Ch 17

EMS arrives on the scene and finds a patient who reports chest pain that radiates down the left arm. the patient askes what is causing this. Which response should the EMT provide?

"Chest pain happens from occluded blood vessels in the heart"

A 44-year-old female patient complains of chest pressure. Her vital signs are P92, R 16, BP 118/72, and SP02 is 95% on room air. She denies past medical history. You should administer:

160-325mg of aspirin If the patient is suspected of suffering from a coronary artery occlusion, administer 160-325mg of aspirin if your local protocol allows it. she has no past history, so she would not be prescribed nitroglycerin. Routine administration of oxygen is not indicated.

How long does it take the heart muscle to being dying without adequate perfusion?

20-30 minutes

Which of the following would you expect to exhibit a typical presentation of angina?

45-year-old male patient with a history of smoking Women, diabetics, and the elderly might not have the typical presentation of signs and symptoms of symptoms of angina. the discomfort can appear to be more diffuse or can be described more vaguely. These patients might not have any chest pain or discomfort but might instead complain of shortness of breath, nausea, fainting, weakness or light-headedness. So, it is more likely that a 45-year-old male patient with a history of smoking will exhibit a typical presentation of angina

A female patient is complaining of feeling tired over the past 2 days, associated with swelling of the ankles, epigastric pain, and nausea. this patient may be suffering from:

A coronary event The following list of symptoms is common for females suffering from a cardiac ischemia or infarction.​ "Classical" findings​ (not necessarily common​ findings) include dull substernal chest pain or​ discomfort, dyspnea, nausea and​ vomiting, and diaphoresis.​ "Nonclassical" or​ "atypical" findings​ (not necessarily uncommon​ findings) include neck​ ache; pressure in the​ chest; pains in the​ back, breast, or upper​ abdomen; tingling of the​ fingers; unexplained fatigue or weight gain​ (water weight​ gain); epigastric​ pain; and insomnia.

Which of the following disorders would NOT likely in heart failure?

A suspected stroke When the heart no longer has the ability to adequately eject blood from the​ ventricle, it is considered to be failing. The heart failure may be a result of a heart attack that affected a large portion of muscle because when the heart muscle​ dies, it no longer contributes to the pumping function of the heart. Heart failure may also be caused by a valve disorder that allows regurgitation of​ blood, hypertension, a pulmonary embolism that blocks blood that is leaving the heart to enter the​ lungs, cardiac rhythm​ disturbances, and certain drugs. A stroke is a neurological dysfunction that may be caused by some of the same risk factors as heart​ failure, but a stroke itself does not cause heart failure.

Due to the increased risk of cardiac arrest in the acute myocardial infarction patient, what should be kept close to the patient?

AED When the signs and symptoms of an acute myocardial infarction are​ present, you should proceed rapidly with your assessment and management of the patient. This patient has the potential to go into cardiac​ arrest; therefore, you should frequently assess the patient and maintain a vigilant watch over the​ patient's condition. If​ possible, the patient should never be left alone while you return equipment to the EMS unit or retrieve and prepare the cot. The automated external defibrillator​ (AED) must always be available and close to the patient.

The site in the heart's condition system where the electrical impulse is temporarily slowed down to allow the ventricles to fill with blood is the :

AV Node The heart's electrical impulse is first generated at the SA node. It travels through the right and left atria by way of the Bachmann bundle. The two atria contract simultaneously as a result of the electrical impulse. The impulse then travels to the AV node by way of an intranodal tract located in the area between the atria and the ventricles. There, the impulse is inhibited briefly to allow the blood from the contracted atria to fill the ventricles, and then the impulse travels down the bundle of His to the left and right ventricles via the left and right bundle branches.

What is the disease process, not the clinical emergency, that can happen when the coronary arteries are narrowed or occluded from atherosclerotic plaque?

Acute Coronary Syndrome ACS is a coronary artery disease that results from a variety of conditions that can affect the heart in which the coronary arteries are narrowed or occluded by fat deposits (plaque), clots, or spasm. The word "acute" refers to a sudden onset, "coronary" refers to a condition that affects the coronary arteries, and "syndrome" indicates a group of signs and symptoms that are produced by the condition. Angina pectoris is a symptom that is commonly associated with coronary artery disease. A pulmonary embolus is a blood clot that lodges in one of the pulmonary arteries.

