1)EMERGENCY CV 6 YEAR.ppt

8/9/2019 1)EMERGENCY CV 6 YEAR.ppt

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CARDIOVASCULAREMERGENCIES


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Cardiovascular Disease

63,400,000 Americans have one or63,400,000 Americans have one or

more forms of heart or blood vesselmore forms of heart or blood vessel

diseasedisease

50% of all deaths are cardiovascular50% of all deaths are cardiovascular

diseasedisease


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AAcutecute MMocardialocardial !!nfarction "#eartnfarction "#eart

Attac$ & leadin' cause of death in ()*)Attac$ & leadin' cause of death in ()*) 1)5 million Americans +ill have AM!s1)5 million Americans +ill have AM!s

this ear this ear

-f these )5 million +ill die.-f these )5 million +ill die.

350,000 +ill die in first t+o hours.350,000 +ill die in first t+o hours.


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/emle Colle'e M* ro'ram 4


is$ actorsMaor (ncontrollableMaor (ncontrollable

A'eA'e*e*e

aceace

#eredit#eredit


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is$ actorsMaor ControllableMaor Controllable

*mo$in'*mo$in'#i'h 7#i'h 7

#i'h blood cholesterol#i'h blood cholesterol

DiabetesDiabetes


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is$ actorsMinor ControllableMinor Controllable

-besit-besit8ac$ of eercise8ac$ of eercise

*tress*tress

ersonalitersonalit


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Control ris$ factors & decreaseControl ris$ factors & decreaseCoronar Arter Disease and AcuteCoronar Arter Disease and Acute

Mocardial !nfarctionMocardial !nfarction


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/emle Colle'e M* ro'ram :

Coronar Arter Disease

Mocardium "heart muscle re;uiresMocardium "heart muscle re;uires

continuous o'en and nutrient sulcontinuous o'en and nutrient sul

Mocardial blood sul assesMocardial blood sul asses

throu'h coronar arteriesthrou'h coronar arteries


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/emle Colle'e M* ro'ram <

Coronar Arter Disease

AtherosclerosisAtherosclerosis

=arro+in' of lumen =arro+in' of lumen la;ue formation & related to is$ actors la;ue formation & related to is$ actors

results in decreased mocardial erfusionresults in decreased mocardial erfusion

oor tissue erfusion causes>oor tissue erfusion causes>

tissue dama'e "ischemiatissue dama'e "ischemia

tissue death "infarctiontissue death "infarction


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Atherosclerotic la;ue

ormation


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An'ina ectoris

?A cho$in' in the chest@

Angere Angere & to cho$e& to cho$e

Mocardial o'enMocardial o'en

demand eceeds suldemand eceeds sul

durin' eriods ofdurin' eriods of

increased activit,increased activit,

eercise, or stressful eventeercise, or stressful event


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An'ina ectoris

Durin' stress the mocardium demandsDurin' stress the mocardium demands

more -more -22

Coronar arteries +ould normall dilateCoronar arteries +ould normall dilate

to sul more blood and -to sul more blood and -22

!n An'ina ectoris, the coronar arteries!n An'ina ectoris, the coronar arteriesare unable to dilate sufficientl toare unable to dilate sufficientl to

increase erfusionincrease erfusion


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*mtoms &An'ina ectoris

ainain

*ubsternal*ubsternal

*;ueein'BCrushin'B#eaviness*;ueein'BCrushin'B#eaviness

Ma radiate to arms, shoulders, a+,Ma radiate to arms, shoulders, a+,

uer bac$, uer abdomen bac$ uer bac$, uer abdomen bac$

Ma be associated +ith shortness ofMa be associated +ith shortness of

breath, nausea, s+eatin' breath, nausea, s+eatin'


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ain usuall associated +ith 3sain usuall associated +ith 3s

erciseercise

atin'atin'

motionmotion


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ain seldom lasts 30 minutesain seldom lasts 30 minutes

ain relieved bain relieved bestest

=itro'lcerin =itro'lcerin


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=ausea =ausea

DiahoresisDiahoresis 7 usuall u durin' attac$ 7 usuall u durin' attac$

Dsrhthmia ma be resentDsrhthmia ma be resent


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/emle Colle'e M* ro'ram 1:

