Standard

Rev.03/17/03

EMS 133 - Cardiology II

(To Review Previous Version of this Standard and Guide, Click Here)

Course Description

This course expounds on the objectives in Cardiology I emphasizing advanced patient assessment and management of the cardiac patient. Topics will include advanced cardiovascular assessment, pharmacological intervention, electrical intervention, and emergency resuscitative treatment utilizing the American Heart Association’s Advanced Cardiac Life Support (ACLS) Providers course. This course provides instruction on topics in Division 5 (Medical), Section 2 (Cardiology) of the USDOT/NHTSA Paramedic National Standard Curriculum.

Competency Areas	Hours
Assessment of the Cardiac patient	Class	4
Emergency Resuscitative Equipment	D. Lab	2
Assessment and Management of Cardiovascular Emergencies	P. Lab/O.B.I.	0
	Credit	5

Prerequisite:	EMS 126, EMS 127, EMS 128, EMS 129
Corequisite:	ENG 101, SCT 100, EMS 132, EMS 200

Course Guide

Competency	After completing this section, the student will:	Hours
		Class	D.Lab	P.Lab/ O.B.I.
ASSESSMENT OF THE CARDIAC PATIENT		5	3	0
History and physical exam	Identify and describe the details of physical exam specific to the cardiovascular system.
	Define pulse deficit, pulsus paradoxus and pulsus alternans.
	Identify the normal characteristics of the point of maximal impulse (PMI).
	Identify and define the heart sounds.
	Relate heart sounds to hemodynamic events in the cardiac cycle.
	Describe the differences between normal and abnormal heart sounds.
	Identify and describe the components of the focused history as it relates to the patient with cardiovascular compromise.
	Based on field impressions, identify the need for rapid intervention for the patient in cardiovascular compromise.
	Identify what is meant by the OPQRST of chest pain assessment.
	Value the sense of urgency for initial assessment and intervention in the patient with cardiac compromise.
	Perform, document and communicate a cardiovascular assessment.
	Demonstrate how to evaluate major peripheral arterial pulses.
The 12-Lead ECG	Describe the abnormalities originating within the bundle branch system.
	Recognize the pitfalls in the differentiation of wide QRS complex tachycardias.
	Describe the phenomena of reentry, aberration and accessory pathways.
	Identify the ECG changes characteristically produced by electrolyte imbalances and specify the clinical implications.
	Identify patient situations where ECG rhythm analysis is indicated.
	Recognize the ECG changes that may reflect evidence of myocardial ischemia and injury.
	Recognize the ECG limitations in reflecting evidence of myocardial ischemia and injury.
	Correlate abnormal ECG findings with clinical interpretation.
	Describe the incidence, morbidity and mortality associated with myocardial conduction defects.
	Defend patient situations where ECG rhythm analysis is indicated.
EMERGENCY RESUSCITATIVE TREATMENT		11	1	0
Electrical therapeutic interventions	Identify the clinical indications for transcutaneous and permanent artificial pacing.
	Describe the components and the functions of a transcutaneous pacing system.
	Explain what each setting and indicator on a transcutaneous pacing system represents and how the settings may be adjusted.
	Describe the techniques of applying a transcutaneous pacing system.
	Describe the characteristics of an implanted pacemaking system.
	Describe artifacts that may cause confusion when evaluating the ECG of a patient with a pacemaker.
	List the possible complications of pacing.
	List the causes and implications of pacemaker failure.
	Identify additional hazards that interfere with artificial pacemaker function.
	Recognize the complications of artificial pacemakers as evidenced on ECG.
Pharmacologic therapeutic interventions	Describe the most commonly used cardiac drugs in terms of therapeutic effect and dosages, routes of administration, side effects and toxic effects.
ASSESSMENT AND MANAGEMENT OF CARDIOVASCULAR EMERGENCIES		24	24	0
Angina	Describe the epidemiology, morbidity and mortality, and pathophysiology of angina pectoris.
	List and describe the parameters to be evaluated in a patient with angina pectoris.
	Identify what is meant by the OPQRST of chest pain assessment.
	List other clinical conditions that may mimic signs and symptoms of coronary artery disease and angina pectoris.
	Identify the ECG findings in patients with angina pectoris.
	Identify the paramedic responsibilities associated with management of the patient with angina pectoris.
	Based on the pathophysiology and clinical evaluation of the patient with chest pain, list the anticipated clinical problems according to their life-threatening potential.
Myocardial infarction	Describe the epidemiology, morbidity and mortality of myocardial infarction.
	List the mechanisms by which an MI may be produced by traumatic and non-traumatic events.
	Identify the primary hemodynamic changes produced in myocardial infarction.
	List and describe the assessment parameters to be evaluated in a patient with a suspected myocardial infarction.
	Identify the anticipated clinical presentation of a patient with a suspected acute myocardial infarction.
	Differentiate the characteristics of the pain/discomfort occurring in angina pectoris and acute myocardial infarction.