If the patient you are treating has a blood pressure of 90/60 mmHg and crushing chest pain, what would be the MOST appropriate treatment?

Administer Oxygen If the patient is experiencing chest​ discomfort, has a systolic blood pressure of more than 90 mmHg before administration of​ nitroglycerin, and has a prescription for​ nitroglycerin, administer one tablet every 3 to 5 minutes up to a total of three tablets. Because this patient has a systolic BP of​ 90, the use of nitroglycerin is not permitted. Administer oxygen to keep the pulse ox reading greater than 94​ percent, call for ALS​ backup, and package the patient for transport. Use of the AED is not indicated for a patient with a pulse.

What is PVC?

An abnormal heartbeat that occurs as a result of an injured heart muscle from a heart attack

A 45-year-old male patient complains of tearing pain in his back. You measure the BP in both arms. The BP on the left is 122/74 and the BP is 100/76. You should suspect:

Aortic Dissection The pain is classically most severe when the dissection first occurs and is most often described as a​ "sharp" pain, or sometimes as a​ "tearing" or​ "ripping" pain, often felt in the​ back, flank, or arm. Syncope might be the only sign in some patients. Depending on the location of the dissection along the​ aorta, it can cause symptoms similar to a stroke or to a myocardial infarction and can lead to a myocardial infarction or other damage to the heart. A difference of 20 mmHg or greater in the systolic blood pressure reading between the upper arms or a severe decrease or difference in the upper and lower extremity pulse amplitude as compared to central pulses in a patient complaining of back or sharp chest pain should cause you to suspect a possible aortic dissection.

When assessing a responsive adult patient with a possible cardiac compromise, you should:

Apply oxygen at a dose that maintains a pulse ox reading of more than 94% You should establish an open airway. If the​ patient's respirations become​ inadequate, begin positive pressure ventilation. Apply the pulse​ oximeter, if​ available, to monitor the oxygen level. Administer supplemental oxygen if the patient is​ dyspneic, hypoxemic, has obvious signs of heart​ failure, has an SpO2 of less than 94​ percent, or the SpO2 is unknown. Initiate oxygen therapy via a nasal cannula at 2 lpm and titrate the concentration and liter flow to achieve and maintain an SpO2 of 94 percent or greater.

A confused, 60-year-old male patient complains of chest discomfort. His vital signs are P 120, R 28, shallow, BP 88/66, and SPO2 is 88% on room air. You should:

Assist ventilations with a bag valve mask (BVM) Emergency care for the patient suffering from angina should be provided regardless if signs and symptoms of an acute coronary syndrome emergency exist. You should establish an open airway with the help of a bag valve mask. If the​ patient's respirations become​ inadequate, begin positive pressure ventilation. Apply the pulse​ oximeter, if​ available, to monitor the oxygen level. He is confused and​ hypotensive, which contradicts nitroglycerin administration.

A systemic arterial disease in which plaque builds up inside the arteries is called:

Atherosclerosis

The number one killer worldwide in economically developed countries is:

Atherosclerosis

Cardiac muscle cells have one property that MOST skeletal and smooth muscle cells do NOT have. This property is:

Automaticity Conductive cells of the heart are grouped in three areas of the heart, known as pacemaker sites, where the electrical impulses are created automatically, independent of the autonomic nervous system of the body (a property known as automaticity)

During atrial systole

Both atria contract simultaneously Both atria contract simultaneously because of the electrical impulse (a process known as atrial systole), ejecting the blood into the ventricles through the atrioventricular valves that open when the pressure in the atria exceeds the pressure in the ventricles

Which of the following blood vessels directly interface with cells throughout the body?

Capillaries The capillaries interface with cells throughout the body. Capillary walls are so thin that oxygen and nutrients that are carried in the blood can move out on the capillaries and into the body's cells. The arteries carry oxygenated blood to the arterioles and then to the capillaries. Carbon dioxide and other waste products that are given off by the cells travel back through the capillaries and venules to the veins and back to the right ventricle through the inferior and superior vena cava

You have just administered nitroglycerin to a patient who has chest pain that he rated as a 9 on a scale of 1 to 10. He suddenly gets very weak and feels dizzy. What should you do?

