Cardiac Emergencies ch 20

The chamber of the heart that receives de-oxygenated blood

Right atrium. (Limmer & O'keefe pg 112)

The vessel that brings de-oxygenated blood to the heart

vena cava. (Limmer & O'keefe pg 112)

Area of the heart that receives oxygenated blood

Left atrium. (Limmer & O'keefe pg 112)

Carry de-oxygenated blood away from the heart

Pulmonary arteries. (Limmer & O'keefe pg 112)

Carry oxygenated blood from the lungs to the heart

Pulmonary veins. (Limmer & O'keefe pg 112)

When it contracts, it pumps oxygenated blood into the aorta,

Left ventricle. (Limmer & O'keefe pg 112)

Prevents blood in the right ventricle from backing up

Tricuspid valve. (Limmer & O'keefe pg 112)

prevents blood from backing up into the right ventricle

Pulmonary valve. (Limmer & O'keefe pg 112)

Prevents blood in the left ventricle form backing up

Bicuspid/mitral valve. (Limmer & O'keefe pg 112)

Prevents blood in the aorta from backing up

Aortic valve. (Limmer & O'keefe pg 112)

Vessels that carry blood away from the heart

Arteries. (Limmer & O'keefe pg 113)

Vessels that carry blood towards the heart

Veins. (Limmer & O'keefe pg 113)

Vessels that branch off the aorta and feed the heart

Coronary arteries. (Limmer & O'keefe pg 113)

The muscle of the heart

Myocardium. (Limmer & O'keefe pg 113)

A system of specialized muscle tissues that conducts electrical impulses that stimulate the heart to beat

Cardiac conduction system. (Limmer & O'keefe pg 113)

The pacemaker of the heart

Sinoatrial (SA) node. (Limmer & O'keefe pg 114)

The largest artery in the body, splits into the iliac arteries at the level of the navel

Aorta. (Limmer & O'keefe pg 114)

The only artery that carries deoxygenated blood

Pulmonary artery. (Limmer & O'keefe pg 114)

Tiny vessels found throughout the body where gases nutrients and waste are exchanged

Capillaries. (Limmer & O'keefe pg 115)

The smaller kind of a vein

Venules. (Limmer & O'keefe pg 115)

Returns blood to the heart from the head and upper body

Superior vena cava. (Limmer & O'keefe pg 115)

The pressure caused by blood exerting force against the walls of blood vessels.

Blood pressure. (Limmer & O'keefe pg 117)

The pressure created when the left ventricle contracts

Systolic blood pressure. (Limmer & O'keefe pg )

When the left ventricle is relaxed and refilling the pressure remaining in the arteries is

Diastolic blood pressure. (Limmer & O'keefe pg 117)

Shortness of breath; labored or difficult breathing

Dyspnea. (Limmer & O'keefe pg 471)

A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle.

Acute coronary syndrome (ACS) or cardiac compromise. (Limmer & O'keefe pg 471)

The pain, pressure or discomfort associated with cardiac compromise commonly radiates ...

Along the arms, down to the upper abdomen, or to the jaw. (Limmer & O'keefe pg 471)

When the heart rate is slow, usually below 60

Bradycardia. (Limmer & O'keefe pg 472)

When the heart rate is fast, above 100 beats per minute

Tachycardia. (Limmer & O'keefe pg 472)

After performing the primary assessment of a patient with cardiac compromise, you should

Perform a history and physical exam. (Limmer & O'keefe pg 472)

Pain, pressure, or discomfort in the chest or upper abdomen (epigastrium), difficulty breathing, palpitations, sudden onset of sweating and nausea or vomiting, anxiety, (feeling of impending doom) irritability, unusual generalized weakness, abnormal pulse

Acute Coronary Syndrome (ACS). (Limmer & O'keefe pg 472)

How should you position a patient with ACS

Position of comfort, typically sitting up. (Limmer & O'keefe pg 472)

If patient has - no history of cardiac problems - or - a history of cardiac problems but no nitroglycerin, - or - a systolic blood pressure below 90 to 100 you should....

Transport immediately. (Limmer & O'keefe pg 475)

The treatment where a balloon is inserted into the coronary artery to push open the artery where the clot is located is called

Percutaneous coronary intervention (PCI). (Limmer & O'keefe pg 475)

To assist a patient on taking his nitroglycerin the blood pressure has to be

Systolic greater than 90 to 100. (Limmer & O'keefe pg 475)

Your cardiac patient with chest pain should not take nitroglycerine if he took Viagra or similar drug within

48 to 72 hours. (Limmer & O'keefe pg 475)

What is the maximum dosage of nitroglycerine and how long should you wait in between each dose

Maximum 3 doses spaced 5 minutes. (Limmer & O'keefe pg 475)

