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Emergency Medical ResponderEmergency Medical Responder
First on SceneFirst on Scene
CHAPTER
TENTH EDITION
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Caring for Cardiac
Emergencies
14
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
NORMAL HEART FUNCTION
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
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Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.3 The coronary arteries supply blood to the heart muscle (myocardium).
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.1 Major anatomy of the heart including blood flow through the chambers.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.2 The heart’s conduction pathway, highlighted in green.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
CARDIAC COMPROMISE
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Cardiac Compromise
• Cardiac Compromise Symptoms
 Chest discomfort
 Diaphoresis
 Dyspnea
 Nausea/vomiting
 Anxiety/irritability
 Abnormal pulse
 Abnormal blood pressure
 Feeling of impending doom
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Angina Pectoris
• Angina pectoris (angina) is pain in the
chest.
• Decreased oxygenated blood supply in
the coronary arteries leads to an
increased oxygenated blood demand in
the heart muscle.
 Exertion
 Partial blockage
 Spasm
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Angina Pectoris
• Signs and symptoms of angina are
nearly identical to a heart attack.
• No actual damage to the heart muscle
• Patients with angina history typically
carry nitro.
• Treatment for angina and myocardial
infarction (heart attack) is the same.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Myocardial Infarction
• Myocardial infarction (MI)
 Myo, muscle
 Cardial, heart
 Infarction, tissue death
• Blockage or narrowing of the coronary
arteries leads to a permanent decrease
in oxygenated blood supply.
• Without oxygenated blood, the tissue of
the heart begins to die.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Myocardial Infarction
• Typical signs and symptoms
 Pain, pressure, tightness, or heaviness
to the chest/upper abdomen
 Pain or discomfort behind the sternum
 Pain radiating to the shoulders or arms
 Pain to the back, neck, jaw or upper
abdomen
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Myocardial Infarction
• Atypical signs and symptoms
 "Flu-like" signs and symptoms such as
nausea and vomiting
 Indigestion
 Feeling of general weakness
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Myocardial Infarction
• Large amounts of tissue death or
damage over an important electrical
pathway may lead to cardiac arrest.
• Patients in cardiac arrest are
unresponsive, not breathing, and have
no pulse.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.4 Both myocardial infarction and angina can present with symptoms of chest pain. Treat all cases of
chest pain as a true cardiac emergency.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Heart Failure
• Congestive heart failure (CHF)
 Weakened heart muscle is unable to
pump blood efficiently and manage
normal blood volume.
• Chronic due to cardiac diseases
• Sudden after a myocardial infarction
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Heart Failure
• Congestive heart failure (CHF)
 Fluid backs up within the circulatory
system.
• Lungs
• Lower extremities
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Heart Failure
• Signs and Symptoms of Heart Failure
 Shortness of breath
 Chest pain/discomfort
 Rapid pulse rate
 Pedal edema (swollen ankles)
 Jugular Vein Distention (JVD)
 Pale, moist skin
 Altered mental status
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.5a Signs of heart failure include bulging neck veins.
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Figure 14.5b Signs of heart failure include swollen ankles (pedal edema).
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
EMERGENCY CARE FOR
CARDIAC COMPROMISE
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Emergency Care for Cardiac
Compromise
• Emergency Care
 Take appropriate Standard Precautions.
 Perform a primary assessment and
support the ABCs as necessary.
 If allowed, provide oxygen per local
protocols.
• SpO2 should read between 95–100%.
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Emergency Care for Cardiac
Compromise
• Emergency Care
 Determine chief complaint.
• Onset
• Provocation
• Quality
• Region and radiate
• Severity
• Time
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Emergency Care for Cardiac
Compromise
• Emergency Care
 Provide emotional support and reassure
the patient.
 Allow the patient to maintain a position
of comfort, usually sitting up.
 Obtain vital signs.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Emergency Care for Cardiac
Compromise
• Emergency Care
 Assist the patient with the prescribed
dose of nitroglycerin, if your protocols
permit. Consult medical direction.
 Continue to monitor vital signs.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Nitroglycerin Medication Form – Tablet
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Nitroglycerin Medication Form – Sublingual Spray
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Emergency Care for Cardiac
Compromise
• Medications
 Aspirin
• Analgesic
• Clot inhibitor
• Prescribed daily for angina
• Beneficial for patients exhibiting signs
and symptoms of an MI
• Assist patient according to protocol.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
SUMMARY
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Summary
• A healthy heart is the core of the
cardiovascular system.
• Blood flows through the heart in a
precise way.
• Electrical impulses flow along the
conduction pathway.
• There are key signs and symptoms of
cardiac compromise.
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Summary
• Angina results from a diminished
supply of oxygenated blood to the
heart.
