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CFD EMT Class > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

What are the 5 types of shock?

A

Cardiogenic, Hypovolemic, Anaphalactic, Septic and Neurogenic

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2
Q

What are the Shockable rhythms an AED recognizes?

A

Pulseless Ventricular tachycardia and Ventricular Fibrillation

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3
Q

What is ROSC?

A

Return Of Spontaneous Circulation- person regains a pulse

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4
Q

During Adult CPR what is the compression to ventilation rate?

A

30:2

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5
Q

During Child CPR what is the compression to ventilation rate?

A

15:2

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6
Q

During neonatal resuscitation what is the preferred technique for compressions due to higher blood pressure and coronary perfusion with less rescuer fatigue

A

The 2-thumb encircling technique

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7
Q

What is the compression to ventilation rate for neonatal resuscitation?

A

3:1- Rationale: the compromise of gas exchange is nearly always the primary cause

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8
Q

What is the difference between a Thrombus and an Embolus?

A

A Thrombus is a fibrinous clot formed in and obstructs a blood vessel; an embolus is a fibrinous clot that forms elsewhere in the body and lodges in a vessel

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9
Q

An accumulation of blood in the sac around the heart is called?

A

Pericardial Tamponade

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10
Q

After you deliver the first shock with an AED, the patient is still pulseless, what should you do next?

A

Perform 2 minutes or 5 cycles of CPR

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11
Q

What are the Shockable rhythms for the AED?

A

Ventricular tachycardia and Ventricular Fibrillation

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12
Q

The 2 types of rhythms that can be shocked by the AED are Pulseless Ventricular Tachycardia and Atrial Fibrillation, True or False?

A

False- They are Pulseless ventricular tachycardia and Ventricular Fibrillation

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13
Q

What does the pneumonic OPQRST stand for?

A

Onset, Provokes, Quality, Radiation, Severity, Time

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14
Q

S/S 64 y.o. c/o trouble breathing, chest pain and congestion. lung sounds crackles bilateral. What is a probable cause?

A

Left ventricular failure-
Rationale these are signs of possible failure of the left ventricle. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs.

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15
Q

What heart rate is considered bradycardic?

A

Heart rate of less than 60 BPM

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16
Q

Which is the best answer for a man down in cardiac arrest.

  • Turn on AED, attach AED, check pulse and initiate analysis
  • BSI, Check pulse, begin compressions, open airway
  • BSI, check pulse, open airway, begin compressions
A

BSI, check pulse, begin compressions, open airway

Remember CAB instead of ABC

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17
Q

What is a side effect of nitroglycerin?

vessel constriction, pitting edema, vessel dilation, headache

A

Headache

Patients often get headaches from nitro. vessel dilation occurs but is not a side effect it is the desired effect.

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18
Q

What is the most common cause of cardiac arrest in children?

A

Respiratory Arrest

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19
Q

What does nitroglycerin do to the vasculature of the body?

A

Dilates them to ease the workload on the heart

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20
Q

Your patient is feeling sick to their stomach and is bradycardic. What type of response is this?
Sympathetic, Parasympathetic, vagal, emotional

A

Parasympathetic- it is responsible for slowing the heart rate and intestinal activity

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21
Q

During diastole what do the ventricles do?

A

Fill with blood- This is the relaxing phase of the heart

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22
Q

During Systole what are the ventricles doing?

A

Emptying of blood and sending to lungs via Right ventricle or to body via left ventricle by contraction

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23
Q

Blood moves from the left ventricle to the?

Lungs, Inferior vena cava, aortic arch, right atrium

A

Aortic arch–

Right ventricle to the lungs, Inferior vena cava to right atrium,

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24
Q

Resuscitation should not be started if obvious signs of death are present. These signs include all except?

Rigor Mortis, Putrefaction of body, absence of heart beat, Dependent lividity

A

Absence of heart beat.
Rigor mortis -limbs of corpse stiffen
Putrefaction of body- decomposing
Lividity- pooling of blood to lower areas of body also called livor mortis livor- (bluish) mortis- (of death)

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25
Q

The recommended field treatment for a patient with cardiac tamponade is?

