Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 14Cardiac and Respiratory

Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

Cardiac Emergencies

Respiratory Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Patient assessment

First responder care

Specific cardiac conditions

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Occur from abnormal heart rhythms

Interruption of oxygen to the heart– Coronary artery disease

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Coronary artery disease– Blood vessels feeding the heart are narrowed– Artery continues to narrow, reducing oxygen

supply– Complete blockage results in a heart attack– Lack of oxygen causes chest pain

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Patient assessment– Chest pain or discomfort that may radiate– Difficulty breathing– Unusual heart beat– Sweating– Feeling of impending doom

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Patient assessment – O: Onset– P: Provocation– Q: Quality– R: Region

– R: Radiation– R: Relief– S: Severity– T: Time

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

First responder care– Place patient in a position of comfort– Ensure adequate breathing– Administer oxygen– Loosen tight clothing– Continually monitor the patient

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Angina pectoris– Acute myocardial infarction

Treatment is the same

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Angina pectoris

Chest pain or discomfort when the heart does not get enough oxygen

Usually associated with physical exertion

Palpitations

Skin changes

Difficulty breathing

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Angina pectoris

Reversible

Generally relieved with rest

Patient may take nitroglycerin

May result in heart attack if untreated

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Nitroglycerin

Can lower blood pressure

Should not take with systolic blood pressure < 100 mmHg

Can be taken up to 3 times in 5-minute intervals

Do not administer without approval of medical director

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Acute myocardial infarction

Results in death of heart tissue

Four serious consequencesSudden death

Shock

Congestive heart failure

Cardiac dysrhythmias

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies Specific cardiac conditions– Acute myocardial infarction

Signs and symptomsChest pain or discomfortSkin changesDifficulty breathingAbnormal heartbeats

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Emergencies

Specific cardiac conditions– Acute myocardial infarction

AspirinDose is 2–4 chewable baby aspirin

Confirm that patient is not allergic

Do not administer if patient is on blood thinners

Only administer if patient is conscious

Only administer with approval of medical director

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Patient assessment

First Responder care

Specific respiratory conditions

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Patient assessment– Signs and symptoms

Inability to speak full sentences

Abnormal respirations

Accessory muscle usage

Tripod position

Skin changes

Altered mental status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

First Responder care– Ensure adequate breathing– Apply oxygen– Place patient in position of comfort– Comfort and reassure the patient

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– COPD – Asthma– Pneumonia– Acute pulmonary edema– Hyperventilation

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Chronic obstructive pulmonary disease

(COPD)Emphysema

Alveoli loose elasticity

Chronic bronchitisInflammation, edema, and excessive mucus

Productive cough for 3 months, for 2 consecutive years

May have a hypoxic drive

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Chronic obstructive

pulmonary diseaseSigns and symptoms

Shortness of breath

Tripod position

Bulging neck veins

Cyanosis

Pursed lip breathing

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Asthma

Attacks vary in duration, intensity, and frequency

Airway obstruction caused by:Bronchospasm

Swelling of bronchial walls

Plugging of bronchi by thick mucus

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Asthma

Tripod position

High-pitched wheezing

Minimal air movement

Rapid, shallow respirations

Inability to speak full sentences

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Asthma

Status asthmaticusLife-threatening, prolonged, asthma attack

Bronchi may be constricted, preventing wheezing

Exhaustion

Pursed lip breathing

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Asthma

TreatmentPrescribed inhaler

Dilates air passagesBe sure medication is indicated and allowedAs the patient takes a deep breath, activate the inhalerHave patient hold his or her breathReassess

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Pneumonia

Lung infection with fluid- or pus-filled alveoli

Caused by bacteria, virus, or aspirated materials

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Pneumonia

Signs and symptomsChest pain made worse with breathing

Respiratory distress

Productive cough, possibly discolored

Fever, chills, and hot, dry skin

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Acute pulmonary edema

Caused by damage to the heart or lungs

Fluid builds up in the alveoli

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Acute pulmonary edema

Signs and symptomsShortness of breath

Rapid, labored breathing

Pink, frothy sputum

Bulging neck veins

Rapid pulse with cool, clammy skin

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Hyperventilation

Breathing too fast

Usually associated with anxiety

Exhales too much carbon dioxide

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Respiratory Emergencies

Specific respiratory conditions– Hyperventilation

Signs and symptomsCarpal pedal spasms

Blurred vision

Chest pain

Syncope

Numbness and tingling

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Regardless of the cause, treat all patients with chest pain the sameBe prepared for the patient experiencing chest pain to become unresponsiveNever withhold oxygen from a patient complaining of difficulty breathingOnly administer medications with the prior approval of your medical director