Volume 3 Chapter 2
The ECG shows you a regular rhythm at a rate of 40, no P waves are present, and the QRS complex width is 0.16 seconds. Thepatient's blood pressure is 82/44. Which of the following would be most appropriate?
0.5 mg bolus of atropine sulfate
Looking at an ECG strip, you count 14 QRS complexes in two 3-second marks. Your estimate for the heart rate would be:
140
What is the standard speed for ECG paper to move across the stylus when printing out the patient's rhythm?
25 mm/sec
When obtaining a 15 lead ECG on a patient, how many electrodes are placed on the patient's right thorax?
3
What is meant by aberrant conduction?
A single supraventricular beat conducted through the ventricles in a delayed manner
Which of the following blood values may be raised if the patient is suffering from congestive heart failure?
ANP
When acquiring a 12 lead ECG on a patient for a suspected ischemic episode, what lead tracing on the monitor is not interpreted for waveform changes?
AVR
The interval that begins at the QRS complex and ends at the apex of the T wave is which of the following?
Absolute refractory period
You are treating a patient with substernal, diffuse chest pain that radiates down his left arm. He is nauseated, has vomited twice, and his skin is pale, cool, and diaphoretic. His blood pressure is 118/60, pulse is 128, showing sinus tachycardia with 3 PVCs per minute, SpO2 on room air is 91 percent. Of the following choices, which is the best initial treatment?
Administer oxygen, titrated to attain a pulse oximetry above 94 percent
After 3-4 minutes of cardiac arrest, what physiological process continues in the heart?
Aerobic metabolism
During the assessment of a patient complaining of chest pain, when should the paramedic obtain the SAMPLE history?
After the primary assessment
Which of the following could cause a prolonged QT interval?
Antipsychotic medication administration
When looking at an ECG, the P wave is representative of what?
Atrial depolarization
Why should the paramedic transport an ROSC patient receiving induced therapeutic hypothermia protocol in the field to an ED that can maintain this therapy?
Because it has been shown that if the patient warms up, survival actually is worse than never starting ITH
A patient you are interviewing suddenly loses consciousness and no pulse is presentdash-ECG reveals ventricular fibrillation. What is your initial action?
Begin CPR immediately, and as soon as the defibrillation pads can be applied, charge the machine and defibrillate the patient
What procedure is utilized on a patient that has extensive myocardial disease and/or is not a candidate for percutaneous coronary interventions and has thrombocytopenia?
CABG
During your assessment, you have determined that the patient is likely suffering from deep venous thrombosis. Which of the following clinical signs is least likely to support this field impression?
Calf pain or tenderness
The ECG monitor shows the following: no rate, no rhythm, P waves that are regular in spacing, no QRS complexes. What would you call this rhythm?
Cardiac standstill
If your patient is suffering poor perfusion to the heart muscle that is drastically reducing the ability of the heart to pump blood, this can result in what kind of shock?
Cardiogenic
You are managing a patient with systemic hypotension, alterations in mental status, and poor peripheral perfusion. You have already assessed for and corrected disturbances pertaining to the heart rhythm, vascular volume, and vascular tone. What is the remaining reason for the hypotension?
Cardiogenic shock
Atropine works by antagonizing which of the following?
Cholinergic response
During what phase of a cardiac arrest event will the heart muscle become distressed due to a lack of oxygen in the myocardial cells?
Circulatory phase
Which of the following is not a cardiovascular cause of chest pain?
Costochondritis
Successful defibrillation depends upon which of the following?
Decreased chest wall resistance to electricity
During the acquisition and interpretation of a 12 lead ECG on a patient with chest pain, you believe the patient may have left ventricular hypertrophy. What finding on the 12 lead may cause you to have that suspicion?
Deep S waves in V1 and V2 and tall R waves in V5 and V6
When evaluating an ECG, you note that in lead III the QRS complex duration is 0.16 seconds. What does this finding imply?
Delayed conduction through the ventricular conduction system
You observe an irregular rhythm on the ECG with a rate of 66 to 80, a normal PR interval, and a regular P wave for every QRS complex. The rate seems to vary with the patient's ventilations. What is your initial action?
Do nothing but observe the patient and transport
Which of the following patients would likely have the highest risk for developing cardiovascular disease?
Elderly male who smokes, is obese, and lives a sedentary lifestyle
Evidence of myocardial injury on a 12 lead ECG will produce an ST segment as which of the following?
Elevated above the baseline, equal to or greater than 1 mm
This mechanism is the result behind ectopic foci automatically depolarizing, producing ectopic (abnormal) beats on the ECG.
Enhanced automaticity
You are managing a patient found in cardiac arrest. Bystander CPR was initiated and the patient was shocked once with an AED. You have determined that the patient is still pulseless and apneic. While one partner is intubating and another is inserting an IO needle into the proximal tibia, what medication should you prepare for administration first via IV push?
Epinephrine
A significant finding in the SAMPLE history that will contraindicate the administration of sublingual nitroglycerine to a patient experiencing myocardial chest pain is which of the following?