What is the indication to administer aspirin

Complains of chest pain. (Limmer & O'keefe pg 475)

Trade names for nitroglycerin

Nitrostat, Nitrolingual. (Limmer & O'keefe pg 476)

A contraindication for nitroglycerin in trauma

Head injury. (Limmer & O'keefe pg 476)

One dosage of nitroglycerine equals

1 pill or 1 spray 0.4 mg given sublingual. (Limmer & O'keefe pg 476)

Actions of nitroglycerine include

Relaxes blood vessels. (Limmer & O'keefe pg 476)

Side effects of nitroglycerine include

Hypotension, headache, pulse rate changes. (Limmer & O'keefe pg 476)

The dosage and route of administration of aspirin is

162 to 324 mg (2 to 4 81 mg tablets of chewable baby aspirin). (Limmer & O'keefe pg 477)

Diseases that affect the arteries of the heart

Coronary artery disease (CAD). (Limmer & O'keefe pg 478)

A clot formed of blood and plaque attached to the inner wall of an artery or vein

Thrombus. (Limmer & O'keefe pg 478)

Blockage, as of an artery by fatty deposits

Occlusion. (Limmer & O'keefe pg 478)

Blockage of a vessel by a clot or foreign material brought to the site by the blood current

Embolism. (Limmer & O'keefe pg 478)

The dilation, or ballooning, of a weakened section of the wall of an artery

Aneurysm. (Limmer & O'keefe pg 478)

The result of the buildup of fatty deposits on the inner walls of arteries causing a narrowing of the inner vessel diameter, and of hardening of the arteries is called

Coronary Artery Disease (CAD). (Limmer & O'keefe pg 478)

The two most common sites of aneurysms that you will encounter in emergency situations are

Aorta and the brain. (Limmer & O'keefe pg 479)

A disturbance in heart rate and rhythm, include bradycardia, tachycardia, and rhythms without a pulse including ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, and asystole.

Dysrhythmias. (Limmer & O'keefe pg 479)

Pain in the chest, occurring when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough oxygen

Angina pectoris. (Limmer & O'keefe pg 479)

The inability of an area of the myocardium to pump and contract is considered

Mechanical malfunction of the heart. (Limmer & O'keefe pg 479)

A 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). (Limmer & O'keefe pg 480)

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. (Limmer & O'keefe pg 480)

The pain of an angina attack usually comes on after _____ and diminish when _____

Stress or exertion, Patient stops activity. (Limmer & O'keefe pg 480)

Acute myocardial infarction is often called---by layperson

Heart attack. (Limmer & O'keefe pg 480)

A patient with an AMI could receive Fibrinolitics medications to help dissolve the clot if transported

Early to appropriate facility. (Limmer & O'keefe pg 480)

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). (Limmer & O'keefe pg 481)

Swelling resulting from a buildup of fluid in the tissues

Edema. (Limmer & O'keefe pg 481)

Accumulation of fluid in the lungs

Pulmonary edema. (Limmer & O'keefe pg 481)

Accumulation of fluid in the feet or ankles

Pedal edema. (Limmer & O'keefe pg 481)

Causes fluid back up, can be brought on by diseased heart valves, hypertension, or some form of obstructive pulmonary disease such as emphysema. Often a complication of AMI

Congestive heart failure (CHF). (Limmer & O'keefe pg 481)

When an area of the left ventricle is damaged from infarction, blood backs up into

Pulmonary circulation and the lungs. (Limmer & O'keefe pg 481)

When you auscultate the patient with pulmonary edema you may hear (this sounds) caused by fluid

Crackles (rales). (Limmer & O'keefe pg 481)

When patient with pulmonary edema coughs, you may noticed

Blood-tinged sputum. (Limmer & O'keefe pg 481)

Left heart failure, if untreated commonly causes

Right heart failure. (Limmer & O'keefe pg 481)

Signs caused by fluid back up due to right heart failure are

Pedal edema or sacral edema in bedridden pt. (Limmer & O'keefe pg 481)

Tachycardia, dyspnea, normal or elevated blood pressure, cyanosis, diaphoresis, pulmonary edema, anxiety, pedal edema, engorged, pulsating neck veins, enlarged liver and spleen with abdominal distention are signs and symptoms of

Congestive Heart Failure (CHF). (Limmer & O'keefe pg 481)

To help decrease the amount of fluid in their body, patients with CHF take-------medications

Diuretics (water pills). (Limmer & O'keefe pg 481)

The 4th link in the adult chain of survival is

Advanced life support. (Limmer & O'keefe pg 483)

The 3th link in the adult chain of survival is

Early defibrillation. (Limmer & O'keefe pg 483)

The 2th link in the adult chain of survival is

Early CPR. (Limmer & O'keefe pg 483)

The first link in the chain of survival is

Immediate recognition and activation. (Limmer & O'keefe pg 483)

