Cardiac Emergencies

Cardiovascular emergencies are life-threatening disorders that must be recognized immediately to avoid delay in treatment and to minimize morbidity and mortality. Patients may present with severe hypertension, chest pain, dysrhythmia, or cardiopulmonary arrest.

  • Changing the Airway (A) – Breathing (B) – Circulation (C) sequence to C-A-B. This change was made to emphasize the importance of rapid initiation of chest compressions because in the old guidelines, significant time is potentially wasted performing airway evaluation. Airway evaluation and initiation of mouth-to-mouth breathing may be a complex, time-consuming process for the layperson, and may delay chest compressions. The phrase “Look, listen and feel” has also been removed from the algorithm to prevent time delays.
  • More emphasis on the quality of CPR performed, including the rate and depth of compressions, allowing complete chest recoil, and minimizing interruptions in compressions. Less emphasis on pulse checks.
  • Highlighting the importance of professional healthcare rescue teams performing multiple tasks during CPR such as establishing an airway or delivering advanced cardiac life support drugs.




  • Oxygen at 15 lpm via a nonrebreather mask
  • PPV
  • Calm the patient to reduce anxiety.
  • Assist patient with administering a dose (0.3-0.4 mg) of prescribed nitroglycerin sublingually. Reassess blood pressure after 2 minutes, and administer another dose after 3-5 minutes if needed, for a maximum of 3 doses.
    • Do not administer if blood pressure is below 90 or drops over 30 over the baseline.
    • Do not administer to extreme bradycardia (<50) or tachycardia (>100).
    • Do not administer for those on drugs for erectile dysfunction within 24 hours.
    • Do not administer if you suspect head injury.
    • Do not administer for infants and children.
  • 160-325 mg of aspirin, nonenteric and ask the patient to chew it.
    • Do not administer if patient is allergic.
    • Follow medical direction and local protocols.
  • Call ALS backup.
  • CPR for cardiac arrest patients (no breathing, no pulse).

Medical conditions and mechanisms

  • Angina pectoris: pain in the chest, caused by inadequate oxygen to the heart.
    • Chest pain, especially during exertion, that radiates to neck, jaw, arms, back, and shoulders.
    • General discomfort, anxiety, and nausea / vomiting.
    • Relief of pain if physical activity is stopped.
  • Acute myocardial infarction: a portion of the heart muscle dies due to lack of oxygen.
    • Chest pain and discomfort, similar to angina, that radiates to the neck, jaw, arms, back, and shoulders.
    • Lasts longer than angina and the pain and discomfort is not able to be relieved.
  • Heart failure: inadequate pumping of the heart.
    • Left ventricle failure: pulmonary edema, because blood is backing into the lungs.
    • Right ventricle failure: peripheral edema, jugular vein distention, and liver enlargement, because blood is backing into the venous circulation.
  • Congestive heart failure: heart failure that causes edema.


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