SCFD EMS CIRCULATORY EMERGENCIES Updated 032017 by J

SCFD EMS CIRCULATORY EMERGENCIES Updated 03/2017 by J. GOODREAU

TYPES OF CIRCULATORY EMERGENICES ACUTE MYOCARDIAL INFARCT CONGESTIVE HEART FAILURE SHOCK BLEEDING CARDIAC ARREST

THE HEART HOLLOW ORGAN SUSPENDED IN THORACIC CHEST CAVITY BY THE GREAT VESSELS AND SURROUNDED BY A FLUID FILLED SAC CALLED THE PERICARDIUM MECHANICAL PUMP ELECTRICAL PUMP Heart Rates • BRADYCARDIA: <60 • NORMAL: 60 -100 • TACHYCARDI: A 100 -150 • SVT: >150 • ASYSTOLE: no activity • PEA: electrical no mechanical • VIFB: mechanical/ electrical dysfunction

BLOOD AND PERFUSION Complex thick red fluid made with: • Plasma - sticky yellow fluid that carries blood cells • Nutrients and waste • Compounds needed for clotting • Red Blood Cells carry oxygen • White blood cells – body’s immune system • Platelets – initial formation of clots BLOOD PRESSURE: • THE FORCE OF THE BLOOD ON THE WALLS OF THE ARTERIES • Contraction phase is call systole • Relaxation phase is called diastole • HYPERTENSION >160 SYSTOLIC • HYPOTENSION <90 SYSTOLIC Adequate perfusion means that: • • Oxygen and nutrients are provided to each cell of body Capillary perfusion of tissues The process of transfer of oxygen and nutrients are brought to every cell Carbon dioxide and waste is removed

CIRCULATION LUNGS TISSUE THE SYSTEM

ACUTE MYOCARDIAL INFARCT PAIN IN THE CHEST CAUSED BY CEASED BLOOD FLOW TO AN AREA OF THE HEART PAIN USUALY 20 MINUTES OR GREATER, MAY BE ACUTE ONSET OR GRDUAL INCREASE PLAQUE NARROWS ARTIERS, LIMITS/ STOPS BLOOD SUPPLY. ISCHEMIA = PAIN= DEATH PAIN MAY BE RELEIVED BY ASA, MORPHINE AND OXYGEN MAY CAUSE HEART TO FAIL: CHF ~CARDIOGENIC SHOCK ~ CARDIAC ARREST SIGNS/ SYMPTOMS CHEST PAIN ~ CENTER (SUBSTERNAL) OR LEFT SIDED. MAY RADIAITE TO ARM(S), JAW, NECK, BACK FEELS LIKE GAS/ INDIGESTION IN EPIGASTRIC AREA SOB, N/V, DIZZINESS, COOL/CLAMMY SKIN, ANXIETY, NEAR SYNCOPE PAIN WONT CHANGE WITH MOVEMENT/ INSPIRATION OR PALPATION FEMALES (ESPECIALY ELDERLY) MAY PRESENT WITH ATYPICAL SIGNS ~ I. E. COUGH/ SORE ARM/ ABD PAIN, SWEATING

CHEST PAIN PROTOCOL C-10 PRIORITIES: ABCs Degree of distress? Shock? Obtain Sample History and Collect Medications. Chest Pain Suspicious of Cardiac Origin (Substernal pain, discomfort or tightness radiating to jaw, left shoulder or arm, nausea, diaphoresis, dyspnea, anxiety. ) Baseline Vitals: BP, RR, PR, room air spo 2%, skin signs, lung sounds Administer 02 ~ adjust to maintain spo 2 >94% Assist pt taking prescribed nitro medication (don’t administered if BP <110 systolic, expired or pt has taken Viagra) Pt may take up to three total doses prior to ALS arrival Treat shock as indicated: keep warm, shock position with legs elevated (modified with head up if crackles in lungs are present), reassess vitals Assist ALS with 12 -lead set-up and spike IV bag as needed

CONGESTIVE HEART FAILURE PUMP FAILURE – LEFT VENTRICLE ENLARGES AND HEART MUSCLE IS TOO WEAK TO ADEQUATLEY PUMP BLOOD THROUGH SYSTEMIC CIRCULATION. MAY LEAD TO CARDIOGENIC SHOCK. SIGNS/ SYMPTOMS LEFT SIDE SOB , COUGH (PINK FROTHY SPUTUM) CRACKLES AT BASES SECONDARY TO FLUID BUILD UP ORTHOPNEA, TACHYPNEA RIGHT SIDE (BECAUSE OF LEFT SIDE FAILURE) JVD, PERIPHERAL EDEMA (COMMONLY AT FEET) FATIGUE, LOSS OF APPATITE, INCREASED URINATION TACHYCARDIA AND HYPOTENSION

