Cardiac Emergencies I Flashcards
Per Dr. Hoffman, Thurston County Medical Director, generally-speaking, right-sided heart failure is fixed with ___, while left-sided failure is fixed with ___.
- Volume;
- Medicine;
* -Dr. Hoffman, Thurston County Medical Director*
Abnormal hardening of body tissues.
- Sclerosis;
An occassional condition caused by a fixed coronary stenosis that causes symptoms only when under stress.
- Unstable Angina;
-EM Basic Podcast: MI and ACS
What mnemonic can be used to recall the principle differentiating signs of Unstable Angina?
RND UA
Random Urinalysis
R - Rest
N - New
D - Different
UA - Unstable Angina
Note: If the patient’s chest pain occurs at rest, is occurring for the first time, or the intensity, character, or exertion level required to produce the chest pain are different than angina they have experienced in the past (and there is no evidence of a STEMI), the diagnosis is of unstable angina.
-EM Basic Podcast: MI and ACS
Which type of ACS does not feature a stenosis large enough to create a cardiac enzyme leak? Which do(es)?
- Unstable angina;
- NSTEMI and STEMI;
* -EM Basic Podcast: MI and ACS*
A Type ___ NSTEMI is an ACS in which the patient experiences chest pain and cardiac enzyme elevation without the presence of a non-cadiac stressor.
- 1;
-EM Basic Podcast: MI and ACS
A Type ___ NSTEMI is an ACS in which the patient experiences chest pain and cardiac enzyme elevation in the setting of a non-cadiac stressor (such as sepsis, trauma, surgical abdomen, etc.), usually due to prolonged ___.
- 2;
- Tachycardia;
* -EM Basic Podcast: MI and ACS*
What mnemonic can be used to recall where to look on an ECG for reciprocal ST-segment changes?
PAILS
P - Posterior
A - Anterior
I - Inferior
L - Lateral
S - Septal
Note: ST elevations in these leads most commonly create reciprocal ST depressions in the corresponding leads of the next letter in the mnemonic. That is to say, posterior ST elevation will usually cause anterior lead ST depressions and anterior lead ST elevations will usually be seen with inferior lead depressions.
-EM Basic Podcast: MI and ACS
What mnemonic is useful in recalling STEMI mimics?
ELEVATION
E - Electrolytes (Hyperkalemia)
L - Left Bundle Branch Block
E - Early Repolarization
V - Ventricular Hypertrophy (Left)
A - Aneurysm (Ventricular, Aortic Dissection, AAA)
T - Thailand (Brugada Syndrome)
I - Inflammation (Pericarditis) / Intracranial Hemorrhage
O - Osborne (J) Waves
N - Non-Ischemic Vasospasm
-wikem.org
Cardioversions, which are primarily intended to terminate ___ arrhythmias, may benefit from different electrode placement than for defibrillations, which are primarily intended to terminate arrhythmias originating in the ___.
- Atrial;
- Ventricles;
* -Physio-Control LIFEPAK 15 User Manual*
Patients with atrial fibrillation are prone to blood clot formation in their ___. _(therapy)_ may knock loose one of these blood clots, causing a ___.
- Left atrium;
- Cardioversion;
- Stroke;
* -Physio-Control LIFEPAK 15 User Manual*
Cardioversion electrodes can be placed either Anterior– Posterior (AP) or Anterior-Anterior (AA; aka Anterior Lateral [AL]), though ___ placement is preferable for maximum current flow through the ___.
- AP;
- Atria;
* -Physio-Control LIFEPAK 15 User Manual*
For what therapies is Anterior-Lateral defibrillation pad placement approved for?
- Defibrillation;
- Synchronized cardioversion;
- Transcutaneous pacing;
* -Physio-Control LIFEPAK 15 User Manual*
To monitor an ECG using the LIFEPAK 15 therapy electrodes, how must they be arranged?
- Anterior-Lateral (AL);
-Physio-Control LIFEPAK 15 User Manual
Describe how to perform anterior-lateral placement of LIFEPAK 15 therapy electrodes.
- Place the positive therapy electrode lateral to the patient’s left nipple in the midaxillary line, with the center of the electrode in the midaxillary line, if possible. Then place the other therapy electrode on the patient’s upper right torso, lateral to the sternum and below the clavicle.
-Physio-Control LIFEPAK 15 User Manual
Describe the anterior-posterior placement of LIFEPAK 15 therapy electrodes.