Check his vitals and lay him down It is possible that the nitroglycerin caused a drop in blood​ pressure, so lay the patient down and reassess his vital signs. The aim of administering nitroglycerin is to dilate blood vessels in the​ heart, but blood vessels in other parts of the body are dilated as well. This dilation can cause​ headache, a drop in blood​ pressure, or changes in pulse rate as the body compensates for the changes in blood vessel size.

You are assessing a 58-year-old male patient who is short of breath and have very little energy. He normally leads a very sedentary lifestyle. You note that he has edema to his lower extremities and a history of two past heart attacks. What is MOST likely to be his problem?

Congestive Heart failure

you are treating a patient who has severely swollen feet and a distended, spongy abdomen. You should suspect that the patient is suffering from:

Congestive Heart failure

What is the leading cause of death in adult females?

Coronary Heart Disease Coronary heart disease in females is now the single largest cause of death of females in the US.

Besides females, what high-risk demographic is likely to present with atypical findings when they experience acute coronary syndrome (ACS) or a myocardial infarction?

Diabetics Err on the side of the​ patient, and provide emergency care for a potential myocardial infarction or acute coronary syndrome​ (ACS), despite a presentation of atypical signs of ischemia or infarction when dealing with diabetics or the elderly. Diabetics and the elderly are also​ high-risk groups that may present with atypical findings. Athletic competitors are less likely to suffer an​ ACS, as is also the case with​ infants, and hemophiliacs experience abnormal blood​ clotting, not anything that would contribute to an increased rate of ACS.

Coronary arteries fill during:

Diastole After the systolic phases of the atria and ventricles, there is a diastolic phase in which the heart cells repolarize and await the next impulse. it is important to note that the coronary arteries fill during the diastolic phase

Damage to the cardiac conduction system caused by hypoxia may lead to:

Dysrhythmias

When the cardiac conduction system becomes irritated, the conduction cells may begin to "fire off" impulses on their own. This can lead to:

Dysrhythmias When the coronary arteries are occluded, either partially or completely, the conduction system can become irritable from the lack of oxygen. When this occurs, the conduction cells might begin to "fire off" impulses on their own. This can lead to cardiac rhythm abnormalities called dysrhythmias. Some of these dysrhythmias can lead to sudden death

Which of the following is a critical element in the EMT's field treatment (scope of practice) for all myocardial infarction patients?

Early recognition

Hyperoxygenating the acute coronary syndrome patient can lead to:

Greater cardiac cell damage

A chambered muscular organ that lies within the thoracic cavity is called the:

Heart The heart consists of four chambers: the atria (top two chambers) and the ventricles (two bottom chambers) The heart has only one purpose: pumping blood to the body. If that single purpose is interrupted, even momentarily, cardiac arrest ensues, and the chance of survival can be slim

Which of the following is a common risk factor for endothelial injury?

Hypertension Common risk factors that are thought to cause endothelial injury include smoking, diabetes, hypertension, high levels of low-density lipoproteins (LDL) and low levels of high-density lipoproteins (HDL)

You are assessing a 58-year-old female patient who called EMS due to a nosebleed, bounding pulse, and ringing in her ears. Of the following what is the likely cause of these symptoms happening together today?

Hypertensive emergency A patient who is having a hypertensive emergency can have a​ strong, often bounding​ pulse; skin that may be​ warm, dry, or​ moist; severe​ earache; ringing in the​ ears; nausea​ and/or vomiting; elevated​ BP; respiratory​ distress; chest​ pain; seizures;​ nosebleeds; and focal neural deficits. If the actual blood pressure during this emergency is near the​ patient's average blood​ pressure, the EMT should focus treatment on the symptoms and not the blood pressure itself.

If blood is NOT circulated adequately through the body's capillaries, cells become starved for oxygen and nutrients and overloaded with carbon dioxide and waste products. This condition is known as:

Hypoperfusion

When might an aspirin administered by the EMT be considered contraindicated?

