EMT-B: Ch 14

Defibrillation works best if it takes place within _____minutes of the onset of cardiac arrest.

2

In general, a maximum of _____ doses of nitroglycerin is given for any one episode of chest pain

3 doses

About _____ minutes after blood flow is cut off, some heart muscle cells begin to die

30 minutes

Normal electrical impulses originate in the sinus node, just above the?______

Atria

Cardiac arrest in younger children is less common than in older children and is usually caused by a breathing problem.

True

Heart disease is the number one killer of women in the US

True

If a patient complaining of chest pain has a hx of a previous AMI, you should ask if this pain feels similar to the previous AMI

True

Blood enters the right atrium from the body through the:

Vena Cava

dilation

Widening of a tubular structure such as a coronary artery.

Dilation of the coronary arteries ____ blood flow.

increases

Atherosclerosis can lead to a complete _____ of a coronary artery

occlusion

_____ are inserted when the electrical-control system of the heart is so damaged that it cannot function properly.

pacemaker

_______ is the max pressure exerted by the left ventricle as it contracts

systolic blood pressure

Angina can result from a spasm of the artery

True

Angina occurs when the heart's need for O2 exceeds its supply

True

Sudden death is usually the result of ______, in which the heart fails to generate an effective blood flow.

A. AMI B. atherosclerosis C. cardiac arrest Answer is cardiac arrest

occlusion

A blockage, usually of a tubular structure such as a blood vessel.

thromboembolism

A blood clot that has formed within a blood vessel and is floating within the bloodstream.

dissecting aneurysm

A condition in which the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressures) to flow between the layers.

atherosclerosis

A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, which eventually leads to partial or complete blockage of blood flow.

congestive heart failure (CHF)

A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs.

syncope

A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain.

acute myocardial infarction (AMI)

A heart attack; death of heart muscle following obstruction of blood flow to it. Acute in this context means "new" or "happening right now."

A patient taking medications such as Lasix or digoxin is likely to have which of the following underlying medical conditions?

A history of Congestive Heart Failure

ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.

cardiac output

A measure of the volume of blood circulated by the heart in 1 minute, calculated by multiplying the stroke volume by the heart rate.

tachycardia

A rapid heart rate, more than 100 beats/min.

ventricular tachycardia

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.

bradycardia

A slow heart rate, less than 60 beats/min.

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

cardiac arrest

A state in which the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest, even if muscular and electrical activity continues in the heart.

parasympathetic nervous system

A subdivision of the autonomic nervous system, involved in control of involuntary, vegetative functions, mediated largely by the vagus nerve through the chemical acetylcholine.

acute coronary syndrome

A term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction.

aortic aneurysm

A weakness in the wall of the aorta that makes it susceptible to rupture.

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?

A. Contact medical control and request permission to defibrillate. B. Deliver the shock followed by immediate CPR. C. Continue CPR and transport the pt to the hospital. D. Avoid defibrillation as this will damage the pt's AICD. The answer is B, Deliver the shock because we treat them like all other pts having an AMI.

_____ allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source.

A. Repetition B. Reactivity C. Automaticity D. Autonomy The answer is

Which of the following statements regarding CHF is False?

A. Stridor is a common lung sound heard on exam. B. it can be caused by diseased heart valves C. it can be treated with nitroglycerin D. ankle edema is a common finding Answer is A, Stridor is a common lung sound heard on exam

Acute coronary syndrome (ACS) is a term used to describe:

A. a group of symptoms that are caused by MI B. the moment a coronary artery is completely occluded. C. a decrease in perfusion caused by changes in HR. D. the warning signs that occur before a heart attack. The answer is A, group of symptoms that are caused by MI

Narrowing of the coronary arteries due to a buildup of fatty deposits is called:

A. acute ischemia. B. arteriosclerosis. C. atherosclerosis. D. angina pectoris. The answer is C, atherosclerosis.

When afterload increases:

A. amt of resistance the Vt must beat against decreases. B. it becomes harder for the ventricle to push blood through the blood vessels. C. the BP falls because of dilation of blood vessels. D. Vol of blood that returns to the R atrium increases. The answer is B, it becomes harder for the vent. to push blood through the blood vessels

After the AED has delivered a shock, the EMT should:

A. assess for a carotid pulse. B. immediately resume CPR. C. transport the patient at once. D. reanalyze the cardiac rhythm. The answer is B, immediately resume CPR

Cardiac output may decrease if the heart beats too rapidly because:

A. blood returns to the heart is not sufficient w/fast HR. B. not enough time btw contractions for heart to refill. C. rapid heart beat causes a decrease in the strength of cardiac contractions. D. as the HR increases, more blood is pumped from the ventricles than the atria. The answer is B, there is not enough time in between contractions for the heart to refill.

Sudden death following AMI is MOST often caused by:

A. cardiogenic shock. B. severe bradycardia. C. ventricular fibrillation. D. congestive heart failure. The answer is C, Ventricular fibrillation

Which of the following is Not a cause of CHF?