	Identify the ECG changes characteristically seen during evolution of an acute myocardial infarction.
	Identify the most common complications of an acute myocardial infarction.
	List the characteristics of a patient eligible for thrombolytic therapy.
	Describe the “window of opportunity” as it pertains to reperfusion of a myocardial injury or infarction.
	Based on the pathophysiology and clinical evaluation of the patient with a suspected acute myocardial infarction, list the anticipated clinical problems according to their life-threatening potential.
	Specify the measures that may be taken to prevent or minimize complications in the patient suspected of myocardial infarction.
	Value and defend the sense of urgency necessary to protect the window of opportunity for reperfusion in the patient with suspected myocardial infarction.
	Based on the pathophysiology and clinical evaluation of the patient with acute myocardial infarction, characterize the clinical problems according to their life-threatening potential.
	Defend the measures that may be taken to prevent or minimize complications in the patient with a suspected myocardial infarction.
Heart failure	Describe the epidemiology, morbidity and mortality of heart failure.
	Define the principle causes and terminology associated with heart failure.
	Identify the factors that may precipitate or aggravate heart failure.
	Describe the physiological effects of heart failure.
	Define the term “acute pulmonary edema” and describe its relationship to left ventricular failure.
	Relate preload, afterload and left ventricular end-diastolic pressure to the pathophysiology of heart failure.
	Differentiate between early and late signs and symptoms of left ventricular failure and those of right ventricular failure.
	Explain the clinical significance of paroxysmal nocturnal dyspnea.
	Explain the clinical significance of edema of the extremities and sacrum.
	List the interventions prescribed for the patient in acute congestive heart failure.
	Describe the most commonly used pharmacological agents in the management of congestive heart failure in terms of therapeutic effect, dosages, routes of administration, side effects and toxic effects.
Cardiac tamponade	Describe the most commonly used pharmacological agents in the management of congestive heart failure in terms of therapeutic effect, dosages, routes of administration, side effects and toxic effects.
	Define the term “cardiac tamponade.”
	List the mechanisms by which cardiac tamponade may be produced by traumatic and non-traumatic events.
	Identify the limiting factor of pericardial anatomy that determines intrapericardiac pressure.
	Identify the clinical criteria specific to cardiac tamponade.
	Describe how to determine if pulsus paradoxus, pulsus alternans or electrical alternans is present.
	Identify the paramedic responsibilities associated with management of a patient with cardiac tamponade.
Cardiogenic shock	Define the term “cardiogenic shock.”
	Describe the major systemic effects of cardiogenic shock.
	Explain the primary mechanisms by which the heart may compensate for a diminished cardiac output and describe their efficiency in cardiogenic shock.
	Differentiate progressive stages of cardiogenic shock.
	Identify the clinical criteria for cardiogenic shock.
	Describe the characteristics of patients most likely to develop cardiogenic shock.
	Describe the most commonly used pharmacological agents in the management of cardiogenic shock in terms of therapeutic effects, dosages, routes of administration, side effects and toxic effects.
	Correlate abnormal findings with clinical assessment of the patient in cardiogenic shock.
	Identify the paramedic responsibilities associated with management of a patient in cardiogenic shock.
Hypertension	Describe the incidence, morbidity and mortality of hypertensive emergencies.
	Define the term “hypertensive emergency.”
	Identify the characteristics of patients at risk for developing a hypertensive emergency.
	Explain the essential pathophysiological defect of hypertension in terms of Starling's law.
	Identify the progressive vascular changes associate with sustained hypertension.
	Describe the clinical features of the patient in a hypertensive emergency.
	Rank the clinical problems of patients in hypertensive emergencies according to their sense of urgency.
	From the priority of clinical problems identified, state the management responsibilities for the patient with a hypertensive emergency.
	Identify the drugs of choice for hypertensive emergencies, rationale for use, clinical precautions and disadvantages of selected antihypertensive agents.
	Correlate abnormal findings with clinical interpretation of the patient with a hypertensive emergency.
	Defend the urgency based on the severity of the patient’s clinical problems in a hypertensive emergency.
	From the priority of clinical problems identified, state the management responsibilities for the patient with a hypertensive emergency.
Vascular disorders	Describe the incidence, morbidity and mortality of vascular disorders.
	Describe the pathophysiology of vascular disorders.
	List the traumatic and non-traumatic causes of vascular disorders.
	Define the terms “aneurysm,” “claudication” and “phlebitis.”
