Drill of the Month Drill of the Month Developed by Gloria Bizjak Developed by Gloria Bizjak Recognizing and Managing Recognizing and Managing Acute Coronary Syndrome Acute Coronary Syndrome
Dec 31, 2015
Drill of the MonthDrill of the MonthDeveloped by Gloria BizjakDeveloped by Gloria Bizjak
Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
Drill of the MonthDrill of the Month 33
Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
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.
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Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
Overview:Overview: DefinitionsDefinitions CausesCauses Risk FactorsRisk Factors SymptomsSymptoms Assessment and careAssessment and care
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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
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Acute Coronary Syndrome: Acute Coronary Syndrome: DefinitionsDefinitions
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: DefinitionsDefinitions
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: DefinitionsDefinitions
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
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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
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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
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Acute Coronary Syndrome: Risk Acute Coronary Syndrome: Risk FactorsFactors
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
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Acute Coronary Syndrome: Risk Acute Coronary Syndrome: Risk FactorsFactors
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
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Acute Coronary Syndrome: Risk Acute Coronary Syndrome: Risk FactorsFactors
Risk factors: OtherRisk factors: Other– Smoking historySmoking history– Metamphetamine useMetamphetamine use– Occupational stressOccupational stress
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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)
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Acute Coronary Syndrome: Acute Coronary Syndrome: SymptomsSymptoms
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: SymptomsSymptoms
SymptomsSymptoms– Difficulty breathingDifficulty breathing– Sudden sent of diaphoresis, nausea, Sudden sent of diaphoresis, nausea,
vomittingvomitting– PalpitationsPalpitations– AnxietyAnxiety
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Acute Coronary Syndrome: Acute Coronary Syndrome: SymptomsSymptoms
Possible findings on examinationPossible findings on examination– RalesRales– Jugular vein distention (JVD) Late signJugular vein distention (JVD) Late sign– Hypertension or hypotensionHypertension or hypotension
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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
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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)– 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
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Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
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Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
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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
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Acute Coronary Syndrome: Acute Coronary Syndrome: Assessment and CareAssessment and Care
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
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Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
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.
Drill of the MonthDrill of the Month 3232
Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
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
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Recognizing and Managing Recognizing and Managing Acute Coronary SyndromeAcute Coronary Syndrome
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