Ch. 7 & 8 - Circulation Emergencies & Shock

Circulatory emergencies are those that affect the heart or vascular system. While a circulatory emergency can often appear as a sudden, dramatic emergency, the underlying cause may be a condition that has been developing over a period of years or even decades. Because circulatory emergencies can deprive vital organs of oxygen, they are often immediately life-threatening.

When vital organs such as the heart, lungs, brain, and kidneys do not receive oxygen-rich blood, their ability to function effectively is compromised. This triggers a series of responses that results in a combination of signs and symptoms known as shock. These responses are the body’s attempts to maintain adequate blood flow to the vital organs and prevent them from shutting down.

Transcript

1. Ch 7 – Pg 141
2. Angina Oxygen demands of the heart exceed the available supply of oxygen-rich blood. This causes intermittent CP or pressure that is exacerbated by exertion and stress. • Can spread to neck, jaw and arms • Usually lasts <10min • Patients will often have prescribed medication (nitroglycerin) • Ask if patient has taken any erectile dysfunction medication • Viagra or Levitra 24hrs • Cialis 48hrs • Non-RTC if patient improves with medication Ch 7 – Pg 142-143
3. Myocardial Infarction (MI) An arterial blockage causing interruption of oxygen supply to myocardium • Hypoxic myocardium cells begin to die This may interrupt the heart’s electrical system • Arrhythmia’s • Cardiac arrest Ch 7 – Pg 143
4. S&S of a Myocardial Infarction • The most important step in providing care is early recognition • All MI signs may not be present • If unsure whether the patient is experiencing angina or an MI, treat for an MI • Rapid Transport Category Ch 7 – Pg 143-145
5. Care for Myocardial Infarctions • Keep patient calm and comfortable • Provide Acetylsalicylic Acid (ASA) • 160-325mg • Acetaminophen and Ibuprofen do not have the same effect • Contraindicated for patients with asthma or bleeding conditions • May assist with nitroglycerin (6 Rights) Ch 7 – Pg 145-146
6. Cerebrovascular Accident (Stroke) • Disruption of blood flow to a part of the brain • Tissue becomes hypoxic and suffers damage • Transient Ischemic Attack (mini- stroke) • Resolves quickly without permanent tissue damage • Significantly increased risk of having CVA • Signs and symptoms essentially identical to CVA Ch 7 – Pg 157
7. S&S of CVA and TIA F A S T Ch 7 – Pg 158-159
8. FAST Test: Face – smile (was it equal on both sides of the of the mouth?) Arms – raise and hold both arms (where both arms raised equally?) Speech – say a phrase (was it slurred, garbled, not understandable) Time – when did the symptoms start (when was the last time they were known to be normal?) • Sudden weakness and/or numbness on one side of body • Difficulty speaking or understanding speech • Blurred or dimmed vision • Pupils of unequal size • Sudden, severe headache • Dizziness • Confusion • Changes in mood • Ringing in the ears • Changes in responsiveness • Loss of bowel or bladder control S&S of CVA and TIA Ch 7 – Pg 158-159
9. Care for CVA • Rapid Transport Category • Time is crucial • It is important to include the time of symptom onset • Do not give anything to eat or drink • Position so you can clear airway easily • Recovery position: affected side of the body downwards • Comfort and reassure the patient Ch 7 – Pg 159
10. Cardiac Arrest Cardiac Arrest When the heart stops circulating blood. S&S • Unresponsive • No pulse • Not breathing or agonal respirations Rapid Transport Category Ch 7 – Pg 147-148
11. Cardiopulmonary Resuscitation (CPR) To artificially replicate the function of the heart and lungs. Interrupted only to perform critical interventions or obvious changes in the patient’s condition. Adult (8+y/o) Child (1-8y/o) Infant (1-12m/o) Neonate (0-1m/o) Hand Position Two hands on the sternum One or two hands on the sternum Two fingers on the sternum OR encircling method Compression Depth 5cm (~2 in.) 1/3rd of the chest depth One Responder Compressions Continuous chest compressions Two+ Responder Compression Ratio 30:2 15:2 3:1 Compression Rate 100-120 compressions/min (~2/s)
12. Cardiopulmonary Resuscitation (CPR) Ch 7 – Pg 149-154, 162
13. • 30 chest compressions • Look inside the mouth • If you see an object, carefully remove it • Attempt to ventilate • If breath goes in, give a second breath • If breath does NOT go in, reposition the head Quick recap from Ch 6 • If breath continues to NOT go in, resume 30 chest compressions • Tilting the patient’s head back farther is only necessary on your initial attempt • Attempt only one breath on consecutive cycles Ch 6 – Pg 110 Complete Airway Obstruction – UNRESPONSIVE Adult, Child, Infant
14. Using a Defibrillator (AED) A device used to analyze the heart’s rhythm and deliver an electric shock. Only effective on shockable rhythms: • Ventricular tachycardia • Ventricular fibrillation Non-Shockable rhythms: • Normal sinus rhythm • Asystole Deploy immediately in case of cardiac arrest. One responder begins CPR while the second prepares the AED. Ch 7 – Pg 154
15. Defibrillation Precautions • Do not use: • In a moving vehicle • In the presence of flammable materials • If someone is touching the patient • Special situations: • Pregnant person (prop under right hip) • Transdermal medication patches • Implanted pacemakers / cardioverters • Body jewelry • Trauma to the torso • Patients in water • Rain or snow • Child/Infant (small chest) • Neonatal Ch 7 – Pg 155-156
16. Using a Defibrillator Ch 7 – Pg 162
17. Post-Cardiac Arrest Care BLS Field Guide Pg 50
18. Post-Cardiac Arrest Care Return of Spontaneous Circulation (ROSC) • Monitor closely: check pulse regularly • Be prepared to resume CPR: keep pads attached • Return of pulse may not accompanied by resumption of respirations • Provide assisted ventilations • High-flow oxygen Ch 7 – Pg 157 (Taka – Bondi Rescue)
19. Ch 8 – Pg 163
20. 3 Causes of Shock Ch 8 – Pg 164 1. The heart is not functioning effectively 2. The quantity of blood circulating in the body is too low 3. The blood vessels are unable to constrict effectively
21. Types of Shock Ch 8 – Pg 164
22. Stages of Shock Compensated Shock • Heart beats faster, eventually weaker • Increased workload on heart increases its oxygen demand, therefore, respiration becomes faster • Blood vessels in arms and legs constrict to maintain blood pressure, therefore skin becomes pale and cool Ch 8 – Pg 165-166
23. Stages of Shock Decompensated Shock • Hypoxia and cellular death begins in the extremities. The brain responds by restoring blood flow to arms and legs. • This causes vital organs to lack adequate oxygen, therefore the heart beats faster Irreversible Shock • Without oxygen, vital organs stop functioning: brain hypoxia leads to restlessness, drowsiness and eventually unresponsiveness; pulse becomes chaotic and eventually cardiac arrest ensues, causing cessation of respiration Ch 8 – Pg 165-166
24. Shock Care • Early recognition and care for serious injuries and conditions • Monitor ABC’s • Help patient maintain normal body temperature • Patient positioning and comfort • Avoid giving anything to eat or drink • Rapid Transport Category