Chapters 16 & 17: Respiratory/Cardiovascular Emergencies

paramedic studies

146 cards·by nasonrumfield

2017

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What is the innermost smooth layer of the heart called?

endocardium

The ______ _____ separates the left atrium from the left ventricle.

mitral valve

The normal dominant pacemaker for the heart is the:

sinoatrial (SA) node

The ___ _______ component of the electrocardiogram (ECG) represents the depolarization of the ventricles.

QRS complex

A paramedic is palpating the radial pulse while listening to the apical pulse withastethoscope. What abnormality are they likely to find?

Pulsus alternans

Of the following, which is NOT a cause of a cardiac dysrhythmia?

Hypoglycemia

An area of fat in the arteries that has calcified is known as:

plaque

In a 65-year-old man, a systolic blood pressure of _________ would indicate hypertension.

140 mm Hg

What symptoms are associated with an acute myocardial infarction (AMI) or acute cardiacsyndrome (ACS)?

Dizziness, palpitations, diaphoresis

The M in the mnemonic MONA stands for...

Morphine

What do the drugs Labetalol and Nitroglycerin lower?

Blood pressure

What would management of left-sided heart failure do?

Decrease preload

What med can help specifically with left-sided heart failure?

Furosemide (Lasix)

If your patient does not qualify for fibrinolytic therapy, what intervention can be used?

Percutaneous intervention

What is the most common symptom of an AMI?

Chest pain

Stable angina follows a recurrent pattern, usually after what?

Exertion

_________ is an electrolyte imbalance that causes very tall and pointed T waves.

Hyperkalemia

During an AMI, the stage of injury appears an a ___________ on the ECG.

ST-segment elevation

Lead V5 is placed on the ______ ______ ____, when placed on the patient.

anterior axillary line

What are 3 possible causes of pulseless electrical activity (PEA)?

Hypovolemia, cardiac tamponade, pulmonary embolism

The signs and symptoms of sick sinus syndrome include:

Dizziness, palpitation, and near-syncope

When using paddles to shock a patient, you apply _________ lbs of pressure to the chest with thepaddles.

The correct term for the use of a defibrillator to end a dysrhythmia other than V-fib or pulseless V-tach is:

Cardioversion

A common treatment for chronic coronary heart failure or rapid atrial dysrhythmias is:

digitalis

One small box on the ECG strip represents _________ seconds.

0.04

What should be attached to the leads prior to placing them on the patient's skin?

Electrodes

What is considered a "tachycardic" heart rate?

Anything above 100 beats/min

What occurs when each successive impulse is delayed a little longer, until finally one impulse is not able to continue?

Mobitz Type 1

Between Polymorphic V-tach and Monomorphic V-tach, which one is considered more serious?

Polymorphic V-tach

Benign Early Repolarization:

early repolarization that is thought to be normal; characterized by ST-segment elevation (or J point elevation), a "J"/ fishhook appearance

Atherosclerosis:

accumulation of fat inside blood vessels resulting in narrowing of the lumen diameter

Angina Pectoris:

sudden pain from myocardial ischemia, caused by diminished circulation to the heart muscle

Where is pain from "angina pectoris" usually felt?

usually substernal and often radiates to the arms, jaw, or abdomen

How long does pain from "angina pectoris" usually last?

3-5 mins (and usually disappears with rest)

Opening Snap:

heart sound indicative of a noncompliant valve

R Atrium:

upper R chamber of heart; receives blood from the venae cavae to R ventricle

Valsalva Maneuver:

forced exhalation against the closed glottis, the effect of which is to stimulate the vagus nerve and slow the HR

Dromotropic:

effects the speed of electricity through pathways

Chronotropic:

speed of which SA node fires

Reentry Arrhythmia:

impulses get stuck in the "round-about" (AV junction) and go out where it entered....or somewhere else... = extra impulses

What does "U.N.L.O.A.D. F.A.S.T." stand for?

