drill of the month developed by gloria bizjak recognizing and managing acute coronary syndrome

Drill of the MonthDrill of the MonthDeveloped by Gloria BizjakDeveloped by Gloria Bizjak

Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome

Acute Coronary SyndromeAcute Coronary Syndrome

Drill of the MonthDrill of the Month 22



Student Performance Objective: Student Performance Objective: Given Given information, resources, and opportunity for information, resources, and opportunity for discussion and practice, EMTs will be able to:discussion and practice, EMTs will be able to:

Define acute coronary syndrome and related terms.Define acute coronary syndrome and related terms. List causes of acute coronary syndrome.List causes of acute coronary syndrome. List general risk factors of acute coronary syndrome.List general risk factors of acute coronary syndrome. List general symptoms of acute coronary syndrome.List general symptoms of acute coronary syndrome. Describe and demonstrate assessment and care of a Describe and demonstrate assessment and care of a

patient suspected of having acute coronary patient suspected of having acute coronary syndrome.syndrome.

EMTs will follow acceptable Maryland medical practice EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency and Maryland Medical Protocols for Emergency

Medical Providers.Medical Providers.



Overview:Overview: DefinitionsDefinitions CausesCauses Risk FactorsRisk Factors SymptomsSymptoms Assessment and careAssessment and care


Acute Coronary Syndrome: Acute Coronary Syndrome: DefinitionsDefinitions

Acute coronary syndromeAcute coronary syndrome– Umbrella term: includes group of Umbrella term: includes group of

clinical symptoms of AMIclinical symptoms of AMI– Includes angina and heart attackIncludes angina and heart attack– Chest or anginal pain and other Chest or anginal pain and other

symptomssymptoms Low oxygen levels to heartLow oxygen levels to heart Caused by plaque build-upCaused by plaque build-up



Acute coronary syndromeAcute coronary syndrome– Includes several signs and symptomsIncludes several signs and symptoms

Chest and epigastric pain/discomfortChest and epigastric pain/discomfort Radiating pain to arm, shoulders, jawRadiating pain to arm, shoulders, jaw Difficulty breathing/shortness of breathDifficulty breathing/shortness of breath Sudden onset of sweating, nausea, vomitingSudden onset of sweating, nausea, vomiting

NOTE: Any type of chest discomfort or NOTE: Any type of chest discomfort or signs and symptoms of acute signs and symptoms of acute

coronary syndrome is serious and coronary syndrome is serious and needs immediate treatmentneeds immediate treatment



Specific termsSpecific terms– Acute: Sudden onset w/severe, sharp Acute: Sudden onset w/severe, sharp

pain (compare to chronic)pain (compare to chronic)– Syndrome: Group of symptoms Syndrome: Group of symptoms

characteristic of disease/disordercharacteristic of disease/disorder– Myocardial: Referring to the heart Myocardial: Referring to the heart

musclemuscle– Ischemia: Decrease of blood supplyIschemia: Decrease of blood supply



Specific termsSpecific terms– Angina: Severe constricting pain w/the Angina: Severe constricting pain w/the

sensation of choking/suffocatingsensation of choking/suffocating– Heart attack: Blockage of a coronary Heart attack: Blockage of a coronary

artery causing tissue damage/deathartery causing tissue damage/death– Plaque: Deposits of fatty material Plaque: Deposits of fatty material

(lipids) on arterial wall(lipids) on arterial wall


Acute Coronary Syndrome: CausesAcute Coronary Syndrome: Causes

Causes: PlaqueCauses: Plaque– Made up of lipids, accumulates in arteriesMade up of lipids, accumulates in arteries– Narrows arteries and blocks blood flowNarrows arteries and blocks blood flow– Build-up and narrowing is ‘coronary artery Build-up and narrowing is ‘coronary artery

disease’disease’– Pain from restricted blood flow causes Pain from restricted blood flow causes

anginaangina– Breaks away from arterial wall, blocks Breaks away from arterial wall, blocks

artery or causes a clot resulting in heart artery or causes a clot resulting in heart attackattack

PlaquePlaque



Acute Coronary Syndrome: Risk Acute Coronary Syndrome: Risk FactorsFactors

Risk factors: Gender and ageRisk factors: Gender and age– Men (commonly)Men (commonly)– Women 15 years post menopausalWomen 15 years post menopausal– Increased ageIncreased age