If the patient is known to be allergic to aspirin Aspirin should not be given to a patient who has a decreased level of consciousness or is known to be allergic (hypersensitive) to the drug

Which assessment finding in the healthy adult patient reflects vasoconstriction?

Increased blood pressure The smaller vessel size, the harder the heart has to work to pump blood, which raises the blood pressure. A decreased rate, respiration, and increased oxygen saturation reflect good blood flow through dilated or larger vessels

Patients with known cardiac problems often will have been prescribed nitroglycerin for their chest pain. Nitroglycerin eases chest pain by:

Increasing the diameter of blood vessels and decreasing the workload of the heart

Which of the following is considered a highly sensitive organ affected by the production of free radicals during reperfusion?

Intestines The heart along with the​ brain, kidneys,​ liver, lungs, and intestines are highly sensitive organs affected by the production of free radicals during reperfusion

Which of the following is true regarding an aortic dissection?

It occurs more often in men than women Two types of​ life-threatening injuries can occur to the aorta that are often confused with each​ other: aortic aneurysm and aortic dissection. Both can cause pain that can be confused with the pain of myocardial infarction. Both occur more often in men than in women.​ However, aortic aneurysm and aortic dissection have distinctly different​ causes, signs, and symptoms.

Which of the following is NOT a part of the administration of nitroglycerin?

Making sure the medication is prescribed to the patient or to another family member All of the following criteria must be met before an EMT administers nitroglycerin to a​ patient: The patient exhibits signs and symptoms of chest​ pain, the patient has​ physician-prescribed nitroglycerin, and the EMT has received approval from medical​ direction, whether online or​ offline, to administer the medication.

What impact does atherosclerosis have on coronary arteries?

Narrows the blood vessels When a patient has a buildup of fatty deposits​ (atherosclerosis) on the inside of the coronary​ arteries, the narrowing of the coronary blood vessel increases the resistance to blood flow through the artery and decreases the amount of blood flow to the distal heart muscle. The fatty deposits reduce the coronary​ arteries' capability to dilate​ (become larger) and deliver additional blood flow to the heart when​ needed, such as for an increase in heart rate or more forceful pumping action. This is coronary artery disease​ (CAD) which is the most common type of heart disease.

Two conditions related to cardiac compromise are angina pectoris and myocardial infarction. In comparing the two, remember that:

Nitroglycerin may give incomplete or no relief of myocardial infarction pain Chest discomfort is the most significant symptom of a heart attack. The discomfort the patient experiences is similar to that of​ angina; however, in a heart​ attack, the symptoms last longer.​ Also, chest discomfort from an acute myocardial infarction will be only partially relieved by nitroglycerin or not relieved at all. The boundaries between unstable angina and acute myocardial infarction are not so​ distinct, and it may be difficult to distinguish between the two conditions.

Which of the heart rhythms would be least likely to present in an unresponsive patient who you believe has experienced a severe heart attack and is in cardiac arrest?

Normal Sinus Rhythm In a normally functioning​ heart, the​ heart's electrical impulse is generated from the sinoatrial node. The electrical impulse then travels through the​ heart's conduction​ system, depolarizing the muscle in an organized fashion and producing the contractions that pump blood into the ventricles and then through the body. This electrical activity is called normal sinus rhythm. It will produce an ECG pattern of regularly spaced peaks that occur between 60 and 100 times each minute separated by nearly flat lines. A patient who is unresponsive who is not in cardiac arrest with a heart attack is more likely to have a rapid heart rate​ (tachycardia). If the patient is unresponsive and in cardiac​ arrest, statistically, the presenting rhythm in the first minutes after arrest are either ventricular fibrillation or pulseless ventricular tachycardia. After a prolonged period of unresponsiveness and​ arrest, the rhythm will eventually become asystole.