Compressions at 100 per minute
transcutaneous pacing
rapid transport to ER
pericardiocentesis

A

Rapid transport to ER
Rationale: removing the fluid surrounding the heart with a needle is the definitive treatment but not recommended in the field and beyond EMT scope of practice. Rapid transport is the most appropriate treatment.

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26
Q

Shock caused by a severe infections is known as?

A

Sepsis

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27
Q

When a patient’s blood pressure drops to a dangerously low level after administration of nitro this is considered a?

A

Side Effect

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28
Q

What is CAD and which vessels of the body does it affect?

A

Coronary Artery disease and Arteries

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29
Q

In neonate resuscitation when do you initiate Bag valve resuscitation?

A

When the pulse rate is below 100 beats per minute.

30
Q

In neonate resuscitation when do you initiate Compressions?

A

When the pulse rate is below 60 Beats per minute

31
Q

You have a patient complaining of severe chest pain. The patient is diaphoretic and has a blood pressure of 96/55. You have the patients prescriptions including nitroglycerin. You contact medical control and are ordered to give the patient 1 nitro tablet sublingual. What would you do?
A. Repeat the blood pressure and give the nitro
B. Repeat the blood pressure and ask again what you should do
C. Give the nitro as instructed
D. Attach the AED then give the Nitro.

A

B. Repeat the blood pressure and ask again what you should do.

Rationale: A side effect of nitroglycerine is a drop in blood pressure which could cause the patient to go into cardiac arrest. By repeating the blood pressure this confirms your last pressure and allows medical control to hear your concern.

32
Q

You are called for an 86.y.o. male with a possible stroke he is c/o trouble putting on his coat and pants. What are the three things you would use to verify your suspicion of stroke?

A

Speech, Facial droop and arm drift.
Rationale:
Cincinnati stroke scale any one failure has a high likelihood of stroke.
Remember always check blood sugar as the symptoms mimic a stroke

33
Q 
What would you look for in an assessment of an emergency related to the nervous system?
A. Level of activity
B. Cardiogenic
C. Symmetry of response
D. Scene size up
A

C. Symmetry of response
Rationale: Symmetry of the sensory systems, motor systems, as well as mental status, and speech should be kept in mind when evaluating.
All part of Cincinnati Stroke scale

34
Q 
All are obvious signs of death, except?
A. Putrefaction
B. Livor Mortis
C. Cyanosis
D. Rigor Mortis
A

C. Cyanosis
Rationale:
Cyanosis is a lack of oxygen to the tissues
Livor mortis, is the discoloration of the skin due to the pooling of blood in the dependent parts of the body following death.
Rigor Mortis, is one of the recognizable signs of death, caused by chemical changes in the muscles post mortem, which cause the limbs of the corpse to stiffen.
Putrefaction, is the decomposition of organic matter

35
Q 
If a patient was feeling nauseated this would likely be a \_\_\_\_\_\_\_\_\_\_\_ response. If a person was tachycardic it would likely be a \_\_\_\_\_\_\_\_\_ response.
A. sympathetic, parasympathetic
B. parasympathetic, sympathetic
C. Fight or flight, nervous response
D. gag, parasympathetic
A

B. parasympathetic, sympathetic
Rationale:
Parasympathetic response is the stimulation of “rest-and-digest” activities that occur when the body is at rest.
Sympathetic response is the fight or flight response increase heart rate and vascular tone

36
Q 
When speaking with a patient, what pneumonic will help to find out past pertinent medical history?
A. DCAP-BTLS
B. SAMPLE
C. CHART
D. OPQRST
A

B. SAMPLE
Rationale:
DCAP-BTLS is used for soft tissue injuries
CHART is used to help with charting your run report
OPQRST is used for discerning the reason for the patients symptoms

37
Q

What is the desired effect of nitroglycerin?