• Myocardial infarction occurs when a
portion of the heart dies due to
inadequate blood supply.
• Congestive Heart failure (CHF) is
caused by a weakened heart that can
no longer pump blood efficiently.
continued on next slide
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Summary
• Care for cardiac compromise includes:
 The ABCs
 Supplemental oxygen
 Obtaining a thorough medical history
 Keeping the patient at rest
 Monitoring vital signs
• Initiate ALS transport if available.
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
REVIEW QUESTIONS
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
Review Questions
1. Describe the normal flow of blood
through the heart.
2. What are some vague symptoms of MI
that may be seen in women or the
elderly?
3. What is the appropriate assessment
and care for a patient experiencing
cardiac compromise?
Copyright © 2016, 2011, 2009
by Pearson Education, Inc.
All Rights Reserved
Emergency Medical Responder: First on Scene, 10/e
Christopher J. Le Baudour | J. David Bergeron
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EMR ch14

  • 1. Emergency Medical ResponderEmergency Medical Responder First on SceneFirst on Scene CHAPTER TENTH EDITION Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Caring for Cardiac Emergencies 14
  • 2. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron NORMAL HEART FUNCTION
  • 3. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.3 The coronary arteries supply blood to the heart muscle (myocardium).
  • 4. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.1 Major anatomy of the heart including blood flow through the chambers.
  • 5. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.2 The heart’s conduction pathway, highlighted in green.
  • 6. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron CARDIAC COMPROMISE
  • 7. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Cardiac Compromise • Cardiac Compromise Symptoms  Chest discomfort  Diaphoresis  Dyspnea  Nausea/vomiting  Anxiety/irritability  Abnormal pulse  Abnormal blood pressure  Feeling of impending doom
  • 8. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Angina Pectoris • Angina pectoris (angina) is pain in the chest. • Decreased oxygenated blood supply in the coronary arteries leads to an increased oxygenated blood demand in the heart muscle.  Exertion  Partial blockage  Spasm continued on next slide
  • 9. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Angina Pectoris • Signs and symptoms of angina are nearly identical to a heart attack. • No actual damage to the heart muscle • Patients with angina history typically carry nitro. • Treatment for angina and myocardial infarction (heart attack) is the same.
  • 10. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Myocardial Infarction • Myocardial infarction (MI)  Myo, muscle  Cardial, heart  Infarction, tissue death • Blockage or narrowing of the coronary arteries leads to a permanent decrease in oxygenated blood supply. • Without oxygenated blood, the tissue of the heart begins to die.
  • 11. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Myocardial Infarction • Typical signs and symptoms  Pain, pressure, tightness, or heaviness to the chest/upper abdomen  Pain or discomfort behind the sternum  Pain radiating to the shoulders or arms  Pain to the back, neck, jaw or upper abdomen
  • 12. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Myocardial Infarction • Atypical signs and symptoms  "Flu-like" signs and symptoms such as nausea and vomiting  Indigestion  Feeling of general weakness
  • 13. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Myocardial Infarction • Large amounts of tissue death or damage over an important electrical pathway may lead to cardiac arrest. • Patients in cardiac arrest are unresponsive, not breathing, and have no pulse.
  • 14. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.4 Both myocardial infarction and angina can present with symptoms of chest pain. Treat all cases of chest pain as a true cardiac emergency.
  • 15. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Heart Failure • Congestive heart failure (CHF)  Weakened heart muscle is unable to pump blood efficiently and manage normal blood volume. • Chronic due to cardiac diseases • Sudden after a myocardial infarction continued on next slide
  • 16. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Heart Failure • Congestive heart failure (CHF)  Fluid backs up within the circulatory system. • Lungs • Lower extremities
  • 17. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Heart Failure • Signs and Symptoms of Heart Failure  Shortness of breath  Chest pain/discomfort  Rapid pulse rate  Pedal edema (swollen ankles)  Jugular Vein Distention (JVD)  Pale, moist skin  Altered mental status
  • 18. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.5a Signs of heart failure include bulging neck veins. continued on next slide
  • 19. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Figure 14.5b Signs of heart failure include swollen ankles (pedal edema).
  • 20. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron EMERGENCY CARE FOR CARDIAC COMPROMISE
  • 21. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Emergency Care for Cardiac Compromise • Emergency Care  Take appropriate Standard Precautions.  Perform a primary assessment and support the ABCs as necessary.  If allowed, provide oxygen per local protocols. • SpO2 should read between 95–100%. continued on next slide
  • 22. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Emergency Care for Cardiac Compromise • Emergency Care  Determine chief complaint. • Onset • Provocation • Quality • Region and radiate • Severity • Time
  • 23. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Emergency Care for Cardiac Compromise • Emergency Care  Provide emotional support and reassure the patient.  Allow the patient to maintain a position of comfort, usually sitting up.  Obtain vital signs.