Risk factors: MedicalRisk factors: Medical– Diabetes mellitus (DM)Diabetes mellitus (DM)– HypertensionHypertension– Hyperlipidemia: Includes fats, oils, waxes, Hyperlipidemia: Includes fats, oils, waxes,

sterols, nucleic acids, triglyceridessterols, nucleic acids, triglycerides– Hypercholesterolemia: Cholesterol is a Hypercholesterolemia: Cholesterol is a

lipidlipid– Prior cerebrovascular accident: Over 7% Prior cerebrovascular accident: Over 7%

of patients with ACS had prior strokeof patients with ACS had prior stroke



Risk factors: MedicalRisk factors: Medical– Inherited metabolic disordersInherited metabolic disorders– Connective tissue disease: Commonly Connective tissue disease: Commonly

known diseases include—known diseases include— Autoimmune diseases, such as lupus, Autoimmune diseases, such as lupus,

rheumatoid arthritisrheumatoid arthritis Inherited diseases, such as Marfan’s Inherited diseases, such as Marfan’s

SyndromeSyndrome Scurvy and other Scurvy and other



Risk factors: OtherRisk factors: Other– Smoking historySmoking history– Metamphetamine useMetamphetamine use– Occupational stressOccupational stress


Acute Coronary Syndrome: Acute Coronary Syndrome: SymptomsSymptoms

SymptomsSymptoms– Chest discomfortChest discomfort

May radiate to arm, shoulders, jaw, backMay radiate to arm, shoulders, jaw, back May feel like crushing pain, muscle ache, May feel like crushing pain, muscle ache,

toothachetoothache

– Anginal painAnginal pain– Shortness of breath (SOB) w/exertionShortness of breath (SOB) w/exertion– Shortness of breath when lying down Shortness of breath when lying down

(orthopnea)(orthopnea)



SymptomsSymptoms– Paroxysmal nocturnal dyspneaParoxysmal nocturnal dyspnea

Waking in the middle of the night w/long-Waking in the middle of the night w/long-lasting SOBlasting SOB

– Patient stands at window to catch his/her breathPatient stands at window to catch his/her breath– Patient sleeps on stacked pillows to elevate Patient sleeps on stacked pillows to elevate

head/chesthead/chest– Patient sleeps in recliner Patient sleeps in recliner



SymptomsSymptoms– Difficulty breathingDifficulty breathing– Sudden sent of diaphoresis, nausea, Sudden sent of diaphoresis, nausea,

vomittingvomitting– PalpitationsPalpitations– AnxietyAnxiety



Possible findings on examinationPossible findings on examination– RalesRales– Jugular vein distention (JVD) Late signJugular vein distention (JVD) Late sign– Hypertension or hypotensionHypertension or hypotension


Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care

Assessment: Perform General Patient Assessment: Perform General Patient Care (Maryland Protocols)Care (Maryland Protocols)– Size up scene; gather infoSize up scene; gather info– Perform initial assessmentPerform initial assessment– Perform focused history, physical examPerform focused history, physical exam

History of present illness—OPQRST History of present illness—OPQRST questionsquestions

SAMPLE historySAMPLE history Baseline vital signsBaseline vital signs



Assessment: Perform General Patient Assessment: Perform General Patient Care (Maryland Protocols)Care (Maryland Protocols)– Follow treatment protocolsFollow treatment protocols– Communicate with hospital, other Communicate with hospital, other

response personnelresponse personnel– Disposition: determine priority and Disposition: determine priority and

mode of transportmode of transport



Emergency careEmergency care– Place patient in position of comfortPlace patient in position of comfort

Patients with SOB or difficulty breathing: Patients with SOB or difficulty breathing: sitting upsitting up

Hypotensive patients: lying downHypotensive patients: lying down Patients with both: let them decide position Patients with both: let them decide position

or change positionor change position

– Give a high concentration of oxygenGive a high concentration of oxygen– Be prepared for respiratory or cardiac Be prepared for respiratory or cardiac

arrestarrest



Emergency careEmergency care– Transport immediately if:Transport immediately if:

This is patient’s first episode—no cardiac This is patient’s first episode—no cardiac historyhistory

Patient has cardiac history but no Patient has cardiac history but no nitroglycerinenitroglycerine

Patient’s systolic blood pressure is less than Patient’s systolic blood pressure is less than 100 mm Hg100 mm Hg



Emergency careEmergency care– Assist patient in taking own Assist patient in taking own

nitroglycerine (Refer to Nitroglycerine nitroglycerine (Refer to Nitroglycerine protocol)protocol) RepeatRepeat

