Chapter 17: Cardiovascular Emergencies

Side Affects of Nitro

- Decrease BP - Severe headache - Changes in pulse rate (tachy or brady cardia) - DO NOT give if systolic is less than 100 mm Hg - if ED meds have been taken in the past 24 to 48 hours

thromboembolism

- a blood clot that is floating through blood vessels until it reaches an area too narrow for it to pass, causing it to stop and block the blood flow at that point.

Hypertensive Emergencies

- a systolic pressure greater than 180 mm Hg in the presence of impending or progressive organ damage.

Which of the following is a major difference between angina pectoris and AMI?

A. Anginal pain typically subsides with rest.

Which of the following would cause the greatest increase in cardiac output?

A. Increased heart rate and increased stroke volume

Which of the following statements regarding the pain associated with AMI is correct?

A. It can occur during exertion or when the patient is at rest.

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

A. dilating the affected coronary artery with a small inflatable balloon.

An acute myocardial infarction (AMI) occurs when:

A. myocardial tissue dies secondary to an absence of oxygen.

The left ventricle has the thickest walls because it:

A. pumps blood into the aorta and systemic circulation.

The posterior tibial pulse can be palpated:

B. behind the medial malleolus, on the inside of the ankle.

It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing:

B. chest pain that does not immediately subside with rest.

In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest:

B. delivers high-energy shocks, similar to an AED.

The right coronary artery supplies blood to the:

B. right ventricle and inferior wall of the left ventricle.

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?

B. Acute myocardial infarction

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 antihypertensive 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?

B. Dissecting aortic aneurysm

Sudden death following AMI is MOST often caused by:

C. ventricular fibrillation.

Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?

D. Administer the medication sublingually and allow it to dissolve or absorb.

Which of the following is NOT a function of the sympathetic nervous system?

D. Constriction of blood vessels in the muscles

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

D. the cause of the pain cannot be diagnosed in the field.

Ventricular tachycardia causes hypotension because:

D. the left ventricle does not adequately fill with blood.

Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort?

D. Family history of hypertension

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

D. Hypotension and flat jugular veins

The head and brain receive their supply of oxygenated blood from the:

D. carotid arteries.

Prior to defibrillating a patient with an AED, it is MOST important that you:

D. ensure that no one is touching the patient.

After assisting your patient with prescribed nitroglycerin, you should:

D. reassess his or her blood pressure within 5 minutes to detect hypotension.

Atherosclerosis

a disorder in which calcium and a fatty material called cholesterol build up and form a plaque inside the walls of blood vessels, obstructing flow and interfering with their ability to dilate or contract.

aortic aneurysm

a weakness in the wall of the aorta. The aorta dilates at the weakened area, which makes it susceptible to rupture.

What is the route of administration for aspirin?

d. PO

Ventricular tachycardia

· Rapid heart rhythm, usually at a rate of 150 to 200 beats/min. electrical activity starts in the ventricle instead of the atrium the heart pumps less volume and the patient's blood pressure may fall, or the pulse may be lost altogether. The patient may also feel weak or lightheaded or may even become unresponsive.

dysrhythmia (Ventricular Fibrillation)

· The heart is twitching, though erratically. The heart is using up energy without pumping any blood

asystole

· the absence of all heart electrical activity. Without CPR, asystole may occur within minutes. Asystole usually reflects a long period of ischemia, and nearly all patients you find in asystole will die.

defibrillate

· to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore a normal rhythmic beat.

Signs & Symptoms of Acute Myocardial Infarction

- Sudden onset of weakness, nausea, and sweating without an obvious causeChest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath. - Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neckIrregular heartbeat and syncope (fainting)Shortness of breath, or dyspnea - Nausea/vomitingPink, frothy sputum (indicating possible pulmonary edema) Sudden death

acute myocardial infarction (AMI)

- heart attack

Acute coronary syndrome (ACS)

- is a term used to describe a group of symptoms caused by myocardial ischemia.

Infarction

- means the death of tissue.

Stable angina

- occurs in response to exercise or activity that increases demand on the heart muscle

dissecting aneurysm

- occurs when the inner layers of the aorta become separated, allowing blood (at high pressures) to flow between the layers. - Uncontrolled hypertension is the primary cause

Nitroglycerin

- relaxes the muscle of blood vessel walls, dilates coronary arteries, increases blood flow and the supply of oxygen to the heart muscle, and decreases the workload of the heart.

parasympathetic nervous system

- slows the heart and respiratory rates, constricts blood vessels in the muscles, and dilates blood vessels in the digestive system

sympathetic nervous system

- speeds up the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscles, and constricts blood vessels in the digestive system

angina pectoris

- the pain caused by a brief laps in time where the heart tissues are not getting enough oxygen - occurs when the heart's need for oxygen exceeds its supply, usually during periods of physical or emotional stress when the heart is working hard. A large meal or sudden fear may also trigger an attack. When the increased oxygen demand goes away (eg, the person stops exercising), the pain typically goes away.

autonomic nervous system

- the part of the brain that controls the functions of the body that do not require conscious thought, such as the heartbeat, respirations, dilation and constriction of blood vessels, and digestion of food

EMS can help reduce deaths by

-Encouraging healthy lifestyle -Early access to medical care -More CPR training of laypeople -Increased use of evolving technology in dispatch and cardiac arrest response -Public access to defibrillation devices -Recognizing need for advanced life support (ALS) -The use of cardiac specialty centers when they are available

Unstable Angina

: occurs in the absence of significant increase in oxygen demand

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:

A. reassess airway and breathing and treat accordingly.

A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:

A. remove the battery from the monitor and then remove the vest.

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?

