ABCD of Emergency Cardiovascular Care (Chapter 1)

Question 1

Nonmodifiable (fixed) risk factors for cardiovascular disease (CVD)

Answer 1

Age, gender, heredity, race

Question 2

Modifiable risk factors for CVD

Answer 2

Diabetes, elevated serum cholesterol levels, high BP, metabolic syndrome, obesity, physical inactivity, tobacco use

Question 3

Contributing risk factors for CVD

Answer 3

Alcohol, inflammatory markers, psychosocial factors, stress

Question 4

What does contributing risk factors mean?

Answer 4

Thought to increase risk, but exact role not yet known

Question 5

Sudden loss of effective blood flow that is caused by cardiac and/or peripheral vascular factors

Answer 5

Cardiovascular collapse

Question 6

Absence of cardiac mechanical activity

Answer 6

Cardiopulmonary (cardiac) arrest

Question 7

How do you confirm cardiac arrest

Answer 7

Absence of pulse, unresponsiveness, apnea or agonal, gasping breathing

Question 8

ECG shows a wide, regular QRS complex at a rate faster than 120 beats/min

Answer 8

Pulseless vtach

Question 9

Irregular chaotic deflections that vary in shape and height on ECG but no coordinated ventricular contraction

Answer 9

Vfib

Question 10

No cardiac electrical activity present

Answer 10

Asystole

Question 11

Electrical activity is present on ECG, but central pulses are absent

Answer 11

Pulseless electrical activity (PEA)

Question 12

Shockable rhythms

Answer 12

Vfib and Vtach

Question 13

Nonshockable rhythms

Answer 13

Asystole, PEA

Question 14

Links in the chain of survival

Answer 14

Early recognition and activation
Early CPR
Early defibrillation
Effective advanced life support
Integration of post-cardiac arrest care

Question 15

Most common S&S of MI

Answer 15

Chest pain or discomfort, pain or discomfort in the arms or shoulder, SOB

Question 16

Components of basic life support

Answer 16

Recognize signs of cardiac arrest, MI, stroke, foreign body airway obstruction (FBAO)
Relief of FBAO
CPR
Defibrillating with an AED

Question 17

Two components of the driving pressure through coronary arteries

Answer 17

Aortic BP and RA pressure; remember, veins drain into the RA so if the pressure is high in the RA, blood flow through the coronary arteries will decrease

Question 18

Determinants of vascular resistance in the coronary vessels

Answer 18

BV radius and degree of external pressure caused by myocardial contraction and relaxation

Question 19

When does most coronary blood flow occur

Answer 19

Diastole

Question 20

Blood pressure range maintained by autoregulation of coronary vessels under normal conditions

Answer 20

60-180 mm Hg

Question 21

Systole and diastole correspond to what during CPR

Answer 21

Systole when you are compressing the chest and diastole is when you release

Question 22

2 most crucial components to neurologically normal survival during cardiac arrest.

Answer 22

Maintenance of coronary and cerebral perfusion

Question 23

Limiting factor in delivery of O2 to tissues in cardiac arrest

Answer 23

Blood flow; arterial oxygen content is normally adequate to perfuse tissues

Question 24

After you determine that CPR is indicated, what should be the initial action performed?

Answer 24

Chest compressions (yes, even before opening airway or giving ventilations)

This enables the delivery of O2 that is already present in lungs to brain and heart

Question 25

CO compared to normal during CPR

Answer 25

25-33%

Question 26

How far should you push in a victims chest during CPR

Answer 26

2 inches in children and adults, 1.5 inches in infants

Question 27

What is the appropriate compression rate for CPR

Answer 27

100 compression/min

Question 28

Likelihood of successful resuscitation during cardiac arrest determined by what

Answer 28

Speed with which CPR and defib are performed

Question 29

Did placing an AED in homes improve overall survival?

Answer 29

Not really

Question 30

How long should you check for a pulse?

Answer 30

10 seconds

Question 31

Where should you check for a pulse in an infant

Answer 31

Brachial a.

Question 32

Where should you check for a pulse in a child

Answer 32

Carotid or femoral aa.

Question 33

Where should you check for a pulse in an adult

Answer 33

Carotids

Question 34

Compression:ventilation ratio for infants and children if one rescuer

Answer 34

30:2

Question 35

Compression:ventilation ratio for infants and children if 2 rescuers

Answer 35

15:2

Question 36

Compression:ventilation ratio for adults

Answer 36

30:2

Question 37

What to do if an infant is choking

Answer 37

5 back blows (slaps) followed by 5 chest thrusts in rapid sequence

Question 38

3 phases of cardiac arrest due to vfib

Answer 38

``` Phase 1 (electrical phase): Onset-5 minutes Phase 2 (circulatory phase or hemodynamic phase):5-15 minutes Phase 3 (metabolic phase): 5 minutes and beyod ```

Question 39

During which phase of cardiac arrest due to vfib is defibrillation most important

Answer 39

Phase 1 (electrical phase)

Question 40

High quality CPR compressions are most important during which phase of cardiac arrest due to vfib

Answer 40

Phase 2 (circulatory phase)

Question 41

When are low-quality CPR compressions most important?

Answer 41

When you want the patient to die

Question 42

What can you do to improve perfusion pressures during vfib cardiac arrest

Answer 42

Give vasopressors

Question 43

What can excessive ventilation in vfib cardiac arrest do?

Answer 43

Increase the intrathoracic pressure and decrease venous return to the heart

Question 44

What should you do to comatose survivors of cardiac arrest?

Answer 44

Cryogenic stasis (therapeutic hypothermia)

Question 45

Therapeutic hypothermia important during which phase?

Answer 45

Metabolic (Phase 3)

Question 46

Cardiocerebral resuscitation (CCR) consists of what

Answer 46

High quality, minimally interrupted chest compressions, delayed active ventilation, early epinephrine administration

Question 47

Ratio of chest compressions to shock in CCR

Answer 47

200:1

Question 48

When do you intubate the pt in CCR

Answer 48

After 3 cycles of chest compressions

Question 49

What is the best CCR song

Answer 49

Fortunate Son

Question 50

ABC's of general impression

Answer 50

Appearance, Breathing, Circulation

Question 51

Rapid hands-on assessment that takes less than 60 seconds

Answer 51

Primary survey

Question 52

ABCDE's of primary survey

Answer 52

``` Assess responsiveness Airway Breathing Circulation Defib and Disability Exposure ```

Question 53

AVPU; what does it stand for and what does it assess

Answer 53

Alert, Verbal stimuli (responds to), Painful stimuli (responds to), Unresponsive

Question 54

During what part of the primary survey would you obtain a Glasgow score

Answer 54

Defib and disability

Question 55

Use what technique to open the airway

Answer 55

Head tilt-chin lift

Question 56

Use what technique to open the airway if trauma is suspected

Answer 56

Jaw-thrust

Question 57

When should you repeat the primary survey

Answer 57

``` Sudden change in pt condition Interventions don't appear to be working Vital signs are unstable Before any procedures Change in rhythm on cardiac monitor ```

Question 58

ABCDEF's of 2ndary survey

Answer 58

``` Obtain vital signs, SAMPLE history Reassess Airway Reassess Breathing Reassess Circulation Differential diagnosis/Diagnostic procedures Evaluate interventions, pain management Facilitate family presence ```