Chapter 16 - Cardiovascular Emergencies
What is acute myocardial infarction?
- heart attack - death of tissue
A dissecting aortic aneurysm occurs when: - all layers of the aorta suddenly contract. - the aorta ruptures, resulting in profound bleeding. - the inner layers of the aorta become separated. - a weakened area develops in the aortic wall.
A dissecting aortic aneurysm occurs when: - all layers of the aorta suddenly contract. - the aorta ruptures, resulting in profound bleeding. *- the inner layers of the aorta become separated.* - a weakened area develops in the aortic wall.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: - obtain vital signs and a SAMPLE history. - administer up to three doses of nitroglycerin. - assess the adequacy of his respirations. - administer up to 324 mg of baby aspirin.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: - obtain vital signs and a SAMPLE history. - administer up to three doses of nitroglycerin. *- assess the adequacy of his respirations.* - administer up to 324 mg of baby aspirin.
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: - obtain a SAMPLE history and contact medical control for advice. - give her high-flow oxygen, attach the AED, and transport at once. - administer oxygen, give her 324 mg of aspirin, and assess her further. - give her one nitroglycerin and reassess her systolic blood pressure.
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: - obtain a SAMPLE history and contact medical control for advice. - give her high-flow oxygen, attach the AED, and transport at once. *- administer oxygen, give her 324 mg of aspirin, and assess her further.* - give her one nitroglycerin and reassess her systolic blood pressure.
What is congestive heart failure?
A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should: - leave the battery attached to the monitor and remove the vest. - remove the battery from the monitor and then remove the vest. - remove the battery from the monitor and leave the vest in place. - perform ventilations only and allow the vest device to defibrillate.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should: - leave the battery attached to the monitor and remove the vest. *- remove the battery from the monitor and then remove the vest.* - remove the battery from the monitor and leave the vest in place. - perform ventilations only and allow the vest device to defibrillate.
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? - Uncontrolled hypertension - Thoracic aortic aneurysm - Acute myocardial infarction - Obstructive lung disease
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? - Uncontrolled hypertension - Thoracic aortic aneurysm *- Acute myocardial infarction* - Obstructive lung disease
A patient with atherosclerotic heart disease experiences chest pain during exertion because: - the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. - the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. - tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen. - the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
A patient with atherosclerotic heart disease experiences chest pain during exertion because: - the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. - the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. - tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen. *- the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.*
Acute coronary syndrome is a group of symptoms caused by what? - Bradycardia - Ischemia - Occlusion - Thromboembolism
Acute coronary syndrome is a group of symptoms caused by what? - Bradycardia *- Ischemia* - Occlusion - Thromboembolism *Acute coronary syndrome is a group of symptoms caused by ischemia, a lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow.*
After the AED has delivered a shock, the EMT should: - immediately resume CPR. - assess for a carotid pulse. - re-analyze the cardiac rhythm. - transport the patient at once.
After the AED has delivered a shock, the EMT should: *- immediately resume CPR.* - assess for a carotid pulse. - re-analyze the cardiac rhythm. - transport the patient at once.
Angina pectoris occurs when: - myocardial oxygen supply exceeds the demand. - myocardial oxygen demand exceeds supply. - one or more coronary arteries suddenly spasm. - a coronary artery is totally occluded by plaque.
Angina pectoris occurs when: - myocardial oxygen supply exceeds the demand. *- myocardial oxygen demand exceeds supply.* - one or more coronary arteries suddenly spasm. - a coronary artery is totally occluded by plaque.
What is thromboembolism?
Blood clot that floats 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. - Tissues downstream will become hypoxic. - If too much time goes by before blood flow is resumed, hypoxic tissues die.
What is ischemia?
Decreased blood flow to heart
Deoxygenated blood from the body returns to the: - right atrium. - right ventricle. - left ventricle. - left atrium.
Deoxygenated blood from the body returns to the: *- right atrium.* - right ventricle. - left ventricle. - left atrium.
(T/F) Percutaneous transluminal coronary angioplasty works by bypassing the coronary artery.
