EMT: Chapter 16 [cardiovascular emergencies]

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?

AMI

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:

BVM ventilation at 10-12 breaths/min and assessment of O2 saturation

What is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique?

CPAP

To assess chest pain, use the mnemonic:

OPQRST

The electrical impulse generated by the heart originates in the:

SA node

Acute coronary syndrome (ACS) is a term used to describe:

a group of symptoms caused by myocardial ischemia

Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?

a rapid HR

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 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, 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 O2, give her 324 mg of aspirin, and assess her further

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

You are treating a 50-year-old woman who has just finished a 10k run. She is complaining of crushing pain in the chest radiating down her left arm and nausea, which came on suddenly. She is sweating profusely. What condition should you suspect?

angina pectoris

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

anginal pain subsides with rest

Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?

aspirin

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

assess the adequacy of his respirations

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

assess the scene for potential hazards

Most often, low blood flow to heart tissue is caused by white?

atherosclerosis

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:

automaticity

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-year-old male with an altered mental status. Upon arrival at the scene, the patient's wife tells you that he complained of 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

Common signs and symptoms of a hypertensive emergency include:

bounding pulse, severe headache, dizziness

When would it be MOST appropriate for a patient to take his or her prescribed nitroglycerin?

chest pain that does not subside immediately with rest

In addition to angina and myocardial infarction, nitroglycerin can be used to treat:

congestive heart failure

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

constriction of the blood vessels in the muscles

The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.

coronary arteries, aorta

The lumen of an artery may be partially or completely blocked by the blood-clotting system due to a _______________ that exposes the inside of the atherosclerosic wall.

crack

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 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?

dissecting aortic aneurysm

Prior to attaching the AED to a cardiac arrest patient, the EMT should:

dry the chest if it is wet

Signs/symptoms of shock include all the following EXCEPT:

elevated heart rate

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

ensure that no one is touching the patient

Angina pain may be felt in the:

epigastrum

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

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:

have chronic hypertension

You are transporting a patient with angina and he loses consciousness on the way to the hospital. When you check, you cannot feel a pulse. What should you do?

have partner pull over the ambulance and come back to help with CPR and AED

Common side effects of nitroglycerin include all of the following, EXCEPT:

hypertension

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

hypotension, flat jugular veins

After the AED has delivered a shock, the EMT should:

immediately resume CPR

When obtaining a 12-lead 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 HR and increased stroke volume

In contrast to AMI, a dissecting aortic aneurysm:

is maximal from the onset

The AED is MOST advantageous to the EMT because:

it delivers prompt defibrillation to patients with v-fib

You are dispatched to a 60-year-old man reporting chest pain and shortness of breath. The patient has angina and is taking nitroglycerin, furosemide, and atorvastatin. You hear crackles when listening to his breath sounds. The patient's difficulty breathing and crackles are due to blood backing up in which part of the body?

lungs

Angina pectoris occurs when:

myocardial O2 demand exceeds supply

An acute myocardial infarction (AMI) occurs when:

myocardial tissue dies secondary to an absence of O2

Which of the following statements regarding nitroglycerin is correct?

nitro usually relieves anginal chest pain within 5 minutes

You are treating a 63-year-old patient whose vital signs are as follows: pulse, 140 beats/min and irregular; respiratory rate, 28 breaths/min; and blood pressure, 90/50 mm Hg. He is complaining of chest pain. Given this information, why would nitroglycerin be contraindicated?

no, BP too low

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

obtain authorization from medical control

When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed:

on the thighs or ankles

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

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:

perform CPR for 2 minutes and reassess

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

place tablet sublingually and have patient keep his/her mouth closed under tongue until it is dissolved and absorbed

Which of the following blood vessels transports oxygenated blood?

pulmonary veins

After assisting your patient with his or her nitroglycerin, you should:

reassess BP within 5 minutes to detect hypotension

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

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. After applying high-flow oxygen, 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:

remove the nitro patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport

Most AEDs are set up to adjust the voltage based on the impedance, which is the:

resistance of the body to electrical flow

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

The purpose of defibrillation is to:

stop the chaotic, disorganized contraction of cardiac cells

Which of the following statements regarding CHF is false?

stridor is a common lung sound heard on exam

When the battery wears out in a pacemaker, the patient may experience:

syncope

_________________ is the maximum pressure exerted by the left ventricle as it contracts.

systolic BP

When the myocardium requires more oxygen:

the HR decreases significantly

A dissecting aortic aneurysm occurs when:

the inner layers of the aorta become separated

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 transport 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 between contractions for the heart to refill completely

When operating an AED, what is the first step in the defibrillation sequence?

turn on the AED

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

use the patient's own words

Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency?

v-fib

Which of the following cardiac arrhythmias has the greatest chance of deteriorating into a pulseless rhythm?

v-tach

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 sternum and the other pad to the left lower chest below the armpit