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EMS Chapter 16 - Cardiovascular Emergencies

Terms in this set (80)

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

Cardiac output
Perfusion
Stroke volume
ROSC
Correct. Cardiac output is calculated by multiplying the heart rate by the volume of blood ejected with each contraction.
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
Sharp or tearing pain
Pain does not abate once it has started
The link in the chain of survival that is the most common determinant for survival is the third link—rapid defibrillation.
TrueFalse
T

Correct. The link in the chain of survival that is the most common determinant for survival is the third link—rapid defibrillation.
Cardiac arrest is indicated in the field by the absence of a carotid pulse.
TrueFalse
T

Correct. Cardiac arrest is indicated in the field by the absence of a carotid pulse.
The factors involved in the defibrillation include voltage, current, and amperage.
TrueFalse
F

Correct. The factors involved in the defibrillation include voltage, current, and impedance.
Percutaneous transluminal coronary angioplasty works by bypassing the coronary artery.
TrueFalse
F

Correct. Percutaneous transluminal coronary angioplasty aims to dilate, rather than bypass, the coronary artery.
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
The lungs

Crackles is a sign of blood backing up into the lungs.
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
Cardiac output is the amount of blood pumped out of the left ventricle in 1 minute.
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 atherosclerosis, where calcium and cholesterol build up and form a plaque inside the walls of blood vessels.
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
The most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique is CPAP.
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
Her symptoms and the fact that she has just exerted herself suggest angina.
Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency?
Bradycardia
Tachycardia
Ventricular tachycardia
Ventricular fibrillation
Ventricular fibrillation is the dysrhythmia that commonly causes sudden death.
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.
If the systolic blood pressure is less than 100 mm Hg, you should not give nitroglycerin.
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 should have your partner pull over the ambulance and come back to help you with CPR and the AED.
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.
To appropriately assist the patient with nitroglycerin, 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.
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.
Risk factors for AMI that cannot be controlled include:
Select one:
A. hyperglycemia.
B. lack of exercise.
C. family history.
D. excess stress.
C. family history.
A patient with atherosclerotic heart disease experiences chest pain during exertion because:
Select one:
A. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.
B. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
C. the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow.
D. the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.
B. the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
Most AEDs are set up to adjust the voltage based on the impedance, which is the:
Select one:
A. direction that the electrical flow takes in the body.
B. actual amount of energy that the AED will deliver.
C. distance between the two AED pads on the chest.
D. resistance of the body to the flow of electricity.
D. resistance of the body to the flow of electricity.
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker?
Select one:
A. Heart rate less than 60 beats/min
B. A rapid heart rate
C. Syncope or dizziness
D. Generalized weakness
B. A rapid heart rate Chapter 16, page 653, Heart Surgeries and Cardiac Assistive Devices
The EMT should use an AED on a child between 1 month and 8 years of age if:
Select one:
A. pediatric pads and an energy-reducing device are available.
B. his or her condition is rapidly progressing to cardiac arrest.
C. he or she is not breathing and has a weakly palpable pulse.
D. special pads are used and the child has profound tachycardia.
A. pediatric pads and an energy-reducing device are available.
Angina pectoris occurs when:
Select one:
A. myocardial oxygen supply exceeds the demand.
B. a coronary artery is totally occluded by plaque.
C. one or more coronary arteries suddenly spasm.
D. myocardial oxygen demand exceeds supply.
D. myocardial oxygen demand exceeds supply.
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:
Select one:
A. have your partner perform CPR while you question the bystanders.
B. immediately apply the AED pads and analyze his cardiac rhythm.
C. begin high-quality CPR and apply the AED as soon as possible.
D. perform two-rescuer CPR for 5 minutes and request ALS backup.
C. begin high-quality CPR and apply the AED as soon as possible.
Nitroglycerin is contraindicated in patients:
Select one:
A. with a history of an ischemic stroke.
B. who have taken up to two doses.
C. who have experienced a head injury.
D. with a systolic blood pressure less than 120 mm Hg.
C. who have experienced a head injury.
When preparing to obtain a 12-lead ECG, the "LL" and "RL" electrodes should be placed:
Select one:
A. on the lower abdomen.
B. anywhere on the arms.
C. on either side of the chest.
D. on the thighs or ankles.
D. on the thighs or ankles. Chapter 16, page 651, Cardiac Monitoring
Deoxygenated blood from the body returns to the:
Select one:
A. right atrium.
B. left ventricle.
C. left atrium.
D. right ventricle.
A. right atrium.
Which of the following signs is commonly observed in patients with right-sided heart failure?
Select one:
A. Dependent edema
B. Labored breathing
C. Pulmonary edema
D. Flat jugular veins
A. Dependent edema Chapter 16, page 642, Pathophysiology
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
Select one:
A. are older than 40 years of age.
B. have had a stroke in the past.
C. have chronic hypertension.
D. regularly take illegal drugs.
C. have chronic hypertension.
After the AED has delivered a shock, the EMT should:
Select one:
A. immediately resume CPR.
B. transport the patient at once.
C. assess for a carotid pulse.
D. re-analyze the cardiac rhythm.
A. immediately resume CPR.
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
Select one:
A. assess for a pulse for 20 seconds.
