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7/18/2019 Chapter 14 Cardiovascular
http://slidepdf.com/reader/full/chapter-14-cardiovascular 1/109
Chapter 14
Cardiovascular
Emergencies
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Anatomy and Physiology (1 of 21)
• Heart’s job is to pump blood to supply
oxygen-enriched red blood cells to tissues.
• Divided into left and right sides
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Anatomy and Physiology (2 of 21)
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Anatomy and Physiology (4 of 21)
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Anatomy and Physiology (5 of 21)
• Heart’s electrical system controls heart rate
and coordinates atria and ventricles.
• The cardiac muscle is the myocardium.
• Automaticity allows cardiac muscles tospontaneously contract.
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Anatomy and Physiology (6 of 21)
Electrical conduction system of the heart
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Anatomy and Physiology (9 of 21)
• The myocardium must have a continuous
supply of oxygen and nutrients to pump
blood.
• Increased oxygen demand by myocardiumis supplied by dilation (widening) of
coronary arteries.
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Anatomy and Physiology (10 of 21)
• Stroke volume is the volume of blood
ejected with each ventricular contraction.
• Coronary arteries are blood vessels that
supply blood to heart muscle.
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• Coronary arteries start at the first part of the
aorta:
– Right coronary artery
– Left coronary artery
Anatomy and Physiology (11 of 21)
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Anatomy and Physiology (12 of 21)
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Anatomy and Physiology (19 of 21)
Carotid Femoral
Brachial Radial Posterior tibial Dorsalis pedis
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Anatomy and Physiology (20 of 21)
• Cardiac output is the volume of blood that
passes through the heart in 1 min.
– Heart rate× volume of blood ejected with each
contraction (stroke volume)
• Perfusion is the constant flow of oxygenated
blood to tissues
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Anatomy and Physiology (21 of 21)
• Good perfusion requires:
– A well-functioning heart
– An adequate volume of blood
– Appropriately constricted blood vessels
• If perfusion fails, cellular and eventually
patient death occur.
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Pathophysiology (1 of 26)
• Chest pain usually stems from ischemia,
which is decreased blood flow.
– Ischemic heart disease involves a decreased
blood flow to one or more portions of the heart. – If blood flow is not restored, the tissue dies.
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Pathophysiology (2 of 26)
• Atherosclerosis is
the buildup of
calcium and
cholesterol in the
arteries.
– Can cause
occlusion of
arteries
– Fatty material
accumulates with
age.
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Pathophysiology (4 of 26)
• A thrombo-embolism is a blood clot
floating through blood vessels.
• If clot lodges in coronary artery, acute
myocardial infarction (AMI) results.
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Pathophysiology (5 of 26)
• Coronary artery disease is the leading
cause of death in the US.
• Controllable AMI risk factors:
– Cigarette smoking, high blood pressure, high
cholesterol, high blood glucose level (diabetes),
lack of exercise, and stress
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Pathophysiology (6 of 26)
• Uncontrollable AMI risk factors:
– Older age, family history, and being a male
• Acute coronary syndrome (ACS) is caused
by myocardial ischemia.
– Angina pectoris
– Acute myocardial infarction
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Pathophysiology (7 of 26)
• Angina pectoris occurs when the heart’s
need for oxygen exceeds supply.
– Crushing or squeezing pain
– Does not usually lead to death or permanentheart damage
– Should be taken as a serious warning sign
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Pathophysiology (8 of 26)
• Unstable angina
– In response to fewer stimuli than normal
• Stable angina
– Is relieved by rest or nitroglycerin
• Treat angina patients like AMI patients.
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Pathophysiology (9 of 26)
• AMI pain signals actual death of cells in
heart muscle.
– Once dead, cells cannot be revived.
– ―Clot-busting‖ (thrombolytic) drugs orangioplasty within 1 hour prevent damage.
– Immediate transport is essential.
