EMT Chapter 16: Cardiovascular Emergencies

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.

Sudden death following AMI is MOST often caused by:

ventricular fibrillation.

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

failure of the EMT to ensure the battery is charged.

Ischemia

lack of oxygen

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

pain exacerbated by breathing

Which of the following is the MOST reliable method of estimating a patient's cardiac output?

Assess the heart rate and strength of the pulse.

_____ allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source.

Automaticity

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

Constriction of blood vessels in the muscles

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, for a brief period of time, heart tissues do not get enough oxygen, the pain is called:

angina

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

blood can pass from the atria to the ventricles.

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

brain

_____is the maximum pressure exerted by the left ventricle as it contracts.

Systolic blood pressure

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

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

Blood that is ejected from the right ventricle:

flows into the pulmonary arteries

The only vein(s) in the body that carry oxygenated blood is/are the:

pulmonary veins

Ventricular tachycardia causes hypotension because:

the left ventricle does not adequately fill with blood.

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.

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

use the patient's own words

While obtaining a 12-lead ECG prior to ALS arrival, you note the presence of artifacts on the tracing. Which of the following is the MOST likely cause of this?

Excessive movement of the patient

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

Family history of hypertension

Infarction

tissue death

Which of the following veins is located inferior to the trunk?

Saphenous

In general, a maximum of___ dose(s) of nitroglycerin is/are given for any one episode of chest pain.

3

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

30

Cardiogenic shock can occur within 24 hours of a(n):

Acute Myocardial Infarction

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

Congestive Heart Failure

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 followed by immediate resumption of CPR

Which of the following statements regarding nitroglycerin is correct?

Nitroglycerin usually relieves anginal chest pain within 5 minutes.

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

Pacemakers

At 0500 hours, you respond to the home of a 76-year-old man complaining of chest pain. Upon arrival, the patient states that he had been sleeping in the recliner all night due to indigestion, when the pain woke him up. He also tells you he has taken two nitroglycerin tablets. His vital signs are as follows: respirations, 16 breaths/min; pulse, 98 beats/min; blood pressure, 92/76 mm Hg. He is still complaining of chest pain. What actions should you take to intervene?

Provide high-flow oxygen

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

Ventricular tachycardia

Thromboembolism is:

a blood clot floating through blood vessels until it reaches a narrow area and blocks blood flow

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

a group of symptoms that are caused by myocardial ischemia.

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

are in denial

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

assess the scene for potential hazards

You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approximately 5 minutes. You should:

begin CPR, apply the AED, and deliver a shock if it is indicated.

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

The posterior tibial pulse can be palpated:

behind the medial malleolus, on the inside of the ankle.

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

carotid arteries

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

hypoglycemia

It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing:

chest pain that does not immediately subside with rest.

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

coronary arteries, aorta

Ischemic heart disease is defined as:

decreased blood flow to one or more portions of the myocardium.

Cardiogenic shock following AMI is caused by:

decreased pumping force of the heart muscle.

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

dilating the affected coronary artery with a small inflatable balloon.

Nitroglycerin relieves cardiac-related chest pain by:

dilating the coronary arteries and improving cardiac blood flow.

You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two off-duty EMTs performing CPR on the patient, a 58-year-old male. Your initial action should be to:

feel for a pulse while compressions are ongoing.

The iliac arteries immediately subdivide into the:

femoral arteries

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

hypertension

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

obtain authorization from medical control.

In contrast to AMI, a dissecting aortic aneurysm:

often presents with pain that is maximal from the onset.

When preparing to obtain a 12-lead ECG, the V1 and V2 electrodes should be placed:

on either side of the sternum

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 been 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.

The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you re-analyze 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.

After assisting your patient with prescribed nitroglycerin, you should:

reassess his or her blood pressure within 5 minutes to detect hypotension.

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 nitroglycerin patch, place him in a supine position and elevate his lower extremities, and prepare for immediate transport.

The right coronary artery supplies blood to the:

right ventricle and inferior wall of the left ventricle.

During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that:

she is not in ventricular fibrillation

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

slows the heart and respiratory rates.

The purpose of defibrillation is to:

stop the chaotic, disorganized contraction of the cardiac cells.

When the myocardium requires more oxygen:

the arteries supplying the heart dilate

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

the cause of the pain cannot be diagnosed in the field.

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

three

he descending aorta divides into the two iliac arteries at the level of the:

umbilicus (navel).