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Signs and symptoms

  • Blood pressure: normally it's 120/80 (higher in the elderly and lower in children). Anything over 140 systolic is hypertension, and under 90 systolic is considered low blood pressure.
  • Pulse: normally, it's strong and regular. Weak and thready pulse indicates shock.
  • Skin: normal skin should be pink, warm and dray. Shock or hypoperfusion is indicated by pale, cool and clammy skin.
  • Chest discomfort or pain that radiates to the shoulders, back and jaw.
  • Unresponsive, not breathing, and no pulse: cardiac arrest - begin CPR.
  • Sluggish pupils indicate hypoxia and poor perfusion.
  • Jugular vein distension indicates congestive heart failure or cardiac tamponade.
  • Crackles when auscultating for breath sounds indicate fluid build up in the lungs, which may have resulted from left ventricular heart failure.
  • Peripheral and presacral edema suggests heart failure.
  • Dyspnea and sudden onset of sweating.
  • Anxiety, feeling of impending doom.
  • Nausea and/or vomiting.

Treatment

  • Oxygen at 15 lpm via a nonrebreather mask
  • PPV
  • Calm the patient to reduce anxiety.
  • Assist patient with administering a dose (0.3-0.4 mg) of prescribed nitroglycerin sublingually. Reassess blood pressure after 2 minutes, and administer another dose after 3-5 minutes if needed, for a maximum of 3 doses.
    • Do not administer if blood pressure is below 90 or drops over 30 over the baseline.
    • Do not administer to extreme bradycardia (<50) or tachycardia (>100).
    • Do not administer for those on drugs for erectile dysfunction within 24 hours.
    • Do not administer if you suspect head injury.
    • Do not administer for infants and children.
  • 160-325 mg of aspirin, nonenteric and ask the patient to chew it.
    • Do not administer if patient is allergic.
    • Follow medical direction and local protocols.
  • Call ALS backup.
  • CPR for cardiac arrest patients (no breathing, no pulse).

Medical conditions and mechanisms

  • Angina pectoris: pain in the chest, caused by inadequate oxygen to the heart.
    • Chest pain, especially during exertion, that radiates to neck, jaw, arms, back, and shoulders.
    • General discomfort, anxiety, and nausea / vomiting.
    • Relief of pain if physical activity is stopped.
  • Acute myocardial infarction: a portion of the heart muscle dies due to lack of oxygen.
    • Chest pain and discomfort, similar to angina, that radiates to the neck, jaw, arms, back, and shoulders.
    • Lasts longer than angina and the pain and discomfort is not able to be relieved.
  • Heart failure: inadequate pumping of the heart.
    • Left ventricle failure: pulmonary edema, because blood is backing into the lungs.
    • Right ventricle failure: peripheral edema, jugular vein distention, and liver enlargement, because blood is backing into the venous circulation.
    • Congestive heart failure: heart failure that causes edema.

Terms

  • Nonenteric: not coated.
  • Myocardial ischemia: cardiac cell hypoxia. Inadequate oxygen to the heart cells.
  • Chain of survival: a term by the American Heart Association.
    • Early access.
    • Early CPR.
    • Early defibrillation.
    • Early ALS.
  • AED: Automated external defibrillators. Used to shock the heart back to normal.
    • Only shock when rhythm analysis indicate that shock is advised.
    • For patients with artificial pacemakers, do not place electrodes over where the pacemaker is implanted.
  • Electrocardiogram (ECG): graphical plot of the heart's electrical activity.
    • P: corresponds to atrial contraction.
    • QRS: corresponds to ventricular contraction.
    • T: corresponds to relaxation.
  • Ventricular fibrillation (V-Fib): chaotic ECG rhythm. Random twitches of the heart that does not pump any blood. This occurs during a heart attack. V-Fib is the only rhythm where shock is advised for the AED.
  • Ventricular tachycardia (V-Tach): Rapid ECG rhythm. Very fast, but inefficient heart beats. Can degenerate into V-Fib.
  • Asystole: no ECG activity of the heart at all.
  • Pulseless electrical activity: the heart has an organized ECG electrical rhythm, but either the muscles are not pumping or there's no blood left to pump.
  • Arteriosclerosis: Arteries become stiff and less elastic.
  • Atherosclerosis: fatty substances deposited on the inside of arteries.
  • Coronary artery disease (CAD): atherosclerosis of the coronary arteries.
  • Acute coronary syndrome (ACS): obstruction of coronary arteries with a sudden onset of symptoms. Includes unstable angina and myocardial infarction.
  • Fibrinolytics: drugs that dissolve early clots.