- Place the positive therapy electrode over the left precordium. The upper edge of the electrode should be below the nipple. Avoid placement over the nipple, the diaphragm, or the bony prominence of the sternum, if possible. Then place the other electrode behind the heart in the infrascapular area. For patient comfort, place the cable connection away from the spine. Do not place the electrode over the bony prominence of the spine or scapula.
-Physio-Control LIFEPAK 15 User Manual
Anterior-posterior placement of LIFEPAK 15 therapy electrodes is an alternative position for noninvasive pacing, manual defibrillation, and synchronized cardioversion, but not for ___ monitoring.
- ECG (it does not represent a standard lead);
-Physio-Control LIFEPAK 15 User Manual
Describe an alternative to anterior-lateral and anterior-posterior therapy electrode placement when performing synchronized cardioversion of atrial fibrillation.
- Either place the positive therapy electrode over the left precordium and the other electrode on the patient’s right posterior infrascapular area, or place the positive therapy electrode to the right of the sternum and the other electrode on the patient’s posterior left infrascapular area.
-Physio-Control LIFEPAK 15 User Manual
Synchronized cardioversion uses a sensor to deliver a shock synchronized with the peak of the ___ complex, - the highest point of the ___ wave.
- QRS;
- R;
* -Physio-Control LIFEPAK 15 User Manual*
If a tachycardic, stable patient presents with a monomorphic wide-complex rhythm, the AHA recommends ___, because treatment has the potential for ___.015
- Expert consultation;
- Harm;
* -2015 AHA ECC Handbook*
Adenosine is said to terminate approximately ___% of reentry tachyarrhythmias within ___ minutes.
- 90;
- Two;
* -2015 AHA ECC Handbook*
If a tachycardic rhythm converts with adenosine, it was most likely ___.
- Reentry SVT;
-2015 AHA ECC Handbook
If a tachycardic rhythm that had been successfully treated with adenosine returns, consider using adenosine again, or consider treating with longer-lasting ___ or ___.
- Beta-Blockers;
- Calcium Channel Blockers (nondihydropyridine);
* -2015 AHA ECC Handbook*
Adenosine should not be given for unstable or for irregular or polymorphic wide-complex tachycardias, because it may cause degeneration of the arrhythmia to ___.
- VF;
-2015 AHA ECC Handbook
Management of chronic, stable atrial fibrillation may involve control of heart rate; however, cardioversion and drugs that may convert the rhythm to sinus rhythm are contraindicated if the patient is not ___ because of the risk of ___ complications.
- Anticoagulated;
- Embolic;
* -2015 AHA ECC Handbook*
The AHA recommends starting an ACS patient on oxygen if their SPO2 level is below ___%.
- 90;
-2015 AHA ECC Handbook
Right ventricular MIs often present on a 12-Lead as ___ wall STEMIs.
- Inferior;
Note: Confirm with a right-sided 12-Lead ECG.
-2015 AHA ECC Handbook
What does PCI stand for, with regards to a cath lab?
- Percutaneous Coronary Intervention;
-2015 AHA ECC Handbook
First-line therapy for unstable, wide-complex tachycardia is immediate ___.
- Synchronized cardioversion;
-2015 AHA ECC Handbook
The AHA advises not to delay cardioversion to get a 12-lead ECG if the patient is ___.
- Unstable;
-2015 AHA ECC Handbook
You should ___ immediately after delivering a shock, and continue for two minutes before doing a rhythm check.
- Resume CPR;
-2015 AHA ECC Handbook
_(medication)_ stimulates spontaneous contractions when asystole is present.
- Epinephrine;
-2015 AHA ECC Handbook
___ to the face is a vagal maneuver that is safe to perform in infants and children of all ages. Children old enough to cooperate can perform a ___ maneuver by ___ through a narrow straw.
- Ice (or cold application);
- Valsalva;
- Blowing;
* -2015 AHA ECC Handbook*
___ is the most common cause of ___ in pediatric patients.
- Hypoxemia;
2 Cardiac arrest;
-2015 AHA ECC Handbook
Complicatons of ACS include shock, pulmonary edema, and hypotension, with ___ being the leading cause of death in patients with acute myocardial infarction (AMI).
- Cardiogenic shock;
-ACLS for Experienced Providers, 2013 Ed.
The text ACLS for Experienced Providers recommends using ECG interpretation to place chest discomfort patients into one of three possible acute ischemic symptom categories: ___.