The mnemonic used to onbain a description of the patient's chest pain is:

OPQRST When conducting a history of the chief complaint and other associated symptoms, such as chest discomfort and shortness of breath, use the OPQRST mnemonic to obtain the information. Chest discomfort is the most common chief complaint and most important signal of patients suffering from cardiac compromise and as acute provocation/palliation, quality, radiation, severity, and time

The EMT is helping a patient with chest pain to take his own nitroglycerin. If the patient continues to experience no relief after one dose, the EMT should:

Obtain medical control permission to administer a second dose If the patient experiences no relief after one​ dose, another dose may be administered after 3 to 5 minutes if authorized by medical​ direction, to a maximum of three doses. Be sure to find out if the patient has already take one or more doses prior to your arrival. Assess the blood pressure and follow your local protocol on administration of additional doses.

Signs and symptoms associated with cardiac compromise may vary widely, so it is important to remember that:

Often the patient will describe chest pressure rather than "pain" The typical response of the heart to ischemia is chest​ discomfort, referred to as chest pain by many health care​ professionals, although the patient normally refers to the sensation as more of a feeling of discomfort than pain. Chest discomfort or pain that is a result of heart muscle ischemia is referred to as​ ischemic-type chest pain. A patient who is asked whether he is experiencing chest pain may answer​ "no." More​ often, the patient feels a crushing chest pressure that is described as dull and aching and not as pain. The pain or discomfort may be localized to the area of the sternum and radiate to the​ jaw, arms,​ shoulders, or​ back, which is considered the typical chest discomfort in cardiac​ compromise, or it may be a diffuse chest or back discomfort or ache. Any time you are collecting a history of a patient who you suspect is suffering a cardiac​ compromise, it is most appropriate to ask whether the patient is experiencing chest discomfort rather than chest pain.

You suspect that your patient is suffering from an aortic aneurysm. You should administer:

Oxygen If a pulsating mass is felt and aortic aneurysm is suspected, administer oxygen and transport immediately because only surgery can prevent or repair a rupture of the aneurysm.

A patient who is considered normoxic has normal:

Oxygen Levels According to the American Heart Association​ (AHA) 2015​ guidelines, withholding supplemental oxygen in the acute coronary syndrome​ (ACS) patient who is normoxic​ (has a normal oxygen​ level) has been shown to minimally reduce the size of the infarct.

A 42-year-old male patient complains of crushing chest discomfort and shortness of breath. His vital signs are P 102, R 20, BP 88/60 and SPO2 is 98& on room air. You should administer:

Oxygen at 2 lpm via a nasal cannula It is recommended that oxygen be provided only to acute coronary syndrome patients with an SpO2 less than 94​ percent, or if an SpO2 is​ unknown, or if the patient is​ dyspneic, hypoxemic, or has obvious signs of heart failure. To limit its concentration in the​ blood, oxygen should be administered via a nasal cannula starting at 2 lpm with just enough administered to reverse the hypoxia.

Abnormal and early contractions of the ventricles in response to conduction system irritability from a lack of oxygen, that are abnormally wide, are called:

PVCs In some cases, the heart muscle becomes hypoxic, is injured, or dies. Also, the electrical conduction system may be damaged or disturbed and may cause the improper functioning of the heart. Sometimes these conditions produce an irritability of the heart that causes the uncoordinated firing of electrical ventricular impulses called premature ventricular complexes (PVCs). When PVCs occur in succession, they may produce ventricular tachycardia (V-tach) which shows up on an ECG as steep peaks and valleys that are very close together.

The processes by which oxygen and nutrients are delivered from the blood through the thin capillary walls into the cells and carbon dioxide and other waste products are removed are known as:

Perfusion A properly functioning circulatory system delivers oxygen and nutrients to the​ body's cells and carries away carbon dioxide and other wastes. These processes take place as blood passes through the capillaries. The delivery of oxygen and nutrients from the blood through the thin capillary walls into the cells and the removal of carbon dioxide and other wastes are the processes known as perfusion. Under some​ conditions, blood does not circulate adequately through all the​ body's capillaries. The chief result of inadequate circulation is a state of profound depression of cell​ perfusion, called shock or hypoperfusion.

The process by which oxygen and nutrients are delivered by the blood and waste products are removed from the cells is known as:

Perfusion The delivery of oxygen and nutrients by the blood through the thin capillary walls into the cells and the removal of carbon dioxide and other wastes are the process known as perfusion.

Which of the following indicates an aortic aneurysm?

