Cardiovascular Emergencies for EMT-P (2) Cardiology and Resuscitation

What are the three presentations of angina-type pain patients?

Angina
STEMI
NSTEMI

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Define:

fibrinolysis

The process of breaking down and removing blood clots in the body.

It involves the enzyme plasmin which dissolves fibrin, the protein that forms clots.

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Define:

PCI

Percutaneous Coronary Intervention

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Interpret what is going on in this 12-Lead.

Inferior STEMI

Elevation in II, III, aVF.
Reciprocal Changes in I and aVL.
Elevation is >1 mm in two contiguous leads.

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What is the treatment for inferior STEMI?

Determine if Right Ventricular Involvement is present

Immediate medical care, administer:

Oxygen
Aspirin
Nitroglycerin (do not give if RVI without volume loading due to risk of hypotension)
Morphine/Fentanyl

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Interpret what is going on in this 12-Lead.

Anterior STEMI

Elevation in V3, V4.
Reciprocal Changes in Posterior Leads if obtained.
Elevation is >1mm in two contiguous leads.

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Interpret what is going on in this 12-Lead.

Septal STEMI

Elevation in V1, V2.
Reciprocal changes in lateral leads.
Elevation is >1 mm in two contiguous leads.

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Interpret what is going on in this 12-Lead.

Posterior STEMI

Depression in anterior leads (posterior 12-lead will reveal elevation).

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What is a benign early repolarization?

A fishhook appearance at the J-point with a concave ST-segment.

It is often mistaken for an ST Elevation.
Reciprocal changes are never present.

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What pathology is in the 12-Lead?

Pericarditis

Diffuse ST segment elevation throughout.
Results from a bacterial, viral or fungal infection.

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What pathology is in this 12-Lead?

Pulmonary Embolism

S1Q3T3 Present
Deep S Wave Lead I
Deep Q Wave Lead III
T wave inversion Lead III
Thorough history and physical exam are essential

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What changes are seen on a 12-Lead when a patient has Hyperkalemia?

tall, peaked T waves
P waves can be flat

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What changes are seen on a 12-Lead when a patient has Hypokalemia?

flattened or absent T waves (U-wave)

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What changes are seen on a 12-Lead when a patient has Hypocalcemia?

widening of QT interval

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What changes are seen on a 12-Lead when a patient has Hypercalcemia?

shortened QT interval

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How long is the QT interval in long QT syndrome?

Males: >450 ms
Females: >470 ms

Risk increases >500 ms.

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What are the two placements for defibrillation pads?

Anterior-Lateral
Anterior-Posterior

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What rhythm(s) is defibrillation used for?

Pulseless Rhythms

Ventricular Tachycardia (w/o Pulse)
Ventricular Fibrillation

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What rhythm(s) is Synchronized Cardioversion used for?

Unstable Tachydysrhythmias

SVT
A-fib RVR
V-tach

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What energy level (in joules) is used for adult defibrillation?

50–360 J, titrated upward

Common starting energy: 50–100 J

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What energy level (in joules) are used for adult synchronized cardioversion?

Study These Flashcards

50-100-200-300-360

What two types of capture should you assess during transcutaneous pacing?

Study These Flashcards

electrical and mechanical

What are some treatments for adult symptomatic bradycardia?

Study These Flashcards

Atropine 0.5-1mg (New ACLS indicates 1mg)
TCP (First Line if 2nd Degree II or 3rd Degree)
Dopamine (2-20mcg/kg/min)
Epinephrine (2-10mcg/min)

What are the treatments for adult SVT?

Study These Flashcards

Vagal Maneuvers
Adenosine (6mg, 12mg)
Synchronized Cardioversion

What are the treatments of **V-Tach** (w/ a pulse)? ## Footnote Hint: unstable vs. stable

**Stable**: * **Amiodarone**: 150 mg in 100 mL D5W over 10 minutes or **Lidocaine** 1-1.5mg/kg (MAX 3mg/kg) **Unstable**: * Synchronized Cardioversion 50-100-200-300-360

What is the treatment for **Asystole and PEA**?

* Epinephrine: 1mg * CPR

What are the American Heart Association's **termination criteria** for conducting **CPR** in the field?

1. No witnessed collapse 2. No bystander CPR 3. No ROSC after ALS care 4. No shocks administered

What is the leading cause of **death** in the U.S.?

Coronary Artery Disease

What is the cause of **Prinzmental Angina**?

Coronary Artery Vasospasm ## Footnote It is characterized by chest pain at rest.

# Define: Unstable Angina

It is identified by changes in **duration, severity** and **frequency** of chest pain felt by the patient.

# Fill in the blanks: The therapy in which a clot is dissolved is called \_\_\_\_\_\_ \_\_\_\_\_\_.

fibrinolytic therapy

# Define: Congestive Heart Failure

The heart is **unable** to properly empty its chambers.

# Left or right. **Pulmonary edema** is a result of ____ sided heart failure **Peripheral edema** is a result of ____ sided heart failure

left right

# Treatment: Left Sided Heart Failure

* Oxygen * CPAP * sit patient up while feet is dangling * Nitroglycerine .4mg * Lasix 20-40mg * Morphine 3mg * Dopamine 2-20mcg/kg/min (low BP)

# Define: cardiac tamponade

Fluid accumulates in the pericardium.

What are the **signs/symptoms** of **cardiac tamponade**?

* **Dyspnea** * **Weakness** * **Chest Pain** * **Beck's Triad**

What are the clinical signs of **Beck's triad**?

1. Muffled heart sounds 2. Jugular venous distention 3. Narrowing pulse pressure

# Treatment: cardiac tamponade

pericardiocentesis

# Define: aortic aneurysm

Abnormal bulging of aortic vessel from a weak spot in the aortic wall.

What are the **signs/symptoms** of **aortic aneurysm**?

* sudden substernal “pressure” * weakness * sweating

What are the signs/symptoms of **ruptured aortic aneurysm**?

* Sudden lower back pain. * Pain radiating into thigh and groin. * Possible palpable mass in abdomen.

# Treatment: ruptured aortic aneurysm

* Administer oxygen. * IV/consider crystalloid bolus if px is hypotensive. * Keep the patient calm.

What is considered a **hypertensive emergency**?

A sudden elevation of BP that causes **end-organ damage**.

What are the **signs/symptoms** of **hypertensive end-organ damage**?

* blurred vision * headache * epistaxis * tinnitus

# Fill in the blank: A MAP \> \_\_\_\_ mmHg breaches the blood brain barrier. | Mean Arterial Pressure

150

# Define: hypertensive encephalopathy

An **acute neurological syndrome** resulting from a sudden and severe elevation in blood pressure. ## Footnote BP \>200/130 mmHg MAP \>150 mmHg

# Treatment: hypertensive emergency

* 12-Lead * Labetalol 20mg slow IVP * Labetalol 2 mg/min infusion * Nitroglycerine .4mg SL

# Define: endocarditis

Inflammation of the **endocardium**.

# Define: rheumatic fever

**Inflammatory response** to streptococcal bacteria. ## Footnote It can cause stenosis of the mitral valve.

# Define: scarlet fever

An **infection** caused by *Streptococcus pyogenes* ## Footnote group A Streptococcus

What are the **signs/symptoms** of **scarlet fever**?

* sore throat * fever * rash * *“strawberry”* tongue

Cardiovascular Emergencies Flashcards

Learn about cardiovascular emergencies and their treatments (51 cards)