Erectile dysfunction medication use within 24 hours
During your treatment of a patient with cardiac type chest pain, you have provided oxygen, IV access, nitroglycerin x3, and morphine x1. The patient is now pain free and the 12 lead ECG changes have resolved. At a minimum, how often should you repeat your reassessment phase during transport?
Every 15 minutes
Which of the following factors that contributes to CVD is not the result of lifestyle choices?
Family genetics
Which of the following is a nonmodifiable risk factor for developing cardiovascular disease?
Family history
Which of the following is a complication of fibrinolytic reperfusion therapy?
Fatal hemorrhage
You are called for a 59-year-old female with chest pain. Her only medical history she tells you is that she was in the hospital once for an allergic reaction to Novocaine after dental surgery. Pulse is 90 and irregular, ventilations 20, blood pressure is 130/80. She takes no medications and her ECG shows sinus rhythm with numerous, multifocal PVCs. What is the most appropriate action?
High flow oxygen therapy
Which of the following is a modifiable risk factor for developing cardiovascular disease?
Hypertension
Which of the following risk factors has NOT been proven to increase the risk of cardiovascular disease?
Hypocholesterolemia
In which of the following arrest situations should the paramedic withhold resuscitation?
If the arrested patient displays dependent lividity
During your assessment of a patient with CHF, what position should he be in prior to the paramedic evaluating for the presence or absence of JVD?
In a sitting-up position of about 45 degrees
You have just regained pulses on a cardiac arrest patient. As of right now, the heart rate is 38/min with sinus bradycardia showing on the monitor with multifocal PVCs, the patient is being ventilated at 10/min with oxygen via ET tube, and the palpable blood pressure is 68/palpation. Given these findings, what should the paramedic focus the next interventions on?
Increasing the heart rate
A term for describing permanently damaged myocardial tissue that will not heal and may cause the appearance of a pathological Q wave on a 12 lead ECG is which of the following?
Infarct
The ECG shows a rhythm with regularly-irregular groups of QRS complexes. There are more P waves than QRSs and the PR intervals become progressively longer until a P wave is not followed by a QRS complex. Which of the following would you suspect?
Ischemia at the AV junction
Which of the following lead patterns showing evidence of myocardial ischemia in a patient with chest pain would be indicative of obtaining right precordial leads?
Leads II, III, and AVF
What area(s) of the heart is/are directly observed by the precordial leads on a 12 lead ECG?
Left ventricle and septum
A patient with a long-standing history of systemic hypertension would most likely produce which of the following waveforms on a 12 lead ECG?
Left ventricular hypertrophy
Where is lead V5 placed on a patient's chest?
Left thorax, fifth intercostal space, anterior axillary line
The majority of out-of-hospital deaths attributed to coronary artery disease are due to what sudden event?
Lethal cardiac rhythm disturbance
The ECG shows a regular rhythm at a rate of 30, QRS is 0.18 seconds, and no P waves are present. Which of the following treatments is NOT appropriate?
Lidocaine
Which of the following is a cause for artifact appearing on the ECG?
Loose electrodes/wires
Synchronized cardioversion delivers energy during which part of the cardiac cycle?
On the peak of an R wave
Which of the following risk factors are thought to increase the risk of cardiovascular disease?
Poor diet
Which of the following statements regarding a patient with ROSC is most accurate?
Postarrest care is almost as important as prearrest care.
The total duration of ventricular depolarization is known as the:
QT interval.
What is the therapeutic endpoint for reducing the blood pressure in a patient with a hypertensive emergency with a severely elevated blood pressure and evidence of end-organ dysfunction?
Reduce MAP by no more than 25 percent initially
What mechanism of abnormal impulse formation is responsible for sustaining rapid rhythms such as paroxysmal supraventriculartachycardia?
Reentry
During the management of a patient in PEA cardiac arrest, you have already intubated and ventilated the patient, you are performing ongoing compressions, and you have administered four doses of epinephrine and a fluid bolus. Prior to termination of the arrest, you elect to give 1 mEq/kg of sodium bicarbonate. However, the IV was just pulled out accidentally by your partner prior to the bicarbonate administration. What should you do next?
Reestablish the IV or initiate an IO
Which of the following can be obtained from a single-lead ECG tracing?
Regularity of heartbeat
During the assessment of a 12 lead ECG on a patient with chest pain, what type of waveform change is the paramedic assessing for that indicates possible damage?
ST segment elevation
Your patient experiencing an MI has ST segment elevation in V1 and V2, with ST depression and T wave inversion in V5 and V6. Given this, what should be your first suspicion as to the ventricular wall injured?
Septal wall
What pacemaker site in the heart serves as the primary pacemaker?
Sinoatrial node
A phasic variation of the R-R interval that is related to the respiratory cycle and changes in intrathoracic pressure produces which of the following rhythms on the ECG?
Sinus arrhythmia
Your 19-year-old patient admits to drinking a six pack of Red Bull, two Monster drinks, and six Cokes in order to pull an all-nighter. Which of the following rhythms are you most likely to see on an ECG?
Sinus tachycardia with multiple PACs
If a patient with an acute coronary syndrome presents to EMS, and the ALS providers are able to resolve all pain through the use of nitrates and narcotics, why should this patient still be taken to a hospital capable of percutaneous coronary interventions?
