CHAPTER 4 (GORSE) SUDDEN CARDIAC ARREST

D

Which of the following are considered as the chain of survival when managing a sudden cardiac arrest (SCA) victim? A) Early recognition of SCA and call 9-1-1 B) Early cardiopulmonary resuscitation (CPR) C) Early CPR and early defibrillation D) Early recognition of SCA, call 9-1-1, early CPR and defibrillation, early advanced life support E) Early recognition of SCA and call 9-1-1, early advanced life support

E

Which of the following are potential signs and symptoms of underlying cardiac conditions that should be identified during a preseason screening? A) Syncope B) Palpitations C) Exertional dyspnea D) Exertional chest pain E) All of the above

F

Which of the following elements should be documented as part of an emergency action plan? A) Document known circumstances leading to the event. B) Document examination findings and record the care that was rendered. C) Record who assumed care of the victim. D) Note the times that various steps or actions were taken (ie, use of automated external defibrillator). E) A & B only F) A, B, C, & D

A

Which of the following groups of individuals should be trained in recognizing sudden cardiac arrest? A) Athletic trainers, coaches, athletes, school medical personnel, the entire school community B) Athletic trainers, coaches, athletes C) Athletic trainers, coaches, athletes, school medical personnel D) Athletic trainers and coaches only

C

Which of the following is a typical cardiac arrhythmia that someone experiencing cardiac arrest would present? A) ventricular defibrillation B) atrial fibrillation C) pulseless electrical activity D) atrial bradycardia E) None of the above

D

46. When an automated external defibrillator (AED) is brought to an unconscious patient who seems to have no pulse, the AED will be able to determine if the patient has a pulse. If the AED indicates that a shock is not advisable, then the athletic trainer should wait to begin compression until the AED suggests that step. A) Both statements are true. B) Only the first statement is true. C) Only the second statement is true. D) Both statements are false.

B

A myocardial infarction (MI) ___________. A) is also termed a sudden cardiac arrest B) often results from occlusion of a coronary artery due to a blood clot C) predisposes to sudden cardiac arrest (SCA), with the SCA risk being greatest in the first five hours after the myocardial infarction (MI) D) develops due to atherosclerosis of the pulmonary arteries

E

A myocardial infarction _____________. A) is different from sudden cardiac arrest B) results in death of some of the heart muscle C) occurs due to occlusion of a coronary artery D) A & B E) A, B, & C

E

Although many episodes of sudden cardiac arrest (SCA) are not preventable, which of the following steps should be taken in an effort to prevent SCA episodes? A) Provide counseling on avoiding performance-enhancing drugs and supplements. B) Explain the importance of proper nutrition and rest. C) Remain watchful and vigilant for potential signs and symptoms of underlying medical conditions. D) Encourage athletes to report symptoms. E) All of the above

B

Although widespread cardiac screening is part of policy when it comes to preparticipation screenings, the process has been of low yield in general. Which of the following explains this statement? A) High incidence of abnormalities B) Occult nature of some heart conditions C) Successful screening methods D) Inclusion of echocardiograms in all preseason screenings

B

An automated external defibrillator (AED) is able to determine if the victim has a pulse and if the heart rhythm is shockable. A) True B) False C) Cannot be determined from the information provided

E

An automated external defibrillator (AED) utilizes computer algorithms to analyze electrocardiogram (ECG) waveforms to determine whether a shock is necessary. Which of the following arrhythmias are AEDs set to defibrillate? A) Ventricular defibrillation B) Rapid ventricular tachycardia C) Ventricular fibrillation and rapid ventricular tachycardia D) Cardioversion E) Cardioversion, ventricular fibrillation, and rapid ventricular tachycardia

B

Approximately 2% of cardiac-related deaths do not involve structural deformity and are considered sudden arrhythmic death syndrome or autopsy-negative sudden unexplained death. These cases occur because of disruptions of the heart's electrical system. These disruptions include all of the following except _________. A) changes at the cellular level B) long p-wave C) short Q-T interval D) Brugada syndromes E) familial catecholaminergic polymorphic ventricular tachycardia

D

As the basketball team's athletic trainer, you are sitting on the sidelines during the game. Part way through the first half, one of your athletes falls to the court in an unprotected manner. Play stops and you immediately go out onto the court. There are a number of things running through your head. Of the options below, what is the appropriate order of these steps? 1. Assess level of consciousness 2. Initiate cardiopulmonary resuscitation (CPR) 3. Assess breathing and circulation 4. Have automated external defibrillator (AED) brought to athlete's side 5. Activate emergency medical services (EMS) A) 1, 2, 3, 4, 5 B) 5, 4, 3, 2, 1 C) 1, 3, 4, 2, 5 D) 1, 3, 5, 2, 4

