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9Chapter CARDIOVASCULAR EMERGENCIES &
! Recognize angina and heart attacks and provide ! Apply the knowledge of risk factors of cardio- ! Understand the need and benefit of early defibril- ! Apply the knowledge of preventative health ! Recognize a stroke / TIA and provide first aid ! Apply the principles involved in treating car- ! Provide care for all cardiovascular emergencies The changes associated with high blood pressurewill increase the risk of having a stroke, heart Cardiovascular diseases kill more Canadians than any other cause of death. Some of these deaths could beprevented if appropriate care was given. Even more Hypertension does not always show warning signs deaths could be prevented if individuals adopted a and therefore is known as the silent killer.
heart-healthy lifestyle that reduces the risk ofcardiovascular disease.
Controllable
Uncontrollable
This lesson will provide the First Responder with theknowledge they will require to recognize cardiovascu- Cardiovascular disease refers to disorders of the heart and blood vessels. High blood pressure andatherosclerosis are cardiovascular disorders. Over time, they can lead to cardiovascular emergenciessuch as angina, heart attack, congestive heart failure, transient ischemic attack, stroke and cardiac arrest.
ATHEROSCLEROSIS
(Narrowing of the Arteries)
People can reduce their chances of suffering fromcardiovascular disease by eliminating risk factors.
There are risk factors that we can control and othersthat we cannot control.
Reducing risk factors in young people will have thegreatest effect. However, it is very important toassess your present lifestyle and make positivechanges wherever possible.
Normal Artery
Arteromatous Plaque
build-up
HIGH BLOOD PRESSURE
This is the pressure of the blood against the inside
This is the process of fat deposition and narrowing of the arteries. Arteries are the blood vessels thatcarry blood away from the heart.
Blood pressure can go up and down naturally. Whena person is excited or emotionally stressed, blood They become diseased when fatty deposits build pressure goes up, but it usually comes down once the up inside them, making the passage for blood In some people their blood pressure stays high all the In the coronary arteries, which carry oxygenated time. This condition is called Hypertension.
blood to the heart, it is called Coronary Artery
Disease.
Over time, hypertension damages the tissues of thecardiovascular system.
As an artery is narrowed, less blood gets throughand at some point, when the artery is narrowed The walls of the blood vessels become thick and lose enough, the tissue on the other side does not their elasticity and the heart becomes enlarged.
receive enough oxygenated blood to functionnormally.
Although the signs and symptoms of hardening of NOTE: There are new drugs available to help dissolve
the arteries usually do not appear until middle age a blood clot in the heart. This is why it is important to or later, Atherosclerosis often begins in
get a patient to the hospital as quickly as possible.
The longer the medication is delayed, the more hearttissue that will be damaged.
SIGNS AND SYMPTOMS OF ANGINA OR
When a coronary artery becomes hardened, the MYOCARDIAL INFARCTION
blood supply feeding that part of the heart musclebecomes limited. Therefore, if the heart works Heaviness, tightness, squeezing, pressure, hard and needs more blood (because of activity), it can’t get the oxygenated blood it needs through This will cause pain or discomfort in the chest and it may spread to the neck, jaw, shoulders and arms. This pain is called ANGINA PECTORIS (or Angina pain, as a rule of thumb, will not last longerthan 10 minutes and if the person rests and/or ASSESSMENT AND MANAGEMENT OF
takes a prescribed medication, it should be ANGINA AND MYOCARDIAL INFARCTION
relieved. People can live somewhat normal livesby taking their medication that increases blood As a First Responder you should understand the flow to the heart. (That medication is nitroglycerin).
difference between Angina and Heart Attack. Treatboth conditions in the same way.
This occurs when heart muscle tissue dies be- cause its supply of oxygenated blood was cut off.
Perform a secondary survey- which includes a set Usually, a blood clot gets stuck in a coronary of vitals, a history (using SAMPLE) and a head to Ensure the patient is in a comfortable position(usually semi-sitting) and at rest. If this increases The supply of blood is cut off and the heart tissue the casualty’s pain or discomfort allow them to beyond the clot is starved of oxygen.
If you have not already done so, loosen any tight The medical term for a heart attack is myocardial
clothing at the neck, chest, and waist.
infarction. A heart attack feels like an angina
If the patient is on medication, assist them in attack; however there is a difference. The patient taking it. Remember to watch the blood pressure, will have pain when they are at rest, it lasts longer and if it is 100 systolic, they should not take a than 10 minutes and even if nitro is taken there is vasodilator (nitroglycerine) as it may lower their no relief. As a first responder never try to blood pressure, causing them to go unconscious.
distinguish between angina pain and a heart If patient becomes unresponsive, secure the airway with an oropharyngeal or nasopharyngealairway.