A. chronic hypotension B. heart valve damage C. a myocardial infarction Answer is A, chronic hypotension

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:

A. defibrillate with the AED while transporting. B. CPR 2 minutes, analyze her rhythm with an AED. C. call hospital and perform CPR duration transport. D. stop the ambulance, begin CPR, and use AED ASAP The answer D, stop the ambulance perform CPR and AED

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:

A. dilating the coronary artery w/a small balloon. B. placing a stent inside the artery to keep it open. C. bypassing the artery with a vessel of the chest or leg. D. scraping fatty deposits off of the lumen of the artery. The answer is A, it dilates the coronary artery w/a balloon

Signs and symptoms of shock include all the following Except:

A. elevated HR B. pale, clammy skin C. air hunger D. elevated BP Answer is D, elevated BP

The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:

A. excitability. B. contractility. C. automaticity. D. impulsivity. The answer is C, automaticity

Common side effects of nitroglycerin include all of the following, EXCEPT:

A. hypertension. B. hypotension. C. severe headache. D. bradycardia. The answer is A, Hypertension

Major risk factors for AMI include all of the following, EXCEPT:

A. hypoglycemia. B. diabetes mellitus. C. hypertension. D. elevated cholesterol. The answer is A, hypoglycemia

All patient assessments begin by determining whether the patient:

A. is breathing B. has a pulse C. is responsive Answer is C, is responsive

Atherosclerosis results in narrowing of the lumen of coronary arteries

True

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:

A. kidneys. B. brain. C. abdomen. D. legs. The answer is B, brain

What type of additional resource is typically required or someone with chest pain

A. life assistance B. ALS C. police Answer is B, ALS

Risk factors for MI include all of the following Except:

A. male gender B. high blood pressure C. stress D. increased activity level Answer is D increased activity level

In contrast to AMI, a dissecting aortic aneurysm:

A. presents with pain that is maximal from the onset. B. is preceded by other symptoms, such as nausea. C. is commonly associated with pressure in the chest. D. presents gradually, often over a period of hours. The answer is A, pts present with maximal pain at the start

The purpose of defibrillation is to:

A. rapid decrease in the heart rate of an unstable patient. B. stop chaotic, disorganized contraction of cardiac cells. C. prevent asystole from deteriorating into V fibrillation. D. improve the chance of cardiopulmonary resuscitation (CPR) being successful in resuscitation. The answer is B, stop chaotic, disorganized contractions

The aorta receives its blood supply from the:

A. right atrium B. left atrium C. right ventricle D. left ventricle Answer is D, Left ventricle

Common signs and symptoms of AMI include all of the following, EXCEPT:

A. sudden unexplained sweating. B. irregular heartbeat. C. pain exacerbated by breathing. D. shortness of breath or dyspnea. The answer is C, pain exacerbated by breathing

The lumen of an artery may be partially or completely blocked by the blood clotting system due to a _____ that exposes the inside of the atherosclerotic wall.

A. tear B. Crack C. Clot Answer is B, crack

When treating a patient with chest pain, you should assume that he or she is having an AMI because:

A. the cause of the pain cannot be diagnosed in the field. B. angina and AMI present identically. C. most pts with chest pain are experiencing an AMI. D. angina usually occurs after an AMI. Answer is A, the cause of the pain can't be dx in the field

Ventricular tachycardia causes hypotension because:

A. the volume of blood returning to the atria increases. B. the left ventricle does not adequately fill with blood. C. blood backs up into the lungs and causes congestion. D. the right ventricle does not adequately pump blood. The answer is B, this rhythm does not allow enough time between beats for the left vent to fill with blood leading to low BP and causes vfib

Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?

A. trouble breathing while lying down B. hypotension and flat jugular veins C. the presence of rales in the lungs D. hypertension and tachycardia The answer is B, hypotension and flat jugular vein

Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?

A. ventricular tachycardia B. sinus tachycardia C. sinus bradycardia D. extra ventricular beats The answer is A, V tach, it may deteriorate into V fib

Atrioventricular node

AV node. Located in the lower wall of the right atrium and sends an impulse through the bundle of His, which passes down between both ventricles through Purkinje fibers. This results in the contraction of the ventricles

hypertensive emergency

An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm.

arrhythmia

An irregular or abnormal heart rhythm.

The _____ are tiny blood vessels that are approximately one cell thick.

Capillaries

perfusion

Circulation of blood within an organ or tissue in adequate amounts to meet current needs of the cells.

defibrillate

To shock a fibrillating (chaotically beating) heart with specialized electrical current in an attempt to restore a normal, rhythmic beat.

infarction

Death of a body tissue, usually caused by interruption of its blood supply.

ventricular fibrillation

Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest.

Which of the following changes in heart function occur in pts with CHF?

Enlargement of the left ventricle

The pain of angina and the pain of AMI are easily distinguishable

False, No it can be difficult even for an MD at a hospital to distinguish between the pain o angina or the pain from an AMI.

White blood cells are the most numerous cells in the blood and help the blood to clot.

False, WBC help to fight infection and RBC's are the most numerous

If an AED malfunctions during use, you must report that problem to the manufacture and the department of HR

False, if an AED fails while you are caring for a patient, you most report the problem to the manufacturer and the US food and Drug administration.

Dissecting aortic aneurysms are rarely considered life-threating

False, if the aorta ruptures, internal blood loss will be so large that the patient will die almost immediately

In the normal heart, the need for increased blood flow to the myocardium is easily met by an increase in heart rate.

False, in the normal heart, increased O2 demands of the myocardium is supplied by dilation or widening of the coronary artery.

Infarction is a temporary interruption of the blood supply to the tissues.

False, infarction means the death of tissue, usually caused by interruption of its blood supply.

Nitroglycerin works in most patients within 5 minutes to relieve the pain of AMI.

False, it may or may not be relieved by rest or nitroglycerin

The right side of the heart pumps oxygen-rich blood to the body

False, the right side receives deoxygenated blood from the body. The left side of the heart pumps oxygen rich blood to the body,

When taking a SAMPLE history of a conscious person with chest pain, what specific questions should the EMT ask of their patient?

Has your patient had a heart attack before?

posterior

In anatomy, the back surface of the body; the side away from you in the standard anatomic position.

Tissues downstream from a blood clot will suffer from lack of O2. If blood flow is resumed in a short time, the _____ tissues will recover.

Ischemic

angina pectoris

Transient (short-lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle.

When assessing a cardiac arrest patient, you notice what appears to be a pacemaker implanted in the upper left chest. Care for this patient should include:

Make sure the AED patches are not directly over the pacemaker device

To assess chest pain, use the Mnemonic:

OPQRST

ventricle

One of two (right and left) lower chambers of the heart. The left ventricle receives blood from the left atrium (upper chamber) and delivers blood to the aorta. The right ventricle receives blood from the right atrium and pumps it into the pulmonary artery.

atrium

One of two (right and left) upper chambers of the heart. The right atrium receives blood from the vena cava and delivers it to the right ventricle. The left atrium receives blood from pulmonary veins and delivers it to the left ventricle.

The only veins in the body that carries oxygenated blood are the?

Pulmonary veins

______ carry O2 to the body's tissues and then remove CO2

Red blood cells

Sinus node

SA node, a group of cells in the right atrium where the electrical signal is generated that establishes the heartbeat. The pacemaker of the Heart

dependent edema

Swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure.

When the battery wears out in a pacemaker, the patient may experience?

Syncope

automaticity

The ability of cardiac muscle cells to contract without stimulation from the nervous system.

coronary arteries

The blood vessels that carry blood and nutrients to the heart muscle.

asystole

The complete absence of any electrical cardiac activity, appearing as a straight or almost straight line on an ECG strip.

anterior

The front surface of the body; the side facing you in the standard anatomic position.

myocardium

The heart muscle.

lumen

The inside diameter of an artery or other hollow structure.

aorta

The main artery that receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body.

aortic valve

The one-way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta; one of four heart valves.

sympathetic nervous system

The part of the autonomic nervous system that controls active functions such as responding to fear (also known as the "fight-or-flight" system).

inferior

The part of the body or any body part nearer to the feet.

superior

The part of the body or any body part nearer to the head.

autonomic nervous system

The part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion, and sweating.

Cardiogenic shock can occur within 24 hours of an?

acute MI

When, for a brief period of time, heart tissues do not get enough O2, the pain is called?

angina

An acute MI is more likely to occur in the larger, think-walled left ventricle, which needs more ______ than the right ventricle.

blood and O2

In addition to angina and MI, nitroglycerin can be used to treat:

congestive heart failure

The link in the chain of survival include all of the following Except:

early administration of nitroglycerin

Because the O2 supply to the heart is diminished with angina, the ____ can become compromised, putting the person at risk for cardiac rhythm problems.

electrical system

Angina pain may be felt in the ?

epigastrium

When administering nitroglycerin to a patient, you should make sure the patient has not been taking medications for _____ in the last 24 hours

erectile dysfunction

Physical findings of AMI include skin that is ______ because of poor cardiac output and the loss of perfusion.

gray

When using the mnemonic OPQRST, the P stands for?

provocation

The AED should be applied only to unresponsive patients with no:

pulse

_____ usually refers to a state of cardiac arrest despite an organized electrical complex.

pulses electrical activity

The underlying cause of a dissecting aortic aneurysm is:

uncontrolled hypertension

Disorganized, ineffective quivering of the ventricles is known as?

ventricular fibrillation

The computer inside the AED is programmed to recognized rhythms that require defibrillation to correct, most commonly:

ventricular fibrillation

Which step should Not be taken to complete a history and physical exam on an unconscious patient with suspected cardiac problems?

you would not look through the patients wallet for medical information