Prehospital Academy Lesson 17.2
Cardiac Emergencies: EMT Treatment Theory
This lesson focuses on the EMT-Basic management of common cardiac emergencies. Understanding the fundamental care principles for conditions like chest pain and discomfort is crucial for improving patient outcomes. This section will cover initial assessment, oxygen administration, patient positioning, and the role of basic medications such as aspirin and nitroglycerin within the EMT scope of practice.
Initial Approach to Cardiac Emergencies
Cardiac emergencies are a leading cause of morbidity and mortality. Rapid assessment and intervention are critical. The EMT's role begins with:
Scene Safety: Always ensure the scene is safe before approaching the patient.
Primary Assessment: Quickly identify and manage immediate life threats (Airway, Breathing, Circulation).
General Impression: Form a rapid impression of the patient's severity.
Chief Complaint: The most common complaint in cardiac emergencies is chest pain or discomfort.
Fundamental Care Pieces for Chest Pain/Discomfort
For patients presenting with chest pain or discomfort, several fundamental care pieces are paramount:
Position of Comfort: Allow the patient to assume a position that is most comfortable for them, typically sitting upright, which can ease breathing and reduce cardiac workload.
Oxygen Administration:
If the patient is hypoxic (SpO2 below 94%) or shows signs of respiratory distress, oxygen is indicated and should not be withheld.
Target SpO2 is generally 94-99%.
Administer oxygen via nasal cannula or non-rebreather mask as appropriate for the patient's condition.
Aspirin Administration (if protocol allows):
Mechanism: Aspirin (acetylsalicylic acid) is an antiplatelet medication that inhibits platelet aggregation, preventing existing clots from getting larger and new clots from forming. It is NOT a clot-busting drug (thrombolytic).
Indications: Suspected cardiac chest pain (e.g., angina, myocardial infarction).
Contraindications: Allergy to aspirin, recent bleeding (especially gastrointestinal), taking other blood thinners (relative contraindication – consult medical control), history of asthma (relative contraindication – consult medical control).
Dose: Typically 162 mg to 324 mg (two to four 81 mg chewable tablets). Chewable aspirin is preferred for faster absorption.
Nitroglycerin Assistance (if protocol allows and patient has prescription):
Mechanism: Nitroglycerin is a vasodilator that relaxes the smooth muscles of blood vessels, leading to dilation of coronary arteries (improving blood flow to the heart) and systemic vasodilation (reducing the heart's workload).
Indications: Cardiac chest pain, patient has a physician-prescribed nitroglycerin, medical control approves.
Contraindications: Systolic BP below 90-100 mmHg, recent use of erectile dysfunction medications (e.g., sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra) within the last 24-72 hours (depending on the drug), increased intracranial pressure, maximum prescribed dose already taken.
Route: Sublingual (under the tongue) is most common (pill or spray).
Dose: One dose (0.3 mg or 0.4 mg) repeated every 3-5 minutes if chest pain persists and blood pressure remains adequate, up to a maximum of three doses (patient's prescribed limit).
Ongoing Assessment and Transport
Continuous assessment is vital for cardiac patients:
Monitor Vital Signs: Regularly reassess blood pressure, pulse, respirations, and SpO2.
ECG Monitoring: If available and within scope, apply ECG leads to monitor cardiac rhythm.
Pain Reassessment: Continuously ask about changes in the chest pain (intensity, character, radiation).
Prepare for Deterioration: Be ready for potential cardiac arrest, including having an AED/defibrillator readily available.
Rapid Transport: For patients with suspected cardiac emergencies, rapid transport to an appropriate facility is often indicated, especially if interventions are not alleviating symptoms or the patient's condition is deteriorating.
Critical Thinking Questions
You are treating a 60-year-old male with crushing chest pain. His blood pressure is 88/60 mmHg, and he states he took a Viagra pill an hour ago. Would you administer nitroglycerin? Justify your answer.
A patient with suspected cardiac chest pain is allergic to aspirin. What alternative prehospital medication (if any, within EMT scope) would you consider, and why is aspirin initially recommended?
Describe the physiological effects of nitroglycerin that make it beneficial in managing cardiac chest pain. How do these effects contrast with those of aspirin?
You have administered oxygen and aspirin to a patient with chest pain, but their pain persists. What are your next assessment steps before considering further interventions like nitroglycerin (assuming it's indicated and not contraindicated)?
Explain the importance of establishing a "position of comfort" for a cardiac patient. How can this simple intervention impact their physiological state and overall well-being during a cardiac emergency?