– 3-5 minutes with persistent chest pain3-5 minutes with persistent chest pain– If BP is greater than 90 mm Hg (consult if If BP is greater than 90 mm Hg (consult if

BP drops more than 20 mm HG)BP drops more than 20 mm HG)– If pulse is greater than 60 bpmIf pulse is greater than 60 bpm



Emergency careEmergency care– Assist patient in taking own nitroglycerine Assist patient in taking own nitroglycerine

DosesDoses– Maximum 3 doses (medical consult for Maximum 3 doses (medical consult for

additional)additional)– 3 doses include patient taken and EMT 3 doses include patient taken and EMT

assistedassisted

NOTE: CONTRAINDICATED if patient has NOTE: CONTRAINDICATED if patient has taken erectile dysfunction meds w/i 48 taken erectile dysfunction meds w/i 48

hours (medical consult)hours (medical consult) ViagraTM, LevitraTM, CialisTMViagraTM, LevitraTM, CialisTM Adcirca, Revatio Adcirca, Revatio


ASPIRIN ASPIRIN Maryland Protocol p 206Maryland Protocol p 206

a) Pharmacologya) Pharmacology (1) Platelet inhibitor(1) Platelet inhibitor

(2) Anti-inflammatory(2) Anti-inflammatory b) Pharmacokineticsb) Pharmacokinetics

Blocks platelet aggregationBlocks platelet aggregationDrill of the MonthDrill of the Month 2727

ASPIRINASPIRIN Acute Coronary Syndrome Acute Coronary Syndrome

c) Indicationsc) Indications Chest pain when acute myocardial Chest pain when acute myocardial

infarction is suspected.infarction is suspected. d) Contraindicationsd) Contraindications Known hypersensitivityKnown hypersensitivity


ASPIRINASPIRIN Acute Coronary Acute Coronary SyndromeSyndrome

Adverse EffectsAdverse Effects (1) Heartburn(1) Heartburn (2) Nausea and vomiting(2) Nausea and vomiting (3) Wheezing(3) Wheezing f) Precautionsf) Precautions GI bleeding and upsetGI bleeding and upset g) Dosageg) Dosage (1) Adult: 324 mg or 325 mg chewed(1) Adult: 324 mg or 325 mg chewed (2) Pediatric: Not indicated(2) Pediatric: Not indicated




Emergency careEmergency care– Assess for shock signs/symptomsAssess for shock signs/symptoms– Provide care for shockProvide care for shock– Monitor the airwayMonitor the airway– Reassess vital signs every 5 minutesReassess vital signs every 5 minutes



Student Performance Objective: Student Performance Objective: Given Given information, resources, and opportunity for information, resources, and opportunity for discussion and practice, EMTs will be able to:discussion and practice, EMTs will be able to:

Define acute coronary syndrome and related terms.Define acute coronary syndrome and related terms. List causes of acute coronary syndrome.List causes of acute coronary syndrome. List general risk factors of acute coronary syndrome.List general risk factors of acute coronary syndrome. List general symptoms of acute coronary syndrome.List general symptoms of acute coronary syndrome. Describe and demonstrate assessment and care of a Describe and demonstrate assessment and care of a

patient suspected of having acute coronary patient suspected of having acute coronary syndrome.syndrome.

EMTs will follow acceptable Maryland medical practice EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency and Maryland Medical Protocols for Emergency

Medical Providers.Medical Providers.



Review: Review: Define the following terms:Define the following terms:– Acute coronary syndromeAcute coronary syndrome– AcuteAcute– SyndromeSyndrome– IschemiaIschemia– Myocardial Myocardial – AnginaAngina– Heart attackHeart attack– PlaquePlaque



ReviewReview Acute Coronary SyndromeAcute Coronary Syndrome

– List causes of acute myocardial syndromeList causes of acute myocardial syndrome– Name the risk factors of acute myocardial Name the risk factors of acute myocardial

syndromesyndrome– Describe the symptoms of acute Describe the symptoms of acute

myocardial syndromemyocardial syndrome– Explain the assessment and care of acute Explain the assessment and care of acute

myocardial syndromemyocardial syndrome

drill of the month developed by gloria bizjak recognizing and managing acute coronary syndrome

Documents

coronary artery diseasepain

risk factorsrisk factors

immediate treatment

anginal pain

sharp pain

blocks artery

maryland medical protocols

blocks blood flowbuild