CARDIAC FINAL

• Age Definitions


  • Infant: > 1 year of age
  • Child: 1 year old to puberty
  • Adult: Adolescent and older
• CPR


  1. If a patient has a pulse and is breathing - Monitor

  2. If a patient has a pulse but is not breathing adequately - Rescue breathing

  3. If a patient has no pulse and is not breathing - Start CPR

  4. Resume compressions immediately after a shock is delivered
• AED


  • Can be used on Infants, Children, and Adults
• CPR Devices


  • LUCAS
  • Autopulse
• Infant CPR


  1. 1 Rescuer: 30:2 Compression to Ventilation ratio

  2. 2 Rescuer: 15:2 Compression to Ventilation ratio

  3. 2-Finger technique

  4. Encircling thumbs technique

  5. Check pulse at Brachial Artery
• Adult/Child CPR


  1. 30:2 Compression to Ventilation ratio

  2. Heel of hand on chest with other hand on top, arms locked out, positioned over the victim's body

  3. Check pulse at Carotid Artery
• Obvious Signs of Death


  • Rigor mortis
  • Dependent Lividity
  • Decomposition of body
  • Non-survivable injury
  • Do Not Resuscitate (DNR) Paperwork
• Layers of the Heart


  • Pericardium
  • Epicardium
  • Myocardium
  • Endocardium
• Heart Valves


  • Tricuspid Valve: Right Atrium into Right Ventricle
  • Pulmonary Valve: Right Ventricle to Pulmonary Artery
  • Mitral Valve: Left Atrium to Left Ventricle
  • Aortic Valve: Left Ventricle to Aorta
• Cardiac Output


  Heart Rate x Stroke Volume
• Electrical Conduction Pathway


  • SA Node
  • AV Node
  • Bundle of His
  • Bundle Branches
  • Purkinje Fibers
• SA Node Intrinsic Firing Rate

  60 - 100
• AV Node Intrinsic Firing Rate

  40 - 60
• AV Node


  Delays impulse by 0.09 seconds
• Nervous System


  • Sympathetic: Fight or Flight, Increases HR and Contractility
  • Parasympathetic: Rest & Digest, Decreases HR and Contractility, Vagus Nerve Innervation
• Cardiac Electrophysiology


  • Chronotropy: Rate
  • Inotropy: Cardiac Contractility
  • Dromotropy: Conduction
• Causes of ECG Artifact


  • Muscle Tremors
  • Shivering
  • Movement
  • Loose Electrodes
  • 60hz Interference
  • Machine Malfunctions
• ECG Leads


  • Bipolar Leads: I, II, III
  • Augmented Leads: aVR, aVL, aVF
  • Precordial Leads: V1 - V6
• 1 Small Box on ECG

  0.04 seconds
• 1 Large Box on ECG

  0.20 seconds
• 1 Large Box on ECG

  5 Small Boxes
• ECG Waveform


  • P-Wave: Atrial Depolarization
  • QRS Complex: Ventricular Depolarization & Atrial Repolarization
  • T-Wave: Ventricular Repolarization
  • P-R Interval: Impulse delay at the AV Junction
• Calculating ECG Rate


  300 divided by # of Large Boxes between QRS Complexes
• Acute Coronary Syndrome Conditions


  • Stable/Unstable Angina
  • NSTEMI
  • STEMI
• Angina Pectoris


  A type of chest pain that results from poor blood flow to the heart muscle, typically from blocked Coronary Arteries
• Stable Angina


  Follows a predictable pattern
• Unstable Angina


  Does not follow a pattern, does not always occur with physical exertion
• NSTEMI


  Diagnosed through Blood Work - CK-MB, Troponin I, Troponin II, ST-Depressions but no elevations
• STEMI


  Caused by occlusion of coronary artery(s), ST Elevations on 12-lead ECG, Pathological Q-wave
• Basic ACS Treatments


  • Morphine/Fentanyl (Pain Management)
  • Oxygen
  • Nitrates
  • Aspirin
• Other ACS Treatments


  • Fibrinolytics
  • Cardiac Catherization/Angioplasty
• Coronary Arteries


  • Right Coronary Artery: Right Marginal Artery, Posterior Descending Artery
  • Left Coronary Artery: Circumflex branch, Left Anterior Descending Artery
• Pre-Cordial Lead Placement


  • V1: 4th Intercostal Space, to the RIGHT of the Sternum
  • V2: 4th Intercostal Space, to the LEFT of the Sternum
  • V3: Between V2 and V3
  • V4: 5th Intercostal Space, Midclavicular
  • V5: Anterior Axillary Line, horizontal to V4
  • V6: Mid-Axillary line, horizontal to V4 and V5
• J-Point

  Where the QRS Complex and ST Segment meet
• Reciprocal Changes


  ST-Depressions occurring on an ECG where there are ST-Elevations in 2 contiguous leads in another region
• Adenosine


  3 Doses: 6mg, 12mg, 12mg, "Chemical Cardioversion", Used for Supraventricular Tachycardia
• Amiodarone


  VTach with a Pulse: 150mg over 10 min Infusion, VTach Cardiac Arrest: 300mg bolus, 150mg bolus
• Atropine


  1mg every 3-5 mins, Blocks acetylcholine to speed up the heart, Used in Bradycardia
• Dopamine


  + Chronotrope, + Inotrope, 5 - 20 mcg/kg/min infusion, Used to treat hypotension
• Epinephrine


  Sympathomimetic, For Hypotension: 2 - 10mcg/min infusion, Cardiac Arrest: 1mg bolus every 3-5 mins