E

Asystole _____________. A) is also referred to as normal sinus rhythm B) is the absence of any cardiac electrical activity of the heart C) results in a higher mortality rate than ventricular fibrillation D) A & C E) B & C

D

Automated or automatic external defibrillators _____________. A) can be used only by trained personnel B) must be plugged into an outlet in order to be used C) provide only visual cues for use D) may require the clinician to analyze and deliver the shock to the patient

A

Because of a lack of standard criteria for listing the cause of death on a death certificate, the incidence of sudden cardiac arrest is not known. That being said, sudden cardiac arrest is said to be the leading cause of death in the United States, claiming more deaths than motor vehicle accidents, fires, lung cancer, and breast cancer combined. A) Both statements are true. B) Both statements are false. C) Only the first statement is true. D) Only the second statement is true.

B

Blood that perfuses the heart comes from the aorta and goes into the heart via the pulmonary arteries. A) True B) False

B

Even in the most ideal situations where a sudden cardiac arrest (SCA) occurs, only one-third of those who have a shockable rhythm survive, even fewer survive when they present with a nonshockable rhythm. A) True for the entire statement B) True if "one-third" read "one-half" C) False for the entire statement

A

Hypovolemia and hyperkalemia are reversible conditions associated with pulseless electrical activity of the heart. A) True B) False

B

In considering cardiac injury prevention, athletic trainers should do which of the following? A) Athletic trainers should ignore the signs of underlying cardiovascular disease. B) Athletic trainers should recognize the signs and symptoms of cardiovascular disease. C) Athletic trainers should only worry about the signs and symptoms of cardiovascular disease when reported by athletes. D) Athletic trainers should advise athletes presenting with these signs and symptoms to follow up with a physician at their convenience.

A

In order to use an automated external defibrillator (AED), you must have detailed knowledge and understanding when it comes to electrocardiogram (ECG) waveforms and cardiac arrhythmias. A) True B) False C) Cannot be determined from the information provided

B

In the event that the patient is unconscious, not breathing, and trauma is not a concern the modified jaw thrust maneuver should be used to administer cardiopulmonary resuscitation (CPR). A) True B) False

D

It is often difficult to determine survival rates following SCA because different studies utilize different denominators. Which of the following are factors that are often used to calculate survival rates? A) All treated by emergency medical services (EMS) B) Geographic location C) Patients that are dead on arrival D) All of the above

B

One-third of people who suffer from sudden cardiac arrest (SCA) have coronary artery disease. A) True B) False

A

Performance-enhancing and recreational substances including anabolic steroids, ma huang, bitter orange, and cocaine are predisposing factors to sudden cardiac arrest. A) True B) False

B

Sudden cardiac arrest is generally fatal if not treated in 5 minutes. A) True B) False

A

Sudden cardiac arrest____________. A) most often occurs in persons aged 50 to 75 B) is not associated with coronary artery disease C) often claims the lives of more men than women D) discriminates with respect to age, gender, and race

C

Sudden cardiac arrests typically present with one of three cardiac arrhythmias. Which of the following is not one of the three typical presentations? A) ventricular fibrillation B) pulseless electrical activity C) syncope D) asystole

A

Survival rates of patients presenting with asystole are often grim. Reports indicate that survival rates are _____. A) 0% to 2% B) 5% to 7% C) 10% to 15% D) Greater than 20%

A

The athletic trainer should continue cardiopulmonary resuscitation (CPR) and use of the automated external defibrillator (AED), until providers with more expertise assume care of the patient. A) True B) False

A

The near-perfect specificity (rare that a shock is advised or delivered inappropriately) and the high degree of sensitivity (recommends a shock 90% of the time when a shockable rhythm is present) assure a greater safety margin in the event that the device is applied to a person who is not in cardiac arrest. A) True B) False C) Cannot be determined from the information provided

A

The occurrence of sudden cardiac arrest in people over 50 years of age is consistent with the development of ischemic heart disease and congestive heart failure. A) True B) False

C

There is a variety of structural diseases of the heart. Which of the following is the most common? A) Congenital coronary artery anomalies B) Aortic dissection C) Hypertrophic cardiomyopathy D) Aneurysm E) Valvular deformities

D

Ventilation aids ____________________. A) are absolutely necessary in order to perform mouth-to-mouth resuscitation B) are absolutely necessary in order to perform mouth-to-mouth resuscitation and to provide protection against blood and bodily fluid exposure C) are absolutely necessary in order to perform mouth-to-mouth resuscitation and should most certainly have a one-way valve to limit bodily fluid and air exchange D) are not absolutely necessary in order to perform mouth-to-mouth resuscitation and to provide protection against blood and bodily fluid exposure