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Pathophysiology (10 of 26)
• Signs and symptoms of AMI
– Weakness, nausea, sweating
– Chest pain that does not change
– Lower jaw, arm, back, abdomen, neck pain
– Irregular heartbeat and syncope (fainting)
– Shortness of breath (dyspnea)
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Pathophysiology (11 of 26)
• Signs and symptoms of AMI (cont’d)
– Pink, frothy sputum
– Sudden death
• AMI pain differs from angina pain
– Not always due to exertion
– Lasts 30 minutes to several hours
– Not always relieved by rest or nitroglycerin
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Pathophysiology (12 of 26)
• AMI patients may not realize they are
experiencing a heart attack.
• AMI and cardiac compromise physical
findings: – Fear, nausea, poor circulation
– Faster, irregular, or bradycardic pulse
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Pathophysiology (13 of 26)
• AMI and cardiac compromise physical
findings (cont’d):
– Decreased, normal, or elevated BP
– Normal or rapid and labored respirations
– Patients express feelings of impending doom.
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Pathophysiology (14 of 26)
• Three serious consequences of AMI:
– Sudden death
• Resulting from cardiac arrest
– Cardiogenic shock
– CHF
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Pathophysiology (15 of 26)
• Arrhythmias:
heart rhythm
abnormalities
– Prematureventricular
contractions
– Tachycardia
– Bradycardia
Source: From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.
Source: From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.
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Pathophysiology (16 of 26)
• Arrhythmias
(cont’d)
– Ventricular
tachycardia – Ventricular
fibrillationSource: From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.
Source: From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.
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Pathophysiology (17 of 26)
• Defibrillation restores cardiac rhythms.
– Can save lives
– Initiate CPR until a defibrillator is available.
• Asystole: no heart electrical activity – Reflects a long period of ischemia
– Nearly all patients will die.
Source: From Arrhythmia Recognition: The Art of Interpretation, courtesy of Tomas B. Garcia, MD.
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Pathophysiology (18 of 26)
• Cardiogenic shock
– Often caused by heart attack
– Heart lacks power to force enough blood
through circulatory system – Inadequate oxygen to body tissues causes
organs to malfunction.
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Pathophysiology (19 of 26)
• Cardiogenic shock (cont’d)
– Often caused by a heart attack
– Heart lacks the power to pump
– Recognize shock in its early stages.
• Congestive heart failure
– Often occurs a few days following heart attack
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Pathophysiology (20 of 26)
• Congestive heart failure
– Increased heart rate and enlargement of left
ventricle no longer make up for decreased heart
function – Lungs become congested with fluid
– May cause dependent edema
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Pathophysiology (21 of 26)
• Hypertensive emergencies
– Systolic pressure greater than 160 mm Hg
– Common symptoms
• Sudden, severe headache
• Strong, bounding pulse
• Ringing in the ears
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Pathophysiology (22 of 26)
• Hypertensive emergencies (cont’d)
– Common symptoms
• Nausea and vomiting
• Dizziness• Warm skin (dry or moist)
• Nosebleed
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Pathophysiology (23 of 26)
• Hypertensive emergencies (cont’d)
– Common symptoms include altered mental
status and pulmonary edema.
–If untreated, can lead to stroke or dissectingaortic aneurysm.
– Transport patients quickly and safely.
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Pathophysiology (24 of 26)
• Aortic aneurysm is weakness in the wall of
the aorta.
– Susceptible to rupture
– Dissecting aneurysm occurs when inner layersof aorta become separated (Table 14-1).
– Primary cause: uncontrolled hypertension
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Pathophysiology (25 of 26)
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Pathophysiology (26 of 26)
• Aortic aneurysm (cont’d)
– Signs and symptoms
• Very sudden chest pain
• Comes on full force• Different blood pressures
– Transport patients quickly and safely.
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Scene Size-up
• Scene safety
– Ensure the scene is safe.
– Follow standard precautions.