Should the heart attack damage the heart’s If breathing stops, start assisted ventilations with electrical system or enough of the heart muscle, 100% oxygen and if there is no pulse, start CPR.
irregular activity may occur or the heart may also Defibrillate as quickly as possible.
stop beating. If this happens it is known as
Cardiac Arrest.
ASSISTING THE PATIENT WITH THEIR NITRO-
casualty makes the final decision whether or not GLYCERIN AND ASA (follow local protocols as
some provinces may not allow assistance)
The emergency responder should ask if thecasualty is allergic to aspirin or if the casualty has 1. Make the casualty comfortable
ever been told by a doctor that they should not While waiting for paramedics to arrive, assist the take aspirin. * Aspirin should NOT be taken in
casualty to the most comfortable position, usually these cases.
semi-sitting with the head and shoulders raised andsupported. Loosen the clothing at the neck, chest, NOTE: People with peptic ulcers, or bleeding disorders
and waist. Reassure the casualty. Assist the fully would normally avoid aspirin, but in this case, the conscious to take appropriate medications as de- medication will do more good than harm. If the casualty does not carry angina medication orthe chest pain is not relieved by the first dose of * When assisting a patient with their medication,always read and follow the manufacturer’s directions. prescribed medication, suggest the casualty chew2 children’s ASA tablets (80 mg each) or one ASA 2. Nitroglycerin
tablet (regular strength adult dose = 325 mg).
Ask the fully conscious casualty if he/she carriesheart medication such as nitroglycerin. If the person *Do NOT substitute acetaminophen (Tylenoltm).
is taking nitroglycerin, ask if he/she uses Viagra. Ifthe person has taken Viagra; do not assist him/her to ASA and acetaminophen do not have the
take nitroglycerin (go to the next step - aspirin
same effect in reducing damage due to heart
administration).
attacks. Once the casualty has taken the ASA,and if the chest pain is not relieved, he or she may take an additional 2 doses of nitroglycerin. ASA will not relieve the chest pain. Do not repeat the dose of ASA. (Nitroglycerin may be repeated, if needed, every 5-10 minutes to relieve pain, or until a maximum of three doses have been taken.) nitroglycerin may be eithertablets or spray. Nitro- 5. Record the time ASA was taken by the casu-
glycerin tablets are placed under the tongue where they quickly dissolve. Nitroglycerin spray is sprayedunder the tongue and is rapidly absorbed. Nitroglyc- 6. Provide an oral report, including the time
erin starts working within one to two minutes and and amount of ASA and Nitroglycerine taken by works for about five to six minutes.
the casualty, to paramedics when they arrive onscene.
3. Assess Blood Pressure
Before assisting the casualty to take the first dose of
7. Monitor respiration and pulse and be ready
the prescribed medication, ensure you check their to provide artificial respiration or CPR.
ASSISTING IN TAKING MEDICATIONS
* If their blood pressure is 100/50 or less, do NOT
help them take the Nitroglycerine (Nitroglycerine
There are five things you have to ensure when is a vaso-dilator, it makes all the vessels open up assisting with a medication. These are called the Six Rights.
* If their blood pressure is over the 100/50, assist
them in taking their medication.
1. The right medication2. The right person 4. Aspirin.
Ask the conscious casualty if aspirin is carried.
Emergency responders may offer aspirin from a first aid kit, but are cautioned that first aiders may only recommend that the casualty take the ASA and You must ensure these five things before assisting explain why. (First aiders are cautioned that the an automated external defibrillator (AED ) isavailable, use as soon as possible.
Occurs when the heart will no longer pump blood.
A cardiac arrest may happen suddenly or it may STEPS TO CPR FOR ADULT/CHILD/INFANT
follow a period of stopped or ineffective breathing 1. Follow management for Cardiac Arrest. Give 30 when much of the oxygen in the body is used up.
compression and two ventilations (this is onecycle of 30:2) A person is considered clinically dead when their 2. Continue compressions and ventilations in the heart has stopped beating, and breathing has ratio of 30 : 2 starting with compressions.
stopped. Brain damage usually begins in 4 – 6 minutes, and brain death usually occurs after 10 Some of the causes of cardiac arrest are: heart attack, severe injuries, electrical shock, drug overdose, drowning, suffocation and stroke.
you are exhausted and cannot continue.
ASSESSMENT AND MANAGEMENT OF
TWO RESCUER CPR
CARDIAC ARREST
Infant - 15:2 chest squeeze to be used.