- STEMI (ST elevation in two or more contiguous leads or new/presumably new LBBB);
- UA/NSTEMI (ST depression or dynamic T-wave inversion);
- Low-/Intermediate-Risk ACS (normal or nondiagnostic changes in ST segment or T wave);
* -ACLS for Experienced Providers, 2013 Ed.*
What does IABP stand for with respect to ACS interventions?
- Intra-aortic balloon pump;
-ACLS for Experienced Providers, 2013 Ed.
What does MACE stand for, with respect to ACS?
- Major adverse cardiac event;
-ACLS for Experienced Providers, 2013 Ed.
Atherosclerosis is the formation and accumulation of ___ and ___ byproducts in an arterial wall.
- Lipid;
- Oxidative;
* -ACLS for Experienced Providers, 2013 Ed.*
ST elevation begins approximately ___-___ hours after cardiac markers are detectable.
- 4-6;
-ACLS for Experienced Providers, 2013 Ed.
___ are ECG findings in ACS which are consistent with a scar.
- Q waves;
-ACLS for Experienced Providers, 2013 Ed.
What should be used as the “baseline” when measuring ST-segment elevation?
- The TP segment;
Note: The TP segment is considered to be a more accurate baseline for evaluation of ST deviation that the PR segment.
-ACLS for Experienced Providers, 2013 Ed.
If the ___ cannot be identifies because of a rapid heart rate or artifact, use the ___ as the baseline reference point for evaluating ST-segment elevation.
- TP segment;
- PR junction;
Note: The PR junction is the intersection of the PR segment with the QRS complex.
-ACLS for Experienced Providers, 2013 Ed.
From what point should ST-segment elevation be measured according to ACLS for Experienced Providers?
- 1 mm after the J point;
-ACLS for Experienced Providers, 2013 Ed.
Coronary arteries are usually closed approximately ___% by angiography (___% closed when viewed by a pathologist) before they cause symptoms and ar econsidered for stending or surgery.
- 70%;
- 90%;
* -ACLS for Experienced Providers, 2013 Ed.*
_(procedure)_ can cause strking ST-segment elevation, often > 10 mm, but lasting only a minute or two immediately after intervention.
- Synchronized cardioversion;
-ACLS for Experienced Providers, 2013 Ed.
The majority of myocardial infarction occurs by ___ hours after the onset of symptoms. After ___ hours the infarct is nearly complete.
- 4;
- 6;
* -ACLS for Experienced Providers, 2013 Ed.*
Guidelines recommend that healthcare providers instruct patients and family to activate EMS if chest discomfort symptoms persist or worsen ___ minutes after their _(number)_ nitroglycerin dose. These patients may have STEMI or prolonged ischemia and ar at risk for sudden cardiac death.
- 5;
- First;
* -ACLS for Experienced Providers, 2013 Ed.*
Relief of _(symptom)_ is an important early goal for patients with STEMI or another ACS. Surges of _(substance)_ have been implicated in plaque fissuring, thrombus propagation and reduction in VF threshold.
- Discomfort;
-ACLS for Experienced Providers, 2013 Ed.
Congestive heart failure occurs when the heart is unable, for any reason, to pump ___ enough or ___ enough to empty its chambers; as a result, blood backs up into the ___ circuit, the ___ circuit, or both.
- Powerfully;
- Fast;
- Systemic;
- Pulmonary;
* -Emergency Care in the Streets, 7th Ed.*
Although CHF may develop in situations other than AMI, for example, in a patient with chronic ___, the basic principles of diagnosis and treatment are similar, whatever the precipitating factors.
- Hypertension;
-Emergency Care in the Streets, 7th Ed.
The ___ ventricle is most commonly damaged duringan AMI.
- Left;
-Emergency Care in the Streets, 7th Ed.
In chronic hypertension, the ___ ventricle tends to suffer the long-term effects of having to pump against an increased afterload (constricted peripheral arteries).
- Left;
-Emergency Care in the Streets, 7th Ed.
As a result of left-sided heart failure, blood backs up behind the left ventricle, and the pressure in the left ___ and ___ veins increases. As the _(same)_ veins become engorged with blood, ___ is forced out of the pulmonary ___ and into the alveoli. The _(same as #3)_ mixes with air in the alveoli to produce ___ (pulmonary edema). This is left-sided heart failure.
- Atrium;
- Pulmonary;
- Serum;
- Capillaries;
- Foam;
* -Emergency Care in the Streets, 7th Ed.*
During left-sided heart failure, in addition to fluid being forced into the alveoli, fluid also leaks into the ___ spaces in the lungs, and increasing _(same)_ pressure causes narrowing of the ___. Air passing through the narrowed _(same)_ creates ___ noises, wheareas air bubbling through fluid-filled alveoli produces ___.