• Mechanism of injury (MOI)/nature of illness
(NOI)
– Clues often include report of chest pain,
difficulty breathing, loss of consciousness. – Obtain clues from dispatch, the scene,
patient, bystanders
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Primary Assessment (1 of 2)
• Form a general impression.
– If unresponsive, pulseless, or apneic, assess
for use of AED.
• Airway and breathing
– If difficulty breathing: apply oxygen via
nonrebreathing mask; if not breathing: give
100% oxygen via bag-mask device.
– CHF patients: use CPAP.
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Primary Assessment (2 of 2)
• Circulation
– Check skin color, temperature, condition.
• Transport decision
– Transport in a stress-relieving manner.
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History Taking (1 of 2)
• Investigate the chief complaint (eg, chest
pain, difficulty breathing).
– Ask about recent trauma.
• Obtain a SAMPLE history from a consciouspatient.
– Use OPQRST (Table 14-2).
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History Taking (2 of 2)
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Secondary Assessment
• Physical examination
– Focus on cardiac and respiratory systems.
• Circulation
• Respirations
• Vital signs
– Obtain a complete set of vital signs
–If available, use pulse oximetry
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Reassessment (1 of 4)
• Reassess vital signs every 5 min or when
patient’s condition changes significantly.
• Sudden cardiac arrest is always a risk.
• Interventions
– Give oxygen.
– Assist unconscious patients with breathing.
– Follow local protocol for administration of low-dose aspirin or prescribed nitroglycerin (see
Skill Drill 14-1).
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Reassessment (3 of 4)
• Interventions (cont’d)
– If cardiac arrest occurs, perform CPR
immediately until an AED is available.
• Reassess your interventions.
• Provide rapid patient transport.
Heart Surgeries and
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Heart Surgeries andPacemakers (1 of 6)
• Many open-heart operations have been
performed in the last 20 years.
• Coronary artery bypass graft (CABG)
– Chest or leg blood vessel is sewn from the aortato a coronary artery beyond the point of
obstruction.
• Others have implanted cardiac pacemakers.
Heart Surgeries and
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Heart Surgeries andPacemakers (2 of 6)
• Percutanous transluminal coronary
angioplasty (PTCA)
– A tiny balloon is inflated inside a narrowed
coronary artery.• Patients who have had open-heart
procedures may have long chest scar.
Heart Surgeries and
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Heart Surgeries andPacemakers (3 of 6)
• Cardiac pacemakers
– Maintain regular cardiac rhythm and rate
– Deliver electrical impulse through wires in direct
contact with the myocardium – Implanted under a heavy muscle or fold of skin
in the upper left portion of the chest
Heart Surgeries and
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Heart Surgeries andPacemakers (4 of 6)
• Cardiac pacemakers
(cont’d)
– This technology is very
reliable. – Pacemaker malfunction
can cause syncope,
dizziness, or weakness
due to an excessivelyslow heart rate.
• Transport patients
promptly and safely.
Source: © Carolina K. Smith, MD/ShutterStock, Inc.
Heart Surgeries and
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Heart Surgeries andPacemakers (5 of 6)
• Automatic implantable cardiac defibrillators
(AICDs)
– Used by some patients who have survived
cardiac arrest due to ventricular fibrillation – Monitor heart rhythm and shock as needed.
– Treat chest pain patients with AICDs like they
are experiencing a heart attack.
Heart Surgeries and
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Heart Surgeries andPacemakers (6 of 6)
• AICDs (cont’d)
– Electricity is low; it
will not affect
responders.
– When an AED is
used, do not place
patches directly
over pacemaker.
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Cardiac Arrest
• The complete cessation of cardiac activity
• Absence of a carotid pulse
• Was terminal before CPR and external
defibrillation were developed in the 1960s
Automated External
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Automated ExternalDefibrillation (1 of 14)
• Analyzes electrical
signals from heart
– Identifies
ventricularfibrillation
– Administers shock
to heart when
neededSource: The LIFEPAK® 1000 Defibrillator (AED) courtesy of Physio-Control.
