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.
- Oxygen at 15 lpm via a nonrebreather mask
- 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.
- 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.