A

Dilate the coronary arteries to improve blood flow and oxygen to the heart

38
Q 
During an assessment of a 78 year old woman you find her skin to be cool, moist, and pale. What would you suspect?
A. Hyperthermia
B. Hyperkalemia
C. Hyperglycemia
D. Hypoperfusion
A

D. Hypoperfusion
Rationale: Pale, Cool, skin suggests a lack of oxygen or hypoperfusion of the tissue
Hyperglycemia usually has flushed skin as well as hyperthermia

39
Q 
Tachypnea, tachycardia and normal blood pressure are signs of what stage of shock?
A. Compensated
B. Decompensated
C. Irreversible
D. Both A & B
A

A. Compensated
Rationale: In decompensated shock the blood pressure begins to drop along with altered level of consciousness
In irreversible shock the patient has a low heart rate, blood pressure and irregular breathing

40
Q

You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate?
A. Check for responsiveness, Assess for breathing, Check carotid pulse , put your gloves on
B. Question the bystanders, direct them to stop CPR , check for pulse and then attach the AED, Begin chest compressions
C. Turn on power to AED, open the patient’s airway, insert an adjunct and then analyze the rhythm while doing chest compressions
D. Check breathing and pulse simultaneously, patient is pulseless and apneic, immediately begin chest compressions

A

D. Check breathing and pulse simultaneously, patient is pulseless and apneic, immediately begin chest compressions
Rationale The best answer is D. Scene safe and PPE should be done first but not listed in that order answer A, Chest compressions begin before attaching the AED answer B, An AED cannot analyze the rhythm while performing chest compressions answer C

41
Q

What is the difference between Infarction of a cell and ischemia of a cell?

A

Infarction is tissue death (necrosis) caused by a reduction / stoppage in blood flow due to artery blockages, mechanical compression, rupture, or vasoconstriction
Ischemia is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue.

42
Q

All of the following are indications for Nitroglycerin except?
A. Systolic BP > 100mmHg
B. Patient has their own nitro
C. Chest pain
D. Patient has taken vardenafil (Levitra, Staxyn) in the last 48 hours.

A

D. Patient has taken vardenafil (Levitra, Staxyn) in the last 48 hours.
Rationale: Levitra, Cialis, Viagra along with pulmonary hypertension drugs are contraindications to taking nitro.
A BP of < 100 mmHg is a contraindication.

43
Q 
Upon assessment of a 55 year old male, you find his blood pressure to be 124/75 his pulse is 122 and his respirations are 18. It would be stated that this man is?
A. Tachycardic
B. Tachypneic
C. Hypotensive
D. Hypertensive
A

A. Tachycardic
Rationale:
Tachypnea is indicated by a breathing rate greater than 20 breaths per minute.
Hypotension is low blood pressure Hypertension is high blood pressure which is in normal limits

44
Q 
You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate?
A. An air embolism
B. Left ventricular failure
C. Right ventricular failure
D. Tension pneumothorax
A

B. Left ventricular failure
Rationale: Inability of the heart to pump blood to the body via the left ventricle so it backs up into the lungs. If it was right side failure the blood would back up into the body i.e. The feet and legs with pedal edema

45
Q

A 73 year old female was in her backyard gardening when she collapsed to the ground. Her husband told 911 that “she is breathing very fast and will not talk to me.” You arrive to find the woman lying on her side in the grass. She is breathing at 7 breaths per minute and her pulse is irregular and very thready. Her lungs also present with crackles upon auscultation As you are taking a blood pressure (88/66) the husband tells you that the woman has been having jaw pain and some weakness for approximately 3 days. What is the most likely cause of this woman’s condition and how would you treat her?
A. Hypoperfusion, High flow O2, and transport in Fowler’s position
B. Cardiac arrest, Treat for shock, and rapid transport
C. Septic shock, Transport in a position of comfort with high flow O2 via NRB
D. Cardiogenic shock, Assist ventilations, and transport

A

D. Cardiogenic shock, Assist ventilations, and transport
Rationale: This woman is likely experiencing pump failure and she is Hypoperfusing. Her poor respiration rate necessitates assisted ventilations. Transporting in the Fowler’s would not be appropriate as it would increase the work load on the heart. Gravity increases the difficulty of pumping blood to the brain when the head and chest are elevated.