Used with Permission of Physio-Control, Inc, and according to the
Material Release Form provided by Physio-Control.
Automated External
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Automated ExternalDefibrillation (3 of 14)
• AED models
(cont’d):
– Most are
semiautomated – Monophasic vs.
biphasic shocks
•Source: The LIFEPAK® 20e Defibrillator monitor courtesy of Physio-Control.
Used with permission of Physio-Control, Inc, and according to
the Material Release Form provided by Physio-Control
Automated External
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Automated ExternalDefibrillation (4 of 14)
• Potential problems:
– Check daily and exercise the battery as
recommended by manufacturer.
– Apply to pulseless, unresponsive patients.
– Most computers identify rhythms faster than 150
to 180 beats/min as ventricular tachycardia,
which should be shocked.
Automated External
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Automated ExternalDefibrillation (5 of 14)
• Advantages of AED use:
– Quick delivery of shock
– Easier than performing CPR
– ALS providers do not need to be on scene
– Remote, adhesive pads safer than paddles
– Larger pad area = more efficient shocks
Automated External
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Automated ExternalDefibrillation (6 of 14)
• Other considerations
– Though all cardiac arrest patients should be
analyzed, not all require shock.
– Asystole (flatline) = no electrical activity
– Pulseless electrical activity usually refers to a
state of cardiac arrest.
Automated External
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Automated ExternalDefibrillation (7 of 14)
• Early defibrillation
– Few cardiac arrest patients survive outside a
hospital without a rapid sequence of events.
–Chain of survival:• Early recognition and activation of EMS
• Immediate bystander CPR
Automated External
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Automated ExternalDefibrillation (9 of 14)
• Early defibrillation (cont’d)
– CPR prolongs period during which defibrillation
can be effective.
–Has resuscitated patients with cardiac arrestfrom ventricular fibrillation
– Nontraditional responders are being trained in
AED use.
Automated External
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Automated ExternalDefibrillation (10 of 14)
• Integrating the AED and CPR
– Work the AED and CPR in sequence.
– Do not touch the patient during analysis and
defibrillation. – CPR must stop while AED performs its job.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (1 of 7)
• Preparation
– Make sure the electricity injures no one.
– Do not defibrillate patients in pooled water.
– Do not defibrillate patients touching metal.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (2 of 7)
• Preparation (cont’d)
– Carefully remove nitroglycerin patch and wipe
with dry towel before shocking.
–Shave hairy chest to increase conductivity.
– Determine the NOI and/or MOI.
• Perform spinal stabilization.
• Performing defibrillation
– See Skill Drill 14-2.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (3 of 7)
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (4 of 7)
• Follow local protocol for patient care after AED shocks.
– After AED protocol is completed, one of the
following is likely:• Pulse regained
• No pulse regained and no shock advised
• No pulse regained and shock advised
• Wait for ALS, and continue shocks and
CPR on scene.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (5 of 7)
• If ALS is not responding and protocolsagree, begin transport when:
– The patient regains a pulse.
–6 to 9 shocks are delivered.
– AED gives three consecutive messages
(every 2 min of CPR) advising no shock.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (6 of 7)
• Transport considerations:
– 2 EMTs in patient compartment, 1 driving
– Deliver additional shocks on scene or, if medical
control approves, en route. – AEDs cannot analyze if vehicle is in motion.
Emergency Medical Care for
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Emergency Medical Care forCardiac Arrest (7 of 7)
• Coordination with ALS personnel
– If AED available, do not wait for ALS.
– Notify ALS of cardiac arrest.
– Do not delay defibrillation.
– Follow local protocols for coordination.
