EMT - Chapter 16
if you suspect a patient is experiencing a hypertensive emergency you should?
-attempt to make him or her comfortable and monitor blood pressure, head elevated ,transport rapidly, consider ALS assistance
How do you treat a patient with signs and symptoms of cardiogenic shock?
-position the patient in comfort -semi Fowler if patient has low blood pressure, a Supine position may be more comfortable -high flow oxygen assist ventilations as necessary
What is ventricular tachycardia?
-rapid heart rhythm of 150 to 200 beats per minute -starts in ventricle instead of atrium -does not allow for left ventricle to fill with blood -Blood pressure may fall and pulse may be lost all together -most cases will be sustained and may deteriorate into ventricular fibrillation
What are the physical findings of an Ami depending on the severity of the heart muscle damage?
1. General appearance; stared, nausea, cold sweat, pale, cyanotic 2. pulse; high pulse rate, irregular or slow 3.blood pressure: normal or possibly elevated blood pressure at first but may fall if not treated 4. Respiration: usually normal unless the patient has CHF, Difficulty breathing is common with cardiac compromise 5. mental status: confusion or agitation, " I think I am going to die"
What are the three primary components of good perfusion?
1.A well-functioning heart or pump Too rapid equals inadequate refill of the heart Too slowly volume of blood circulated per minute decreases due to the slow pulse rate 2. inadequate volume of blood reduce volume will limit the amount of tissue that can be perfused 3. the blood container should be properly sized or not too dilated if blood vessels are too dilated the volume of fluid Remains the Same and there will not be enough blood to fill the vessels leading to reduced perfusion
How to treat vfib?
1.defibrillation so the heart can restore to a normal rhythmic beat 2.within the first few minutes of sudden death 3.initiate CPR until defibrillator arrives 4.chances of survival diminish 10% each minute until a defibrillation is accomplished
how long does angina usually last for? what are other symptoms of anginal pain?
3 to 8 minutes rarely longer than 15, shortness of breath, nausea, or sweating
what is a thromboembolism? what does it cause?
A blood clot that floats there blood vessels until it reaches an area too narrow for it to pass..Stops and blocks the blood flow..can cause hypoxic tissues and possible death of hypoxic tissues
Common signs and symptoms of a hypertensive emergency include:
A bounding pulse, a severe headache, and dizziness
what is angina pain commonly described as?
A crushing, squeezing, or " like somebody is standing on my chest",usually felt in the mid portion of the chest, under the sternum, but can radiate to the jaw, the arms mailing the left arm, mid portion of the back, or the epigastrium/ upper middle region of the abdomen
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
A rapid heart rate
What is a dysrhythmia?
Abnormality of heart rhythm
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 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, 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
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
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet?
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 Because of her symptoms and the fact that she just exerted herself
Which of the following is a major difference between angina pectoris and AMI?
Anginal pain typically subsides with rest
What are the signs and symptoms of cardiogenic shock?
Anxiety or restlessness brain is hypoxic "Air hunger" Pale cool or clammy skin in patients high pulse rate laid into low pulse rate or irregular rapid and shallow breathing, nausea and vomiting, decrease in body temperature. Can lead to decompensated shock
When does congestive heart failure or CHF usually occur?
Anytime after a myocardial infarction, heart valve damage long-standing high blood pressure
How does atherosclerosis start?
As a person ages cholesterol is deposited..these deposits would grow as well as calcium deposits...the inner wall of the artery becomes rough and brittle with atheroslerotic plaques
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
if untreated what kind of unstable ventricular tachycardia or fibrillation lead to?
Asystole(reflective of a prolonged ischemia)
Most often, low blood flow to heart tissue is caused by what?
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 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 oxygen saturation
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
What is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique?
CPAP
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
what is diastolic blood pressure?
Diastolic blood pressure is the pressure exerted against the walls of the arteries while the left ventricle is at rest
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
Prior to defibrillating a patient with an AED, it is MOST important that you:
Ensure that no one is touching the patient
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 your partner pull over the ambulance and come back to help you with CPR and the AED
what are the two specific changes in heart function when the heart muscle can no longer contract effectively?
Heart rate increase, left ventricle enlarges in an effort to increase the amount of blood pumped each minute, CHF will develop when these adaptations to no longer make up for decreased heart function
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
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?
Hypotension and 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 heart rate and increased stroke volume
Acute coronary syndrome is a group of symptoms caused by what?
Ischemia
The AED is MOST advantageous to the EMT because:
It delivers prompt defibrillation to patients with ventricular fibrillation
Angina pectoris occurs when:
Myocardial oxygen demand exceeds supply
An acute myocardial infarction (AMI) occurs when:
Myocardial tissue dies secondary to an absence of oxygen
what is a dissecting aneurysm? what are the symptoms?
