Acute Coronary Syndrome for EMS

Transcription

1 Acute Coronary Syndrome for EMS Rocco Altobelli BS, CCT-Paramedic, FP-C Alpine Institute, Kalispell, MT No part of this presentation may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval method without express written permission from CentreLearn Solutions, LLC. The Same Problem? Medic 4 respond to 123 Spruce Street for a 57 year old male with chest pain. Ambulance Rescue 3 respond 6 respond to 789 to 456 Oak Pine Street Ave for for a year old female diabetic with complaining difficulty breathing. of fainting. Jason Pack/FEMA Jason Pack/FEMA Mark Wolfe/FEMA The Same Problem? 1

2 Objectives Acute Coronary Syndromes Understand what they are Understand how to assess Learn to differentiate types Explore treatment & transport The Big Net Objective 1 The Big Net Joan US Drinkwin/USFWS Fish and Wildlife 2

3 The Big Fish Problem List Immediate Life Threats HEART ATTACK! Pulmonary embolism Aortic aneurysm Pneumothorax Cardiac tamponade Drug overdose Important Mimics Stable Angina Indigestion Anxiety Pleurisy Infection of the heart or lung Drug seeking Cancer Intercostal pain Problem List 3

4 Problem List Acute Coronary Syndrome Click to Continue General Impression Objective 2 4

5 O P History Gathering onset P provocation/palliation Q quality R radiates T S severity time The interaction, Pain Assessment, has been removed. The interaction, ACS Pain Assessment, has been removed. 5

6 Mimics Mimics Ischemic Chest Pain LifeArt/ 6

7 Ischemic Chest Pain Definitive Care Ischemic Chest Pain 7

8 Ischemic Chest Pain Pain in both arms Nausea Vomiting Diaphoresis LifeArt/ Ischemic Chest Pain Anatomy of the Heart LifeArt/ 8

9 Anatomy of the Heart LifeArt/ Anatomy of the Heart LifeArt/ Coronary Arteries LifeArt/ 9

10 Pathophysiology LifeArt Risk Factors Stable Angina Click to Continue 10

11 3 Major Syndromes Objective 3 3 Major Syndromes STEMI Unstable angina Non ST Elevation MI Non Diagnostic 3 Major Syndromes Very Bad STEMI Unstable angina Non ST Elevation MI Concerning Non Diagnostic 11

12 12-Lead Assessment Rocco Altobelli 12-Lead Acquisition Acute Onset MI Q Waves LBBB ST Segment Elevation 12

13 BLS 12-Lead Interpretation J-Point Non-diagnostic ECG 13

14 Non-diagnostic ECG Pleurisy Non-diagnostic ECG Greg Friese Localization LATERAL I, avl, V5 and V6 ANTERIOR V3 and V4 SEPTAL V1 and V2 INFERIOR Leads II, III, avf LifeArt/ 14

15 15 I avr V1 V4 I avr V1 V4 Lead-Vessel Association LifeArt/ II avl V2 V5 III avf V3 V6 II avl V2 V5 III avf V3 V6 I avr V1 V4 I avr V1 V4 LifeArt/ Lead-Vessel Association I avr V1 V4 LifeArt/ II avl V2 V5 III avf V3 V6 II avl V2 V5 III avf V3 V6 II avl V2 V5 III avf V3 V6 Collateral Flow LifeArt

16 16 I avr V1 V4 LCA Impairment LifeArt/ II avl V2 V5 III avf V3 V6 ECG Regions I avr V1 V4 II avl V2 V5 III avf V3 V6 ECG Analysis

17 17 ECG Analysis I avr V1 V4 I avr V1 V4 LifeArt/ II avl V2 V5 III avf V3 V6 II avl V2 V5 III avf V3 V6 The Widow Maker LifeArt/ Transport Triage

18 Transport Triage 12-lead ECG shows STEMI? Yes Go directly to cath lab No Go to closest facility Click to Continue Treatments Objective 4 M morphine O oxygen N nitro A aspirin LifeArt/ Treatments Do not give if allergic or active GI bleed 18

19 Treatments Watch for a precipitous fall in the blood pressure Treatments Being looked at closer for possible detrimental effects when used in ACS Fibrinolytic INCLUSION CRITERIA Y N Chest pain > 30 minutes? Possibly accompanied by jaw, arm, or back pain. Sudden onset shortness of breath? Nausea/vomiting? Pale, cool, diaphoretic skin? 12-lead EKG evidence of AMI, if available? Recent onset of AMI symptoms (< 6 hours)? EXCLUSION CRITERIA Y N Do you have active internal bleeding? Have you ever had a stroke? Have you had brain or spine surgery or injury within the past 2 months? Do you have a brain tumor, growth, or aneurysm? Do you have a bleeding disorder (e.g., hemophilia)? Do you have severe uncontrolled high blood pressure? 19

20 Point-of-Care Testing Rocco Altobelli EMS Treatment Summary Continuance of Care Department of Veterans Affair 20

21 Outcomes Jocelyn Augustino/FEMA Additional Lessons Visit CentreLearn CE library to learn more Basic 12 Lead ECG Shock and Shock Management Non-Shockable Rhythms Shockable Rhythms Summary Acute Coronary Syndrome 21

22 Credits Acute Coronary Syndrome Lesson Author Research Librarian and Reviewers Rocco Altobelli, BS, CCT-Paramedic, FP-C Sheree West, MILS Buck Feris, EMT-P and Greg Friese, MS, NREMT-P Design and Production Images Emergency Preparedness Systems LLC FEMA Photo Library US Fish and Wildlife Service LifeART images copyright 2002 Lippincott Williams and Wilkins. Models Steve Murphy, OStJ Ruth Wes, EMT-III Nicole Gallien, EMT-III Wilma Vinton, Paramedic Kari Absher-Gras, FF/EMT Bart Mitchell, FF/EMT Narrator John A. Chamberlain, Jr. References Acute Coronary Syndrome References: Dubin, Dale. Rapid Intervention of EKG s, 6th edition. Cover Publishing. p Bledsoe, B. and Benner, R. Critical Care Paramedic. Prentice Hall. P Resources Reviewed: Ryan T, Reeder G, Management of Suspected Acute Coronary Syndrome in the Emergency Department. Downloaded from on 22 August 2010 ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina / non ST-Elevation Myocardial Infarction Circulation 2007;116;e148-e304; Downloaded from circ.ahajournals.org on January 31, 2009 Antman, et al 2007 Focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction. DOI: /CIRCULATIONAHA Downloaded from circ.ahajournals.org on December 10, 2007 Robert E. O'Connor, et al; Part 10: Acute Coronary Syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care download from on October 20,