EMS 280 Lesson B Boone County Fire Protec/on District EMS Educa/on - PowerPoint PPT Presentation

EMS 280 Lesson B Boone County Fire Protec/on District EMS Educa/on

Lesson B Overview • Chest Pain due to Myocardial Infarction • Chest Pain due to Pulmonary Embolus Boone County Fire Protec/on District EMS Educa/on

Myocardial Infarction • Compromised blood supply to myocardium due to an obstructed coronary artery. • Obstruction can be one or more of the following: • Clot • Artery clogged by plaque • Artery clamped down (vasospasm) Boone County Fire Protec/on District EMS Educa/on

Signs / Symptoms • Substernal pressure / heaviness • Radiating pain to arm / jaw possibly • Nausea- (vomiting possibly) • Sweaty (diaphoresis possibly) • Shortness of breath • Weak / Dizzy Boone County Fire Protec/on District EMS Educa/on

Atypical (Common) • Some groups of patients are less likely to have the “typical” pain presentation: • Elderly • Women • Diabetics Boone County Fire Protec/on District EMS Educa/on

12-Lead EKG • May show nothing abnormal • May show STE • May show STD • Serial EKGs are a great plan Boone County Fire Protec/on District EMS Educa/on

Location • EKG changes may suggest which artery or arteries are involved and therefore which ventricular wall(s) are impacted. • More than one wall or both ventricles may be involved—should be concerning. Boone County Fire Protec/on District EMS Educa/on

Treatable • Ischemic tissue can be salvaged • Injured tissue can be salvaged • Time is heart muscle • Infarcted tissue is not salvageable Boone County Fire Protec/on District EMS Educa/on

Complications • Cardiac Arrest!!! (one of the “T’s”) • Compromised BP due to decreased cardiac output related to reduced ventricular contractility. • CHF from poorly functioning pump Boone County Fire Protec/on District EMS Educa/on

Hospital TX • Angiogram • Angioplasty • Stent placement • Thrombolytics • CABG Boone County Fire Protec/on District EMS Educa/on

Field TX • ASA to limit further clot formation or extension of the existing clot. (ASA does NOT bust clots) • NTG when safe to use—to reduce workload on the left ventricle which might reduce its oxygen demand downward to match the newly reduced oxygen supply. Boone County Fire Protec/on District EMS Educa/on

More Field TX • Nausea can be managed with ondansetron etc. • Pain control is important as well—probably Fentanyl is best although Morphine is an option. • Reduction in pain = reduction in HR in theory which results in less myocardial oxygen demand Boone County Fire Protec/on District EMS Educa/on

Pulmonary Embolus • Blood clot lodged in pulmonary artery or pulmonary arterioles. • Reduced lung perfusion • Clot probably formed elsewhere (thrombus— legs typically) and traveled to lungs (embolus) • May resolve on own—may lead to cardiac arrest (one of the “T’s”). Boone County Fire Protec/on District EMS Educa/on

PE Pain • Sudden onset • Sharp (not dull / heavy / squeezing like MI) • Can point to one spot (not general area like MI) • Pleuritic (worse with deep breath) Boone County Fire Protec/on District EMS Educa/on

EKG for PE • For now, consider that STE in numerous leads can be the result but… • …we don’t make a field dx of PE based on EKG—just realize that not all STE is an MI. Boone County Fire Protec/on District EMS Educa/on

Ax of PE • Lung Sounds DO NOT CHANGE with PE • Mostly based on History of Present Illness (HPI) • Depending on underlying pulmonary status and the location of the embolus, may or may not be acutely hypoxic / dyspneic. Boone County Fire Protec/on District EMS Educa/on

Tx of PE • Definitive care is not done in the field. • Oxygen is an obvious choice. • Maybe PEEP (via CPAP) to recruit all available lung tissue into action. • Urgent transport (take help in case pt. codes) • IV fluid if needed to support the preload starved right ventricle. Boone County Fire Protec/on District EMS Educa/on

EMS 280 LAB B Prep Boone County Fire Protec/on District EMS Educa/on

Lesson B Main Points • Use HPI and EKG to assess but…Transport urgently while assessing / treating • ASA for clot prevention • NTG when safe for reduction in LV workload for MI but…not good for PE (RV needs preload) • Pain and nausea control are good • O2 per the usual protocol for either Boone County Fire Protec/on District EMS Educa/on

Scenario 1 56 M with substernal chest pressure for 1 • hour with mild shortness of breath, mild • diaphoresis, nausea but no vomiting non-radiating pain, onset at rest, last meal • 3 hours ago (no “indigestion”) no history of similar, no known cardiac • history, no pertinent other history STEMI on 12-lead • Boone County Fire Protec/on District EMS Educa/on

Scenario 2 56 M with sharp, right-sided chest pain • pleuritic, can point with one finger, • moderate shortness of breath sudden onset at rest, last meal 3 hours ago • (no “indigestion”) no history of similar, no known cardiac • history, no pertinent other history no STEMI on 12-lead • Boone County Fire Protec/on District EMS Educa/on