The failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body or both
Congestive heart failure (CHF)
Shortness of breath; labored or difficulty breathing
Dyspnea
Diseases that affect the arteries of the heart
Coronary artery disease (CAD)
A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle
Acute coronary syndrome (ACS)
The dilation, or ballooning, of a weakened section of the wall of an artery
Aneurysm
Pain in the chest, which occurs when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough oxygen
Angina pectoris
Facts about Acute Coronary Syndrome (ACS):
� Sometimes called cardiac compromise
� Refers to any time the heart may not be getting enough oxygen
� Many different kinds of problems under the ACS heading
� Symptoms often mimic non-cardiac conditions
� Treat all patients with ACS-like signs and sympt
Symptoms of Acute Coronary Syndrome (ACS):
� Chest pain is best-known symptom
� Can be described as "crushing, dull,
heavy, or squeezing"
� Sometimes described only as pressure or discomfort
� Radiates to arms, upper abdomen, jaw
� Dyspnea also found in ACS
� May be the only finding in some patien
Indications for administering nitroglycerin:
- Chest pain
- History of cardiac problems and prescribed nitroglycerin
- Patient has nitroglycerin
- Medical direction authorizes administration
Contraindications for administering
nitroglycerin:
- Systolic blood pressure less than 90-100 (consult local protocol)
- Patient has taken Viagra or similar drug for erectile dysfunction within 48-72 hours
Indications for administering aspirin:
- Chest pain
- Ability to safely swallow
- Medical control authorization
Contraindications for administering aspirin:
- Inability to swallow
- Allergy to aspirin
- History of asthma
- Patient already taking other anti-clotting medications
Facts about Coronary Artery Disease:
� Conditions that narrow or block arteries of heart
� Often result from fatty deposit build-up on inner walls of arteries
� Build-up narrows inner vessel diameter, restricts flow of blood
� Thrombus�occlusion of blood flow caused by formation of a clot on
Facts about Aneurysms:
� Weakened sections of blood
vessels begin to dilate (balloon)
� Bursting can cause rapid, life-threatening internal bleeding
Facts about Electrical Malfunction of the Heart:
� Malfunction of heart's electrical system generally results in dysrhythmia
� Dysrhythmias include bradycardia,
tachycardia, and rhythms that may be present when there is no pulse
� Angina pectoris
� Acute myocardial infarction (AMI)
� Congestive Heart Fa
Facts about Angina Pectoris:
� Chest pain caused by insufficient blood flow to the myocardium
� Typically due to narrowed arteries
secondary to coronary artery disease
� Pain usually during times of increased myocardial oxygen demand, such as exertion or stress
Facts about Acute Myocardial Infarction (AMI):
� Death of a portion of the myocardium due to lack of oxygen
� Coronary artery disease is usually the underlying reason
Facts about Congestive
Heart Failure (CHF):
� Inadequate pumping of the heart
� Often leads to excessive fluid build-up in lungs and/or body
� May be brought on by diseased heart valves, hypertension, obstructive pulmonary disease
� Often a complication of AMI
Progression of CHF:
� Patient sustains AMI
� Myocardium of left ventricle dies
� Because of damage to left ventricle, blood backs up into pulmonary circulation and lungs
� If untreated, left heart failure commonly causes right heart failure
Signs and Symptoms of CHF:
� Tachycardia
� Dyspnea and cyanosis
� Normal or elevated blood pressure
� Diaphoresis
� Pulmonary edema
� Anxiety or confusion due to hypoxia
� Pedal edema
� Engorged, pulsating neck veins (late sign)
� Enlarged liver and spleen
The Chain of Survival in Cardiac Arrest:
� Five elements
1. Immediate recognition and activation
2. Early CPR
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post-cardiac arrest care
� Teamwork
� Coordination
AED Safety facts:
� Do not defibrillate soaking-wet patient
� Do not defibrillate if patient is touching
anything metallic that other people are touching
� Remove nitroglycerin patches before defibrillating
� Defibrillation can be performed on patient with an implanted dev
When providing CPR:
- Compressions must not be interrupted for any longer than 10 seconds
- Compressions at least 2 inches deep for adult and at least one-third depth of chest for
infants and children with full chest recoil
- Rate should be at least 100 per minute
- Rotate p
The condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by laypersons
Acute myocardial infarction (AMI)
When the heart rate is slow, usually below 60 beats per minute
Bradycardia
The heart and the blood vessels
Cardiovascular system
A disturbance in heart rate and rhythm
Dysrhythmia
A cardiac arrest that occurs within 2 hours of the onset of symptoms; the patient may have no prior symptoms of coronary artery disease
Sudden death
Swelling resulting from a build-up of fluid in the tissues
Edema
Accumulation of fluid in the lungs
Pulmonary edema
A medication that dilates the blood vessels
Nitroglycerin
Accumulation of fluid in the feet or ankles
Pedal edema
A clot formed of blood and plaque attached to the inner wall of an artery or vein
Thrombus
A condition in which the heart's electrical impulses are disorganized, preventing the heart muscles from contracting normally
Ventricular fibrillation (VF)
Blockage, as of an artery by fatty deposits
Occlusion
A condition in which the heart's electrical rhythm remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity, causing cardiac arrest
Pulseless electrical activity (PEA)
Blockage of a vessel by a clot or foreign material brought to the site by the blood current
Embolism
A condition in which the heart has ceased generating electric impulses
Asystole
A condition in which the heartbeat is quite rapid; if rapid enough, it will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's need
Ventricular tachycardia (V-Tach)
Acute coronary syndrome (ACS) is a blanket term that refers to:
Any time the heart may not be getting enough oxygen
Chest pain from the heart is typically described by the patient as a "crushing pain". It is also often described as what?