So that the cause of the MI can be more permanently resolved within a very narrow and time-sensitive window of opportunity
What is the physiological action of dopamine?
Stimulates alpha and beta receptors
Your patient responds only to your voice. He is diaphoretic, pale, and cool, blood pressure is 80/50, ventilations 28, and pulse is 34. The ECG monitor shows a rhythm that has regular, but independent atrial and ventricular rhythms with no consistent PR interval and a QRS width of 0.14 seconds. Select the most appropriate treatment.
Supine position, IV, oxygen, externally pace at a rate greater than 60
You respond to a call for a male patient experiencing chest pain. He has an altered level of consciousness, blood pressure of 80/60, carotid pulse of 200, cold, diaphoretic skin, and the ECG shows ventricular tachycardia. What is your best treatment option for him?
Synchronized cardioversion
Cardiac arrest beyond what time period exceeds the metabolic phase of death?
Ten minutes
During the management of a patient found in cardiac arrest without a known downtime, which of the following factors should not be considered as either inclusionary or exclusionary criteria for terminating efforts?
The downtime before EMS arrival
You are transporting a patient with ECG changes and a clinical presentation consistent with an acute coronary event. Assuming that all of the following receiving facilities are roughly the same distance from your location, which receiving facility would you transport to?
The hospital with PCI capability
Which of the following best describes afterload?
The resistance against which the ventricle must contract
If a patient has a PR interval that is 7 mm (7 small boxes) in duration, what can be said about the overall ECG?
There is a conduction delay in the AV node.
In order for a paramedic to honor an advance directive presented to him at the side of a patient that has just arrested, whose signature MUST appear on the written document?
The patient's physician
Your patient is an 85-year-old male who is experiencing a septal wall AMI. Which of the following rhythms would you expect to see on the ECG?
Third degree heart block
You see ST segment elevation in leads II, III, and aVf. Why do you switch the precordial leads to the right side of the chest and take another 12 lead?
To rule in or rule out a right ventricular AMI
Which of the following would be a reason to continue a cardiac resuscitation?
Transient return of a pulse
Which troponin isoform value is most specific for cardiac injury?
Troponin I
Which of the following ECG leads would best indicate the presence of a right ventricular myocardial infarction?
V4R
Which of the following vascular disorders would probably require the least amount of prehospital intervention by the paramedic?
Varicose veins
When looking at an ECG, the QRS complex is representative of what?
Ventricular depolarization
Which of the following rhythms has an indication for defibrillation as part of its treatment?
Ventricular fibrillation
Which of the following best describes the identification of left atrial enlargement on the 12 lead ECG?
Widened P wave of 2.5 mm
Your patient states "I...can't...breathe...it feels...like...I...am...suffocating!" Physical examination reveals cyanosis, diaphoresis, and bilateral rales in the lung bases. Patient has 2+ pitting edema bilaterally to the ankles as well as mild ascites. A productive cough is noted with pink-tinged sputum and pulses/movement are present in all four extremities. Which of the following conditions is most likely for this patient?
Worsening left heart failure
When the administration of epinephrine increases the heart rate, this is called a positive ________ effect.
chronotropic
A degenerative disease of connective tissue often associated with hypertension and aging is known as:
cystic medial necrosis.
The two major components of the cardiovascular system are the:
heart and peripheral blood vessels.
The three types of ECG leads are bipolar, augmented, and
precordial.
The right semilunar valve, or pulmonic valve, connects the right ventricle to the:
pulmonary artery.
When the sinus node fails to discharge for a brief period, resulting in short periods of cardiac standstill that persists until pacemaker cells lower in the conduction system discharge, this is called:
sinus arrest.
When a coronary artery is blocked completely and the result is damage to the full thickness of the myocardium, this is known as a______infarction.
transmural
Which of the following descriptors of pain is common in a patient suffering from chest pain secondary to a heart attack?
"Heavy"
When implementing therapeutic hypothermia in an ROSC patient, what is the target temperature that is desired?
32-34 degrees Celsius
Each year, approximately how many Americans die from complications due to heart disease?
610,000
According to current estimates, how many Americans have some form of cardiovascular disease?
>60 million
Your patient is a 63-year-old male complaining of chest pain, stating his pain is an "8" on the 1-10 scale. His skin is cool and diaphoretic; he is confused and has a productive cough with pink-tinged sputum. ECG shows sinus tachycardia at a rate of 110 and his blood pressure is 74/40, ventilations are 24. What is the most appropriate pharmacological intervention?
Dopamine, titrated to maintain blood pressure
The rhythm on your ECG shows a rate of 74, PR interval of 0.28 seconds, QTC interval of 0.35 seconds, and QRS width of 0.08 seconds. What is your best course of action?
Observe, address, and treat any other chief complaints
The blood flow through a blood vessel is directly proportional to the fourth power of the vessel's radius. This is the definition of:
Poiseuille's law.
Signs and symptoms of isolated right ventricular failure include which of the following?
Tachycardia, JVD, hepatic congestion
The two superior chambers of the heart are the and they .
atria, pump blood to the ventricles