46
Q 
A Transient Ischemic Attack (TIA) will usually stop after?
A. 30-60 minutes
B. 1-2 days
C. 10-15 minutes
D. 8 Hours
A

C. 10-15 minutes

Rationale: Transient Ischemic Attack (TIA) is a blockage of vessels in the brain that usually subsides after a period of 10 to 15 minutes. However, if the patient’s symptoms persist longer than 15 minutes, continue to treat the patient as if they are having a CVA (Cerebrovascular Accident). If resolution takes place within the 10-15 minutes, then chances are they have had a TIA. The final diagnosis of TIA is made if the symptoms resolve within 24 hours and is determined by a physician.

47
Q

A 57 year old woman is complaining of chest pain. Her blood pressure is 109/88 and her respirations are at 22 per minute. What condition does the patient’s blood pressure indicate?

A. Paradoxical pressure
B. Low Pulse pressure
C. Systolic trans cardiac ischemia
D. Biot’s sign

A

B. Low Pulse pressure

Rationale: A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. In this question it is about 20% of the systolic value. The pulse pressure is the difference between the systolic and diastolic measurements of the blood pressure. 109 systolic - 88 diastolic = 21 mmHg. In trauma a low pulse pressure suggests significant blood loss. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade.

48
Q 
The single largest cause of death for Americans is/are?
A. Chronic obstructive pulmonary disease
B. Cancer
C. Coronary heart disease
D. Traumatic injuries
A

C. Coronary heart disease

49
Q 
You are treating a 49-year-old patient who complains of intense pain between his shoulder blades radiating to his lower back. Pain began 10 minutes prior to your arrival while he was eating and has been constant. he rates the pain as 10 out of 10. Pain is described as a sharp tearing pain. He has no significant past medical history. Blood pressure is 130/76 mm Hg in the right arm and 78/48 in the left arm. Radial pulse in his right arm is 98 beats per minute and regular, and a respiratory rate of 20 and non labored. What condition would you suspect?
A. Myocardial infarction
B. Angina Pectoris
C. Congestive heart failure
D. Aortic dissection
A

D. Aortic dissection

Rationale:
An MI, Angina or CHF normally do not present with pain between the shoulders or interarm blood pressure differences.

50
Q 
What is cardiac compromise?
A. Angina
B. Heart Attack
C. A period when the heart stops
D. Any type of heart problem
A

D. Any type of heart problem

51
Q 
An AED is used to treat patients in:
A. Ventricular Fibrillation
B. Asystole
C. Pulseless Electrical activity
D. Bradycardia
A

A. Ventricular Fibrillation

Rationale: When the heart is in VFib (ventricular fibrillation) the hearts electrical activity becomes disordered. The shock resets the electrical pathways.

52
Q 
What is the normal heart rate for a newborn ( 0- 3 months)?
A. 140-160
B. 120-140
C. 100-120
D. 80-100
A

A. 140-160

Rationale: When you deliver a baby if the heart rate is below 100 you begin assisting respirations with a BVM (bag valve mask) if below 60 cardiac compressions begin

53
Q 
The two flap valve on the left side of the heart is called?
A. Bivalve
B. Aortic valve
C. Bicuspid valve
D. Pulmonary valve
A

C. Bicuspid valve

Rationale: The two flap valve is called the mitral valve, also known as the bicuspid valve. The three flap valve located in the right atrium is the Tricuspid valve.