Dull; squeezing; heavy
Your 55-year-old male patient states that his pain seems to radiate from the chest. This sensation, when it is due to a heart problem, commonly radiates to the:
Arms and jaw
In addition to chest pain or discomfort, the patient with cardiac compromise will also complain of:
Dyspnea
Patient with heart problems may complain of:
Pain in the center of the chest; mild chest discomfort; difficulty breathing
Early in your assessment of the 56-year-old male who presents with chest pain, you take his radial pulse. This is a very important vital sign because, if the heart is beating too fast or too slow, the patient with cardiac compromise may also:
Lose consciousness
You are evaluating a 59-year-old female patient who you suspect may be exhibiting the signs and symptoms if an acute coronary syndrome. Her signs and symptoms may include what?
Difficulty breathing and abnormal pulse rate; sudden onset of sweating with nausea or vomiting; pain in the chest or upper abdomen
You are treating a 62-year-old male patient who is complaining of crushing substernal chest pain and shortness of breath. His pulse is fast, BP is high, and pulse oxygen is in the low 90s. The EMT management of the patient with a suspected acute coronary
Placing the patient in the position of comfort; administering high-concentration oxygen by nonrebreather mask; assisting the patient with nitroglycerin administration if medical direction authorizes
What is the typical position of comfort that you should consider using for "You are treating a 62-year-old male patient who is complaining of crushing substernal chest pain and shortness of breath. His pulse is fast, BP is high, and pulse oxygen is in the
Fowler
These coronary syndrome patients are candidates for immediate transport:
No history of cardiac problems; a history of cardiac problems, who does not have nitroglycerin; a systolic blood pressure of less than 90-100
You should consider using nitroglycerin when the 65-year-old female patient:
Has her own nitroglycerin and has crushing chest pain
Which of the following is the BEST description of the role of medical direction in the treatment of a 55-year-old male who you suspect is having an acute coronary syndrome?
Authorizing the EMT to assist the patient in taking his prescribed nitroglycerin
A patient is complaining of chest pain. In order for the EMT to administer nitroglycerin, what conditions must be met?
Medical direction should authorize its administration; the patient's physician should have prescribed the mediation; the patient's blood pressure is greater than 100 systolic
The maximum number of doses nitroglycerin routinely given by the EMT with medical control permission, or taken by the patient at the advice of his physician is:
Three
If the patient's blood pressure falls below 100 systolic after the EMT has administered nitroglycerin, the EMT should:
Treat for shock and transport promptly
Nitroglycerin is contraindicated for the patient who has:
An obvious head injury and altered mental status
You are treating a 62-year-old male patient who has a chief complaint of chest pain. You are considering administering aspirin to the patient. Of the following consideration, which would NOT be pertinent to administering the medicine?
The patient has taken Viagra
You have administered aspirin (ASA) to the patient with chest pain per your protocols. The patient has his own prescribed nitro and a stable BP, so you decide to assist him in administering one of his nitro pills. After administering the nitroglycerin, it
Reassess the vital signs
The patient you are assessing who has been complaining of chest pain asks you what causes most cardiovascular emergencies. You explain that these conditions are caused, directly or indirectly, by what?
