Cardiac (Heart)

Atrial Fibrillation (AFib)

Atrial Fibrillation (AFib) is an irregular and often rapid heart rate that can lead to complications such as stroke and heart failure. In the emergency room, the focus is on stabilizing the patient and managing the rhythm to prevent immediate complications.

Symptoms

  • Palpitations
  • Rapid or irregular heartbeat
  • Fatigue
  • Dizziness or lightheadedness
  • Shortness of breath
  • Chest discomfort

Treatment

  • Check vitals and symptoms
  • Administer an ECG (Electrocardiogram) by placing probes on the patient’s chest
  • Administer oxygen if saturation levels are low
  • Check if patient has had heart issues in the past (could lead to increased risk of stroke)
  • Consider blood thinners long-term to prevent blood clots
  • Consider long-term treatment
    • Consider beta-blockers to help control rhythm, would require follow-up for checkups and prescription
    • Consider a pacemaker to maintain rhythm, would require surgery, no follow-ups, no future metal detectors

Bradycardia

Low Heart Rate (Below 60)

Symptoms

  • Slow heartbeat (heart rate below 60 beats per minute at rest)
  • Fatigue
  • Dizziness or lightheadedness
  • Fainting or near-fainting spells
  • Shortness of breath
  • Chest pain or discomfort
  • Confusion or difficulty concentrating

Treatment

  • Take Vitals
  • If not apparent, check for underlying symptoms
    • Medication side effects
    • Electrolyte imbalance
    • Recent injury
  • Administer Epinepherine
  • Monitor vitals for rising of heart rate
  • If patient would like to treat underlying cause, collect blood work and send to lab
  • OOC with patient on lab results
  • Consider placing a pacemaker if patient desires

Cardiac Arrest

Cardiac arrest is a life-threatening emergency characterized by the sudden cessation of effective blood circulation due to the heart’s failure to contract effectively. Immediate and coordinated efforts are crucial to increase the chances of survival.

Symptoms

  • Unresponsiveness
  • Absence of normal breathing
  • Absence of a pulse or weak pulse

Treatment

  • Establish the criteria for a code blue
    • Airway is clear
    • Patient has no pulse
    • Patient is not breathing
    • No open chest wound
  • Start CPR
  • Remove clothing to allow access to chest
    • Ensure it is dry
  • Turn on the AED and attach the pads
  • Allow the machine to analyze the patient for a shockable rhythm
    • If no shockable rhythm, continue CPR
    • If shockable rhythm detected, start the AED
  • Administer a shock via the AED
  • Check vitals for stable pulse
    • If no response after first shock, administer Epinepherine
    • If response, remove pads
  • Continue with a second shock
    • DO NOT administer another round of Epinepherine
  • If the patient still does not return:
    • Discuss with another doctor or Nancy that you are only going to shock one more time. If the patient doesn’t respond, you will have to call a time of death.
  • Attempt the third shock
  • Check vitals for stable pulse
    • If response, remove pads
  • If patient is still not responding, perform an /OOC or /ME to confirm perma
  • If patient confirms, call TOD.

Hypertension (High Blood Pressure)

Elevated blood pressure, which can lead to complications such as stroke, heart attack, or kidney damage.

Symptoms

  • Severe headache
  • Visual disturbances
  • Chest pain
  • Shortness of breath
  • Nausea or vomiting
  • Altered mental status

Treatment

  • Obtain blood pressure
    • Considered emergency at 180/120
  • Administer oxygen
  • Administer medication
    • Under 180/120, Administer nitroglycerin
    • Over 180/120, Administer nicardipine
  • Offer ECG or chest Xrays to check for any organ damage
  • Stabilize the patient and discharge
  • Schedule a follow-up within 7 days

Tachycardia

Elevated Heart Rate (Above 100)

Symptoms

  • Rapid heartbeat (heart rate over 100 beats per minute at rest)
  • Palpitations (sensation of fluttering or pounding in the chest)
  • Dizziness or lightheadedness
  • Shortness of breath
  • Chest pain or discomfort
  • Fainting or near-fainting spells
  • Fatigue

Treatment

  • Take Vitals
  • Place an Oxygen mask on the patient
  • Administer Cardizem
  • Monitor vitals for lowering of heart rate
  • If patient would like to treat underlying cause, collect blood work and send to lab
  • OOC with patient on lab results