Black Belt Development

 

 

CARDIAC CONDITIONS

 

 

CARDIAC CONDITIONS

 

ACUTE MYOCARDIAL INFARCTION

 

An M.I or ‘Heart Attack’ occurs when a portion of heart muscle (Myocardium), is deprived of coronary blood flow long enough that the muscle dies, (undergoes necrosis, or infarcts). Several things can diminish flow through the coronary vessels, especially those already

                                                                                                             

 

 

 

The occlusion of a coronary artery by a blood clot (thrombus), or spasm of a coronary artery or reduction of overall blood flow from any cause, i.e., Shock.

                                         The location and size of the myocardial infarct depends on which coronary artery has blocked and where along its course the blockage occurred. The majority of infarcts involve the left ventricle. If 40% of the heart muscle is damaged due to an infarct, the patient usually does not survive.

 

ACUTE M.I.

 

SIGNS AND SYMPTOMS

Vice-like pain behind the sternum (severe, intense, terrifying)

 

Pain may radiate into neck, jaw, arms, back and abdomen

 

Sudden onset – even at rest

 

Pain may last for hours

 

G.T.N tabs or spray does not ease the pain

 

Patient may appear – Cyanosed, Dyspnoea, Sweating, Cold to touch, Agitated, vomiting, dizziness and feeling of impending death.

 

TREATMENT 

AVPU - ABC – Keep calm, put patient at ease

 

Place patient in semi-recumbent position

 

Loosen all tight clothing, explain what you are doing

 

Administer high concentration of oxygen (100%)

 

Consider Entonox for pain relief

 

Give 300MG of aspirin,  (can also try GTN) (as per JRCALC)

 

Place on heart monitor (consider Paramedic assistance)

 

Check BP,

 

Constant Observation – be prepared to carry out CPR

 

Keep patient warm by covering with blanket

 

Speedy journey to casualty, inform casualty staff of condition of patient prior to your arrival.

 

CARDIAC CONDITIONS

ANGINA PECTORIS

 

Angina Pectoris means ‘Strangled or Choked Chest’ and is the principal symptom of coronary artery disease. Angina is caused by a narrowing of the coronary arteries, reducing the blood flow to the myocardium when demands on it increases,  i.e during exertion or exercise. As a result, the cardiac muscle becomes ischaemic and accumulates lactic acid and carbon dioxide. The concept of Supply on Demand is critical here.

 

 

 

 

CARDIAC CONDITIONS

ANGINA PECTORIS

 

 

SIGNS AND SYMPTOMS

 

Squeezing type pain behind sternum

 

Pain brought on during exertion or exercise

 

Pain lasts for 3 to 10 mins (usually stops after exertion stops)

 

May have no associated symptoms - Pain may radiate into back, arms, neck and jaw Pale, Sweating, Anxiety and Nausea

 

 

TREATMENT

 

Primary survey (AVPU - ABC)

 

Reassure patient and inform them of what you are doing.

 

Administer high concentration of oxygen/consider Entonox

 

Administer GTN  (monitor B.P)

 

Place on heart monitor – constant monitoring en route to hospital

 

Note BP & Spo2 readings (repeat en route to hospital)

 

Loosen all tight clothing,  keep warm

 

Place in semi-recumbent position on trolley-cot

 

 

 

 

Cardiac Tamponade

 

 

 

CARDIAC TAMPONADE

 

Cardiac Tamponade occurs when there is an accumulation of blood in the pericardial sac (see above). Tamponade most commonly results from penetrating injuries, such as stab wounds to the heart, but blunt chest trauma and even acute Myocardial Infarction with cardiac rupture may cause the Myocardium to fill with blood. On rare occasions, overly aggressive CPR has led to this complication.

                          As blood begins to fill the pericardial sac, the function of the heart is progressively compromised. Since the pericardium is not elastic it does not take a great deal of blood to restrict cardiac activity.

 

 

CARDIAC TAMPONADE

 

SIGNS AND SYMPTOMS

 

Pale,

Cool

Sweating

Tachycardia

Muffled heart sounds

Falling blood pressure (narrowed pulse pressure)

Distended neck veins

 

 

 

TREATMENT

 

Check airway

 

When confirmed as cardiac tamponade, speedy evacuation from scene to ambulance – to casualty

 

If conscious, place in semi-recumbent position.