Changes in the inner walls of arteries; problems with the heart's electrical function; problems with the heart's mechanical function
When the body is subjected to exertion or stress, the heart rate will normally:
Increase
A condition that is often the result of the build-up of fatty deposits on the inner walls of the arteries is called:
Coronary artery disease
Factors that put a person at risk for developing acute coronary syndromes include:
Age; cigarette smoking; obesity
The reason an emergency occurs in most cardiac-related emergencies is due to:
Reduced blood flow to the myocardium
Angina pectoris means, literally:
A pain in the chest
Why is nitroglycerin administered to the patient with chest pain?
It dilates the blood vessels and deceases the work of the heart
A condition in which a portion of the myocardium dies as a result of oxygen starvation is known as:
Acute myocardial infarction
A cardiac arrest that occurs within 2 hours of the onset of cardiac symptoms is referred to as:
Sudden death
Unfortunately, nearly how many of the patients who experience a cardiac arrest within 2 hours of the onset of symptoms have no previous history of cardiac problems
25 %
Your 70-year-old female patient has a cardiovascular disorder that stems from weakened sections in the arterial walls. These weak spots begin to dilate to form a condition that is known as a(n):
Aneurysm
You are treating a 55-year-old male patient who has a history of three past MIs and angina. Due to his difficulty breathing and normally sedentary lifestyle, you suspect he may be experiencing congestive heart failure (CHF). CHF is a(n):
Condition in which excessive fluids build up in the lungs and/or other organs
Damage to the left ventricle and blood backing up into the lungs usually presents in the form of:
Pulmonary edema
The five elements of the chain of survival include early access and what?
CPR; defibrillation; and advanced care
You are treating a 59-year-old male patient whose wife called EMS because he had difficulty breathing and was acting anxious and confused. He is diaphoretic and cyanotic, and his vitals are rapid respirations, tachycardia and hypertension. He has swollen
He has CHF as well as right heart failure
You just treated a 17-year-old male who was struck in the chest with a baseball and went into sudden cardiac arrest. Your Medical Director says that you did a good job on the call but this was not the typical cardiac arrest victim. Who is the typical card
A male in his sixties
The most common witness to a cardiac arrest is a:
Female in her sixties
The single most important factor in determining survival from cardiac arrest is:
Early defibrillation
If the response time from the moment a call is received to arrival of the defibrillator is longer than how many minutes, virtually no one survives a cardiac arrest.
Eight minutes
When treating a cardiac arrest patient and there is no ALS unit in the community, the EMT should:
Package quickly, provide high-quality CPR, and transport to the closest hospital
To manage a patient in cardiac arrest, the EMT should provide high-quality CPR as well as:
Use a bag-valve mask device with oxygen; use an automated external defibrillator; request advanced life support backup (when available)
Which of the following steps is NOT necessary for the EMT to take when using a fully automated defibrillator?
Press the button to deliver the shock
The primary electrical disturbance resulting in cardiac arrest is:
Ventricular fibrillation
The shockable rhythms are:
Ventricular fibrillation; pulseless ventricular tachycardia; ventricular tachycardia
A nonshockable rhythm that can be the result of a terminally sick heart or severe blood loss is called:
Pulseless electrical activity
A nonshockable rhythm that is commonly called flatline is named:
Asystole
When the AED is analyzing the patient's heart rhythm, the EMT must:
Avoid touching the patient
The AED should routinely be used on:
Adults, infants and children in cardiac arrest
The AED pads are first attached to the cables. Then the pad attached to what cable goes on which side of lower ribs?
Red; left - (Smoke over Fire, Clouds over Grass)
After the first shock, the patient seems to move and you assess a strong carotid pulse. The patient is also breathing adequately. You should then do what and transport.
Give high-concentration oxygen via nonrebreather mask
After three shocks, the EMT should what, unless local protocol says otherwise.
Being to transport the patient with high-quality CPR
Which of the following is NOT a general principal of AED use?
Hook up oxygen before beginning defibriation
Of the cardiac arrest patients, which patient can be defibrillated immediately?
Patient with an implanted defibrillator
If it is necessary to remove a nitroglycerin patch to defibrillate a patient, you should:
Wear gloves
If a 55-year-old patient who has a cardiac pacemaker needs to be defibrillated, the EMT should:
Place the pad several inches away from the pacemaker battery
The five elements (links) in the chain of survival:
Early...
-Access
-CPR
- Defibrillation
- Advanced Care
- Post-resuscitation care