	Identify the peripheral arteries most commonly affected by occlusive disease.
	Identify the major factors involved in the pathophysiology of aortic aneurysm.
	Recognize the usual order of signs and symptoms that develop following peripheral artery occlusion.
	Identify the clinical significance of claudication and presence of arterial bruits in a patient with peripheral vascular disorders.
	Describe the clinical significance of unequal arterial blood pressure readings in the arms.
	Recognize and describe the signs and symptoms of dissecting thoracic or abdominal aneurysm.
	Describe the significant elements of the patient history in a patient with vascular disease.
	Identify the hemodynamic effects of vascular disorders.
	Identify the complications of vascular disorders.
	Identify the Paramedic's responsibilities associated with management of patients with vascular disorders.
	Develop, execute and evaluate a treatment plan based on the field impression for the patient with vascular disorders.
	Based on the pathophysiology and clinical evaluation of the patient with vascular disorders, characterize the clinical problems according to their life-threatening potential.
	Value and defend the sense of urgency in identifying peripheral vascular occlusion.
	Value and defend the sense of urgency in recognizing signs of aortic aneurysm.
Clinical applications of advanced cardiac life support	Differentiate between signs and symptoms of cardiac tamponade, hypertensive emergencies, cardiogenic shock, and cardiac arrest.
	Based on the pathophysiology and clinical evaluation of the patient with chest pain, characterize the clinical problems according to their life-threatening potential.
	Apply knowledge of the epidemiology of cardiovascular disease to develop prevention strategies.
	Integrate pathophysiological principles into the assessment of a patient with cardiovascular disease or chest pain and synthesize patient history, assessment findings and ECG analysis to form a field impression for the patient with cardiovascular disease.
	Integrate pathophysiological principles to the assessment of a patient in need of a pacemaker and synthesize patient history, assessment findings and ECG analysis to form a field impression for the patient in need of a pacemaker.
	Develop, execute, and evaluate a treatment plan based on field impression for the patient in need of a pacemaker.
	Synthesize patient history, assessment findings and ECG analysis to form a field impression for the patient with angina pectoris or myocardial infarction.
	Develop, execute and evaluate a treatment plan based on the field impression for the patient with chest pain.
	Integrate pathophysiological principles into the assessment of a patient with a suspected myocardial infarction or heart failure and synthesize assessment findings and patient history information to form a field impression of the patient with heart failure or cardiogenic shock.
	Develop, execute and evaluate a treatment plan based on the field impression for the suspected myocardial infarction or heart failure patient.
	Integrate pathophysiological principles to the assessment of a patient with cardiac tamponade and synthesize assessment findings and patient history information to form a field impression of the patient with cardiac tamponade.
	Develop, execute and evaluate a treatment plan based on the field impression for the patient with cardiac tamponade.
	Integrate pathophysiological principles to the assessment of the patient with a hypertensive emergency and synthesize assessment findings and patient history information to form a field impression of the patient with a hypertensive emergency.
	Develop, execute and evaluate a treatment plan based on the field impression for the patient with a hypertensive emergency.
	Synthesize assessment findings and patient history information to form a field impression of the patient with cardiogenic shock.
	Develop, execute, and evaluate a treatment plan based on the field impression for the patient with cardiogenic shock.
	Integrate the pathophysiological principles to the assessment of the patient with cardiac arrest and synthesize assessment findings to formulate a rapid intervention for a patient in cardiac arrest, including consideration of termination of resuscitative efforts.
	Integrate pathophysiological principles to the assessment of a patient with vascular disorders and synthesize assessment findings and patient history to form a field impression for the patient with vascular disorders.
	Given the model of a patient with signs and symptoms of heart failure, position the patient to afford comfort and relief.
	Demonstrate how to determine if pulsus paradoxus, pulsus alternans or electrical alternans is present.
	Demonstrate satisfactory performance of psychomotor skills of basic and advanced life support techniques according to the current American Heart Association Standards and Guidelines.
Final written and practical testing	Successfully complete a final written and practical examination over all material covered in this course.

Suggested Resources

Mosby’s Paramedic Textbook, Sanders, McKenna, Lewis and Quick, Current Edition 

Paramedic Emergency Care, Bledsoe, Porter, Third Edition,

Emergency Care in the Streets, Nancy Caroline, Fifth Edition