EMS Cardiac Emergencies - Pericarditis

Overview

Pericarditis is the inflammation of the pericardium, the protective sac around the heart. For EMS providers, recognizing pericarditis is critical because it can lead to serious complications like pericardial effusion or cardiac tamponade. 

The condition can be caused by a range of factors, including viral infections, bacterial infections, autoimmune disorders like lupus, trauma, and certain medications. 

It may also occur after a myocardial infarction (post-MI pericarditis or Dressler's Syndrome) or be associated with cancer or renal failure. Understanding the causes can help guide treatment and determine how urgent the patient’s condition may be.

Here are some things an EMS Provider needs to know:

Signs and Symptoms

Patients with pericarditis typically present with chest pain that is sharp, stabbing, and pleuritic in nature, meaning it worsens with deep breaths or coughing. A distinguishing feature of pericarditis-related chest pain is that it often improves when the patient sits up and leans forward, and worsens when lying flat. The pain can radiate to the neck, shoulders, or back, which can sometimes mimic the pain of a myocardial infarction.

In addition to chest pain, fever may be present, especially in cases caused by infections. Patients might also experience dyspnea, particularly if pericardial effusion (fluid buildup around the heart) develops. 

A classic sign detectable on physical examination is a pericardial friction rub, a scratchy or grating sound heard with a stethoscope near the left sternal border. 

EMS Providers may notice widespread ST-segment elevation across multiple leads and PR-segment depression on an EKG, both of which are characteristic of pericarditis. 

These combined symptoms can help differentiate pericarditis from other cardiac conditions, such as myocardial infarction.

Prehospital Treatment

Prehospital care for pericarditis focuses on symptom management and preventing complications. Positioning the patient in an upright or leaning-forward posture can relieve pain, and oxygen should be administered if hypoxia or dyspnea is present. 

NSAIDs, such as aspirin, if within protocol, can be used to alleviate pain and reduce inflammation. 

EKG monitoring is essential to detect any potential changes, such as arrhythmias or signs of tamponade. 

Providers should establish IV access for medications or fluid resuscitation, and if cardiac tamponade is suspected (marked by hypotension, jugular venous distention, and muffled heart sounds a.k.a Beck's Triad), rapid transport to a hospital is critical. 

Early hospital notification can prepare the receiving facility for advanced care.

In-Hospital Treatment

Once in the hospital, patients with pericarditis will undergo diagnostic testing, including an EKG to assess for pericardial effusion, and other tests such as chest X-rays or bloodwork to identify the underlying cause. 

Treatment usually involves anti-inflammatory medications like NSAIDs or colchicine to reduce inflammation and prevent recurrence. In some cases, corticosteroids may be used, but they are typically reserved for autoimmune cases or refractory pericarditis. 

Antibiotics are administered if a bacterial infection is identified. If a large pericardial effusion or cardiac tamponade is detected, emergency pericardiocentesis (draining fluid from the pericardium) is necessary. 

For recurrent or chronic pericarditis, surgical intervention, such as a pericardiectomy, might be considered.

Key Takeaways for EMS Providers

EMS Providers should be able to recognize pericarditis through its hallmark symptoms, including sharp, pleuritic chest pain and characteristic ECG changes. 

Rapid identification and intervention can prevent complications such as cardiac tamponade.

Prehospital care should focus on pain management, patient positioning, and continuous cardiac monitoring, while maintaining a high index of suspicion for worsening conditions. 

Prompt transport to a facility equipped for advanced cardiac care is essential, where definitive treatments, such as anti-inflammatory medications or pericardiocentesis, can be administered. Early intervention and effective prehospital management play a key role in patient outcomes.

Further Reading:

Ari D. Leib; Lisa A. Foris; Tran Nguyen; Karam Khaddour (2023) Dressler Syndrome. Treasure Island, Florida: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK441988/ Accessed September 7, 2024

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson.

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell.

Xanthopoulos, A. & Skoularigis, J. (2017) Diagnosis of Acute Pericarditis. Journal of Cardiology Practice #15 https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis Accessed September 6, 2024

EMS Leadership - Embracing a Growth Mindset

As EMS providers, we are constantly in high-stakes situations where quick thinking and adaptability are essential. Carol Dweck’s concept of a growth mindset —believing that abilities and intelligence can develop through dedication and hard work— is gaining traction across various fields, and it's especially relevant in the fast-paced world of emergency medical services.

A growth mindset is not just a trendy term; it has real implications for how we operate in the field, how we approach challenges, and how we support our teams. However, like any popular idea, misconceptions can arise. Some believe a growth mindset is simply about praising effort, but this isn't enough in EMS, where outcomes can be a matter of life or death. Effort matters, but so do results. The key is understanding that while some treatments may not lead to the desired outcome, the lessons learned from these experiences are invaluable.

In EMS organizations, it's common to hear motivational phrases like “adopt a growth mindset, and good things will happen.” It’s easy to agree with ideals such as growth, empowerment, and innovation, but what do these words mean without the policies and support systems to make them attainable? As EMS providers, we must ask: How are these values being put into practice in our everyday operations?

Organizations that truly embrace a growth mindset create an environment where calculated risk-taking is encouraged, knowing that not every decision will have the desired outcome. In these environments, it's not just about whether a protocol worked perfectly; it’s about the critical lessons learned, the shared knowledge within the team, and how we can improve care in the future.

But there's another piece to this puzzle. As individuals, we can't solely rely on our organization to foster this mindset. Whether you’re new to EMS or a seasoned veteran, the responsibility for your growth rests with you. This means continuously developing your skills, learning from your experiences, and seeking feedback. When you take ownership of your growth, you become not only a more effective provider but also a leader who influences the team for the better.

By cultivating a growth mindset on a personal level, you're more likely to become an agent of positive change—both for your patients and within your EMS team. The more invested you are in your own development, the more you contribute to the collective success of the team, enhancing both your leadership skills and your role as an engaged, proactive team member.

Further Reading:

Dweck, C. S. (2007) Mindset: The New Psychology of Success. New York, NY: Ballantine Books

Dweck, C. S. (2016) What Having a “Growth Mindset” Actually Means. Harvard Business Review (January 2016) https://hbr.org/2016/01/what-having-a-growth-mindset-actually-means Accessed September 6, 2024

Dweck, C. S. & Yeager, D. S. (2019) Mindsets: A View From Two Eras. Perspectives on Psychological Science 14 (3):481-496 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594552/ Accessed September 6, 2024

EMS Celebrations - Labor Day Responders

Today, as we celebrate Labor Day, we honor the unwavering dedication of our first responders and EMS personnel. While many enjoy a day of rest, you stand ready, tirelessly serving and protecting our communities.

Your courage, compassion, and commitment do not go unnoticed. Thank you for being the backbone of safety and care, always answering the call to help others in times of need. We are deeply grateful for your service and sacrifice.

Happy Labor Day, to all the heroes working today!