Standard

Rev : 4/18/07; Posted: 06/11/07

EMS 132 - Cardiology I

Course Description

Emphasizes the study of the cardiovascular system. Cardiology I will introduce and explore cardiovascular epidemiology, anatomy and physiology, pathophysiology, and electrophysiology. This course will also provide instruction on initial cardiovascular assessment, focused history, detailed physical examination, and electrocardiographic monitoring. Management of the cardiovascular patient will be taught in Cardiology II. At the completion of this unit, the paramedic student will be able to integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for the patient with cardiovascular disease. This course provides instruction on topics in Division 5 (Medical), Section 2 (Cardiology) of the USDOT/NHTSA Paramedic National Standard Curriculum.

Competency Areas	Hours
Cardiovascular  Epidemiology, Anatomy and Physiology	Class	4
Pathophysiology, and Electrophysiology	D. Lab	2
Initial Cardiovascular Assessment	P. Lab/O.B.I.	0
Focused History and Detailed Physical Examination	Credit	5
Principles of Electrocardiography

Prerequisite:	EMS, 126, EMS127, EMS 128 EMS 129, AHS 101
Corequisite:

Course Guide

Competency	After completing this section, the student will:	Hours
		Class	D.Lab	P.Lab/ O.B.I.
CARDIOVASCULAR EPIDEMIOLOGY, ANATOMY AND PHYSIOLOGY		12	0	0
Epidemiology	Describe the incidence, morbidity and mortality of cardiovascular disease.
	Discuss prevention strategies that may reduce the morbidity and mortality of cardiovascular disease.
	Identify the risk factors most predisposing to coronary artery disease.
Anatomy	Describe the anatomy of the heart, including the position in the thoracic cavity, layers of the heart, chambers of the heart, and location and function of cardiac valves.
	Identify the major structures of the vascular system.
	Identify the arterial blood supply to any given area of the myocardium.
	Compare and contrast the coronary arterial distribution to the major portions of the cardiac conduction system.
	Identify the structure and course of all divisions and subdivisions of the cardiac conduction system.
Physiology	Define the functional properties of cardiac muscle.
	Identify the factors affecting venous return.
	Identify and define the components of cardiac output.
	Identify phases of the cardiac cycle.
	Describe the clinical significance of Starling's law.
	Define preload, afterload and left ventricular end-diastolic pressure.
Electrophysiology	Define the events comprising electrical potential.
	List the most important ions involved in myocardial action potential and their primary function in this process.
	Describe the events involved in the steps from excitation to contraction of cardiac muscle fibers.
	Explain the physiological basis of conduction delay in the AV node.
Nervous system control	Identify the structures of the autonomic nervous system (ANS).
	Identify the effect of the ANS on heart rate, rhythm and contractility.
	Define and give examples of positive and negative inotropism, chronotropism and dromotropism.
PATHOPHYSIOLOGY, AND ELECTROPHYSIOLOGY		14	6	0
INITIAL CARDIOVASCULAR ASSESSMENT		4	4	0
FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION		4	4	4
PRINCIPLES OF ELECTROCARDIOGRAPHY		6	6	0
Overview of the ECG	Explain the purpose of ECG monitoring.
	Describe how ECG wave forms are produced.
	Correlate the electrophysiological and hemodynamic events occurring throughout the entire cardiac cycle with the various ECG wave forms, segments and intervals.
	Relate the cardiac surfaces or areas represented by the ECG leads.
	Identify the limitations to the ECG.
Rhythm analysis	Identify and describe how the heart's pacemaking control, rate, and rhythm are determined.
	Identify how heart rates, durations, and amplitudes may be determined from ECG recordings.
	Differentiate among the primary mechanisms responsible for producing cardiac arrhythmias.
	Describe a systematic approach to the analysis and interpretation of cardiac arrhythmias.
Cardiac monitoring	Demonstrate how to set and adjust the ECG monitor settings to varying patient situations.
	Demonstrate a working knowledge of various ECG lead systems.
	Demonstrate how to record an ECG.
Recognition of cardiac dysrrhythmias	Describe the arrhythmias originating in the sinus node, the AV junction, the atria, and the ventricles.
	Describe the arrhythmias originating or sustained in the AV junction.
	Describe the abnormalities originating within the bundle branch system.
	Describe the process of differentiating wide QRS complex tachycardias
	Recognize the pitfalls in the differentiation of wide QRS complex tachycardias.
	Given an ECG, identify the arrhythmia.
Cardiac arrest resuscitation	Define the term “cardiac arrest.”
	Identify the characteristics of patients at risk for developing cardiac arrest.
	Identify non-cardiac causes of cardiac arrest.
	Describe the arrhythmias seen in cardiac arrest.
	Identify the critical actions in caring for the patient with cardiac arrest.
	Describe the most commonly used pharmacological agents in the managements of cardiac arrest in terms of therapeutic effects.
	Identify resuscitation.
	Identify circumstances and situations where resuscitation efforts would not be initiated.
	Describe the conditions of pulseless electrical activity.
	Explain how to confirm asystole using the 3-lead ECG.
	Define the terms defibrillation and synchronized cardioversion.
	Specify the methods of supporting the patient with a suspected ineffective implanted defibrillation device.
	Identify the inclusion and exclusion criteria for termination of resuscitation efforts.
	Identify communication and documentation protocols with medical direction and law enforcement used for termination of resuscitation.
	Value and defend the urgency in rapid determination of and rapid intervention of patients in cardiac arrest.
	Value and defend the possibility of termination of resuscitative efforts in the out-of-hospital setting.
	Demonstrate satisfactory performance of psychomotor skills of basic and advanced life support techniques to manage Cardiac arrest according to the current American Heart Association Standards and Guidelines, including Cardiopulmonary resuscitation and defibrillation.
	Complete a communication patch with medical direction and law enforcement used for termination of resuscitation efforts.
Final written and practical testing	Successfully complete a final written and practical examination over all material covered in this course.

Suggested Resources

Bledsoe, et al; Essentials of Paramedic Care 1^st ed., 2003; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13-098792-1

Sanders, et al; Mosby’s Paramedic Textbook 2^nd ed., 2002; Mosby Publishing, Philadelphia, PA 19106; ISBN: 032301416X

Bledsoe, et al; Paramedic Care: Principles & Practice- Vol. 3-Medical Emergencies 1^st ed.; 2001; Brady-Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13-021598-8

Walraven, Gail; Basic Arrhythmias 5^th ed., 1999; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-8359-5305-X

Dalton et al; Advanced Medical Life Support 2^nd ed.; 2003; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13-098632-1

AHA, Advanced Cardiac Life Support 2001, American Heart Association; Dallas, TX 75231; ISBN: 0-87493-327-7

Beasley; Understanding EKGs: A Practical Approach 2^nd ed; 2003; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0130452157

West, et al; Understanding 12-Lead EKGs 1^st ed.; 2000; Brady Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0130272817

Mistovich et al; Prehospital Cardiac Life Support 2^nd ed.; 2004; Prentice Hall Publishing, Upper Saddle River, NJ 07458; ISBN: 0-13-110143-9

Nagel; A Case-based Approach to ECG Interpretation 1^st ed; 2003; Mosby Publishing, Philadelphia, PA 19106; ISBN: 0323019684