Review
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Review
1. All of the following are common signs andsymptoms of cardiac ischemia, EXCEPT:
A. headache.
B. chest pressure.C. shortness of breath.
D. anxiety or restlessness.
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Review
Answer: A
Rationale: Cardiac ischemia occurs when the
heart’s demand for oxygen exceeds the
available supply. Common signs andsymptoms of cardiac ischemia include chest
pain or discomfort, shortness of breath
(dyspnea), and anxiety or restlessness.
Headache is not a common symptom ofcardiac ischemia.
Review (1 f 2)
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Review (1 of 2)
1. All of the following are common signs andsymptoms of cardiac ischemia, EXCEPT:
A. headache.
Rationale: Correct answer
B. chest pressure.
Rationale: Chest pressure is a definite
symptom of a cardiac event.
Review (2 f 2)
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Review (2 of 2)
1. All of the following are common signs andsymptoms of cardiac ischemia, EXCEPT:
C. shortness of breath.
Rationale: This is a response to decreased
cardiac output and hypoxia.
D. anxiety or restlessness.
Rationale: This is caused by a fear of death
and is a result of hypoxia, decreased cardiac
output, and ischemia.
Review
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Review
2. While palpating the radial pulse of a 56-year-old man with chest pain, you note that
the pulse rate is 86 beats/min and irregular.
This indicates:
A. pain.
B. fear.
C. anxiety.
D. an arrhythmia.
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Review
Answer: D
Rationale: An irregular pulse in a patient with
a cardiac problem suggests an arrhythmia—
an abnormality in the heart’s electrical
conduction system. Patients with signs of
cardiac compromise, who have an irregular
pulse, must be monitored closely for cardiac
arrest.
Review (1 f 2)
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Review (1 of 2)
2. While palpating the radial pulse of a 56-year-old man with chest pain, you note that
the pulse rate is 86 beats/min and irregular.
This indicates:
A. pain.
Rationale: Pain could be a result or symptom
of cardiac ischemia.
B. fear.Rationale: Fear of impending death is usually
the psychological result of having chest pain.
Review (2 f 2)
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Review (2 of 2)
2. While palpating the radial pulse of a 56-year-old man with chest pain, you note that
the pulse rate is 86 beats/min and irregular.
This indicates:
C. anxiety.
Rationale: Anxiety is also a symptom of a
cardiac event.
D. an arrhythmia.Rationale: Correct answer
Review
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Review
3. A 56-year-old man has an acutemyocardial infarction. Which of the
following blood vessels became blocked
and led to his condition?
A. Coronary veins
B. Coronary arteries
C. Pulmonary veins
D. Pulmonary arteries
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Review
Answer: B
Rationale: The coronary arteries, which
branch off the aorta, supply the myocardium
(heart muscle) with oxygen-rich blood.Occlusion of one or more of these arteries
results in a cessation of oxygenated blood
beyond the area of occlusion and results in
acute myocardial infarction (AMI).
Review (1 of 2)
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Review (1 of 2)
3. A 56-year-old man has an acutemyocardial infarction. Which of the
following blood vessels became blocked
and led to his condition?
A. Coronary veins
Rationale: Coronary veins do not carry
oxygen and would not be the direct cause of
an acute MI.
B. Coronary arteries
Rationale: Correct answer
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Review (2 of 2)
3. A 56-year-old man has an acutemyocardial infarction. Which of the
following blood vessels became blocked
and led to his condition?
C. Pulmonary veins
Rationale: Pulmonary veins are the primary
blood supply to the lungs and not the heart.
D. Pulmonary arteriesRationale: Pulmonary arteries are the route of
blood return to the left atrium from the lungs.
An obstruction would not cause an acute MI.
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4. Major controllable risk factors for an AMIinclude:
A. older age.
B. family history.C. cigarette smoking.
D. male sex.
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Answer: C
Rationale: Smoking is a major controllable
risk factor for any cardiovascular disease.
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Review (1 of 2)
4. A major controllable risk factor for an AMIincludes:
A. Older age.
Rationale: This is an uncontrollable risk
factor.
