Chest pain and other cardiac problems represented just over 8% of emergency responses to 999 calls made to a UK Ambulance Service Trust in 2011–2012, with unconscious/fainting episodes representing a further 3% (South East Coast Ambulance Service NHS Foundation Trust, 2012). Although I have been unable to find a more up-to-date reference, it is likely that these figures have not changed much. In fact, they are comparable to findings from a recent study in Northern Ireland, which found that 5% of patients attending the emergency department presented with chest pain (McDevitt-Petrovic et al, 2017). Although slightly different, this means that on average, per shift, a paramedic will probably encounter at least one patient who has chest pain or another cardiac symptom such as fainting, dizziness or shortness of breath.
In light of this, it comes as no surprise that the assessment and management of cardiac patients is included in undergraduate paramedic courses, and that practical placements in coronary care units are recommended by the College of Paramedics (2015). In fact, Kingston University and St Georges University of London (2018) even offer a 30-credit module solely focused on ‘Cardiac Care for Paramedics’ as part of their BSc (Hons) Paramedic Practice.
Learning about cardiac patients should definitely not stop after graduating and becoming a newly qualified paramedic (NQP): there is a wide range of continuing professional development (CPD) events out there and many cover cardiac care and/or specifically electrocardiograms (ECGs). However, if you don't have the time or money to attend a course but would still like a refresher on cardiac patients, Rapid Cardiac Care by Emma Menzies-Gow and Christine Spiers is a concise guide for the assessment and management of patients with cardiac conditions.
The authors are both registered nurses and university lecturers in cardiology, which makes them more than qualified to write this book. Their intended audience consists of students and newly qualified nurses, as well as allied health professionals that work with acutely ill patients—paramedics in particular get a special mention on the back cover!
The book is divided into four sections:
Anatomy and physiology
Part 1 provides a solid overview of cardiac anatomy and physiology. Despite the authors managing to explain difficult concepts in a simple way, as well as using figures to illustrate what they are describing, I found this part of the book a bit overwhelming. Maybe I've just been out of higher education for too long though. Certainly, remembering back to my university days, I would have been grateful to find this information on cardiac anatomy and physiology succinctly presented as in this chapter rather than having to search through the entire library of anatomy and physiology books to find what I was looking for.
Cardiac assessment
Part 2 focused on cardiac assessment i.e. history-taking, physical examination and rhythm interpretation (with full 12-lead ECG interpretation being saved for part 3 of the book). This part of the book was a great refresher on what should be included during history-taking and I enjoyed being reminded of the importance of looking at respiratory character rather than just respiratory rate, as well as conducting bilateral blood pressures. I also thought this part of the book provided useful background knowledge such as estimating risk factors pertinent to cardiac disease and information regarding cardiac blood tests. Disappointingly, the physical examination aspect of this section was short and not very detailed compared with other cardiology books in this price range.
ECG interpretation
Part 3 focused on ECG interpretation. Conducting and interpreting ECGs is a big part of a paramedic's assessment of cardiac patients; however, sadly I did not feel like this part of the book provided sufficient detail. Although the causes of QRS axis deviation were interesting to read about, I could not help but feel that other aspects of ECG interpretation were not covered in the required detail. One example of this was the provided ECG analysis assessment tool, which seemed to consist merely of headings without explaining to the reader how this was to be used. A further example was that the authors only provided a formula to calculate the heart rate from an ECG with a regular rhythm but not for an irregular rhythm—although easily looked up using other resources, I would have expected this to be included in the book.
Cardiac conditions A–Z
Part 4 was easily my favourite part of the book. For almost 30 cardiac conditions, the authors have provided an excellent overview for each by covering history, signs and symptoms, assessment/investigations and treatment. These summaries are brief but detailed, simply conveying complex medical conditions, focused on hospital care yet relevant to the pre-hospital setting, and a great reminder while still providing new information.
Suggestions
Overall, I sincerely missed the inclusion of case studies or references in this textbook. The lack of these may be a result of the authors only seeking to cover key facts; nevertheless, I think some references or suggestions of further reading would have been helpful.
My suggestion to any (prospective) paramedics reading this book would be to read it alongside JRCALC or any relevant ambulance service policies to ensure that you are following the correct guidelines as, on at least one occasion, I noted a difference between the book and JRCALC. This discrepancy was pertaining to ST-elevation criteria in STEMIs, which the authors suggested were different according to age and gender—however, without references, I was unable to research this matter further despite being intrigued.
Lastly, I would advise anyone thinking of purchasing this book to steer away from the electronic version. I found accessing the e-book via the VitalSource Bookshelf website cumbersome and the app did not allow me to view my downloaded book at all. However, this is certainly not any fault of the authors so I tried not to let it taint my review of their book and vowed to only mention these difficulties as a side note.
Conclusion
I would recommend this book to student paramedics and NQPs if they have not yet purchased a cardiology book. In my opinion, this book is a useful refresher of cardiac anatomy and physiology, as well as a good resource to look up cardiac conditions in the A–Z part of the book. I would not recommend buying the book solely for the brief ECG or cardiac physical assessment sections; a more extensive textbook on physical examination would probably serve student paramedics better in preparation for practical exams. However, as a rapid refresher to keep in your helmet bag for a bit of CPD on the move, this book is certainly worth putting on your graduation present wish list.