Pulsating Mass Aortic aneurysms occurs most often in the abdominal region. Pain can be felt, especially in the back, when the aneurysm gets large enough, perhaps shortly before rupture occurs. Usually, the aorta cannot be felt with a physical examination, but at this final stage it can be felt as a pulsating mass in the abdomen, although this can be difficult or impossible to detect in a heavyset patient

In a patient experiencing a cardiovascular emergency, hypertension would be found in each of the following, EXCEPT:

Pump failure secondary to an MI to the right ventricle An acute myocardial infarction typically is the result of coronary artery disease that causes severe narrowing or complete blockage of the coronary arteries. A plaque erosion or rupture within the coronary artery may cause the narrowing and blockage to occur. The result is that a portion of heart muscle does not receive an adequate supply of oxygenated blood. After about 20 to 30 minutes without adequate​ perfusion, the heart muscle tissue begins to die. When patients have pump​ failure, they often develop shock rather than​ hypertension, especially when the right ventricle is​ failing, as this provides the preload to the left ventricle.

What is the terminal portion of the hearts conduction system?

Purkinje fibers From the bundle of His and the left and right bundle branches, the electrical impulse travels to the terminal portion of the conduction system for the heart, which is in the ventricles. The Purkinje fibers, which are embedded in the ventricular muscle, cause the ventricles to contract simultaneously, a process known as ventricular systole.

Of the three main portions of the ECG tracing, the portion that corresponds with the depolarization of the ventricles is the:

QRS complex The QRS complex is the second waveform and corresponds to the depolarization (contraction) of the ventricles and the main contraction of the heart.

The cardiac conduction system allows the heart to generate electrical impulses. Trace an electrical impulse through the structures of the heart, in order:

SA node, AV node, bundle of His, and Purkinje fibers

What pacemaker site in the heart serves as the primary pacemaker?

Sinoatrial Node

The capillaries are a network of tiny blood vessels:

That connect arterioles to venules

The term "depolarization" refers to:

The contraction of the heart muscle Each heartbeat, or mechanical contraction of the heart, has two distinct components of electrical activity: depolarization and repolarization. In the 1st component, depolarization, electrical charges of the heart muscle change from positive to negative and cause heart muscle contraction. In the 2nd component, repolarization, the electrical charges of the heart muscle return to positive during relaxation of the heart muscle.

Heart failure is defined as:

The heart's inability to pump sufficient amount of blood from the ventricles When the heart no longer has the ability to adequately eject blood from the ventricle, it is considered to be failing. The heart failure may be a result of a heart attack that affected a large portion of muscle because when the heart muscle dies, it no longer contributes to the pumping function of the heart. Heart failure may also be caused by a valve disorder, hypertension, pulmonary, embolism, cardiac rhythm disturbances, and certain drugs. It does not result from the loss of the "arterial kick" (the atrium's decreased volume transfer to the ventricle), or by a sinus dysrhythmia (cyclic changes in the heart rate during a breathing cycle)

Which statement accurately differentiates angina and myocardial infarction?

The pain of angina usually goes away on its own, or with nitroglycerin Angina pectoris is a symptom of inadequate oxygen supply to the heart​ muscle, or myocardium. It results from a decrease in oxygen delivered to the myocardium that is often caused by partial blockage of the coronary​ arteries, which causes ischemia that in turn results in tissue hypoxia. The lack of oxygen causes the​ discomfort, sometimes described by the patient as crushing or squeezing or as tightness.​ Generally, angina pectoris occurs during periods of physical or emotional stress. Once the stress has been relieved or removed or the patient​ rests, the pain usually goes away.

Which of the following is TRUE about the heart and blood vessels?

The pulmonary arteries are the only arteries that carry oxygen-depleted blood

A clot that develops in a blood vessel to the point that it occludes it, is called a:

Thrombus The clot that is formed is called a thrombus. Several components are involved in the clot formation system, the most important of which are platelets (disk-shaped elements in the blood that are fragments of cells from the bine marrow), thrombin (a protein that is responsible for activating the formation of a clot), and fibrin (strands that are responsible for making the clot stronger). A thrombus may form within a coronary artery at a site where plaque (a fatty deposit) has built up.