  • 24. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Emergency Care for Cardiac Compromise • Emergency Care  Assist the patient with the prescribed dose of nitroglycerin, if your protocols permit. Consult medical direction.  Continue to monitor vital signs.
  • 25. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Nitroglycerin Medication Form – Tablet
  • 26. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Nitroglycerin Medication Form – Sublingual Spray
  • 27. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Emergency Care for Cardiac Compromise • Medications  Aspirin • Analgesic • Clot inhibitor • Prescribed daily for angina • Beneficial for patients exhibiting signs and symptoms of an MI • Assist patient according to protocol.
  • 28. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron SUMMARY
  • 29. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Summary • A healthy heart is the core of the cardiovascular system. • Blood flows through the heart in a precise way. • Electrical impulses flow along the conduction pathway. • There are key signs and symptoms of cardiac compromise. continued on next slide
  • 30. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Summary • Angina results from a diminished supply of oxygenated blood to the heart. • Myocardial infarction occurs when a portion of the heart dies due to inadequate blood supply. • Congestive Heart failure (CHF) is caused by a weakened heart that can no longer pump blood efficiently. continued on next slide
  • 31. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Summary • Care for cardiac compromise includes:  The ABCs  Supplemental oxygen  Obtaining a thorough medical history  Keeping the patient at rest  Monitoring vital signs • Initiate ALS transport if available.
  • 32. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron REVIEW QUESTIONS
  • 33. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Review Questions 1. Describe the normal flow of blood through the heart. 2. What are some vague symptoms of MI that may be seen in women or the elderly? 3. What is the appropriate assessment and care for a patient experiencing cardiac compromise?
  • 34. Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Please visit www.bradybooks.com and follow the Resource Central links to access content for this text.

Editor's Notes

  1. Thinking Point: First ask the students to define cardiac compromise.
  2. Critical Thinking: How can you tell when a patient is experiencing acute angina versus a heart attack? (A: A diagnosis can not be made in the prehospital setting; patients should be transported to a hospital for definitive diagnosis and treatment.)
  3. Talking Point: Angina triggered by exertion is often resolved with rest whereas myocardial infarction symptoms will not resolve with rest. EMRs should never cancel responding EMS even if the patient claims relief.
  4. Critical Thinking: How effective will the heart muscle be if any of the tissue begins to die? (A: The heart's overall effectiveness will be diminished.)
  5. Critical Thinking: What should immediately be done for victims of cardiac arrest? (A: CPR & AED)
  6. Talking Point: Elderly people, diabetics and women are the most likely candidates for atypical symptoms.
  7. Talking Point: Patients with shortness of breath may have difficulty speaking and answering questions. Critical Thinking: Why do people experiencing shortness of breath usually prefer an upright position? (A: It is easier to breathe sitting up.)
  8. Critical Thinking: Why might it be beneficial to obtain medical history from a family member on scene rather than asking a patient with shortness of breath to respond? (A: Patients with shortness of breath often have difficulty speaking in full sentences and talking can cause unnecessary exertion, further taxing their system.)
  9. Class Activity: Using the index cards from the Take Action activity completed at the end of Chapter 13; direct students to select one cause of cardiac compromise (angina, heart attack (MI), or heart failure) and, working in pairs, allow one student to role-play symptoms while the other performs the OPQRST assessment. Be sure each student has an opportunity to perform the assessment. Also make sure they cover the three possibilities. Suggest to the students to role-play some vague, less common symptoms.
  10. Critical Thinking: Why is it important to ensure the patient does not exert him/her self? (A: The heart tissue may be dying and exertion, such as walking, can compromise the heart's performance even further.)
  11. Class Activity: Bring small candy mints to class. Referring to Chapter 13, have students work in pairs to follow the Nitroglycerin "Steps for Assisting the Patient." Be sure each student has an opportunity to perform the steps.
  12. Blood flows through the heart beginning with the right atrium (Figure 13-1). It then flows down into the right ventricle. From there it flows into the lungs, where it drops off carbon dioxide and picks up oxygen. It returns from the lungs and enters the left atrium, and then flows down into the left ventricle. The left ventricle is the largest and strongest chamber of the heart and must force blood out to the entire body. The heart muscle itself receives its blood supply from tiny vessels called coronary arteries. During a cardiac event, those populations may experience what appear as "flu-like" signs and symptoms, such as nausea and vomiting, indigestion, or a feeling of general weakness. The patient may simply tell you, "I don't feel right," or "Something is wrong with me, but I don't know what it is." OPQRST; be sure to review with the students specific questions to be asked in their assessment of suspected cardiac compromise.