Cardiology And Resuscitation (Adult and Peds)

Question 1

Signs and symptoms of stroke

Answer 1

• Altered mental status (coma, stupor, confusion, seizures, delirium)
• Severe sudden headache or any headache with decreased LOC or neuro deficit. Unusual or severe neck or facial pain
• Aphasia (incoherent or difficulty understanding)
• Facial droop or weakness (can be on either side from limb paralysis)
• Incoordination, weakness, paralysis, sensory loss one or more limbs. Usually one half the body especially hands
• Ataxia (poor balance, clumsiness, or trouble walking)
• Vision loss (both or one eye full or partial)
• Dysarthria (slurred or indistinct speech)
• Intense vertigo, double vision, nausea, vomiting, photophobia, unilateral hearing loss)

Question 2

List BLS treatment for infant, child, or adult in cardiac arrest

Answer 2

Infant - under 1 year
Assess Responsiveness and Activate EMSS. Get an AED and attach pads (if alone perform 5 cycles of CPR first).
Assess Airway (head tilt/chin lift - place head in sniffing position with padding under shoulders and torso). Jaw thrust.
Assess Breathing by look listen feel for chest rise and fall and air exchange at mouth and nose. If breathing can be placed in recovery position in case of vomiting. If not breathing begin rescue breathing via BVM or mouth to mouth.
Assess Circulation by checking for brachial pulse. If no breathing but pulse greater than 60bpm provide rescue breaths at 20 breaths/min (1:3sec) If less than 60bpm with signs of poor perfusion, begin chest compressions (CPR) at a rate of 15:2 for 2 person CPR. Do 5 cycles then switch EMTs.

Child - 1 to puberty (for AED 1-8yrs)
Assess Responsiveness and Activate EMSS. Get an AED and attach pads (if alone perform 5 cycles of CPR first).
Assess Airway (head tilt/chin lift with Jaw thrust.)
Assess Breathing by look listen feel for chest rise and fall and air exchange at mouth and nose. If breathing can be placed in recovery position in case of vomiting. If not breathing begin rescue breathing via BVM or mouth to mouth.
Assess Circulation by checking for carotid If no breathing but pulse greater than 60bpm provide rescue breaths at 20 breaths/min (1:3sec) If less than 60bpm with signs of poor perfusion, begin chest compressions (CPR) at a rate of 15:2 for 2 person CPR. Do 5 cycles then switch EMTs.

Adult -
Assess for level of responsiveness. Open airway and assess for breathing. Assess for pulse and apply AED. If none begin compressions (CPR)

Question 3

Signs and symptoms of shock (or hypoperfusion) for an adult, child, and infant

Answer 3

ADULT
Weakness
Change in skin color such as cyanosis or pale skin
Tachycardia and weak pulse
Cool clammy skin
Rapid shallow breathing
Restlessness and anxiety
Altered mental status (as shock progresses)
Low or decreasing BP (late sign)

CHILD
Systolic less than 70
Tachycardia 
Cool skin
Apnea

INFANT

• Tachycardia
• Decreased Urinary Output
• Dry Mucosal Membranes
• sunken fontanels
• no tears/sunken eyes
• Delayed cap refill
• Hyperventilation
• altered mental status
• apnea
• drop in BP in child/infant is very late stage sign as they compensate much longer than adults. Can maintain up to 40% blood loss before BP may change

Question 4

Treatment of shock or hypoperfusion in an adult, child, and infant

Answer 4

• stop any bleeding
• maintain open airway
• high flow O2
• elevate legs
• keep pt warm with blankets
• for pelvic fractures use binding device
• splint any fractures if possible
• rapid transport

Children or infants can lose body heat quickly due to proportionate size differences and breathing rates.

Question 5

Describe the function of the left ventricle

Answer 5

It receives oxygen rich blood from the left atria and,upon contraction, pumps this blood to the aorta (largest artery in body) for distribution to the body.

Question 6

List the treatment including use of the AED for an adult in cardiac arrest

Answer 6

Verify arrest (unresponsive, apneic, and pulseless)
Have one person start CPR
Turn on monitor or AED
Apply pads (shave chest if needed) and clear patient
Press analyze button
Deliver shock if advised if not resume CPR for two minutes or five rounds
Check pulse
Insert airway adjunct as needed
Administer high flow oxygen via BVM
After two minutes of CPR clear the patient and analyze rhythm
Shock if indicated
Check for a pulse
Resume CPR as indicated
Prepare for rapid transport

Question 7

Define systolic blood pressure

Answer 7

Pressure created in the arteries when the left ventricle contracts and forces blood out into circulation

Question 8

List the treatment for cardiogenic chest pain

Answer 8

1. Place patient in a position of comfort usually sitting up
2. Determine if oxygen should be administered titrate to at least 94%
3. Immediate transport if no history of cardiac, history but does not have nitro, systolic below 90 to 100
4. Obtain 12 lead ECG
5. Administer nitro if the patient has chest pain, a history of cardiac, has a nitro prescription, has nitro with them, systolic remains above than 90 to 100, patient has not taken ED drugs within 48 to 72 hours, approval from medical direction
   Repeat dose in five minutes if no relief or only partial, systolic remains above 90 to 100, approval of medical direction.
   Max of 3 doses
6. If pt able to swallow Administer 162 to 324 mg of children’s aspirin if no allergy and no history of asthma or taking additional thinners or other contraindication. Also obtain approval of medical direction.
7. Transport

Question 9

Describe function of the aorta

Answer 9

The aorta is the largest artery in the body and transports oxygenated blood from the left ventricle to begin systemic circulation