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Medical: 5

Cardiology: 2 ════════════════════════════════════════════════════════════════════════════════════ ══════════════════════════

D.

E.

Focused history

  • 1.

    Chief complaint

    • a.

      Typical - sudden onset of discomfort, usually of brief duration, lasting three to five minutes, maybe five to 15 minutes; never 30 minutes to two hours

    • b.

      Typical - usually relieved by rest and/ or medication

    • c.

      Epigastric pain or discomfort

    • d.

      Atypical

  • 2.

    Denial

  • 3.

    Contributing history

    • a.

      Initial recognized event

    • b.

      Recurrent event

    • c.

      Increasing frequency and/ or duration of event

Detailed physical exam

  • 1.

    Airway

  • 2.

    Breathing

    • a.

      May or may not be labored

      • (1)

        Sounds

        • (a)

          May be clear to auscultation

        • (b)

          May be congested in the bases

  • 3.

    Circulation

a. b. c. d .

e.

Alterations in heart rate and rhythm may occur Peripheral pulses are usually not affected Blood pressure may be elevated during the episode and normalize afterwards ECG Devices

  • (1)

    Monitor

  • (2)

    Transmission

  • (3)

    Documentation

  • (4)

    Computerized pattern identification

    • (a)

      Pitfalls

    • (b)

      Common errors

Findings

  • (1)

    ST segment changes are often not specific

  • (2)

    Arrhythmias and ectopy may not be present

F.

Management

1. 2 .

3.

Position of comfort Pharmacological

  • a.

    Gases

  • b.

    Nitrates

  • c.

    Analgesics

  • d.

    Possible antiarrhythmic

  • e.

    Possible antihypertensives

ECG

  • a.

    Whenever possible, and scene time is not delayed, record and transmit 3-lead and/ or 12-lead ECG during pain, since ECG may be normal during the pain-free period

  • b.

    Measure, record and communicate ST segment changes

4.

Transport

a.

Indications for rapid transport

───────────

─────────────────────────────────────────────────────────────────────────

────────────────────────── United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

22

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