What are the key components of a cardiac-focused primary assessment?
LOC, airway, breathing, circulation, skin, perfusion
On which patients should a 12-lead ECG be performed?
As early as possible in suspected ACS, arrhythmias, syncope, unexplained SOB, and atypical presentations in high-risk patients
What findings on a cardiac assessment would indicate poor perfusion?
Cool/clammy skin, delayed cap refill, altered LOC, weak/rapid pulse, hypotension
What are the classic symptoms of ACS?
Chest pain/pressure, radiation, nausea, diaphoresis, dyspnea, anxiety
What atypical ACS symptoms are common in older adults, diabetics, and females?
Fatigue, syncope, general malaise, nausea/vomiting, epigastric discomfort, SOB
What is the ideal timeline to acquire 12-lead after first patient contact?
Within 10 minutes
What is the overall treatment plan for suspected cardiac chest pain?
Oxygen to 94%, ASA, 12-lead, NTG/entonox, transport with early notification
When should you withhold NTG even if BP is adequate?
Suspected R ventricular infarct, or severe bradycardia
What symptoms suggest acute cardiogenic pulmonary edema?
Severe SOB, orthopnea, crackles, frothy sputum, tachycardia, hypertension
What differentiates acute LV failure from COPD?
Crackles (not wheezes), hypertension, JVD, pink frothy sputum, rapid onset at night
What is the priority intervention for severe pulmonary edema?
CPAP
What is the compression-to-ventilation ratio for cardiac arrest without advanced airway?
30:2
What rhythm requires immediate defibrillation?
VF and pulseless VT
What are reversible causes of cardiac arrest? (H’s & T’s)
Hypoxia, hypovolemia, H+ (acidosis), hypo/hyperkalemia, hypothermia, tension pneumo, tamponade, toxins, thrombosis (pulmonary or coronary)
What vital sign determines if an arrhythmia is unstable?
Blood pressure - signs of shock indicate instability
What symptoms indicate an unstable tachyarrhythmia?
Hypotension, chest pain, altered LOC, poor perfusion
What bradycardia signs require immediate concern?
HR<50 with hypotension, chest pain, poor perfusion, or syncope
What blood pressure suggests cardiogenic shock?
SBP<90 with signs of poor perfusion
What skin findings are most consistent with cardiogenic shock vs. sepsis?
Cool, pale, clammy skin vs. warm/flushed in early sepsis
What is the recommended fluid administration for suspected cardiogenic shock?
Small, cautious bolus (250ml), monitor for worsening pulmonary edema
What symptom combination suggest an aortic dissection?
Sudden tearing chest or back pain, pulse deficits, unequal BP, neurological symptoms
What BP target should you aim for with a suspected dissection?
Permissive hypotension - aim for 90 mmHg to maintain perfusion of organs
What red flags in syncope require cardiac suspicion?
Abrupt onset/no warning, family Hx of sudden death, exertional syncope, arrhythmia Hx
What are signs of a hypertensive emergency?
High BP with headache, neuro deficits, chest pain, or pulmonary edema