False. Percutaneous transluminal coronary angioplasty aims to *dilate, rather than bypass,* the coronary artery.
(T/F) The factors involved in the defibrillation include voltage, current, and amperage.
False. The factors involved in the defibrillation include voltage, current, and *impedance.*
Most AEDs are set up to adjust the voltage based on the impedance, which is the: - distance between the two AED pads on the chest. - actual amount of energy that the AED will deliver. - direction that the electrical flow takes in the body. - resistance of the body to the flow of electricity.
Most AEDs are set up to adjust the voltage based on the impedance, which is the: - distance between the two AED pads on the chest. - actual amount of energy that the AED will deliver. - direction that the electrical flow takes in the body. *- resistance of the body to the flow of electricity.*
Most often, low blood flow to heart tissue is caused by what? - Atherosclerosis - Thromboembolism - Acute myocardial infarction - Ventricular fibrillation
Most often, low blood flow to heart tissue is caused by what? *- Atherosclerosis* - Thromboembolism - Acute myocardial infarction - Ventricular fibrillation
Nitroglycerin is contraindicated in patients: - with a history of an ischemic stroke. - who have taken up to two doses. - who have experienced a head injury. - with a systolic blood pressure less than 120 mm Hg.
Nitroglycerin is contraindicated in patients: - with a history of an ischemic stroke. - who have taken up to two doses. *- who have experienced a head injury.* - with a systolic blood pressure less than 120 mm Hg.
Prior to attaching the AED to a cardiac arrest patient, the EMT should: - assess for a pulse for 20 seconds. - dry the chest if it is wet. - perform CPR for 30 seconds. - contact medical control.
Prior to attaching the AED to a cardiac arrest patient, the EMT should: - assess for a pulse for 20 seconds. *- dry the chest if it is wet.* - perform CPR for 30 seconds. - contact medical control.
Risk factors for AMI that cannot be controlled include: - excess stress. - family history. - lack of exercise. - hyperglycemia.
Risk factors for AMI that cannot be controlled include: - excess stress. *- family history.* - lack of exercise. - hyperglycemia.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: - have chronic hypertension. - regularly take illegal drugs. - have had a stroke in the past. - are older than 40 years of age.
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: *- have chronic hypertension.* - regularly take illegal drugs. - have had a stroke in the past. - are older than 40 years of age.
The EMT should use an AED on a child between 1 month and 8 years of age if: - special pads are used and the child has profound tachycardia. - his or her condition is rapidly progressing to cardiac arrest. - he or she is not breathing and has a weakly palpable pulse. - pediatric pads and an energy-reducing device are available.
The EMT should use an AED on a child between 1 month and 8 years of age if: - special pads are used and the child has profound tachycardia. - his or her condition is rapidly progressing to cardiac arrest. - he or she is not breathing and has a weakly palpable pulse. *- pediatric pads and an energy-reducing device are available.*
The electrical impulse generated by the heart originates in the: - coronary sinus. - bundle of His. - sinoatrial node. - atrioventricular node.
The electrical impulse generated by the heart originates in the: - coronary sinus. - bundle of His. *- sinoatrial node.* - atrioventricular node.
(T/F) Cardiac arrest is indicated in the field by the absence of a carotid pulse.
True.
(T/F) The link in the chain of survival that is the most common determinant for survival is the third link—rapid defibrillation.
True.
What is cardiac output? - The number of times the heart contracts in 1 minute - The volume of blood pumped out by the left ventricle in one contraction - The amount of blood pumped out of the left ventricle in 1 minute - The amount of venous flow return to the right atrium
What is cardiac output? - The number of times the heart contracts in 1 minute - The volume of blood pumped out by the left ventricle in one contraction *- The amount of blood pumped out of the left ventricle in 1 minute* - The amount of venous flow return to the right atrium
What is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique? - CPAP - Nasal cannula - BVM with 100% oxygen - Nonrebreathing mask
What is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique? *- CPAP* - Nasal cannula - BVM with 100% oxygen - Nonrebreathing mask
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed: - anywhere on the arms. - on either side of the chest. - on the thighs or ankles. - on the lower abdomen.
