Chapter 16: Cardiovascular Emergencies
You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approximately 5 minutes. You should:
Begin CPR, apply the AED, and deliver a shock if it is indicated.
You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:
Begin high-quality CPR and apply the AED as soon as possible.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
Assess the adequacy of his respirations.
Which of the following is the MOST reliable method of estimating a patient's cardiac output?
Assess the heart rate and strength of the pulse.
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
Assess the scene for potential hazards.
The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the:
Autonomic nervous system.
The descending aorta divides into the two iliac arteries at the level of the:
Umbilicus.
When documenting a patient's description of his or her chest pain or discomfort, the EMT should:
Use the patient's own words.
Sudden death following AMI is MOST often caused by:
Ventricular fibrillation.
Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm?
Ventricular tachycardia.
Nitroglycerin is contraindicated in patients:
Who have experienced a head injury.
Acute coronary syndrome (ACS) is a term used to describe:
A group of symptoms that are caused by myocardial ischemia.
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
A rapid heart rate.
A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced?
Acute myocardial infarction.
Cardiogenic shock can occur within 24 hours of a(n):
Acute myocardial infarction.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should:
Administer oxygen, give her 324 mg of aspirin, and assess her further.
When, for a brief period of time, heart tissues do not get enough oxygen, the pain is called:
Angina.
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they:
Are in denial.
You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You should:
Begin ventilatory assistance.
The posterior tibial pulse can be palpated:
Behind the medial malleolus, on the inside of the ankle.
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:
Blood can pass from the atria to the ventricles.
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:
Brain.
The head and brain receive their supply of oxygenated blood from the:
Carotid arteries.
It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing:
Chest pain that does not immediately subside with rest.
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
Congestive heart failure.
Which of the following is NOT a function of the sympathetic nervous system?
Constriction of blood vessels in the muscles.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.
Coronary arteries, aorta.
Ischemic heart disease is defined as:
Decreased blood flow to one or more portions of the myocardium.
Cardiogenic shock following AMI is caused by:
Decreased pumping force of the heart muscle.
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS.
Three.
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?
Deliver the shock followed by immediate resumption of CPR.
Which of the following signs is commonly observed in patients with right-sided heart failure?
Dependent edema.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:
Dilating the affected coronary artery with a small inflatable balloon.
Nitroglycerin relieves cardiac-related chest pain by:
Dilating the coronary arteries and improving cardiac blood flow.
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
Dry the chest if it is wet.
While obtaining a 12-lead ECG prior to ALS arrival, you note the presence of artifacts on the tracing. Which of the following is the MOST likely cause of this?
Excessive movement of the patient.
The MOST common error associated with the use of the AED is:
Failure of the EMT to ensure the battery is charged.
Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort?
Family history of hypertension.
Risk factors for AMI that cannot be controlled include:
Family history.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two off-duty EMTs performing CPR on the patient, a 58-year-old male. Your initial action should be to:
Feel for a pulse while compressions are ongoing.
The iliac arteries immediately subdivide into the:
Femoral arteries.
Blood that is ejected from the right ventricle:
Flows into the pulmonary arteries.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
Have chronic hypertension.
Common side effects of nitroglycerin include all of the following, EXCEPT:
Hypertension.
Major risk factors for AMI include all of the following, EXCEPT:
Hypoglycemia.
After the AED has delivered a shock, the EMT should:
Immediately resume CPR.
Which of the following statements regarding the pain associated with AMI is correct?
It can occur during exertion or when the patient is at rest.
What is the function of the left atrium?
It receives oxygenated blood from the lungs.
Angina pectoris occurs when:
Myocardial oxygen demand exceeds supply.
Which of the following statements regarding nitroglycerin is correct?
Nitroglycerin usually relieves anginal chest pain within 5 minutes.
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must:
Obtain authorization from medical control.
In contrast to AMI, a dissecting aortic aneurysm:
Often presents with pain that is maximal from the onset.
When preparing to obtain a 12-lead ECG, the V1 and V2 electrodes should be placed:
On either side of the sternum.
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed:
On the thighs or ankles.
Common signs and symptoms of AMI include all of the following, EXCEPT:
Pain exacerbated by breathing.
The EMT should use an AED on a child between 1 month and 8 years of age if:
Pediatric pads and an energy-reducing device are available.
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has been prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:
Placing her in an upright position.
At 0500 hours, you respond to the home of a 76-year-old man complaining of chest pain. Upon arrival, the patient states that he had been sleeping in the recliner all night due to indigestion, when the pain woke him up. He also tells you he has taken two nitroglycerin tablets. His vital signs are as follows: respirations, 16 breaths/min; pulse, 98 beats/min; blood pressure, 92/76 mm Hg. He is still complaining of chest pain. What actions should you take to intervene?
Provide high-flow oxygen.
The only vein(s) in the body that carry oxygenated blood is/are the:
Pulmonary veins.
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you re-analyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to:
Reassess airway and breathing and treat accordingly.
After assisting your patient with prescribed nitroglycerin, you should:
Reassess his or her blood pressure within 5 minutes to detect hypotension.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:
Remove the battery from the monitor and then remove the vest.
You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. After applying high-flow oxygen, you expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should:
Remove the nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.
Most AEDs are set up to adjust the voltage based on the impedance, which is the:
Resistance of the body to the flow of electricity.
Deoxygenated blood from the body returns to the:
Right atrium.
The right coronary artery supplies blood to the:
Right ventricle and inferior wall of the left ventricle.
Which of the following veins is located inferior to the trunk?
Saphenous.
During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that:
She is not in ventricular fibrillation.
The electrical impulse generated by the heart originates in the:
Sinoatrial node.
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
Slows the heart and respiratory rates.
The purpose of defibrillation is to:
Stop the chaotic, disorganized contraction of the cardiac cells.
Which of the following statements regarding the AED and defibrillation is correct?
The AED will not analyze the rhythm of a moving patient.
When the myocardium requires more oxygen:
The arteries supplying the heart dilate.
When treating a patient with chest pain, you should assume that he or she is having an AMI because:
The cause of the pain cannot be diagnosed in the field.
A dissecting aortic aneurysm occurs when:
The inner layers of the aorta become separated.
Ventricular tachycardia causes hypotension because:
The left ventricle does not adequately fill with blood.
A patient with atherosclerotic heart disease experiences chest pain during exertion because:
The lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
Cardiac output may decrease if the heart beats too rapidly because:
There is not enough time in between contractions for the heart to refill completely.