Occurs when the inner layers of aorta return separated, allowing blood at high pressures to flow between the layers, pain does not abate once it has started and a sharp or tearing pain, difference in blood pressure between arms or diminished pulses in lower extremities
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 blood vessels transports oxygenated blood?
Pulmonary Veins
what are peripheral pulses?
Pulses felt in the extremities such as the radio and posterior tibial
what are central pulses?
Pulses near the trunk of the body such as the femoral and carotid pulses
what is tachycardia?
Rapid beating of the heart 100 beats or more per minute
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
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
Deoxygenated blood from the body returns to the:
Right Atrium
What is a treatment for a patient with CHF?
Same way to treat a patient with chest Take Vital Signs and give oxygen via non-rebreather mask sitting upright with legs down be reassuring patients may have specific medication if they have had CHF before Nitroglycerin transport
The electrical impulse generated by the heart originates in the:
Sinoatrial Node
What are the Lesser factors that play a role in heart disease?
Stressed, excessive alcohol, and poor diet.
What is cardiac output?
The amount of blood pumped out of the left ventricle in 1 minute
what is dependent edema?
The collection of fluid in the part of the body that is closest to the ground
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
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 lungs
What is systolic blood pressure?
The maximum pressure generated in the arms and legs during the contraction of the left ventricle during systole.
where is the dorsalis pedis pulse located?
Top of the foot
what is the primary cause of dissecting aortic aneurysm?
Uncontrolled hypertension
what is bradycardia?
Unusually slow beating of the heart at 60 beats per minute or less
how is anginal pain usually treated?
Usually disappears promptly with rest, supplemental oxygen, Or nitroglycerin
Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency?
Ventricular fibrillation
What is an aortic aneurysm?
Weakness in the wall of the aorta, ballooning effect
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 left of the upper sternum and the other pad just to the right of the left nipple
What are the signs and symptoms of CHF?
agitation, chest pain may or may not be present, distended neck veins that do not collapse, difficulty breathing when sitting up, Swollen ankles from dependent edema, high blood pressure, rapid heart rate, rapid respirations, pale and cyanotic skin, accessory breathing muscles of the neck and ribs apparent, rails may be heard on either side of the patient's chest about Midway down the back and in severe cases even at the top of the lung
what is diastole?
as the left ventricle relaxes arterial pressure Falls. The aortic valve closes and blood flow between the left ventricle and the aorta stops
Where is the Carotid pulse located?
between the trachea and the neck muscle
what are the major controllable factors to prevent cardiac arrest?
cigarette smoking, high blood pressure, elevated cholesterol level, diabetes, lack of exercise, and obesity
what is an acute myocardial infarction or AMI?
classic heart attack, blockage of a coronary artery, infarction means death of tissue
what is atherosclerosis?
disorder in which calcium and cholesterol buildup and form a plaque inside the wall of blood vessels obstructing flow and interfering with their ability to dilate or contract (can cause complete occlusion of a coronary artery)
what is ventricular fibrillation Or vfib?
disorganized, ineffective quivering of the ventricle No blood is pumped through the body and the patient usually becomes unconscious within seconds
What happens when clots develop some sort of crack?
exposes the interior side of the atheroslerotic walls. like a torn blood vessel, the ragged edge activates the blood clotting factors which further narrows the lumen of the arteries. If complete occlusion does not occur, A thromboembolism may occur
What happens when the pressure in the capillaries exceeds a certain volume?
fluid,mostly water passes through the walls of the capillary vessels and into the alveoli creating a pulmonary edema. -it may occur slowly over the months chronic CHF or as an AMI
what is angina pectoris?
hearts need for oxygen exceeds its Supply, when the increase oxygen demand is gone pain typically goes away, usually occurs during periods of physical or emotional distress when the heart is working really hard
where is the femoral pulse located?
in the groin area
where is the posterior tibial pulse located?
inside of the ankle
where is the brachial pulse located?
inside of the upper arm
what are the major risk factors that cannot be controlled to prevent cardiac arrest?
older age, family history of atheroslerotic coronary artery disease, race, ethnicity, male sex.
What is ischemia?
restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism
What are side effects to a hypertensive emergency?
sudden severe headache
what happens if the right side of the heart is Damaged?
swelling in the feet and legs. left-sided failure May often lead to right-sided failure and so patients may present signs of both
where is the radial pulse located?
thumb side of the wrist
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 an electrical activity continues in the heart
What is an acute coronary syndrome or ACS?
when the heart is not getting enough oxygen, Group of symptoms caused by myocardial ischemia , This is most of EMS calls relating to chest pain, Pain due to decreased oxygen of the heart leads to angina pectoris
What is stable angina?
when you get angina symptoms during moderate physical activity or when you are pushing yourself physically. These symptoms go away with rest and/or medication.
what is unstable angina?What can it lead to?
when you get angina symptoms while doing very little or resting. This can happen to people who have never experienced angina before.
