The document discusses cardiovascular emergencies and provides guidance on assessment and treatment. It begins by noting that cardiovascular disease is a leading cause of death and outlines ways to reduce deaths through healthy lifestyle choices and access to emergency care. It then describes the anatomy of the cardiovascular system and signs of various emergencies like chest pain, heart attack, hypertensive emergencies, and aortic aneurysm. The document concludes by detailing the steps for primary assessment of a patient with a potential cardiovascular emergency, including scene safety, monitoring breathing and circulation, gathering the medical history, providing initial care, and ensuring rapid transport to the hospital.

1. Cardiovascular
Emergencies
Anas Bahnassi PhD
9

2. Anas Bahnassi PhD CDM CDE 2

3. Introduction:
3Anas Bahnassi PhD CDM CDE
• Cardiovascular disease has been leading
killer since 1900.
• Accounts for 1 of every 3 deaths
You can help reduce deaths by:
• Encouraging healthy life-style
• Early access
• More CPR training of laypeople
• Public access to defibrillation devices
• Recognizing need for advanced life
support (ALS)

4. Cardiovascular System:
• Heart’s job is to pump blood to
supply oxygen-enriched red blood
cells to tissues.
• Divided into left and right sides
• Atria receives incoming blood, and
ventricles pump outgoing blood.
• One-way valves keep blood flowing
in the proper direction.
• Aorta, body’s main artery, receives
blood ejected from left ventricle.
Anas Bahnassi PhD CDM CDE 4

5. Pulse:
A pulse is felt when blood passes through
an artery during systole.
– Peripheral pulses felt in the extremities
– Central pulses felt near the body’s trunk
Anas Bahnassi PhD CDM CDE 5
Carotid
FemoralBrachial
Radial
Posterior tibial
Dorsalis pedis

6. Chest pain:
• Usually results from
ischemia: a decreased
blood flow.
– Ischemic heart
disease involves a
decreased blood flow
to one or more
portions of the heart.
– If blood flow is not
restored, the tissue
dies

7. Atherosclerosis :
• Usually results from
ischemia: a decreased
blood flow.
– Ischemic heart
disease involves a
decreased blood flow
to one or more
portions of the heart.
– If blood flow is not
restored, the tissue
dies

8. Thrombo-embolism:
• A blood clot floating through blood vessels.
• If clot lodges in coronary artery, acute
myocardial infarction (AMI) results.

9. Coronary Artery Disease (CAD):
• The leading cause of death
• Controllable AMI risk factors:
– Cigarette smoking, high blood
pressure, high cholesterol, high
blood glucose level (diabetes),
lack of exercise, and stress
Coronary artery
• Uncontrollable AMI risk factors:
Older age, family history, and being a male
• Acute coronary syndrome (ACS) is caused by
myocardial ischemia.
• Angina pectoris
• Acute myocardial infarction

10. Angina Pectoris:
• Partial blocking of coronary artery.
• It occurs when the heart’s need for oxygen
exceeds supply.
– Crushing or squeezing pain
– Does not usually lead to death or permanent
heart damage
– Should be taken as a serious warning sign
• Unstable angina
– In response to fewer stimuli than normal
• Stable angina
– Is relieved by rest or nitroglycerin
• Treat angina patients like AMI patients.

11. Acute Myocardial Infraction (AMI):
• AMI pain signals actual death of cells in heart muscle.
– Once dead, cells cannot be revived.
– “Clot-busting” (thrombolytic) drugs or angioplasty within 1 hour
prevent damage.
– Immediate transport is essential.
• Signs and symptoms of AMI
– Weakness, nausea, sweating
– Chest pain that does not change
– Lower jaw, arm, back, abdomen, neck pain
– Irregular heartbeat and syncope (fainting)
– Shortness of breath (dyspnea)
– Pink, frothy sputum
– Sudden death

12. Acute Myocardial Infraction (AMI):
• Three serious consequences of AMI:
– Sudden death
• Resulting from cardiac arrest
– Cardiogenic shock
• Often caused by heart attack
• Heart lacks power to force enough blood through
circulatory system
• Inadequate oxygen to body tissues causes organs
to malfunction
– CHF
• Often occurs a few days following heart attack.

13. Hypertensive emergencies:
– Systolic pressure greater than 160 mm Hg
• Common symptoms
– Sudden, severe headache
– Strong, bounding pulse
– Ringing in the ears
– Nausea and vomiting
– Dizziness
– Warm skin (dry or moist)
– Nosebleed
• If untreated, can lead to stroke or dissecting
aortic aneurysm.
• Transport patients quickly and safely.

14. Aortic Aneurysm:
• A weakness in the wall of the aorta.
– Susceptible to rupture
– Dissecting aneurysm occurs when inner
layers of aorta become
– Primary cause: uncontrolled hypertension
– Signs and symptoms
• Very sudden chest pain
• Comes on full force
• Different blood pressures
– Transport patients quickly and safely.

15. Primary Assessment:
• Scene Safety:
– Ensure scene safety and safe access to the patient.
– Standard precautions should include a minimum of gloves.
– Determine the number of patients.
– ALS should be requested.
– Assess the need for additional resources.
• Mechanism of Injury (MOI)/Nature of Illness (NOI):
– Clues often include report of chest pain, difficulty breathing,
loss of consciousness.
– Obtain clues from dispatch, the scene, patient, bystanders.
Scene Size-up

16. Primary Assessment:
• Observe overall appearance of the patient, age, body position, and
responsiveness.
• Observe work of breathing and circulation.
– Pale skin and cyanosis are indicators of poor perfusion.
• Determine the level of consciousness using the AVPU scale.
– Is the patient calm or anxious? Is the patient able to speak in full sentences?
• Identify immediate threats to life.
• Determine priority of care based on the MOI/NOI.
• If the patient is unconscious, determine whether CPR is needed.
• If the patient has a poor general impression, call for ALS assistance.
• A rapid visual examination will help you identify and manage life threats.
Form a general impression:

17. Primary Assessment:
• Ensure the airway is open, clear, and self-maintained.
• A patient with an altered level of consciousness may need
emergency airway management; consider inserting a properly sized
oropharyngeal airway.
• If difficulty breathing: apply oxygen via nonrebreathing mask; if not
breathing: give 100% oxygen via bag-mask device.
• CHF patients: use CPAP.
Airway and Breathing:

18. Primary Assessment:
• Check skin color, temperature, condition.
Circulation:
Transport decision:
• Transport in a stress-relieving manner.

19. Primary Assessment:
• Investigate the chief complaint (eg, chest pain, difficulty
breathing).
– Ask about recent trauma.
• Obtain a SAMPLE history from a conscious patient.
History taking:
O
P
Q
R
S
T

20. Primary Assessment:
• Focus on cardiac and respiratory systems.
– Circulation
– Respirations.
Physical Examination :
Vital Signs:
• Obtain a complete set of vital signs
• If available, use pulse oximetry

21. Primary Assessment:
• Reassess vital signs every 5 min or when patient’s
condition changes significantly.
• Sudden cardiac arrest is always a risk
Reassessment:
Interventions:
• Give oxygen.
• Assist unconscious patients with breathing.
• Follow local protocol for administration of low-dose
aspirin or prescribed nitroglycerin
• If cardiac arrest occurs, perform CPR

22. Primary Assessment:
• Reassess your interventions.
• Provide rapid patient transport.
Interventions :
Communication and documentation:
• Alert emergency department about patient condition
and estimated time of arrival.
• Report to hospital while en route.
• Document assessment and interventions

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Anas Bahnassi PhD CDM CDE
Clinical Pharmacy VI:
First Aid