2. Perform a primary survey, secure the airway Provide CPR. Ventilate using pocket mask orbag valve mask with 100% Oxygen THE NEED AND BENEFIT OF DEFIBRILLATION
Defibrillation is the act of using electricity to stop allelectrical activity of the heart, so that the heart’snormal rhythm will resume.
CPR is two basic life support skills put together—artificial respiration and artificial circulation.
Artificial respiration provides oxygen to thelungs. Artificial circulation causes blood to flowthrough the body, but flows only enough to give aperson a chance for survival. The purpose of CPR As described earlier a heart attack can damage the is to circulate oxygenated blood to the brain and heart’s electrical system. When this happens a other organs until either the heart starts beating, patient may suffer an abnormal rhythm that causes cardiac arrest. These abnormal rhythms only last ashort time when the patient’s heart is not pumping When you find an unresponsive casualty, send for blood. If untreated, all electrical activity will stop.
help immediately (scene survey). Then, start the When this happens the chances of restarting the heart are slim. Treating a cardiac arrest patient with checking for normal breathing. If there is no defibrillation is the most important factor in having a breathing, give two breaths. Next begin CPR. If positive outcome for the patient (restarting the heart).
Heart failure means the heart can not circulate the Also known as a Cerebrovascular Accident
blood effectively any more. It may be caused by (CVA) or a Transient Ischemic Attack (TIA).
chronic heart disease or a previous heart attack.
The main cause is hardening of the arteries. Over Blood can no longer be circulated properly; therefore, time, an artery in the brain becomes narrow and a it begins to back up in the lungs causing breathing clot blocks it or an artery ruptures. The tissue problems. It can also back up in the rest of the body beyond the damaged artery lacks oxygen and SIGNS AND SYMPTOMS OF CHF
A less severe stroke can cause brain damage and thus impair certain body functions, depending on Difficulty breathing when lying flat.
the part of the brain affected, a severe stroke can Blueness /cyanosis around the lips, fingernail beds, ears, and other parts of the body.
ASSESSMENT AND MANAGEMENT OF CHF
1.
Perform a primary survey and administer 100 %oxygen via a non-rebreather mask.
Provide assisted ventilations if required.
Perform a secondary survey- to include a set of vitals, a history (using SAMPLE ) and a head totoe examination.
Place the casualty at rest and in a comfortableposition, loosen tight clothing.
It is similar to a stroke. It is caused by the lack ofoxygen to part of the brain, which results in the same signs and symptoms as a stroke. The maindifference is that a TIA will last for less than 24hours and will leave no permanent brain damage.
A TIA is a warning sign that a stroke may soonfollow.
SIGNS AND SYMPTOMS OF STROKE OR TIA
ASSESSMENT AND MANAGEMENT OF STROKE/
The signs and symptoms will depend on the part of the brain that is affected. Often only one side ofthe body is affected because only one side of the A First Responder will not be able to tell the difference between the two and the management for both is thesame. Should the signs and symptoms pass after a short while, ensure the patient sees a doctor.
Difficulty in speaking, swallowing (slurredspeech, drooling) Numbness or weakness of the arms or legs,particularly one side 2. Perform a primary survey and administer 100% 3. Perform a secondary survey- to include a set of vitals, a history (using SAMPLE) and a head to toe 4. Ensure the patient is at rest and has an open If the patient is conscious, place them in asemi-sitting position and watch their LOC.
If they are unconscious, place them in therecovery position, unaffected side down.
5. If you have not already done so, loosen tight 6. Reassure and keep the casualty warm.
7. If breathing stops, begin assisted ventilations with Remember FAST as a way to check for the
100% oxygen and perform CPR if there is no signs and symptoms of a stroke
Facial droop- one side of the face doesn’t move
as well as the other side
Arm drift- have casualty hold both arms out- one
arm may not move or drifts down compared to the
other arm
Speech- casualty slurs words, uses the incorrect
words or is not able to speak
Time- get immediate medical help- the earlier a
stroke is treated the better the outcome
What are the components of the circulatorysystem? What vessels will the blood flow through? De-scribe the path as it leaves and the returns to theheart.
What are the risk factors we can control when wetalk about cardiovascular disease? What is artheosclerosis, what do we call it whenit involves the coronary arteries, and when does itbegin? 11. What is the difference between angina and a heart 12. What are some signs and symptoms of heart 13. What is congestive heart failure and its signs and 14. What is the difference between a stroke and a 15. What are the signs and symptoms of a cere- 16. What is cardiac arrest and its signs and symp- 17. What are the six rights when assisting with a

Source: http://scesoc.ca/~dunbar/mfr/MFR%20student%20manual/06-Chap09.pdf