The single most important factor in determining survival from cardiac arrest is

Early defibrillation. (Limmer & O'keefe pg 484)

The maximum response time for effective defibrillation is

8 minutes. (Limmer & O'keefe pg 484)

The two types of automated defibrillators are

Semiautomatic and fully automatic. (Limmer & O'keefe pg 486)

The type of defibrillator that advises the operator to press a button that will cause the machine to deliver a shock is

Semiautomatic defibrillator. (Limmer & O'keefe pg 486)

the type of defibrillator that delivers the shock automatically

Fully automated. (Limmer & O'keefe pg 486)

The type of defibrillator that delivers the shock from the negative pad to the positive pad

Monophasic. (Limmer & O'keefe pg 486)

This type of machine delivers the shock in one direction and then the other, and measures resistance between the two pads and adjusts the energy accordingly.

Biphasic defibrillator. (Limmer & O'keefe pg 486)

When AEDs deliver shocks inappropriately it is usually caused by

Human error. (Limmer & O'keefe pg 486)

The most common conditions that result in cardiac arrest are shockable rhythms:

Ventricular fibrillation, Ventricular tachycardia. (Limmer & O'keefe pg 487)

The primary electric disturbance resulting in cardiac arrest is

Ventricular fibrillation. (Limmer & O'keefe pg 487)

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). (Limmer & O'keefe pg 487)

A condition in which the heart has ceased generating electrical impulses

Asystole. (Limmer & O'keefe pg 487)

Nonshockable rhythms include:

Pulseless electrical activity (PEA) and Asystole. (Limmer & O'keefe pg 487)

At what point should you transport the patient in cardiac arrest with ongoing CPR and defibrillation

After 3 shocks. (Limmer & O'keefe pg 488)

Whenever a no shock indicate message appears you should

Begin 2 minutes (5 cycles) of CPR. (Limmer & O'keefe pg 488)

After three consecutive no shock indicated messages separated by 2 minutes of CPR, you should...

Transport. (Limmer & O'keefe pg 488)

When should you interrupt compressions during CPR

To analyze, to shock only as necessary. (Limmer & O'keefe pg 489)

The dose of electricity delivered by a monophasic unit is

360 joules (J). (Limmer & O'keefe pg 492)

Biphasic defibrillators use energy levels

Between 120 to 200 J. (Limmer & O'keefe pg 492)

Not breathing

Apnea. (Limmer & O'keefe pg 493)

Irregular, gasping breaths that precede apnea and death

Agonal breathing. (Limmer & O'keefe pg 493)

The sequence of treatment for patients in cardiac arrest is

CAB. (Limmer & O'keefe pg 493)

if you don't have pediatric pads for a child or infant in cardiac arrest, you should

Use adult pads may have to put in front and one in the back. (Limmer & O'keefe pg 494)

Before delivering a shock, you should

Ensure no one is touching the patient. (Limmer & O'keefe pg 494)

When the AED gives a "No shock" message you should

Resume CPR. (Limmer & O'keefe pg 494)

You should check your equipment when you start the shift including the AED's.....

Batteries. (Limmer & O'keefe pg 495)

When providing CPR with an advanced airway in place, the compressor, compresses at a rate of at least 100 per minute without pausing for ventilations, the ventilator provides one ventilation at a rate of .... To....

8 to 10 per minute or every 8 seconds. (Limmer & O'keefe pg 496)

You are transporting an unconscious patient who has been resuscitated after CPR, you are providing artificial ventilations, you should

Check the pulse frequently. (Limmer & O'keefe pg 496)

While you are transporting a patient who becomes unconscious, pulseless, and apneic you, should

Stop the vehicle, start CPR, analyze the rhythm as soon as possible. (Limmer & O'keefe pg 497)

Patients who are severely hypothermic are usually ------ before defibrillation

Re-warmed. (Limmer & O'keefe pg 497)

A patient who needs defibrillation and is wet or if it's raining you should

Dry the patient's chest or move him out of the wet environment. (Limmer & O'keefe pg 498)

Using adhesive pads is convenient and prevents the passage of electrical current outside the chest from too little paddle pressure known as...

Arcing". (Limmer & O'keefe pg 498)

Cardiac arrest patients with cardiac pacemakers, implanted defibrillators or who had cardiac bypass surgery, should get

CPR and defibrillation as for any other patient. (Limmer & O'keefe pg 500)

The process methods to evaluate and improve your ability to resuscitate patients in cardiac arrest are part of

Quality improvement program. (Limmer & O'keefe pg 500)

Devices for mechanical CPR include

Thumper and the Auto-Pulse. (Limmer & O'keefe pg 500)

the effects of beta blockers in the heart are...

slows the heart and makes it beat less strtongly. (Limmer & O'keefe pg 481)