Chapter 16 EMT Cardiovascular emergencies

In general, a maximum of _____ doses of nitroglycerin is given for any one episode of chest pain

3 doses

Normal electrical impulses originate in the sinus node, just above the?______

Atria

The electrical stimulus that originates in the heart's primary pacemaker is controlled by impulses from the brain that arrive by way of the:

autonomic nervous system.

The purpose of defibrillation is to:

stop chaotic, disorganized contractions

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:

stop the ambulance perform CPR and AED

The purpose of defibrillation is to

stop the chaotic, disorganized contraction of the cardiac cells.

When treating a patient with chest pain, you should assume that he or she is having an AMI because:

the cause of the pain can't be dx in the field

When taking a SAMPLE history of a conscious person with chest pain, what specific questions should the EMT ask of their patient?

Has your patient had a heart attack before?

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

Hypertension

Which of the following statements regarding nitroglycerin is correct?

Nitroglycerin usually relieves anginal chest pain within 5 minutes.

To assess chest pain, use the Mnemonic:

OPQRST

______ carry O2 to the body's tissues and then remove CO2

Red blood cells

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by

dilating the affected coronary artery with a small inflatable balloon.

Which of the following statements regarding the AED and defibrillation is correct?

The AED will not analyze the rhythm of a moving patient.

Sudden death following AMI is MOST often caused by:

Ventricular fibrillation

The head and brain receive their supply of oxygenated blood from the:

carotid arteries.

Nitroglycerin relieves cardiac-related chest pain by

dilating the coronary arteries and improving cardiac blood flow.

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 are her signs and symptoms MOST indicative of?

dissecting aortic aneurysm

Which of the following is of LEAST pertinence when obtaining medical history information from a patient complaining of chest discomfort?

family history of hypertension

Risk factors for AMI that cannot be controlled include:

family history.

The iliac arteries immediately subdivide into the

femoral arteries.

Blood that is ejected from the right ventricle

flows into the pulmonary arteries.

Blood that is ejected from the right ventricle:

flows into the pulmonary arteries.

Physical findings of AMI include skin that is ______ because of poor cardiac output and the loss of perfusion.

gray

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

have chronic hypertension.

The AED should be applied only to unresponsive patients with no:

pulse

_____ usually refers to a state of cardiac arrest despite an organized electrical complex.

pulses electrical activity

The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you reanalyze the patient's cardiac rhythm and receive a "no shock advised" message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to:

reassess airway and breathing and treat accordingly

when an electrical impulse reaches the AV node, it is slowed for a brief period of time so that :

sinoatrial (SA) node can reset and generate another impulse

The electrical impulse generated by the heart originates in the:

sinoatrial (SA) node.

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.

The computer inside the AED is programmed to recognized rhythms that require defibrillation to correct, most commonly:

ventricular fibrillation

Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS

three

Nitroglycerin is contraindicated in patients

who have experienced a head injury.

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implanted cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?

Deliver the shock because we treat them like all other pts having an AMI.

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

chest pain that does not immediately subside with rest

When the myocardium requires more oxygen:

the arteries supplying the heart dilate.

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

group of symptoms that are caused by MI

Blood enters the right atrium from the body through the:

Vena Cava

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

immediately resume CPR

Defibrillation works best if it takes place within _____minutes of the onset of cardiac arrest.

2

About _____ minutes after blood flow is cut off, some heart muscle cells begin to die

30 minutes

A patient taking medications such as Lasix or digoxin is likely to have which of the following underlying medical conditions?

A history of Congestive Heart Failure

Which of the following statements regarding CHF is False?

A. Stridor is a common lung sound heard on exam.

Which of the following is Not a cause of CHF?

A. chronic hypotension

What type of additional resource is typically required or someone with chest pain

ALS

The _____ are tiny blood vessels that are approximately one cell thick.

Capillaries

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 atherosclerotic wall.

Crack

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an implanted pacemaker. The AED advises that a shock is indicated. What should you do?

Deliver the shock followed by immediate resumption of CPR.

Which of the following changes in heart function occur in pts with CHF?

Enlargement of the left ventricle

Tissues downstream from a blood clot will suffer from lack of O2. If blood flow is resumed in a short time, the _____ tissues will recover.

Ischemic

Which of the following statements regarding the pain associated with AMI is correct?

It can occur during exertion or when the patient is at rest.

What is the function of the left atrium?

It receives oxygenated blood from the lungs.

When assessing a cardiac arrest patient, you notice what appears to be a pacemaker implanted in the upper left chest. Care for this patient should include:

Make sure the AED patches are not directly over the pacemaker device

The only veins in the body that carries oxygenated blood are the?

Pulmonary veins

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

Syncope

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

V tach, it may deteriorate into V fib

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

a rapid heart rate

Cardiogenic shock can occur within 24 hours of an?

acute MI

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?

acute myocardial infarction

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, and her respirations are 22 breaths/min with adequate depth. The patient does not have prescribed nitroglycerin, but her husband does. You should

administer oxygen, give her 2 (81mg each tablet) chewable aspirin, and assess her further.