An'ina ectoris

ollo+in' an an'ina attac$ there isollo+in' an an'ina attac$ there is

no residual dama'e to theno residual dama'e to themocardiummocardium


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/emle Colle'e M* ro'ram 1<

orms of An'ina ectoris

*table An'ina*table An'ina

-ccurs +ith eercise-ccurs +ith eercise

redictableredictable

elieved b rest or =itro'lcerinelieved b rest or =itro'lcerin


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orms of An'ina ectoris

(nstable An'ina(nstable An'ina

More fre;uentBsevereMore fre;uentBsevere

Can occur durin' restCan occur durin' rest

Ma indicate imendin' M!Ma indicate imendin' M!

e;uires immediate treatment ande;uires immediate treatment andtransort to aroriate facilittransort to aroriate facilit


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Acute Mocardial !nfarction

?#eart Attac$@

!nade;uate erfusion of!nade;uate erfusion of

mocardiummocardiumDeath of mocardiumDeath of mocardium

InfarctInfarctDama'e to mocardiumDama'e to mocardium

IschemiaIschemia


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*mtoms & AM!

Chest ainChest ain & cardinal si'n of& cardinal si'n of

mocardial infarctionmocardial infarction

-ccurs in :5% of M!s-ccurs in :5% of M!s

*ubsternal*ubsternal

??Crushin',@ ?s;ueein',@ ?ti'ht,@Crushin',@ ?s;ueein',@ ?ti'ht,@?heav@?heav@


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*mtoms & AM! Chest ainChest ain

Ma radiate to arms, shoulders, a+, uer bac$,Ma radiate to arms, shoulders, a+, uer bac$,

uer abdomen bac$ uer abdomen bac$

Ma var in intensitMa var in intensit(naffected b>(naffected b>

s+allo+in's+allo+in'

cou'hin'cou'hin'

dee breathin'dee breathin'

movementmovement


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*mtoms & AM! Chest ainChest ain

(nrelieved b restBnitro'lcerin(nrelieved b restBnitro'lcerin

ain lasts lon'er than an'ina ain "uain lasts lon'er than an'ina ain "uto 12 hoursto 12 hours

??*ilent M!*ilent M!

15% of atients +ith M!,15% of atients +ith M!, articularl common in elderl and articularl common in elderl and

diabeticsdiabetics


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*mtoms & AM! *hortness of breath*hortness of breath

Eea$ness, diiness, faintin'Eea$ness, diiness, faintin'

=ausea, vomitin' =ausea, vomitin' allor and diahoresis "heavallor and diahoresis "heav

s+eatin's+eatin'


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*mtoms & AM!

*ense of imendin' doom*ense of imendin' doom

DenialDenial

50% of deaths occur in first t+o hours50% of deaths occur in first t+o hours

Avera'e atient +aits 3 hours beforeAvera'e atient +aits 3 hours before

see$in' helsee$in' hel


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*mtoms & AM!

Changes in pulse, !,Changes in pulse, !,

respirati"n are n"t #iagn"sticrespirati"n are n"t #iagn"stic"f AMI"f AMI


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Acute Mocardial !nfarction

arl reco'nition of M! isarl reco'nition of M! is

criticalcritical


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Mana'ement of Cardiac

Chest ainEhen in doubt, mana'eEhen in doubt, mana'e

all chest ain as M!all chest ain as M!


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Chest ain 7e'in mana'ement immediatel if7e'in mana'ement immediatel if

an'ina or M! are susected)an'ina or M! are susected)

Comlete the histor and hsicalComlete the histor and hsical

eam as ou treat)eam as ou treat)


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Chest ain osition of Comfortosition of Comfort

atent Air+aatent Air+a

#i'h concentration -#i'h concentration -22 non&rebreather mas$ 10&15 lmnon&rebreather mas$ 10&15 lm


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Chest ain eassure the atienteassure the atient

-btain a brief histor and hsical-btain a brief histor and hsical

eameam

Asirin 325m' )o)Asirin 325m' )o)


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Chest ain =itro'lcerin 0)4m' tablet sublin'ual =itro'lcerin 0)4m' tablet sublin'ual

atient should be sittin' or lin' do+natient should be sittin' or lin' do+n

#as t) /a$en nitro'lcerin in last 10#as t) /a$en nitro'lcerin in last 10

minutesF !s ain relievedF #eadacheFminutesF !s ain relievedF #eadacheF

!s 7


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Chest ain !f ain is unrelieved b rest, o'en,!f ain is unrelieved b rest, o'en,nitro'lcerin or if a chan'e hasnitro'lcerin or if a chan'e has

occurred in attern of an'ina,occurred in attern of an'ina,transort immediateltransort immediatel

