Heart (Cardiac)

Cardiac cases are among the most urgent and time-sensitive situations in emergency medicine. The heart is the engine of the body—when it struggles, everything else follows. From irregular rhythms to full cardiac arrest, cardiac events can escalate in seconds.

Cardiac Arrest

Heart stops pumping — emergency situation!

What to Look For:

  • Patient isn’t responsive
  • Not breathing normally
  • No pulse or very weak one

What To Do:

  1. Check if this is a full arrest (“Code Blue”):
    • No breathing
    • No pulse
    • Clear airway
    • No open chest wound
  2. Start CPR immediately.
  3. Expose the chest and dry it off.
  4. Turn on AED (defibrillator) and stick on the pads.
  5. Let AED check for shockable rhythm.
    • If YES, press shock button.
    • If NO, keep doing CPR.
  6. After 1st shock, check for pulse:
    • If no pulse, give Epinephrine.
    • If there’s a pulse, remove AED pads.
  7. If still no pulse, give 2nd shock.
    • Do NOT give more Epinephrine.
  8. Still no response?
    • Talk with another doc or Nancy — plan 1 final shock.
  9. Give 3rd and final shock.
  10. If still no pulse, ask patient /OOC or /ME if they want to perma.
  11. If yes, call time of death.

Bradycardia

Low heart rate (under 60 beats per minute)

What to Look For:

  • Slow heartbeat
  • Feeling faint or dizzy
  • Trouble breathing
  • Chest discomfort
  • Feeling tired or confused

What To Do:

  1. Take the patient’s vitals.
  2. Check for causes like:
    • Side effects from meds
    • Low electrolytes
    • Recent injuries or trauma
  3. Give Epinephrine to help raise the heart rate.
  4. Keep checking vitals to see if the heart rate improves.
  5. Offer bloodwork to find the root cause (get results /OOC).
  6. Talk about a pacemaker if the patient wants long-term treatment.

Atrial Fibrillation (AFib)

Irregular and often fast heart rate — can lead to stroke or heart failure.

What to Look For:

  • Fluttering heartbeat
  • Tiredness or weakness
  • Dizzy or lightheaded
  • Trouble breathing
  • Chest feels strange or uncomfortable

What To Do:

  1. Take the patient’s vitals.
  2. Run an ECG (stick probes on chest to check heart rhythm).
  3. Give oxygen if their oxygen levels are low.
  4. Ask if they’ve had heart issues before — this raises risk of stroke.
  5. Mention long-term options:
    • Blood thinners (to prevent clots)
    • Beta-blockers (to slow down the heart)
    • A pacemaker (requires surgery, no future metal detectors, no follow-ups needed)

Hypertension

High blood pressure — can cause strokes, heart attacks, or organ damage.

What to Look For:

  • Bad headache
  • Blurry vision
  • Chest pain
  • Trouble breathing
  • Nausea or confusion

What To Do:

  1. Check blood pressure.
    • Over 180/120 = Emergency!
  2. Give oxygen if needed.
  3. Give medication:
    • If BP is under 180/120 → Nitroglycerin
    • If BP is over 180/120 → Nicardipine
  4. Offer ECG or chest X-ray to check for organ damage.
  5. Stabilize the patient, then discharge.
  6. Book a follow-up within 7 days.

Tachycardia

Fast heart rate (over 100 beats per minute)

What to Look For:

  • Fast or pounding heart
  • Dizzy or faint
  • Shortness of breath
  • Chest discomfort
  • Tired or weak

What To Do:

  1. Take vitals.
  2. Put an oxygen mask on the patient.
  3. Give Cardizem to help slow the heart.
  4. Watch vitals to see if the heart rate improves.
  5. Offer bloodwork to check for causes (share results).