54
Q 
The three flap valve in the right side of the heart is called?
A. tri-valve
B. Pulmonary valve
C. Tricuspid valve
D. Bicuspid valve
A

C. Tricuspid valve

Rationale: The tricuspid valve, or right atrioventricular valve is between the right atrium and the right ventricle.
The two flap valve on the left side of the heart is called the bicuspid valve.

55
Q 
The cardiovascular system is made up of three major components; which of the following is not a component of the cardiovascular system?
A. Heart
B. Myoglobin
C. Blood vessels
D. Blood
A

B. Myoglobin

Rationale: Myoglobin is a protein found in the muscle tissue not part of the cardiovascular system

56
Q 
Name the layers of the heart from the outside in?
A. pericardium, endocardium, epicardium
B. myocardium, epicardium, endocardium
C. epicardium, myocardium, endocardium
D. endocardium, myocardium, epicardium
A

C. epicardium, myocardium, endocardium

Rationale: the prefix “epi” means above on or over.
Myocardium is the middle layer “myo” means muscle.
the prefix “endo” means inward or within

57
Q

Which of the following complaints is often used to describe chest pain resulting from a cardiac event?
A. Sharp stabbing pain which can be located with one finger
B. A ton of bricks on my chest
C. A tickling feeling
D. Sharp tearing pain between my shoulder blades

A

B. A ton of bricks on my chest

Rationale: Sharp stabbing pain usually all over can’t pinpoint, sharp tearing pain is most often an aortic dissection

58
Q 
What artery carries deoxygenated blood and which vein carries oxygenated blood?
A. Pulmonary, Aorta
B. Pulmonary, inferior vena cava
C. Pulmonary, Pulmonary
D. Aorta, Superior vena cava
A

C. Pulmonary, Pulmonary

Rationale: Pulmonary artery carries deoxygenated blood from the right ventricle of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left atrium of the heart

59
Q 
All of the following are blood components responsible for clot formation except?
A. Platelets
B. Plaque
C. Thrombin
D. Fibrin
A

B. Plaque

Rationale:
Plaque is formed with fat, calcium and other substances combined with cholesterol.

60
Q

Where does blood travel when it leaves the right ventricle of the heart?
A. To the pulmonary veins, then to the lungs
B. To the Aorta, then out to the body
C. To the vena cava then to the left atrium
D. To the pulmonary arteries, then to the lungs

A

D. To the pulmonary arteries, then to the lungs
Rationale:
Deoxygenated blood from the body enters the right atrium then to the right ventricle then through the pulmonary artery to the lungs.

61
Q 
Research shows that most cases of inappropriate delivered shocks from the AED have been caused by?
A. Mechanical interference
B. Improperly charged batteries
C. Human Error
D. Malfunctioning defibrillator pads
A

C. Human Error

Rationale:
Almost all documented cases of inappropriate shocks have been attributed to human error, such as using the AED in a moving vehicle or operating it on a patient with a pulse.

62
Q

Which statement about the assessment of a patient with cardiac compromise is correct?
A. You cannot determine the degree of cardiac damage in the field
B. You should not ask patients about nitroglycerin or medications
C. The purpose of the focused history is to determine whether to use the AED
D. Patients usually describe cardiac pain as localized and moderately severe

A

A. You cannot determine the degree of cardiac damage in the field

Rationale: It is impossible to determine the actual degree of tissue damage in the field, so the purpose of the focused assessment is to gather information for the receiving facility. You should always ask about medications; it is the M of SAMPLE. The focused history has nothing to do with AED use. Cardiac pain has all sorts of presentations, making it difficult to differentiate from other conditions.