A. Absence of a palpable pulse

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:

A. placing her in an upright position.

Deoxygenated blood from the body returns to the:

A. right atrium.

When documenting a patient's description of his or her chest pain or discomfort, the EMT should:

A. use the patient's own words.

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 is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should:

B. remove the nitroglycerin patch, administer oxygen, and place him in a supine position.

Which of the following veins is located inferior to the trunk?

B. Saphenous

Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:

B. assess the scene for potential hazards.

Narrowing of the coronary arteries caused by a buildup of fatty deposits is called:

B. atherosclerosis.

atrioventricular (AV) node

Between the atria and the ventricles, the impulses cross a bridge of special electrical tissue. Here, the signal is slowed for about one- to two-tenths of a second to allow blood time to pass from the atria to the ventricles

Which of the following statements regarding the AED and defibrillation is correct?

C. The AED will not analyze the rhythm of a moving patient.

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:

C. assess the adequacy of his respirations.

The EMT should use an AED on a child between 1 month and 8 years of age if:

C. pediatric pads and an energy-reducing device are available.

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:

C. perform CPR for 2 minutes and reassess.

When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that:

C. blood can pass from the atria to the ventricles.

When obtaining a 12-lead ECG, the patient should be:

C. in a supine position with legs uncrossed.

Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must:

C. obtain authorization from medical control.

Tachycardia

Rapid beating of the heart, 100 beats/min or more

Bradycardia

Unusually slow beating of the heart, 60 beats/min or less

Which of the following statements regarding nitroglycerin is correct?

Which of the following statements regarding nitroglycerin is correct?

After administering your patient's prescribed Nitrolingual, the patient becomes lightheaded, reports a pounding headache, and has a brief syncopal episode. What is the correct action to take?

a. Lay the patient supine to increase cerebral blood flow.

Automaticity

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

You are treating an adult patient for a suspected acute myocardial infarction. The patient takes a daily "baby" aspirin and did take their dose this morning. How should you proceed with aspirin administration?

b. Administer 81 - 243 mg of additional aspirin

What form of aspirin is appropriate to use in an emergency for an adult?

b. Chewable non-enteric coated tablets

You are treating a 60-year-old female patient with a history of heart failure. She presents with severe dyspnea, tripoding, crackles heard on auscultation of all lung fields. Her vital signs are RR 28 bpm, Sp)2 87 % on non-rebreather mask, HR 110 bpm, BP 158/96. She has prescriptions for hydrochlorothiazide and nitroglycerin. Which may you administer?

b. Nitroglycerin

The route of administration of nitroglycerin is:

b. Sublingual

When is aspirin administration indicated for the EMT?

b. Suspected myocardial infarction

Which of the following is a correct single dose of nitroglycerin?

c. 0.4 mg

What is the primary action of aspirin?

c. Inhibits platelet aggregation

You have administered nitroglycerin to your patient twice already. What should you do next regarding nitroglycerin administration?

c. Administer another dose after rechecking that SBP > 100 mm Hg. The maximum is 3 doses.

Why should aspirin not be administered to pediatric patients?

c. It can result in a serious neurologic complication in children.

You have administered an appropriate initial dose of aspirin to your patient. After five minutes, the patient reports that they continue to have symptoms with no relief. What does this indicate?

c. Nothing. The medication is not expected to relieve symptoms.

A 56-year-old male presents with exertional, crushing, substernal chest pressure for the last 30 minutes. He is mildly nauseated and had one episode of vomiting a coffee ground like substance yesterday. What is the appropriate dose of aspirin to give this patient?

c. None. Aspirin is contra-indicated.

You are treated a 62-year-old man with a history of angina pectoris. He is complaining of crushing chest pain and shortness of breath. He has a prescription for nitroglycerin but no prescription for aspirin. Which of the following is true about aspirin administration?

d. Aspirin should be administered

You are treating a patient with a history of angina who is having crushing chest pain after performing physical activity. He has a prescription for nitroglycerin tablets. Which of the following would be a contra-indication to use of this medication?

d. SBP < 100 mm Hg

The primary action of nitroglycerin is:

d. Vasodilation

How does nitroglycerin affect a myocardial infarction?

d. Decreased O2 delivery to the affected myocardium

You are treating a 66-year-old male patient for suspected ACS. His cardiologist has prescribed a daily aspirin, nitroglycerin as needed, and metoprolol. On further history taking, you learn his primary care physician has prescribed lisinopril, atorvastatin, and tedalafil. He has taken all of these medications today except for his nitroglycerin. How should you proceed?

d. Do not administer the nitroglycerin because it is contra-indicated based on treatment provided by his primary care physician.

In addition to its primary action, aspirin is a/an:

d. NSAID

You are treating a 54-year-old man with tightness in his chest after doing yard work on a warm sunny day. You retrieve his Nitrostat from the kitchen windowsill and bring it over to him. Which of the following statements is most true?

d. The patient should be asked if there is a fresh bottle of Nitrostat available instead.

Thrombolytic

drugs are important in the first few hours to prevent damage

sinoatrial (SA) node

where normal electrical impulses begin

Ventricular fibrillation

· Disorganized, ineffective quivering of the ventricles. No blood is pumped through the body, and the patient becomes unconscious within seconds.

Cardiogenic shock

· Inadequate blood through circulatory system

Congestive heart failure

· Often occurs a few days following heart attack · Increased heart rate and enlargement of left ventricle no longer make up for decreased heart function · Lungs become congested with fluid · May cause dependent edema: The collection of fluid in the part of the body that is closest to the ground