 

Administer high percentage of oxygen (100%)

 

Place on heart monitor

 

Dress any wounds

 

Observe vital signs constantly

 

Prepare for immediate CPR

 

CPR with supplemental oxygen constantly until arrival at casualty

This is a dire emergency, and will led quickly to cardiac arrest if not treated by Pericardiocentesis.

 

 

CONGESTIVE CARDIAC FAILURE

(CCF)

 

Congestive Cardiac Failure (CCF) occurs when the heart is unable, for any reason, to pump powerfully enough or fast enough to empty it’s chambers; as a result, blood backs up into the systemic or pulmonary circuit, or both. Causes; M.I., Myocarditis (inflammation of the heart muscle, Hypertension (high B.P.) and heart valve disease.

 

TYPES

 

                        LEFT VENTRICULAR FAILURE (LVF)

                       RIGHT VENTRICULAR FAILURE (RVF)

 

LEFT VENTRICULAR FAILURE

 

LVF s common in patients who have suffered an AMI (Heart Attack) or by prolonged Hypertension (High Blood Pressure), where the left ventricle is damaged or affected. In both instances, the right side of the heart continues to pump relatively normally and deliver normal volumes of blood to the pulmonary circulation.  But the left side of the heart may no longer be able to pump out the blood being delivered from the lungs, via the 4 pulmonary veins. As a result, blood backs up behind the left ventricle, and the pressure in the left atrium and pulmonary veins increases. As the pulmonary veins become engorged with blood, fluid (serum) is forced out of the capillaries in the lungs and into the alveoli (air sacs). This serum (fluid), then mixes with the air in the alveoli to produce foam (Pulmonary Oedema).

 

SIGNS & SYMPTOMS OF LVF

 

Dyspnoea – especially when patient is lying down (Orthopnoea)

Cyanoses – bluish tinge from the skin, lips, ear lobes, extremities

Wheezing – constricted bronchioles

Foamy Blood-tinged Sputum – Fluid/blood in the Alveoli

Crackles through Stethoscope – Fluid in Lungs

Also - Pallor, Elevated Blood Pressure, Air Hunger, Confusion or Disorientation.

 

 

CONGESTIVE CARDIAC FAILURE

(CCF)

 

TREATMENT OF LVF

 

ABC, Reassurance

 

Administer High Concentration of Oxygen (100%)

 

Place Patient in SITTING POSITION with FEET DANGLING. (this will help with patient’s breathing and reduces venous return to the heart).

 

Place on cardiac Monitor – patients are prone to dysrhythmias

 

Administer GTN (monitor Blood Pressure)

 

I.V. Access (if trained)

 

Keep warm

 

Constant Observation – Never leave patient alone.

 

Speedy journey to A&E, Alert Casualty Department of your arrival (Stand-by)

 

 

 

RIGHT VENTRICULAR FAILURE (RVF)

 

RVF most commonly occurs as a result of left ventricular failure. As blood backs up from the left-hand side of the heart into the lungs, the right-hand side of the heart is unable to keep up with the increased workload, and it to fails.

Right Ventricular Failure may also occur as a result of Pulmonary Embolism (Clot or blockage), or long-standing COPD (Chronic Obstructive Pulmonary Disease), especially chronic bronchitis.

 

 

 

CONGESTIVE CARDIAC FAILURE

(CCF)

 

RIGHT VENTRICULAR FAILURE (RVF) –contiued

 

The development of RVF can actually improve LVF. That is because the failing right-side of the heart can no longer pump as much blood into the lungs. Thus the decrease in output from the right-side of the heart amounts to a decease in preload for the left-side of the heart and may bring about lessening of Pulmonary congestion.

 

 

SIGNS & SYMPTOMS OF RVF

 

Jugular Veins in the neck become engorged & distended – (due to increased pressure).

 

Oedema – in the feet/ankles/ lower legs and in fingers & hands.

 

RVF by itself, is seldom a life-threatening emergency. Usually it develops gradually over days to weeks, and it likewise requires days to weeks to reverse the process by reddening the body of it’s excess salt and water.

 

TREATMENT

 

Make the patient comfortable usually in the semi-recumbent position.

 

Administer Oxygen

 

Place on heart monitor

 

If signs associated with LVF are present treat as outlined .

 

Constant Observation en-route to hospital.