ACUTE PULMONARY EDEMA PROTOCOL R-7 PRIORITIES: ABCs Degree of distress? Shock? RR >20? Inadequate Ventilation? Cyanosis? Accessory Muscle Use? Tripod Position? Obtain Sample History and Collect Medications. Acute Pulmonary Edema (Acute onset of respiratory difficulty; may have history of cardiac, rales, occasional wheezes, spo 2 >94%) Baseline Vitals: BP, RR, PR, room air spo 2%, skin signs, lung sounds Administer 02 ~ adjust to maintain spo 2 >94%. Assist Ventilations with BVM if in severe distress with spo 2 <94% with crackles in lungs present not relieved with Hi Flow 02 and/or pt lethargic or unresponsive. Treat shock as indicated: keep warm, shock position with legs elevated (modified with head up if crackles in lungs are present), reassess vitals Assist ALS with 12 -lead, CPAP set-up and spike IV bag as needed

SHOCK INABLITY TO ADEQUATELY SUPPLY BLOOD TO THE BODY. TACHYCARDIA, HYPERTENSION, WEAKNESS, ANXIETY, SWEATING, ALOC, WEAK RADIAL PULSE, PALE/ COOL/CLAMMY SKIN FOUR FORMS: CARDIOGENIC: FAILURE OF THE HEART TO PUMP EFFECTIVLEY • MYOCARDIAL INFARCTION • CONGESTIVE HEART FAILURE • HYPOVOLEMIC: LACK OF SUFFICENT BLOOD OR FLUIDS IN CIRCULATION • INTERNAL/ EXTERNAL HEMORRHAGE • VOMITING/ DIARRHEA/ DEHYDRATION • OBSTRUCTIVE: IMPAIRED BLOOD FLOW • CARDIAC TAMPONADE • TENSION PENUMOTHORA • DISTRIBUTIVE: DILATION OF VESSELS OR ENLARGMENT OF VASCULAR COMPONETS • SEPTIC (INFECTION) • ANAPHYLAXIS (ALLERGIC REACTION) • NEUROGENIC (SPINAL CORD INJURY)

SHOCK BODY HOLDS 4, 700 ML OF BLOOD PULSE POINTS: RADIAL – BP ~ 90 SYSTOLIC BRACHIAL – BP ~ >80 SYSTOLIC FEMORAL – BP ~ >50 SYSTOLIC

BLEEDING CONTROL • EXTREMITY BLEEDING • HOLD DIRECT PRESSURE. IF NO CHANGE, APPLY TORNIQUET PROXIMAL TO INJRUY SITE • CHEST/ ABD BLEEDING • APPLY TRAUMA DRESSING AND DIRECT PRESSURE TO INJURY SITE. IF NO CHANGE, DON’T REMOVE DRESSING, APPLY ANOTHER BANDAGE ONTOP OF CURRENT ONE. • EPISTAXIS • SIT PT FORWARD, HAVE THEM PINCH NOSTRIL JUST BELOW BRIDE OF NOSE FOR 10 -15 MINUTES. MAY APPLY COLD PACL TO EXTERIOR OF NOSE • *IF SUSPECTED SKULL FX DO NOT ATTEMPT STOP BLEEDING MAY INCREASE INTRACRANIAL PRESSURE. ** • VAGINAL • APPLY TRAUMA DRESSING OR PADS TO OUTSIDE OF VAGINA TO ABSORB BLOOD. DON’T APPLY DIRECT PRESSURE. • ELEVATE LEGS • POST-BIRTH, GIVE FUNDAL MASSAGE

CARDIAC ARREST C-3 HEART HAS FAILED AS AN EFFICIANT PUMP CAUSING CEASED BLOOD FLOW THROUGH SYSTEMIC CIRCULATION. PRIORITIES: ABCs. Initiate high quality CPR per most current ECC guidelines. Perform 2 minutes of continuous CPR prior to reassessing for pulse. Obtain age, sex and weight Attempt to estimate time patient last seen breathing, down time with NO CPR DETERMINE NO OBVIOUS SIGNS OF DEATH AND ABSENCE OF PALPABLE CAROTID PULSE (WITHIN 10 SECONDS) AND NO BRETAHING IS DETERMINED. MOVED PT TO FLAT/ HARD SURFACE BEGIN CPR 100/MIN , INSERT OPA WITH NRB AT 15 LPM AND CLEAR AIRWAY WITH SUCTION AS NEEDED ATTACHED AND ALLOW TO ANALYZE, FOLLOW DIRECTIONS. ENSURE ALL CREW ARE CLEAR PRIOR TO SHOCK AFTER TWO CYCLES OF CPR (4 MINUTES) MAY BEGAN TO USE 30: 2 COMPRESSION WITH BVM IF NO ADVANCED AIRWAY ESTABLSIHED UPON ARRIVAL OF MEDIC, ASSIST PARAMEDIC AS NEEDED CONSIDER: Victims suffering from hypothermia often look dead when they are still salvageable; All near drowning victims should be resuscitated. People who have been submerged in cold water for a long time may be salvageable; DNR – Follow Solano County Policy #6130.

END BREAK INTO GROUPS FOR SKILLS STATIONS