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Chapter 2 Cardiac emergencies
Michael Porter and Joel Beake
Queensland Ambulance Service, Brisbane, QLD, Australia
CHAPTER CONTENTS
Level 1: Cardiac arrest
Level 1: Acute coronary syndrome (ACS)
Level 2: Pericarditis and pericardial tamponade
Level 2: Narrow complex tachycardia (NCT)
Level 3: S‐T segment elevation myocardial infarction (STEMI)
Level 3: Hyperkalemia
LEVEL 1 CASE STUDY
Cardiac arrest
| Information type | Data |
| Time of origin | 07:15 |
| Time of dispatch | 07:30 |
| On‐scene time | 07:39 |
| Day of the week | Tuesday |
| Nearest hospital | 15 minutes |
| Nearest backup | Critical care paramedic (CCP), 15 minutes |
| Patient details | Name: Robert Drury DOB: 12/09/1946 |
CASE
You have been dispatched code 1 (the most urgent response) to a residence of a 74‐year‐old male who has woken with chest pain and collapsed.
Pre‐arrival information
The male is unconscious and not breathing effectively. CPR instructions are being given over the phone to a female on scene.
Windscreen report
The house is low set and appears to be neat, nil signs of any danger. You can see through the window that the patient is in the bedroom on the bed, with CPR being performed by a neighbour.
Entering the property
You are met at the door by an elderly woman, visibly distressed. She states that the patient is in the bedroom with the neighbour, also stating that he woke up and did not look well and collapsed onto the bed. You walk through the large, spacious lounge room into a small, cramped bedroom where the patient is located.
On arrival with the patient
The male patient is lying on the bed with a neighbour performing ineffective CPR. The patient is in his pyjamas, but his exposed limbs look grey in colour. You notice some saliva coming out of his mouth and he is not responding to the CPR being provided.
Patient assessment triangle
General appearance
The patient is unresponsive, lying across the bed.
Circulation to the skin
Grey in colour and is the same temperature as the bedroom.
Work of breathing
The patient took an agonal breath as you walked in the room, but no other breaths have been noted.
SYSTEMATIC APPROACH
Danger
Nil.
Response
No response.
Airway
Some saliva noted in the airway.
Breathing
One deep breath on arrival, no more breaths witnessed.
Circulation
No pulse.
Disability
GCS 3/15.
Exposure
Nil signs of trauma, The patient has central cyanosis.
Case history
The partner states that the patient slept in this morning and when he awoke