B. Family history.
Rationale: This is an uncontrollable risk
factor.
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Review (2 of 2)
4. A major controllable risk factor for an AMIincludes:
C. Cigarette smoking.
Rationale: Correct answer.
D. Male sex.
Rationale: This is an uncontrollable risk
factor.
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5. A patient with cardiac arrest secondary toventricular fibrillation has the greatest
chance for survival if:
A. CPR is initiated within 10 minutes.B. oxygen and rapid transport are provided.
C. defibrillation is provided within 2 minutes.
D. paramedics arrive at the scene within
5 minutes.
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Answer: C
Rationale: Survival from cardiac arrest
secondary to ventricular fibrillation is highest if
CPR is provided immediately and defibrillationis provided within 1 minute of the patient’s
cardiac arrest. Early high-quality CPR and
defibrillation are the two most important
factors that influence survival from cardiacarrest.
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5. A patient with cardiac arrest secondary toventricular fibrillation has the greatest
chance for survival if:
A. CPR is initiated within 10 minutes.Rationale: CPR needs to be initiated
immediately.
B. oxygen and rapid transport are provided.
Rationale: Oxygen therapy and transport areimportant parts of resuscitation, but CPR and
early defibrillation afford the greatest chance
of survivability.
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5. A patient with cardiac arrest secondary toventricular fibrillation has the greatest
chance for survival if:
C. defibrillation is provided within 2 minutes.Rationale: Correct answer
D. paramedics arrive at the scene within
5 minutes.
Rationale: Not necessarily; CPR and earlydefibrillation will provide the greatest chance
of survivability.
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6. A 59-year-old woman presents with chestpressure. She is conscious and alert, but
her skin is cool, pale, and clammy. Your
first step in providing care (treatment)
should be:
A. apply the AED.
B. administer high-flow oxygen.
C. ask her if she takes nitroglycerin.
D. take a complete set of vital signs.
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Answer: B
Rationale: Any patient with suspected cardiac
compromise should be given high-flow oxygen
as soon as possible. Obtaining vital signs andinquiring about the use of nitroglycerin are
appropriate; however, you should administer
oxygen first. The AED is only applied to
patients in cardiac arrest.
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Review (1 of 2)
6. A 59-year-old woman presents with chestpressure. She is conscious and alert, but
her skin is cool, pale, and clammy. Your
first step in providing care (treatment)
should be:
A. apply the AED.
Rationale: The AED is only applied to
patients in cardiac arrest.
B. administer high-flow oxygen.
Rationale: Correct answer
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Review (2 of 2)
6. A 59-year-old woman presents with chestpressure. She is conscious and alert, but
her skin is cool, pale, and clammy. Your
first step in providing care (treatment)
should be:
C. ask her if she takes nitroglycerin.
Rationale: Inquiring about the use of
nitroglycerin is appropriate, but not the first step.
D. take a complete set of vital signs.
Rationale: Obtaining vital signs is important, but
not the first step.
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7. If a patient with an implanted pacemaker isin cardiac arrest, the EMT should:
A. avoid defibrillation with the AED and transport
at once.
B. not apply the AED until he or she contacts
medical control.
C. place the AED pads at least 1″ away from the
pacemaker.D. apply the AED pads directly over the
implanted pacemaker.
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Answer: C
Rationale: The only modification required for
cardiac arrest patients with an implanted
pacemaker is to ensure that the AED pads areat least 1″ away from the pacemaker. Placing
the AED pads directly over the pacemaker will
result in a less effective defibrillation and may
damage the pacemaker.
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7. If a patient with an implanted pacemaker isin cardiac arrest, the EMT should:
A. avoid defibrillation with the AED and transport
at once.
Rationale: AEDs can be used with
pacemakers, but avoid placing pads over
pacemakers.
B. not apply the AED until he or she contacts
medical control.
Rationale: EMTs are trained in the use of
AEDs.
