, delivering shocks with an AED for shockable rhythms, resuming CPR after "no shock" messages, safety practices for AED use, and maintaining AEDs to ensure proper function.

1. Chapter Cardiac Emergencies Fourteen

3. Heart

4. Right Atrium Right Ventricle Left Atrium Left Ventricle Receives blood from veins; pumps to right ventricle Receives blood from lungs; pumps to left ventricle Pumps blood to the lungs Pumps blood through the aorta to the body Four Chambers of the Heart

5. Cardiac Conduction System

6. Coronary Arteries

7. Vessels of Circulation C a p i l l a r y b e d V e i n A r t e r y A r t e r i o l e s V e n u l e s V a l v e

8. C ARDIAC COMPROMISE

9. Cardiac Compromise Any kind of problem with the heart K EY TERM

12. Causes of Cardiovascular Compromise Atherosclerosis

13. Coronary arteries Partial blockage producing chest pain Area of decreased blood supply Causes of Cardiac Compromise Angina Pectoris

14. Causes of Cardiac Compromise Acute Myocardial Infarction Area of Infarct

15. Causes of Cardiovascular Compromise Aneurysms

16. Mild to severe confusion Anxiety Increased respiratory rate Dyspnea (shortness of breath) Difficulty breathing while lying flat Cyanosis Distended neck veins Pink sputum Rapid heart rate Normal to high blood pressure Abdominal distention Edema of the lower extremities Causes of Cardiac Compromise Congestive Heart Failure

17. Perform initial assessment.

18. Perform focused history and physical exam; take baseline vital signs.

19. If patient meets nitroglycerin criteria, consult medical direction. Check the “rights” and the expiration date.

20. Place patient in position of comfort; give high-concentration oxygen by nonrebreather mask.

23. Remove oxygen mask and ask patient to open mouth and lift tongue.

24. Place tablet or spray medication under tongue.

25. Have patient close mouth. Replace oxygen mask. Reassess patient; document findings.

28. C ARDIAC COMPROMISE AND BLS

29. You need to be able to do CPR alone while your partner is preparing equipment or you are transporting a patient in cardiac arrest. One-Rescuer CPR

32. High Quality Compressions Research has shown that high quality CPR compressions can double, if not triple, survival if applied promptly. Always press hard, fast (at least 100/minute) and allow full chest recoil. K EY TERM

34. American Heart Association's Chain of Survival

36. AEDs are extremely accurate in distinguishing between shockable and nonshockable rhythms. AED Analysis of Cardiac Rhythm

42. Take BSI. Briefly question bystanders about pre-arrest events.

43. Perform initial assessment. Verify patient is pulseless and not breathing. Check for no longer than 10 seconds.

46. Set up AED as partner starts (or resumes) CPR. Unless the arrest was witnessed, administer 2 minutes (5 cycles) of CPR.

47. Turn on power and, if appropriate, begin verbal report.

48. Firmly attach one pad to right upper bare chest. Firmly place one pad over lower left bare ribs.

49. Proper Placement of AED Pads

50. Say "Clear!" Ensure no one is touching patient. Press analyze button.

51. If AED advises shock, say "Clear," ensure no one touching patient, and press shock button.

52. After delivery of shock, immediately perform CPR for 2 minutes (5 cycles), unless the patient wakes up.

53. Check effectiveness of CPR by evaluating pulse.

54. Gather additional information on arrest events.

55. Insert an airway adjunct and ventilate with high-concentration oxygen.

56. After two minutes of CPR, have all individuals stand clear and reanalyze with the AED.

57. If no shock is advised, check carotid pulse, for a maximum of 10 seconds. If present, assess adequacy of breathing.

58. If breathing is adequate, give high- concentration oxygen by nonrebreather. If inadequate, ventilate with high-concentration oxygen.

59. If the AED gives 3 consecutive no- shock messages with no carotid pulse . . . . . . or a total of 3 shocks are delivered . . . then transport with CPR and oxygen.

65. AED in Progress If AED is in use by a first responder when you arrive, ensure they are performing properly, and continue with shock analysis and 2 minutes of CPR sequence.

79. 1. What signs and symptoms should prompt you to treat a patient for cardiac compromise? 2. What are the indications, contra-indications, and dose for nitroglycerin? Review Questions

80. 3. How many shocks should you give to a patient with a shockable rhythm? 4. What should you do when you get a no-shock message? Review Questions

81. 5. Which patients in cardiac arrest should not have an AED applied? 6. When using an AED, what safety practices should you follow? 7. How can you be sure that your AED will work when you need it? Review Questions