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed: - anywhere on the arms. - on either side of the chest. *- on the thighs or ankles.* - on the lower abdomen.
What is cardiac arrest?
When the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest, even if muscular and electrical activity continues in the heart.
Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency? - Bradycardia - Tachycardia - Ventricular tachycardia - Ventricular fibrillation
Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency? - Bradycardia - Tachycardia - Ventricular tachycardia *- Ventricular fibrillation*
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? - Heart rate less than 60 beats/min - Syncope or dizziness - Generalized weakness - A rapid heart rate
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker? - Heart rate less than 60 beats/min - Syncope or dizziness - Generalized weakness *- A rapid heart rate*
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet? - Encourage the patient to chew the tablet to increase its effectiveness. - Place the medication under the tongue and have the patient swallow it. - Administer the medication sublingually and allow it to dissolve or absorb. - Wait 15 minutes and reassess the patient's blood pressure prior to administering another dose.
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet? - Encourage the patient to chew the tablet to increase its effectiveness. - Place the medication under the tongue and have the patient swallow it. *- Administer the medication sublingually and allow it to dissolve or absorb.* - Wait 15 minutes and reassess the patient's blood pressure prior to administering another dose.
Which of the following signs is commonly observed in patients with right-sided heart failure? - Flat jugular veins - Labored breathing - Pulmonary edema - Dependent edema
Which of the following signs is commonly observed in patients with right-sided heart failure? - Flat jugular veins - Labored breathing - Pulmonary edema *- Dependent edema*
Which of the following symptoms would you see in a patient with a dissecting aneurysm? - Gradual onset of pain with additional symptoms - Peripheral pulses equal - Sharp or tearing pain - Pain does not abate once it has started
Which of the following symptoms would you see in a patient with a dissecting aneurysm? - Gradual onset of pain with additional symptoms - Peripheral pulses equal *- Sharp or tearing pain* *- Pain does not abate once it has started*
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? - Acute myocardial infarction - Angina pectoris - Congestive heart failure - Cardiogenic shock
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? - Acute myocardial infarction *- Angina pectoris* - Congestive heart failure - Cardiogenic shock
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: - have your partner perform CPR while you question the bystanders. - perform two-rescuer CPR for 5 minutes and request ALS backup. - begin high-quality CPR and apply the AED as soon as possible. - immediately apply the AED pads and analyze his cardiac rhythm.
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: - have your partner perform CPR while you question the bystanders. - perform two-rescuer CPR for 5 minutes and request ALS backup. *- begin high-quality CPR and apply the AED as soon as possible.* - immediately apply the AED pads and analyze his cardiac rhythm.
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? - The heart - The lungs - The vessels - The arteries
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? - The heart *- The lungs* - The vessels - The arteries
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? - Tell your partner to drive faster as you begin CPR on the patient. - Immediately apply the AED and wait for it to analyze the rhythm before taking any other action. - Have your partner pull over the ambulance and come back to help you with CPR and the AED. - Begin CPR and after 2 minutes stop to apply the AED while your partner continues driving to the hospital.
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? - Tell your partner to drive faster as you begin CPR on the patient. - Immediately apply the AED and wait for it to analyze the rhythm before taking any other action. *- Have your partner pull over the ambulance and come back to help you with CPR and the AED.* - Begin CPR and after 2 minutes stop to apply the AED while your partner continues driving to the hospital.
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? - He may have already exceeded the dosage limit. - His blood pressure is too low. - He may be allergic to it. - He may have taken Viagra in the last 24 hours.
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? - He may have already exceeded the dosage limit. *- His blood pressure is too low.* - He may be allergic to it. - He may have taken Viagra in the last 24 hours.
________ is calculated by multiplying the heart rate by the volume of blood ejected with each contraction. - Cardiac output - Perfusion - Stroke volume - ROSC
________ is calculated by multiplying the heart rate by the volume of blood ejected with each contraction. *- Cardiac output* - Perfusion - Stroke volume - ROSC