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 oxygen, give her 324 mg of aspirin and assess her further

When, for a brief period of time, heart tissues do not get enough O2, the pain is called?

angina

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

angina pain usually subsides with rest

The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they

are in denial

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.

Narrowing of the coronary arteries due to 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 without delay.

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.

Sudden death is usually the result of ______, in which the heart fails to generate an effective blood flow.

cardiac arrest

The posterior tibial pulse can be palpated

behind the medial malleolus.

An acute MI is more likely to occur in the larger, think-walled left ventricle, which needs more ______ than the right ventricle.

blood and O2

The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the:

brain

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

congestive heart failure

Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:

congestive heart failure.

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

coronary arteries, aorta

Cardiogenic shock following AMI is caused by:

decreased pumping force of the heart muscle

Which of the following signs is commonly observed in patients with right-sided heart failure?

dependent edema

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

dry the chest off if it is wet

The link in the chain of survival include all of the following Except:

early administration of nitroglycerin

Because the O2 supply to the heart is diminished with angina, the ____ can become compromised, putting the person at risk for cardiac rhythm problems.

electrical system

Signs and symptoms of shock include all the following Except:

elevated BP

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 ?

epigastrium

When administering nitroglycerin to a patient, you should make sure the patient has not been taking medications for _____ in the last 24 hours

erectile dysfunction

The MOST common error associated with the use of the AED is

failure of the EMT to ensure the battery is charged

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

hypertension.

Major risk factors for AMI include all of the following, EXCEPT:

hypoglycemia

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

hypotension and flat jugular vein

Risk factors for MI include all of the following Except:

increased activity level

Which of the following would cause the greatest increase in cardiac output?

increased heart rate and increased stroke volume

Dilation of the coronary arteries ____ blood flow.

increases

When afterload increases:

it becomes harder for the vent. to push blood through the blood vessels

The AED is MOST advantageous to the EMT because:

it delivers prompt defibrillation to patients with ventricular fibrillation.

A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:

it dilates the coronary artery w/a balloon

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.

Angina pectoris occurs when:

myocardial oxygen demand exceeds supply

Angina pectoris most commonly occurs when:

myocardial oxygen demand exceeds the supply

An acute myocardial infarction (AMI) occurs when:

myocardial tissue dies secondary to an absence of oxygen.

Prior to assisstin a patient with his or her prescribed nitroglycerin, the EMT should:

obtain authorization from medical control

Atherosclerosis can lead to a complete _____ of a coronary artery

occlusion

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

on the thighs or ankles

_____ are inserted when the electrical-control system of the heart is so damaged that it cannot function properly.

pacemaker

Common signs and symptoms of AMI include all of the following, EXCEPT:

pain exacerbated by breathing

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

A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:

placing her in an upright position.

When using the mnemonic OPQRST, the P stands for?

provocation

In contrast to AMI, a dissecting aortic aneurysm:

pts present with maximal pain at the start

Which of the following blood vessels transports oxygenated blood?

pulmonary veins

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

reassess the blood pressure 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

In contrast to monophasic defibrillation, biphasic defibrillation:

requires a lower energy setting.

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

resistance of the body to the flow of electricity

All patient assessments begin by determining whether the patient:

responsive

Deoxygenated blood from the body returns to the:

right atrium

Deoxygenated blood from the body returns to the

right atrium.

Defibrillator pads are placed on the patient's chest with one pad to the

right of the upper sternum and the other pad just to the left and below the left nipple.

In contrast to the sympathetic nervous system, the parasympathetic nervous system

slows the heart and respiratory rates.

_______ is the max pressure exerted by the left ventricle as it contracts

systolic blood pressure

When the myocardium requires more oxygen

the arteries supplying the heart dilate.

Cardiac output may decrease if the heart beats too rapidly because

there is not enough time in between contractions for the heart to refill completely.

Cardiac output may decrease if the heart beats too rapidly because:

there is not enough time in between contractions for the heart to refill.

Ventricular tachycardia causes hypotension because:

this rhythm does not allow enough time between beats for the left vent to fill with blood leading to low BP and causes vfib

Nitroglycerin is contraindicated in patients:

took 5 mins ago, took 3 doses, BP<100 sys, ALOC, sexual enhancing drugs, head injury

The descending aorta divides into the two iliac arteries at the level of the

umbilicus.

The underlying cause of a dissecting aortic aneurysm is:

uncontrolled hypertension

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

use the patient's own words.

Disorganized, ineffective quivering of the ventricles is known as?

ventricular fibrillation

Which step should Not be taken to complete a history and physical exam on an unconscious patient with suspected cardiac problems?

you would not look through the patients wallet for medical information