Which of the following is an atypical finding of a heart attack in females?

Unexplained Fatigue

Chest discomfort that occurs without exertion is known as:

Unstable Angina Unstable angina has a variety of definition but usually indicates angina discomfort that is prolonged and worsening or that occurs without exertion and when the patient is at rest

The symptoms of myocardial infarction in females are:

Usually more subtle than, or slightly different from, those in males Females who experience a cardiac event may present with different signs and symptoms from males. However, the event is just as dangerous for females and can be as deadly. Therefore, the EMT must recognize some of the more subtle signs and symptoms that females who are suffering from acute coronary syndrome experience

Which of the following is true regarding blood vessels and blood pressure?

Vasodilation causes the resistance to decrease

Which of the following blood vessels primarily carry deoxygenated blood?

Veins

The electrical impulse within the Purkinje fibers normally causes:

Ventricular Contraction From the bundle of His and left and right bundle branches, the electrical impulses travels to the Purkinje fibers, which are embedded in the ventricular muscle, causing the ventricles to contract simultaneously (a process known as ventricular systole)

You are assessing a 55-year-old male patient complaining of chest pain. Your paramedic partner advises you that the patient is experiencing PVCs. You know that this patient is at risk for:

Ventricular Tachycardia

When looking at an ECG, the QRS is representative of what?

Ventricular depolarization

A lethal heart rhythm that can occur as a response to conduction system injury or death and results in an absence of cardiac output is called:

Ventricular fibrillation

You are assessing a 58-year-old male patient with a chief complaint of chest pain and difficulty breathing. He states that he has had a crushing substernal pain for the past hour. He has his nitroglycerin with him but forgot to take it. Should you assist him in the administration of his nitroglycerin?

Yes, if his BP is above 90 mmHg systolic

You must reassess your patient within 2-3 min after administering nitroglycerin because one of the side effects is:

a decrease in blood pressure

A 65-year-old male patient complains of chest pressure. He took 325mg of aspirin and 2 nitroglycerin tablets prior to your arrival. His vitals are P 96, R 16, BP 146/90, and SPO2 is 97% on room air. You should consider:

assisting with another nitroglycerin tablet Place the patient in a position of comfort. If the patient has a prescription for nitroglycerin, administer one tablet every 3-5 min up to a total of three tablets. Follow your local protocol. Be sure the systolic blood pressure is above 90mmHg and remains above 90mmHg following each nitroglycerin administration. if local protocol allows, administer 160-325 mg of aspirin

Documentation for the administration of nitroglycerin includes all of the following EXCEPT:

the position the patient was in during administration Record your​ actions, including baseline vital signs before​ administration; medical direction​ approval; dosage; time of​ administration; and the​ patient's response. It is not necessary to document the position the patient was in during the administration of the nitroglycerin.

With the hypoxia and damage to the heart muscle that comes with ischemia or infarction, what can happen to the conduction cells of the myocardium?

they may become damaged and fail

During cardiac arrest, instead of coordinated contractions, the heart may show uncoordinated twitching that cannot produce a pulse, known as:

ventricular Fibrillation When PVCs occur in​ succession, they may produce ventricular tachycardia​ (V-tach), which shows up on an ECG as steep peaks and valleys that are very close together. Ventricular tachycardia can either create a​ pulse, or not. If left​ untreated, ventricular tachycardia can degenerate into ventricular fibrillation​ (VF or​ V-fib), which shows up as​ smaller, uneven, disorganized peaks and valleys that prevent an organized contraction of the heart and stop cardiac output

When asking about the quality of the chest pain a patient with angina is experiencing, you are asking:

whether the pain is sharp, dull, burning, or squeezing The EMT can ask the patient whether the pain is experienced as​ pressure, squeezing,​ crushing, or burning and whether it is sharp and stabbing or dull. The chest discomfort that is associated with a heart attack is most commonly described as a crushing pressure. It is also often described as​ dull, aching,​ squeezing, or burning. Many patients​ state, "It feels like someone is sitting on my​ chest." Other patients present with their fist clenched over the center of their chest. This is called the Levine sign. It is an indication of severe chest discomfort.