Upright position - Nitrates - Lasix - O2 - Ace inhibitors - Digoxin - Fluids - Afterload - Sodium restriction - Test

Non-compensatory Pause:

- SA node has NOT fired b/c something else fired early; interrupted SA node firing

Compensatory Pause:

SA node NOT fired - but no interruption; both SA node firing reg. AND an extra beat added

Supraventricular Tachycardia (SVT):

rate: > around 150bpm - rhythm: reg. - P-wave: indiscernible - PRI: can't obtain - QRS: narrow

Paroxysmal Supraventricular Tachycardia (PSVT):

you can see a "start and stop" - "supraventricular" - above ventr. - reg. narrow QRS tachycardia that starts & stops suddenly

Rules for V-fib:

chaotic rhythm, begins in ventricles - no cardiac output

Rules for V-Tach:

PVC lands on a T-wave ("R-on-T") - non-sustained VT (group of (3) or more PVC's = a run of V-tach)

Rules for Atrial Fibrillation:

irreg. rhythm - continuous chaotic atrial spikes - irreg. ventr. rhythm

Atrial Flutter:

more P-waves than QRS Atria working harder than ventr. Rate: 70 (ventr.), 280 (atrial)

Premature Atrial Contraction (PAC):

b/c of "spike" P-wave gets pushed together w/ T-wave

Multifocal Atrial Tachycardia (MAT):

irreg. rhythm - P-wave shape varies - atrial rate: > 100bpm - ventr.r rate: irreg.

Rules for Accelerated Idioventricular Rhythm (AIVR):

rate: 41-100bpm, faster than typical pacemaker but slower than tachycardia - has incr. rate of ventr. impulses - unstable rhythm

Rules for Sinus Pause (Arrest):

SA node not firing - escape pacemaker (AV junction) will take over - related to frequency and duration of periods of sinus arrest

Rules for Sinus Block:

results from blocked sinus impulses - SA node fires but impulse not carried - related to frequency and duration of blocks

How can you tell, by reading a 12-lead, if a patient is having an AMI?

- ST segment elevation of 1mm or more, in (2) or more contiguous leads

For biphasic defibrillators, once the pads are placed and the power switch is turned on, setthe energy level to ____

200 J

Monophonic defibrillators should be set to ___ for the first and all successive shocks.

360 J

Defibrillation needs to be carried out as soon as possible in two rhythms ______ and _______

Ventricular fibrillation and pulseless ventricular tachycardia

What should you do immediately after delivering the defibrillating current?

ontinue CPR for 2 minutes or five cycles, and then pause to check for a pulse and reevaluate the rhythm

If you witness a patients cardiac arrest, begin CPR starting with chest compressions and attach the AED as soon as possible. Why?

Because the heart is more likely to respond to defibrillation within the first few minutes of the onset of ventricular fibrillation.

Synchronized cardioversion:

The use of the defribillator to terminate hemodynamically unstable tachydysrhythmias

Emergency cardioversion is indicated for :

rapid ventricular and supra ventricular rhythms that are associated with severely compromised CO

Supraventricular tachycardia can often be converted with energy levels as low as ___ J

Ventricular Tachycardia will usually require at least ___ J for conversion.

100

What is a Vagolytic drug?

A therapeutic or chemical agent that has inhibitory effects on the vagus nerve

What is considered the "primary pacemaker of the heart?"

Sinoatrial (SA) node

What percentage is considered normal for an LV ejection fraction?

55% or higher

Blood is carried away from the heart by the...

Arteries

The blood vessels in the cardiovascular system are subdivided into...

the pulmonary and systemic circuits

The left atrium receives blood from the pulmonary circuit and empties it into the

left ventricle

The double pump function of the heart includes the right side, which serves as the _______, while the left side serves as the _______.

pulmonary circuit pump - systemic circuit pump

The great cardiac vein drains blood from the heart muscle to the

right atrium

The visceral pericardium, or epicardium, covers the...

outer surface of the heart

Blood from systemic circulation is returned to the right atrium by the...

superior and inferior vena cava

When deoxygenated blood leaves the right ventricle through a semilunar valve, it is forced into the...

pulmonary arteries

Oxygenated blood from the systemic arteries flows into...

peripheral tissue capillaries

The lung capillaries receive deoxygenated blood from the...

pulmonary arteries

One of the important differences between skeletal muscle tissue and cardiac muscle tissue is that cardiac muscle tissue is:

striated involuntary muscle

Generally speaking, wide QRS complexes are presumed ______ in origin, whereas narrow QRS complexes are presumed to be ______ in origin.

ventricular, supraventricular

Symptoms such as ______ and ______ are common indications for treatment of bradycardic patients.

altered mental status and hypotension

SVTs may originate in the ___, ____, or the ____.