B. dry the chest if it is wet.
C. contact medical control.
D. perform CPR for 30 seconds.
B. dry the chest if it is wet.
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:
Select one:
A. leave the battery attached to the monitor and remove the vest.
B. remove the battery from the monitor and then remove the vest.
C. remove the battery from the monitor and leave the vest in place.
D. perform ventilations only and allow the vest device to defibrillate.
B. remove the battery from the monitor and then remove the vest.
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?
Select one:
A. Uncontrolled hypertension
B. Obstructive lung disease
C. Acute myocardial infarction
D. Thoracic aortic aneurysm
C. Acute myocardial infarction
A dissecting aortic aneurysm occurs when:
Select one:
A. a weakened area develops in the aortic wall.
B. all layers of the aorta suddenly contract.
C. the aorta ruptures, resulting in profound bleeding.
D. the inner layers of the aorta become separated.
D. the inner layers of the aorta become separated.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
Select one:
A. administer up to 324 mg of baby aspirin.
B. assess the adequacy of his respirations.
C. administer up to three doses of nitroglycerin.
D. obtain vital signs and a SAMPLE history.
B. assess the adequacy of his respirations.
The electrical impulse generated by the heart originates in the:
Select one:
A. sinoatrial node.
B. bundle of His.
C. atrioventricular node.
D. coronary sinus.
A. sinoatrial node.
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:
Select one:
A. administer oxygen, give her 324 mg of aspirin, and assess her further.
B. give her one nitroglycerin and reassess her systolic blood pressure.
C. obtain a SAMPLE history and contact medical control for advice.
D. give her high-flow oxygen, attach the AED, and transport at once.
A. administer oxygen, give her 324 mg of aspirin, and assess her further.
Acute Coronary Syndrome
A group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction.
Acute Myocardial Infarction (AMI)
A heart attack; death of heart muscle following obstruction of blood flow to it. Acute in this context means "new" or "happening right now."
Angina Pectoris
Transient (short-lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle; also called angina.
Anterior
The front surface of the body; the side facing you in the standard anatomic position.
Aorta
The main artery, which receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body.
Aortic Aneurysm
A weakness in the wall of the aorta that makes it susceptible to rupture.
Aortic Valve
The one-way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta; one of four heart valves.
Artifact
A tracing on an ECG that is the result of interference, such as patient movement, rather than the heart's electrical activity.
Asystole
The complete absence of a ll heart electrical activity.
Atherosclerosis
A disorder in which cholesterol and calcium build up inside the walls of blood vessels, eventually leading to partial or complete blockage of blood flow.
Atrium
One of two (right and left) upper chambers of the heart. The right atrium receives blood from the vena cava and delivers it to the right ventricle. The left atrium receives blood from pulmonary veins and delivers it to the left ventricle.
Automaticity
The ability of cardiac muscle cells to contract without stimulation from the nervous system.
Autonomic Nervous System
The part of the nervous system that controls the involuntary activities of the body such as the heart rate, blood pressure, and digestion of food.
Bradycardia
A slow heart rate, less than 60 beats/min.
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.
Cardiac Output
A measure of the volume of blood circulated by the heart in 1 minute, calculated by multiplying the stroke volume by the heart rate.
Cardiogenic Shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.
Congestive Heart Failure (CHF)
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.
Coronary Arteries
The blood vessels that carry blood and nutrients to the heart muscles.
Defibrillate
To shock a fibrillating (chaotically beating) heart with specialized electric current in an attempt to restore a normal, rhythmic beat.
Dependent Edema
Swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure.
Dilation
Widening of a tubular structure such as a coronary artery.
Dissecting Aneurysm
A condition in which the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressures) to flow between the layers.
Dysrhythmia
An irregular or abnormal heart rhythm.
Hypertensive Emergency
An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm.
Infarction
Death of a body tissue, usually caused by interruption of its blood supply.
Inferior
The part of the body or any body part nearer to the feet.
Ischemia
A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.
Lumen
The inside diameter of an artery or other hollow structure.
Myocardium
The heart muscle.
Occlusion
A blockage, usually of a tubular structure such as a blood vessel.
Parasympathetic Nervous System
The part of the autonomic nervous system that controls vegetative functions such as digestion of food and relaxation.
Perfusion
The flow of blood through body tissues and vessels.
Posterior
The back surface of the body; the side away from you in the standard anatomic position.
Return of Spontaneous Circulation (ROSC)
The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.
Stroke Volume
THe volume of blood ejected with each ventricular contraction
Superior
The part of the body or any body part nearer to the head.
Sympathetic Nervous System
The part of the autonomic nervous system that controls active functions such as responding to fear (also known as the "fight-or-flight" system).
Syncope
A fainting spell or transient loss of consciousness.
Tachycardia
A rapid heart rate, more than 100 beats/min.
Thromboembolism
A blood clot that has formed within a blood vessel and is floating within the bloodstream.
Ventricle
One of two (right and left) lower chambers of the heart. The left ventricle receives blood from the left atrium (upper chamber) and delivers blood to the aorta. The right ventricle receives blood from the right atrium and pumps it into the pulmonary artery.
Ventricular Fibrillation
Disorganized, ineffective quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest.
Ventricular Tachycardia
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.
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