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7. If a patient with an implanted pacemaker isin cardiac arrest, the EMT should:
C. place the AED 1″ away from the pacemaker.
Rationale: Correct answer
D. apply the AED pads directly over the
implanted pacemaker.
Rationale: AEDs should not be placed over
pacemakers.
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8. The main advantage(s) of the AED is:
A. it provides quick delivery of a shock.
B. it is easier than performing CPR.
C. there is no need for ALS providers to be onscene.
D. All of the above.
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Answer: D
Rationale: The AED provides quick delivery
of a shock, is easier to perform than CPR, and
does not require ALS providers to operate it.
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e e ( )
8. The main advantage(s) of the AED is:
A. it provides quick delivery of a shock.
Rationale: The AED provides quick delivery
of a shock.
B. it is easier than performing CPR.
Rationale: The AED is easier to perform than
CPR.
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( )
8. The main advantage(s) of the AED is:
C. there is no need for ALS providers to be on
scene.
Rationale: ALS providers do not need to be
on scene to put the AED to use.
D. All of the above.
Rationale: Correct answer.
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9. After administering a nitroglycerin tablet toa patient, the EMT should:
A. check the expiration date of the nitroglycerin.
B. reassess the patient’s blood pressure within 5minutes.
C. instruct the patient to chew the tablet until it is
dissolved.
D. ensure that the nitroglycerin is prescribed tothe patient.
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Answer: B
Rationale: Nitroglycerin is a vasodilator and
can lower the patient’s BP; therefore, you
should reassess the patient’s BP within5 minutes after giving nitroglycerin. Instruct the
patient to allow the nitroglycerin to dissolve
under his or her tongue; it should not be
chewed. You should check the drug’s expirationdate and ensure that it is prescribed to the
patient before administering it.
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( )
9. After administering a nitroglycerin tablet toa patient, the EMT should:
A. check the expiration date of the nitroglycerin.
Rationale: This is checked before medication
administration.
B. reassess the patient’s blood pressure within
5 minutes.
Rationale: Correct answer
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( )
9. After administering a nitroglycerin tablet toa patient, the EMT should:
C. instruct the patient to chew the tablet until it is
dissolved.
Rationale: The tablet is placed under the
patient’s tongue and allowed to dissolve.
D. ensure that the nitroglycerin is prescribed to
the patient.
Rationale: This is checked before medicationadministration.
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10. Nitroglycerin is contraindicated inpatients:
A. with a systolic blood pressure less than
100 mm Hg.
B. with chest pain of greater than 30 minutes
duration.
C. who are currently taking antibiotics for an
infection.D. who are less than 40 years of age and have
diabetes.
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Answer: A
Rationale: Nitroglycerin is a vasodilator and
may cause a drop in BP; therefore, it is
contraindicated in patients with a systolic BPof less than 100 mm Hg and in patients who
have taken erectile dysfunction (ED) drugs
(eg, Viagra, Cialis, Levitra) within the past 24
to 36 hours. ED drugs are also vasodilators; ifgiven in combination with nitroglycerin, severe
hypotension may occur.
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( )
10. Nitroglycerin is contraindicated inpatients:
A. with a systolic blood pressure less than
100 mm Hg.
Rationale: Correct answer
B. with chest pain of greater than 30 minutes
duration.
Rationale: Cardiac chest pain is the primary
indication for the use of nitroglycerin.
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10. Nitroglycerin is contraindicated inpatients:C. who are currently taking antibiotics for an
infection.
Rationale: Antibiotics are not a contra-indication for nitroglycerin use. Prior adverse
reactions to the drug and the use of other
nitrates would be a contraindication.
D. who are less than 40 years of age and havediabetes.
Rationale: While the patient’s age must be
considered, it is not a contraindication.
Credits
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• Background slide image (ambulance):Galina Barskaya/ShutterStock, Inc.
• Background slide images (non-ambulance):
© Jones & Bartlett Learning. Courtesy ofMIEMSS.