63
Q

The Left Atrium:
A. receives blood from the arteries of the body
B. receives blood from the vena cava
C. receives blood from the pulmonary vein
D. pumps blood out to the body through the Aorta

A

C. receives blood from the pulmonary vein

Rationale: The right atrium receives blood from the vena cava, the right ventricle pumps blood into the pulmonary artery and the left ventricle pumps blood to the Aorta to the body

64
Q 
You should apply the AED pads to your patient when he?
A. complains of chest pain
B. Is unconscious and breathing
C. Is pulseless and apneic
D. is having a seizure
A

C. Is pulseless and apneic

Rationale: An AED should be attached only if a patient has no pulse and is not breathing

65
Q 
What are the two lower chambers of the heart called?
A. Ventricles
B. Atriums
C. Arterioles
D. Venules
A

A. Ventricles

Rationale: the upper chambers of the heart are the atrium, arterioles and venules are the smaller arteries and veins

66
Q 
You are dispatched to a 65-year old male who is complaining of severe chest pain, and has a history of cardiac problems. What is the primary role of medical direction in this scenario? 
A. Medical direction serves no purpose
B. Give authorization for interventions
C. Talk to and calm the patient
D. Talk to the family and calm them
A

B. Give authorization for interventions

Rationale: If the patient needs assistance with medications medical direction can give authorization

67
Q 
You are dispatched to a 70-year old male who is complaining of chest pain, and has a history of cardiac problems. If you assist in the administration of nitroglycerin, what is the maximum dosage to be given, without additional medical direction?
A. 2 tablets
B. 3 tablets
C. 4 tablets
D. 5 tablets
A

B. 3 tablets

Rationale: The maximum dosage amount is three tablets, or sprays, without additional medical direction

68
Q 
You are dispatched to a 75-year old female patient who is complaining of extreme chest pain, and trouble breathing. This patient is a high-capacity chain-smoker, and over-weight. Which of the following is most likely to be present? 
A. Pulmonary edema
B. Coronary artery disease
C. Pulseless electrical activity
D. Ventricular Fibrillation
A

B. Coronary artery disease

Rationale: With this patient you could suspect many things, however the best choice is coronary artery disease. PEA and VFib are lethal electrical rhythms its possible to have pulmonary edema but extreme chest pain is not normally a symptom

69
Q 
You are dispatched to a 21-year old male patient who has an elevated pulse. When asked what he was doing, he replies, "I was just running". From the given information, what do you suspect? 
A. the patient needs an AED
B. Nothing this is normal at this point
C. The patient needs to be transported
D. The patient needs a nitro tablet
A

B. Nothing this is normal at this point

Rationale: Try not to look too deep into the question. Only look at the facts. he is not pulseless (AED)

70
Q

You are dispatched to a 75-year old female patient who is currently in cardiac arrest. After one shock via the AED she begins breathing at 15 breaths per minute, and has a strong carotid pulse; what is your next step?
A. Assist ventilations with a bag valve mask
B. Provide supplemental oxygen via Non rebreather mask
C. Continue to administer shocks
D. Request a non transport and leave the scene

A

B. Provide supplemental oxygen via Non rebreather mask
Rationale:
The next step after shocking with the AED, and the patient is breathing and has a pulse, is to apply high concentration oxygen via NRB. If the respiratory rate is above or below the minimum and maximum limits, however, you would assist with a bag valve mask.

71
Q

You are dispatched to a 50-year old male patient who is having extreme chest pain. Of the following, which is a contraindication to administer nitro?
A. The patient has a prescription
B. Medical direction approves
C. The patient has a systolic pressure greater than 100
D. The patient has a systolic pressure less than 100

A

D. The patient has a systolic pressure less than 100

Rationale: Because Nitro is a Vasodilator it should not be administered to a patient with a systolic blood pressure of below 100, because it may cause their blood pressure to drop to a dangerous level.

72
Q

You are dispatched to a 53-year old female patient who has extreme chest pain. Upon gaining medical direction to administer nitroglycerin, you administer one tablet. What action should you now perform?
A. If chest pain continues administer a second nitro
B. Begin transport
C. Check blood pressure
D. continue with the SAMPLE history

A

C. Check blood pressure

Rationale: Because nitro is a vasodilator you should always check the patient’s blood pressure after giving nitro and before giving another dose.

CFD EMT Class (6 decks)

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