SA node - elsewhere in the atria - AV node

In SVTs, you should attempt to stimulate the patients _______.

Vagus nerve

Common vagal stimulation techniques include:

1. Carotid sinus massage - 2. Most common: have the patient bear down against the closed glottis

In EMS, _______ is used to transiently induce AV nodal blockade in order to interrupt tachydysrhythmias involving the AV node.

Adenosine

In a SVT patient if vagal stimulation proves unsuccessful, administer _________ by rapid IV push.

adenosine (Adenocard), 6mg

The calcium channel blocker ___ is often used by paramedics to achieve rate control of narrow QRS complex tachydysrhythmias.

verapamil

_______ is a safe and effective way to protect the ventricles from atrial tachydysrhythmias and to slow the overall heart rate.

AV nodal blockade

Wide QRS complexes on the ECG may be signs of:

1. bundle branch block - 2. ventricular dysrhythmia - 3. preexcitation

Any interruption of CPR should be limited to ______ seconds or less

During cardiac arrest as soon as IV or IO access has been established administer a ________ drug.

Vasopressor

The two recommended vasopressor drugs during cardiac arrest are:

Epinephrine or Vasopressin

Epinephrine dose for cardiac arrest:

1 mg IV push (1:10,000) repeated every 3-5 minutes

Vasopressin dose during cardiac arrest:

40 units IV push one time only

The preferred antidysrhythmic medication during cardiac arrest is:

Amiodarone 300 mg bolus. May be repeated once at 150 mg in 3-5 minutes

In treating cardiac arrest, if amiodarone is unavailable you may administer ______.

Lidocaine 1 - 1.5 mg/kg IV push. Can be repeated at 0.5 to 0.75 mg/kg every 10 min until max dose of 3mg/kg has been reached.

PEA may be found in:

Cardiogenic or hypovelemic shock, cardiac tamponade, massive pulmonary embolism, electrolyte imbalance

Whenever you give a medication through a peripheral IV line during CPR follow it immediately with:

20 to 30 ml bolus of IV fluid and then elevate the extremity

As part of postresuscitative care you should elevate the patients head ___ degrees

What are the "Hs"?

Hypovelemia, hypoxia, hydrogen ions (acidosis), hyper/Hypokalemia, hypothermia

What are the "Ts"?

Tablets, tamponade, tension pneumothorax, thrombosis

The events between the start of one hearbeat and the start of the next is called the:

cardiac cycle

An excessively large QRS complex often indicates that the:

heart has become enlarged

ECGs are useful in detecting and diagnosing abonormal patterns of cardiac activity called:

cardiac arrhythmias

The QRS complex of the ECG appears when the:

ventricles depolarize

The P wave of a normal electrocardiogram indicates:

atrial depolarization

If each heart muscle cell contracted at its own individual rate, the condition would resemble:

fibrilation

The sinoatrial node acts as the pacemaker of the heart because these cells are:

the ones that depolarize and reach threshold first

The "lubb-dubb" sounds of the heart have practical clinical value because they provide information concerning:

the action and efficiency of the AV and semilunar valves

At the start of the atrial systole, the ventricles are filled to around:

70% of capacity

The amount of blood ejected by the left ventricle per minute is the:

cardiac output

The amount of blood pumped out of each ventricle during a single beat is the:

stroke volume

Under normal circumstances, the factors responsible for making delicate adjustments to the heart rate as circulatory demands change are:

autonomic activity and circulatory hormones

The function of the chordae tendinae is to:

anchor the AV valve flaps and prevent backflow of blood into the atria

During ventricular diastole, when the pressure in the left ventricle rises above that in the left atrium:

the left AV valve closes

During ventricular systole, the blood volume in the atria is _______, and the volume in the ventricle is _______

increasing; decreasing

When the pressure within the L. ventricle becomes greater than the pressure within the aorta:

the aortic semilunar valve is forced open

The volume of blood in the L. ventricle is at its lowest when:

the AV valve opens

The dicrotic wave indicates a brief rise in the aortic pressure. The rise in pressure is due to:

the closure of the semilunar valve

During isovolumertric contraction, pressure is highest in the:

aorta

What is consistent with JVD?

right-sided heart failure - also: pulmonary embolism, Superior Vena Cava Obstruction,trauma, tamponade, v-tach, pneumothorax

What is spontaneous pneumothorax classically characterized by?

hypotension, hypoxia - spontaneous means not caused by trauma, likely due to small sacs of air in lungs forming and rupturing

Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

Neck/jaw/shoulder/back/abdominal discomfort, shortness of breath, Pain in arms, Nausea/vomiting, Sweating, dizziness, fatigue

Myocardial Infarction vs. Stable Angina:

MI = indicates a complete blockage of blood supply to heart - Angina: chest pain that usually comes from activity or stress

Which part of heart do the coronary arteries perfuse?

"myocardium" - Coronary arteries are the vessels that deliver oxygen-rich blood there

What is coronary artery disease?

The usual cause is a buildup of plaque in the coronary arteries, causing them to narrow and limit blood flow to the heart

What are we most likely to expect in pneumonia rather than lung cancer?

Infection/fever

What is cardiogenic shock?

condition in which heart suddenly can't pump enough blood to meet your body's needs. most often caused by severe heart attack.

What are the preferred meds used to treat cardiogenic shock?

Dopamine / dobutamine

What is specific to cardiovascular disease in the geriatric population?

it is the leading cause of death/healthcare burdens in that popuation and has become more common than ever

What would be the skin findings in a cardiac compromise situation?

ashen gray skin due to poor cardiac output / cyanosis

What is the "sequence" of MONA?

1. Oxygen - 2. Aspirin - 3. Nitroglycerin - 4. Morphine

What are common findings when assessing a patient suffering a myocardial infarction?

Chest pain that radiates - malaise - tachycardia/hypertension - irregular heart rate - fever - rales/wheezing - pallor

What findings with cystic fibrosis?

most often found in very young, infant patients - patient may present with: meconium ileus, wheezing, coughing, pneumonia

In what situation would you place a MAGNET over a pacemaker?

when you may need to temporarily "reprogram" the pacer into an asynchronous pacing mode - to determine need for battery replacement

When would you use SYNCED cardioversion?

when meds fail - to treat: unstable atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachycardias

What age and gender is AAA (abdominal aortic aneurysm) most common in?

Geriatric MEN. It becomes more common with increasing age, and 4 out 100 men will get it vs. 1 out of 100 women.

What med is used for PVCs?

Beta blockers - also: calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone (Cordarone, Pacerone) or flecainide

Increased pulmonary pressures (Pulmonary Hypertension) are directly associated with what?

COPD - right sided heart failure - obesity

What are some high thoracic aneurysm findings?

Hoarseness, problems swallowing, swelling, stridor, chest/back pain, clammy skin, vomiting, tachycardia

Where does a Thoracic aortic aneurysm take place?

in the part of the body's largest artery (the aorta) that passes through the chest

What is Bruits associated with? Where would you listen for it?

a 50% decrease in carotid artery luminal diameter - at a point just lateral to the Adam's apple

What is Kussmauls associated with?

deep and labored breathing pattern often associated with severe metabolic acidosis/diabetic ketoacidosis, and also kidney failure

What is Cheyne-Stokes?

abnormal breathing characterized by rapidly deeper breathing, followed by a decrease, then a temporary stop in breathing

What would be the cause of hearing Cheyne-Stokes breathing in a patient?

damage to their respiratory centers, or by physiological abnormalities in chronic heart failure

How does an aneurysm develop?

it develops from a weakness or destruction of the medial layer of the blood vessel

What would pulsus parodoxis identify?

an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration