Ch. 17 - Cardiovascular emergencies
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
Which of the following statements regarding nitroglycerin is correct?
nitroglycerin usually relieves anginal chest pain within 5 minutes
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 the 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
Defibrillator pads are placed on the patient's chest
with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit
Which of the following represents the most appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?
Administer the medication sublingually and allow it to dissolve or absorb
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
Aspirin
The electrical stimulus that originate in the heart's primary pacemaker is controlled y impulses from the brain that arrive by way of the:
Autonomic nervous system
A 40-year-old man is in cardiac arrest. Your partner is preforming CPR. You are attaching the AED when the patients wife tells you that he has an automatic implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?
Deliver the shock followed by immediate resumption of CPR
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
Common signs and symptoms of a hypertensive emergency include:
a bounding pulse, a severe headache, and dizziness
Acute coronary syndrome (ACS) is a term used to describe:
a group of symptoms that are caused by myocardial ischemia
A patient with a left ventricular assist device (LVAD) tells you that the device's pump flow is continuous. Which of the following should you expect to encounter during your assessment?
absence of a palpable pulse
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
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours duration. He r blood pressure is 140/90 mmHg, 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 aspirin, and assess her further
Which of the following is a major difference between angina pectoris and AMI?
anginal pain typically subsides with rest
The most common reason that many people experiencing AMI do not seek immediate medical attention is because they:
are in denial
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
Narrowing of the coronary arteries caused by a buildup of fatty deposits is called:
atherosclerosis
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:
automatically
You and your partner have achieved return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest. An ALS unit will arrive in less than 2 minutes. The patient remains unresponsive and has slow, irregular breathing. Further treatment for this patient should include:
bag-mask ventilation at 10 breaths/min and assessment of oxygen saturation
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
You are dispatched to a residence for a 56-year0old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained t 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 returning from the body can fill the atria
The inferior vena cava return deoxygenated blood to the right side of the heart from all of the following areas except:
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
The myocardium receives oxygenated blood from the ______ which originates from the _______.
coronary arteries, aorta
The electrical impulse generated by the heart originates in the
coronary sinus
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
In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest:
delivers high-energy shocks, similar to an AED
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
A 66-year old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her hypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms most likely indicate?
dissecting aortic aneurysm
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
dry the chest if it is wet
Which of the following is the most likely cause of artifact on an ECG tracing?
excessive movement of the patient
The main legal risk in using the AED is:
failing to deliver a shock when one is needed
Risk factors for AMI that cannot be controlled include:
family history
Which of the following is least important when obtaining a medical history from a patient complaining of chest discomfort?
family history of hypertension
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 axtion should be to:
feel for a pulse while compressions are ongoing
The iliac arteries immediately subdivide into the:
femoral arteries
Upon arriving at the residence of a patient with a possible cardiac problem, it is most important to:
gain immediate access to the patient
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
Which of the following signs or symptoms would you not expect to encounter in a patient with congestive heart failure?
hypotension and flat jugular veins
After the AED has delivered a shock, the EMT should:
immediately resume CPR
When obtaining a 12-led ECG, the patient should be:
in a supine position with legs uncrossed
Which of the following would cause the greatest increase in cardiac output?
increased heart rate and increased stroke volume
Which of the following statements regarding the pain associated with AMI is correct?
it can occur during the exertion or when the patient is at rest
the AED is most advantageous to the EMT because:
it delivers prompt defibrillations to patients with ventricular fibrillation
Angina pectoris occurs when:
myocardial oxygen demand exceeds supply
An acute myocardial infarction (AMI) occurs when:
myocardial tissue dies secondary to an absence of oxygen
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 aneurism:
often present 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 thigs or ankles
Common signs and symptoms of AMI include all of the following except:
pain exacerbated by breathing
Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. You should:
perform CPR for 2 minutes and reassess
A 67-year-old 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 mmHg and her heart rate is 120 beats/min. Treatment for this patient includes:
placing her in an upright position
Which of the following blood vessels transports oxygenated blood?
pulmonary veins
The left ventricle has thickest walls because it:
pumps blood into the aorta and systemic regulation
Which of the following is not a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
rapid heart rate
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 hypotnsion
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. 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 in 78/50 mmHg, and his pulse is 110 beats/min and irregular. You should:
remove the nitroglycerin patch, administer oxygen, and place him in a supine position
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
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
slows the heart and respiratory rate
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:
stop the ambulance, begin CPR, and attach the AED as soon as possible
Which of the following statements regarding the AED and defibrillation?
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 diagnose 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
Prompt transfer of a patient with a suspected AMI is important because:
the patient may be eligible to receive thrombolytic therapy
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
Most patients are instructed by their physician to take up to ____ doses of nitroglycerin before calling EMS.
three
The descending aorta divides into the two iliac arteries at the level of the:
umbilicus
