Chapter 16; Cardiovascular Emergencies

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

atherosclerosis

Which of the following symptoms would you see in a patient with a dissecting aneurysm?

Sharp or tearing pain & Pain does not abate once it has started

Which of the following is NOT a common sign or symptom associate with malfunction of an implanted cardiac pacemaker? -Heart rate less than 60 beats/min. -Syncope or dizziness. -A rapid heart rate. -Generalized weakness.

-A rapid heart rate. Page 653, Heart Surgeries and Cardiac Assistive Devices

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? -Thoracic aortic aneurysm -Uncontrolled hypertension -Acute myocardial infarction -Obstructive lung disease

-Acute myocardial infarction Page 654, Heart Surgeries and Cardiac Assistive Devices

Which of the following signs is commonly observed in patients with right-sided heart failure? -Pulmonary edema. -Flat jugular veins. -Labored breathing. -Dependent edema.

-Dependent edema. Page 642, Pathophysiology

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. -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. Page 655, Cardiac Arrest

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: -give her high-flow oxygen, attach the AED, and transport at once. -obtain a SAMPLE history and contact medical control for advice. -administer oxygen, give her 324 mg of aspirin, and assess her further. -give her one nitroglycerin and reassess her systolic blood pressure.

-administer oxygen, give her 324 mg of aspirin, and assess her further. Page 647, Emergency Medical Care for Chest Pain or Discomfort

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: -administer up to 324 mg of baby aspirin. -assess the adequacy of his respirations. -administer up to three doses of nitroglycerin. -obtain vita signs and a SAMPLE history.

-assess the adequacy of his respirations. Page 643, Patient Assessment

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. -immediately apply the AED pads and analyze his cardiac rhythm. -begin high-quality CPR and apply and AED as soon as possible. -perform two-rescuer CPR for 5 minutes and request ALS backup.

-begin high-quality CPR and apply and AED as soon as possible. Page 660, Emergency Medical Care for Cardiac Arrest

Prior to attaching the AED to a cardiac arrest patient, the EMT should: -contact medical control. -assess for a pulse for 20 seconds. -perform CPR for 30 seconds. -dry the chest if it is wet.

-dry the chest is it is wet. Page 659, Emergency Medical Care for Cardiac Arrest

Risk factors for AMI that cannot be controlled include: -family history. -excess stress. -hyperglycemia. -lack of exercise.

-family history. Page 637, Pathophysiology

Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who: -are older than 40 years of age. -regularly take illegal drugs. -have chronic hypertension. -have had a stroke in the past.

-have chronic hypertension. Page 642, Pathophysiology

After the AED has delivered a shock, the EMT should: -assess for a carotid pulse. -immediately resume CPR. -re-analyze the cardiac rhythm. -transport the patient at once.

-immediately resume CPR. Page 660, Emergency Care for Cardiac Arrest

Angina pectoris occurs when: -myocardial oxygen demand exceeds supply. -one or more coronary arteries suddenly spasm. -a coronary artery is totally occluded by plaque. -myocardial oxygen supply exceeds the demand.

-myocardial oxygen demand exceeds supply. Page 637, Pathophysiology

When preparing to obtain a 12-lead ECH, the "LL" and "RL" electrodes should be placed: -on the thighs or ankles. -on the lower abdomen. -on either side of the chest. -anywhere on the arms.

-on the thighs or ankles. Page 651, Cardiac Monitoring

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. -leave the battery attached to the monitor and 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.

-remove the battery from the monitor and then remove the vest. Page 654, Heart Surgeries and Cardiac Assistive Devices

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.

-resistance of the body to the flow of electricity. Page 655, Cardiac Arrest

Deoxygenated blood from the body returns to the: -left atrium. -right atrium. -right ventricle. -left ventricle.

-right atrium. Page 629-630, Anatomy and Physiology

The electrical impulses generated by the heart originates in the: -coronary artery. -atrioventricular node. -sinoatrial node. -bundle of His.

-sinoatrial node. Page 631, Anatomy and Physiology

A dissecting aortic aneurysm occurs when: -all layers of the aorta suddenly contract. -the aorta ruptures, resulting in profound bleeding. -a weakened area develops in the aortic wall. -the inner layers of the aorta become separated.

-the inner layers of the aorta become separated. Page 642, Pathophysiology

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. -the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow. -the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing. -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. Page 636, Pathophysiology

Nitroglycerin is contraindicated in patient: -with a systolic pressure less than 120 mm Hg. -who have taken up to two doses. -with a history of an ischemic stroke. -who have experienced a head injury.

