EMT - Cardio and Resuscitation

• Tricuspid: between RA, RV

  Bicuspid: between LA, LV
• Target oxygen saturation levels:

  ACS: 90%

  Stroke: 95-98%

  Post cardiac arrest: 92-98%
• Central pulses: carotid and femoral (from larger arteries and easiest to palpate)

  Peripheral pulses: brachial, radial, posterior tibial, dorsalis pedis
• Infant: brachial pulse

  Anyone over 1 yr: carotid
• CPR

  Adult: 30:2 

  1 Person on child: 30:2

  2 Person for infants: 15:2, breaths every 3-5 seconds (12-20 breaths per minute)
• V fib and V tachy = shock advised
• V tachy (150-200 bpm)
• treating chest pain begins with placing in a position of comfort (Fowler, semi-Fowler), high flow o2, vital signs then nitroglycerin (contraindicated for systolic below 100)
• Aspirin: 2-4 x 81 mg

  cardiac patients with chest pain; only given with medical direction

  Absolute contradictions: allergy or liver damage, pediatric, inability to chew
• Nitroglycerin:

  contradicted if systolic BP less than 100, head injury, ED meds in past 48 hours, max 3 doses, bradycardia (HR below 50), tachycardia (HR above 110)
• Pulmonary embolism

  decreased breath sounds, hypotension, JVD, tracheal deviation toward unaffected side
• Hemorrhagic Stroke More likely to have headaches, altered mental, seizure, vomiting, hypertension
• cushings triad: widened pulse pressure, bradycardia, irregular respiration

  points to: increased intracranial pressure
• Symptoms of MI: chest pain, dyspnea, nausea, sweating, palpitations, dizziness, syncope, anxiety, weakness, fatigue, pallor, cold clammy skin, pale lips, decreased LOC, ST elevation on ECG
• Beck's Triad: bilateral JVD, narrowing pulse pressure, muffled heart sounds
• Septic Shock: bacterial infection

  Tachycardia, hypotension but also with fever, warm skin
• Cardiogenic Shock: heart lacks power to force proper blood volume through body

  -restlessness and anxiety are early signs

  -patients can then develop dyspnea, cool, clammy skin, weak thready pulse, tachycardia, rapid shallow breathing, nausea/vomiting, hypertension 🡪 hypotension
• Neurogenic Shock

  Bradycardia, hypotension, warm flushed skin below lvl of spinal cord, cool clammy skin above, loss of bladder control, priapism, paralysis of small bowel
• Compensated shock: tachycardia
• Decompensated shock:

  hypotension (ominous in children)

  Cushing's Triad
• For pediatric patients, most cardiac arrest is from respiratory arrest
• albuterol function: bronchodilator

  albuterol route: nebulizer
• epinephrine function: vasodilator

  epinephrine route: epi pen
• Aortic Aneurysm: separation of the layers within the aortic wall; tearing of intimal layer results in propagation of the dissection due to blood entering the newly created space

  -uncontrolled hypertension is primary cause

  -sudden onset deep chest pain radiating to shoulder blades

  -sharp and tearing

  -nitroglycerin and aspirin not appropriate

  -rapid transport without delay
• Transient Ischemic Attack (TIA): focal brain, spinal cord, retinal ischemia without acute infarction

  what they indicate: “warning stroke”, can indicate stroke coming

  What to do: establish time of symptom onset, check glucose and treat if indicated, triage to most appropriate stroke center, Postictal state, alcohol intoxication, and hypoglycemia can mimic a stroke

  Will usually resolve in 10-15 min
• Congestive Heart Failure (CHF):

  symptoms: pulmonary and peripheral edema, pink frothy sputum, crackles, hypertension, tachycardia, tachypnea, cyanosis

  • Left: pulmonary edema, dyspnea, hypoxia, crackles in lungs, pink frothy sputum
  • Right: JVD, hepatomegaly, portal hypertension, ascites, peripheral edema
• Vagus nerve: vasovagal response, drop in HR with dizziness or passing out
• If 6 AED shocks/3 no shock messaged, resume CPR and transport
• Adult normal Blood pressure: between 90/60 mmHg and 120/80 mmHg
• systolic 80-110 mm Hg is considered a normal range for a child.
• A pulse pressure is considered abnormally low if it is less than 25% of the systolic value
• The basic causes of shock are poor heart function, loss of blood and fluid, and dilation of vessels