E

Ventricular fibrillation ____________. A) is electrical chaos of the heart B) does not typically represent a mechanical problem with the heart C) can be successfully treated with high-energy shock delivered to the heart D) A & B E) A, B, & C

D

Ventricular fibrillation ____________. A) is the most common initial rhythm B) occurs in 60% of cases when assessed by AEDs C) involves no cardiac activity D) A & B E) B & C

D

What is the purpose of a debriefing following activation of an emergency action plan (EAP)? A) To determine if improvements can be made B) To assess effectiveness of communication C) To determine accessibility of the automated external defibrillator (AED) during the incident D) All of the above E) A & B only

D

When a collapsed person is observed, what steps should the athletic trainer take to manage the situation? A) Determine level of consciousness by calling to the patient. B) Determine level of consciousness by gently shaking the patient. C) Determine level of consciousness, suspect a spinal trauma if the patient is unconscious, activate emergency medical services (EMS), and wait for EMS to initiate cardiopulmonary resuscitation (CPR) if patient is not breathing. D) Determine level of consciousness, activate EMS, initiate CPR if patient has no pulse, and have an automated external defibrillator (AED) brought to the patient's side.

A

When an individual suddenly collapses, there is a high likelihood that the person is unconscious. A) True B) False

D

When blood is not being pumped by the heart _________. A) permanent brain damage may result B) unconsciousness will result after 2 minutes without oxygen C) delivery of oxygen to the body is affected negatively D) A & C E) A, B, & C

A

When cardiac arrest occurs, blood flow to the brain declines. This decline in blood flow can result in the patient becoming unconscious in 30 seconds, with permanent brain damage occurring after 4 to 6 minutes. A) Both statements are true. B) Only the first statement is true. C) Only the second statement is true. D) Both statements are false.

C

When considering the emergency action plan (EAP) that should be in place to aid in managing sudden cardiac arrest (SCA), which of the following statements is true? A) The EAP need only identify the need for bystanders with cardiopulmonary resuscitation (CPR) training to respond. B) Individuals serving as EAP responders should be trained only in CPR. C) Emergency action plan respondents should have training in CPR, automated external defibrillator (AED) use, and first aid. D) Once an EAP is in place, the facility should not need to revisit it, unless there is an emergency.

A

When performing cardiopulmonary resuscitation (CPR) the quality of chest compressions is critical. Ensuring that the compressions are performed without interruptions is very important to the success of CPR. A) Both statements are true. B) Only the first statement is true. C) Only the second statement is true. D) Both statements are false.

A

When the heart is not pumping, both oxygen and glucose circulating in the blood do not flow to the tissues of the body, including the heart. A) True B) False

E

Which of the following should be done in order to determine if the unconscious victim is breathing? A) The athletic trainer must lean over the patient. B) The athletic trainer should place his cheek next to the mouth of the patient to feel for breathing. C) The athletic trainer should be looking for the rise and fall of the chest. D) The athletic trainer should be listening for breath sounds. E) All of the above F) Only A, B, & D

D

Which of the following statements is true regarding seizurelike activity and cardiac arrest? A) Seizures may occur because of stoppage of blood flow to the brain. B) Intermittent gasping breaths, agonal respirations, may occur following a seizure. C) Agonal respirations do not indicate the presence of a heartbeat. D) All of the above

E

Which of the following statements is true with regard to where an automated external defibrillator (AED) should be located? A) The AED should remain with the team medical equipment. B) The AED should be affixed to a specific location. C) The AED should be stored in a lockable cabinet that has an alarm and automated 9-1-1 dialer. D) The AED should either be wall mounted or kept in a specific cabinet. E) The AED can be located in a number of places; these locations should be agreed upon and accessible.

F

Which of the following statements is true with respect to exercise-related sudden cardiac arrest (SCA) and death? A) Sudden cardiac arrest is the leading cause of death in athletes. B) The majority of cardiac-related deaths in athletics are the result of an underlying cardiac condition. C) Ischemic heart disease is typically to blame for heart-related deaths in athletes. D) Structural heart diseases are major contributors to cardiac-related deaths in athletes. E) All of the above are true. F) All of the above are true except for one statement

A

While immediate cardiopulmonary resuscitation (CPR) can improve survival rates associated with ventricular fibrillation, survival rates decline 5 to 10% for every minute that passes from the time of collapse until defibrillation is achieved. A) True B) False

F

Who should be involved in the review of and debriefing of an emergent scenario following activation and implementation of the emergency action plan (EAP)? A) Team physician and emergency medical services (EMS) director B) Only medical personnel C) Team athletic trainers D) Coaches that were not in attendance E) Responders and other involved personnel F) All individuals, medically trained or otherwise, involved in the incident