-who have experienced a head injury. Page 648, Emergency Medical Care for Chest Pain or Discomfort

Please take a moment to check your understanding of administering nitroglycerin. Write the steps you learned in the Skill Drill and then compare your answer. 4 Steps

1. Obtain an order from medical control. Take the patient's blood pressure. Administer nitroglycerin only if the systolic blood pressure is greater than 100 mm Hg 2. Check the medication and expiration date. Ask the patient about the last dose he or she took and its effects. Make sure that the patient understands the route of administration. Prepare to have the patient lie down to prevent fainting 3. Ask the patient to lift his or her tongue. Place the tablet or spray the dose under the tongue (while wearing gloves), or have the patient do so. Have the patient keep his or her mouth closed with the tablet or spray under the tongue until it is dissolved and absorbed. Caution the patient against chewing or swallowing the tablet 4. Recheck the blood pressure within 5 minutes. Record each medication and the time of administration. Reevaluate the chest pain and blood pressure, and repeat treatment if necessary

Please take a moment to check your understanding of performing cardiac monitoring. Write the steps you learned in the Skill Drill and then compare your answer. 8 Steps

1. Take standard precautions 2. Explain the procedure to the patient. Prepare the skin for electrode placement 3. Attach the electrodes to the leads before placing them on the patient 4. Position the limb electrodes on the patient. Place the leads on the torso if performing continuous monitoring, or on the limbs if you will be acquiring a 12-lead ECG 5. If you plan to obtain a 12-lead ECG tracing, place the chest leads on the chest 6. Turn on the monitor 7. Record tracings 8. Label each strip

Please take a moment to check your understanding of performing defibrillation. Write the steps you learned in the Skill Drill and then compare your answer 5 Steps

1. Take standard precautions. Determine scene safety. Question bystanders. Determine responsiveness.Assess compression effectiveness if CPR is already in progress. If the patient is unresponsive and CPR has not been started yet, begin providing chest compressions and rescue breaths at a ratio of 30 compressions to 2 breaths and a rate of 100 to 120 compressions per minute, continuing until an AED arrives and is ready for use 2. Turn on the AED. Apply the AED pads to the chest and attach the pads to the AED. Stop CPR. If a shock is not advised, perform five cycles (about 2 minutes) of CPR, beginning with chest compressions, and then reanalyze the cardiac rhythm. If a shock is advised, reconfirm that no one is touching the patient and push the Shock button. If at any time the AED advises to check the patient, quickly assess for a carotid or femoral pulse. This should not take longer than 5 to 10 seconds. If you feel a pulse, the patient has experienced ROSC (return of spontaneous circulation). Continue to monitor the patient 3. Verbally and visually clear the patient. Push the Analyze button, if there is one. Wait for the AED to analyze the cardiac rhythm. If no shock is advised, perform five cycles (2 minutes) of CPR and then reanalyze the cardiac rhythm. If a shock is advised, recheck that all are clear, and push the Shock button. After the shock is delivered, immediately resume CPR beginning with chest compressions and remember to switch rescuers 4. After five cycles (2 minutes) of CPR, reanalyze the cardiac rhythm. Do not interrupt chest compressions for more than 10 seconds 5. If shock is advised, clear the patient, push the Shock button, and immediately resume CPR compressions. If no shock is advised, immediately resume CPR compressions and be sure to switch rescuers. After five cycles (2 minutes) of CPR, reanalyze the cardiac rhythm. Repeat the cycle of five cycles (2 minutes) of CPR, one shock (if indicated), and 2 minutes of CPR. Transport and contact medical control as needed

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

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

CPAP

________ is calculated by multiplying the heart rate by the volume of blood ejected with each contraction

Cardiac output

Percutaneous transluminal coronary angioplasty works by bypassing the coronary artery.

False

The factors involved in the defibrillation include voltage, current, and amperage.

False

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?

HIs blood pressure is too low

What is cardiac output?

The amount of blood pumped out of the left ventricle in 1 minute

Cardiac arrest is indicated in the field by the absence of a carotid pulse.

True

The link in the chain of survival that is the most common determinant for survival is the third link—rapid defibrillation.

True

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

Ventricular fibrillation

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?

You should have your partner pull over the ambulance and come back to help you with CPR and the AED.

Acute coronary syndrome is a group of symptoms caused by what?

ischemia

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

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

place the tablet under the patient's tongue and have the patient keep his or her mouth closed with the tablet under the tongue until it is dissolved and absorbed