August 2014 CE

Site code # 107200E-1214

Angina, Acute MI, Stroke

Objectives by Reviewed/revised by Sharon Hopkins, RN, BSN, EMT-P

To view on the Advocate Condell website visit:

http://www.advocatehealth.com/condell/2014-ems-continuing-education

Date of CE presentation: August, 2014 Topic: Angina, Acute MI, Stroke Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to:

1. Describe the pathophysiology of angina. 2. Describe the pathophysiology of the acute myocardial infarction process. 3. Describe the atypical presentations of women, elderly, and those with long standing diabetes. 4. Describe the pathophysiology of ischemic and hemorrhagic strokes. 5. Describe field assessment of the patient with a possible stroke including documentation of time of onset, blood sugar level, and Cincinnati Stroke Scale. 6. Actively participate in review of selected Region X SOP’s. 7. Actively participate in review of a variety of EKG rhythms and 12 lead EKG’s. 8. Actively participate in case scenario discussion. 9. Actively participate in calculating and preparing medication doses for the pediatric patient. 10. Review responsibilities of the preceptor role. 11. Successfully complete the post quiz with a score of 80% or better Bibliography:

• Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices, 4th edition. Brady. 2013.

• Mistovich, J., Karren, K. Prehospital Emergency Care 9th Edition. Brady. 2010.

• Region X SOP’s; IDPH Approved April 10, 2014. • http://www.merckmanuals.com/professional/neurologic_disorders/spinal_c

ord_disorders/overview_of_spinal_cord_disorders.html • http://lifeinthefastlane.com/ecg-library/basics/left-bundle-branch-block/ • http://www.interactive-biology.com/75/show-me-a-diagram-of-the-human-

heart-here-are-a-bunch/ • https://sites.google.com/site/caduceusnewsletter/medical-

reference/myocardial-infarction---by-cornelia-riedl • http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/c

ardiology/complications-of-acute-myocardial-infarction/ • http://www.uhnj.org/stroke/types.htm • http://floatnurse-mike.blogspot.com/2012_10_01_archive.html

Layers of the heart wall Diagram of the heart Main coronary risk factors

ü Hypertension

ü Hyperlipidemia

ü Smoking

ü Diabetes

Plague formation

Wave form evolution

Identifying AMI location

Wall Coronary

artery

EKG Change Reciprocal wall

Reciprocal Leads

Inferior

RCA II, III, aVF Lateral wall I, aVL

Anterior Left coronary LAD

V3, V4 Inferior wall II, III,aVF

Anterioseptal Left coronary LAD

V1 – V4 Posterior wall V7-9

Anteriolateral Left coronary LAD and/or circumflex

I, aVL, V3 – V6 Inferior and posterior wall

II, III, aVF,V7 -9

Lateral LAD and/or Circumflex

I, aVL, V5, V6 Inferior wall II, III, aVF

Coronary Arteries

Identification of ST elevation Stroke – Ischemic vs Hemorrhagic

Major Risk Factors for Stroke

ü Atherosclerosis ü High cholesterol levels ü Hypertension ü Diabetes ü Smoking

Contributing Risk Factors for Stroke

ü Obesity ü Alcohol consumption ü Substance abuse ü Oral contraceptive use ü Sickle cell disease ü Atrial fibrillation ü Sedentary habits

Rhythm Strip Identification Case Scenario #1

Case Scenario #1

Case Scenario #3

Case Scenario #3

Case Scenario #3

Case Scenario #4

Medication Dosing Med & Pt Weight Region X SOP Dosing Broselow Tape Dosing Amiodarone 55#

Versed 80#

Fentanyl 60#

Glucagon 65#

Narcan 90#

Valium 35#

Epinephrine 1:10,000 40#

Zofran 30#

File: CE, EMS; CE Packets; 2014; August; Handout; Angina, AMI, Stroke