/ransort in semi&sittin' osition if/ransort in semi&sittin' osition if

7 normal or elevatedG flat if 7 lo+7 normal or elevatedG flat if 7 lo+


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Chest ain Do notDo not +al$ atient to the ambulance+al$ atient to the ambulance

Do notDo not use li'htsBsiren if atient isuse li'htsBsiren if atient is

a+a$e, alert, breathin' +ithout distressa+a$e, alert, breathin' +ithout distress

Monitor vital si'ns ever 5&10 minutesMonitor vital si'ns ever 5&10 minutes


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Chest ain e;uest earl A8* bac$&ue;uest earl A8* bac$&u

Deaths in M! result from arrhthmiaHsDeaths in M! result from arrhthmiaHs

ArrhthmiaHs can be revented +ith earlArrhthmiaHs can be revented +ith earl

dru' theradru' thera


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Con'estive #eart ailure

C# I !nabilit of heart to umC# I !nabilit of heart to um

blood out as fast as it enters) blood out as fast as it enters) Ma be left&sided, ri'ht&sided, orMa be left&sided, ri'ht&sided, or

both) both)


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(suall be'ins +ith left&sided failure)(suall be'ins +ith left&sided failure)

8eft ventricle fails8eft ventricle fails

7lood ?stac$s u@ in lun's7lood ?stac$s u@ in lun's

#i'h ressure in caillar beds#i'h ressure in caillar beds

luid forced out of caillaries into alveoliluid forced out of caillaries into alveoli


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i'ht&sided failure most commonli'ht&sided failure most commonl

caused b 8eft&sided failure) 7loodcaused b 8eft&sided failure) 7lood

?bac$s u@ into sstemic circulation?bac$s u@ into sstemic circulation

Distended nec$ veinsDistended nec$ veins

luid in abdominal cavitluid in abdominal cavit

edal edemaedal edema


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Causes of C#

Coronar Arter DiseaseCoronar Arter Disease

Chronic hertension "hi'h bloodChronic hertension "hi'h blood

ressure ressure

AM!AM!

Jalvular heart diseaseJalvular heart disease


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*mtoms of C#

Eea$nessEea$ness

DsneaDsnea

Dsnea on eertionDsnea on eertion

arosmal nocturnal dsneaarosmal nocturnal dsnea

Attac$s of *-7 that usuall occur atAttac$s of *-7 that usuall occur atni'ht that a+a$ens the atientni'ht that a+a$ens the atient


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*mtoms of C#

-rthonea-rthonea

Difficult breathin' in an osition otherDifficult breathin' in an osition other

than standin' or sittin'than standin' or sittin'

Abdominal discomfortAbdominal discomfort

Ku'ular Jein Distention "KJDKu'ular Jein Distention "KJD

edal ?ittin'@ edema in lo+eredal ?ittin'@ edema in lo+er

etremitiesetremities


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*mtoms of C#

/achcardia/achcardia

ulmonar demaulmonar dema

=ois, labored breathin' =ois, labored breathin'

Cou'hin'Cou'hin'

ales, +heein'ales, +heein'in$, froth sutumin$, froth sutum


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Mana'ement of C# *it atient u, let feet dan'le*it atient u, let feet dan'le

Administer hi'h concentration -Administer hi'h concentration -22

Assist ventilation as neededAssist ventilation as needed Monitor vital si'ns ; 5&10 minutesMonitor vital si'ns ; 5&10 minutes

e;uest earl A8* bac$&ue;uest earl A8* bac$&u


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acema$er ailure osition of comfortosition of comfort

atent air+aatent air+a

#i'h Concentration -#i'h Concentration -22 Assist ventilations as neededAssist ventilations as needed

A8* !ntercetA8* !ntercet

C as neededC as needed

D- =-/ +orr about dama'e toD- =-/ +orr about dama'e to

acema$er acema$er


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Coronar Arter 7ass

osition of comfortosition of comfort atent air+aatent air+a

#i'h Concentration -#i'h Concentration -22

Assist ventilations as neededAssist ventilations as needed

A8* !ntercetA8* !ntercet

C as neededC as neededD- =-/ +orr about dama'e toD- =-/ +orr about dama'e to

suturesBstales or b&assed arteriessuturesBstales or b&assed arteries


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!mlanted Defibrillator

!f erformin' C on a atient>!f erformin' C on a atient>

!mlanted defibrillator ma ?fire@!mlanted defibrillator ma ?fire@

Ma feel sli'ht ?tin'le@Ma feel sli'ht ?tin'le@

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