- Intersitial;
- Bronchioles;
- Wheezing;
- Crackles;
* -Emergency Care in the Streets, 7th Ed.*
The ___ response to the feeling of hypoxemia-induced panic during left-sided heart failure produces peripheral vaso___: Peripheral resistance (afterload) ___, and the weakened, hypoxic heart now has to push blood out into smaller and smaller vessels. Clinically, peripheral vasoconstriction is apparent as ___, ___ and ___ skin as well as ___ blood pressure;
- Sympathetic nervous system;
- Pale;
- Cold;
- Diaphoretic;
- Elevated;
* -Emergency Care in the Streets, 7th Ed.*
Prehospital treatment of left-sided heart failure is aimed at improving oxygenation and ___ the workload of the heart, chiefly by reducing the ___ so that the ___ ventricle is less overburdened.
- Decreasing;
- Preload (volume of venous blood retun to the heart);
- Left;
* -Emergency Care in the Streets, 7th Ed.*
In what position is it recommended to place a patient suffering from left-sided heart failure? How does this position positively affect the burden on the heart?
- Sit the patient up, with the feet and/or legs dangling.
- This position encourages venous pooling in the legs, thereby reducing venous return to the heart and hence reducing its workload.
Note: The sitting position also makes breathing easier for a patient in respiratory distress.
-Emergency Care in the Streets, 7th Ed.
How can nitroglycerin positively affect a patient suffering from left-sided heart failure?
- Nitroglycerin acts as a vasodilator to create venous pooling, reducing the volume of blood returned from the periphery to the heart, and hence its workload.
-Emergency Care in the Streets, 7th Ed.
Right-sided heart failure most commonly occurs as a result of ___. Name one (of two listed) additional precipitating condition.
- Left-sided heart failure;
- PE;
- COPD;
* -Emergency Care in the Streets, 7th Ed.*
Edema resulting from right-sided heart failure is most likely to be visible in ___ parts of the body, such as the ___ in a person who is sitting or standing or the ___ in a bedridden patient.
- (Gravity) Dependent;
- Feet (pedal edema);
- Lower back (presacral edema);
* -Emergency Care in the Streets, 7th Ed.*
___ is a medical term used to describe the accumulation of fluid in the abdominal cavity.
- Ascites;
-Emergency Care in the Streets, 7th Ed.
____% of patients with an inferior wall myocardial infarction will also have a right ventricular infarction.
- 30;
FireRescue1 Academy - Myocardial Infarction
It is said that only ___% of patients experiencing a myocardial infarction will exhibit diagnostic changes on their prehospital ECG.
- 50;
FireRescue1 Academy - Myocardial Infarction
Myocardial infarction (MI) is typically the result of a blockage in one of the ___ arteries due to an ___ plaque.
- Coronary;
- Atherosclerotic;
* FireRescue1 Academy - Myocardial Infarction*
Name three (of six listed) varieties of fibrinolytic drugs used for dissolving coronary artery blood clots.
- tPA;
- rtPA;
- Streptokinase;
- Activase (Alteplase);
- TNKase;
- Retavase (Reteplase);
* FireRescue1 Academy - Myocardial Infarction*
* https://en.wikipedia.org/wiki/Thrombolysis*
Name four (of seven listed) common “blood thinners” (anticogulants).
- Warfarin (Coumadin);
- Heparin;
- Dabigatran;
- Rivaroxaban;
- Apixaban;
- Edoxaban;
- Betrixaban;
* https://en.wikipedia.org/wiki/Anticoagulant*
The abnormal narrowing of a passage in the body.
- Stenosis;
Google Search, Oxford Dictionary
According to Poiseuille’s Law, resistance to laminar fluid flow in a tube increases by a factor of ___ when the diameter of the tube is decreased by half.
- 16;
Note: Poiseuille’s Law states that resistance to laminar fluid flow in a tube = (8 x Length x Viscosity) / (π x r4)
Kahn Academy: Resistance in a Tube
What is the formular for systemic vascular resistance (SVR)?
- SVR = ([MAP - CVP] / CO) x 80;
Note: Normal SVR is 700 - 1,500 dynes / seconds / cm-5
https://www.nursingcenter.com/ncblog/may-2017/systemic-vascular-resistance-and-pulmonary-vascula
