EMS 280 Lesson B Boone County Fire Protec/on District EMS Educa/on - - PowerPoint PPT Presentation

Boone County Fire Protec/on District EMS Educa/on

EMS 280 Lesson B

Boone County Fire Protec/on District EMS Educa/on

Lesson B Overview

• Chest Pain due to Myocardial Infarction
• Chest Pain due to Pulmonary Embolus

Boone County Fire Protec/on District EMS Educa/on

Myocardial Infarction

• Compromised blood supply to myocardium

due to an obstructed coronary artery.

• Obstruction can be one or more of the

following:

• Clot
• Artery clogged by plaque
• Artery clamped down (vasospasm)

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Signs / Symptoms

• Substernal pressure / heaviness
• Radiating pain to arm / jaw possibly
• Nausea- (vomiting possibly)
• Sweaty (diaphoresis possibly)
• Shortness of breath
• Weak / Dizzy

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Atypical (Common)

• Some groups of patients are less likely to have

the “typical” pain presentation:

• Elderly
• Women
• Diabetics

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12-Lead EKG

• May show nothing abnormal
• May show STE
• May show STD
• Serial EKGs are a great plan

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Location

• EKG changes may suggest which artery or

arteries are involved and therefore which ventricular wall(s) are impacted.

• More than one wall or both ventricles may be

involved—should be concerning.

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Treatable

• Ischemic tissue can be salvaged
• Injured tissue can be salvaged
• Time is heart muscle
• Infarcted tissue is not salvageable

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Complications

• Cardiac Arrest!!! (one of the “T’s”)
• Compromised BP due to decreased cardiac
• utput related to reduced ventricular

contractility.

• CHF from poorly functioning pump

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Hospital TX

• Angiogram
• Angioplasty
• Stent placement
• Thrombolytics
• CABG

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Field TX

• ASA to limit further clot formation or

extension of the existing clot. (ASA does NOT bust clots)

• NTG when safe to use—to reduce workload
• n the left ventricle which might reduce its
• xygen demand downward to match the newly

reduced oxygen supply.

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More Field TX

• Nausea can be managed with ondansetron etc.
• Pain control is important as well—probably

Fentanyl is best although Morphine is an

• ption.
• Reduction in pain = reduction in HR in

theory which results in less myocardial

• xygen demand

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Pulmonary Embolus

• Blood clot lodged in pulmonary artery or

pulmonary arterioles.

• Reduced lung perfusion
• Clot probably formed elsewhere (thrombus—

legs typically) and traveled to lungs (embolus)

• May resolve on own—may lead to cardiac

arrest (one of the “T’s”).

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PE Pain

• Sudden onset
• Sharp (not dull / heavy / squeezing like MI)
• Can point to one spot (not general area like

MI)

• Pleuritic (worse with deep breath)

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EKG for PE

• For now, consider that STE in numerous leads

can be the result but…

• …we don’t make a field dx of PE based on

EKG—just realize that not all STE is an MI.

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Ax of PE

• Lung Sounds DO NOT CHANGE with PE
• Mostly based on History of Present Illness

(HPI)

• Depending on underlying pulmonary status

and the location of the embolus, may or may not be acutely hypoxic / dyspneic.

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Tx of PE

• Definitive care is not done in the field.
• Oxygen is an obvious choice.
• Maybe PEEP (via CPAP) to recruit all

available lung tissue into action.

• Urgent transport (take help in case pt. codes)
• IV fluid if needed to support the preload

starved right ventricle.

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EMS 280 LAB B Prep

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Lesson B Main Points

• Use HPI and EKG to assess but…Transport

urgently while assessing / treating

• ASA for clot prevention
• NTG when safe for reduction in LV workload for

MI but…not good for PE (RV needs preload)

• Pain and nausea control are good
• O2 per the usual protocol for either

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Scenario 1

• 56 M with substernal chest pressure for 1

hour

• with mild shortness of breath, mild

diaphoresis, nausea but no vomiting

• non-radiating pain, onset at rest, last meal

3 hours ago (no “indigestion”)

• no history of similar, no known cardiac

history, no pertinent other history

• STEMI on 12-lead

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Scenario 2

• 56 M with sharp, right-sided chest pain
• pleuritic, can point with one finger,

moderate shortness of breath

• sudden onset at rest, last meal 3 hours ago

(no “indigestion”)

• no history of similar, no known cardiac

history, no pertinent other history

• no STEMI on 12-lead