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Medical: 5

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

E.

3. Denial Detailed physical exam

  • 1.

    Airway

  • 2.

    Breath sounds

    • a.

      May be clear to auscultation

    • b.

      Congestion in bases may be present

  • 3.

    Circulation

    • a.

      Skin

      • (1)

        Pallor during the episode

      • (2)

        Temperature may vary

      • (3)

        Diaphoresis is usually present

    • b.

      Alterations in heart rate and rhythm may occur

    • c.

      Peripheral pulses are usually not affected

    • d.

      Blood pressure may be elevated or lowered

    • e.

      ECG findings

      • (1)

        ST segment elevation

        • (a)

          Height, depth and contour

        • (b)

          ST changes

        • (c)

          ST segment depression in reciprocal leads

      • (2)

        Q waves

        • (a)

          Depth, duration and significance

          • i)

            Greater than 5 mm, greater than .04 seconds

          • ii)

            May indicate necrosis

          • iii)

            May indicate extensive transient ischemia

      • (3)

        ECG Rhythm analysis

        • (a)

          Criteria for patient selection for rapid transport and reperfusion

        • (b)

          Value

        • (c)

          Signs of acute ischemia, injury, and necrosis

        • (d)

          Criteria for patient selection for rapid transport and reperfusion

          • i)

            Time of onset of pain

          • ii)

            Location of ischemia and infarction

          • iii)

            ST segment elevation

      • (4)

        Cardiac arrhythmias

F.

Position of comfort Pharmacological

a. b. c. d.

Gases Nitrates Platelet aggregate inhibitor Analgesia

e.

Increase or decrease heart rate

Management

1. 2 .

  • (a)

    Sinus tachycardia with or without ectopy

  • (b)

    Narrow or wide QRS complex tachycardia

  • (c)

    Sinus bradycardia

  • (d)

    Heart blocks

  • (e)

    Ventricular fibrillation

  • (f)

    Pulseless electrical activity (PEA)

  • (g)

    Asystole (confirmed in a second lead)

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

24

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