Cardiovascular

Question 1

What 4 spectrums accompany ACS?

Answer 1

1. Stable Angina
2. Unstable Angina
3. N-STEMI
4. STEMI

Question 2

Medications that are used in ACS evetns?

Answer 2

ASA - 162mg
Nitro - .4mg SL
Gravol - 25-50mg
Fentanyl - 50-100mcg
Atropine - .6mg for symptomatic bradycardia

Question 3

Where should you place the IV when there is a confirmed STEMI?

Answer 3

On the left forearm

Question 4

Angina

Answer 4

Acute CP that is caused by exertion and the narrowing of the coronary vessels. It is relieved by rest or nitro.

Question 5

Unstable Angina

Answer 5

Acute CP that is caused by non-excertional pain and is not relieved by rest. Typically pt.’s have a previous dx. of angina and this is a progression of worsening ACS of the pt.

Question 6

N-STEMI

Answer 6

When there is a partial blockage or spasming of the coronary arteries causing CP, with ischemic changes on the 12 lead (flipped t waves, st depression) with an increase Troponin count.

Question 7

STEMI

Answer 7

Transmural necrosis of the heart tissue that shows ST elevation on the 12 lead. This is the final and worse kind of ACS.

Question 8

Can atropine be used on a heart transplant pt.?

Answer 8

No, could be potentially harmful for the pt.

Question 9

What is the max dose of atropine?

Answer 9

3mg

Question 10

What can atropine cause if pushed slow or to low of a dose?

Answer 10

Transient bradycardia, if this does happen push a subsequent dose immediately

Question 11

If atropine is not able to resolve bradycardia what is the next in line medication?

Answer 11

EPi infusion

Question 12

BRASH

Answer 12

Bradycardia
Renal Failure
AV node blockade
Shock
Hypotensive

These are the signs of a pt. when they are hyperkalemic

Question 13

Management of Hyperkalemia includes?

Answer 13

In cases of hyperK, you have to call clinicall prior to initiation of treatments:

Ca++
Sodium Bi-carb
Salbutamol

Question 14

Transcutaneous Pacing procedures

Answer 14

Used after the failed response to atropine and or epi infusion for symptomatic bradycardia.

1. Limb leads are to be attached as well as defib pads
2. Possible sedation (procedural sedation of .5mg/kg Ketamine with midaz 1-2mg for emergency phenomenon
3. ENABLE PACING MODE
4. Choose rate (60 is typical)
5. Slowly increase current until electrical capture
6. Turn up 10% for mechanical capture
7. Reassess BP/ Perfusion

Question 15

Do you attempt to control or a heart that is believed to be compensatory?

Answer 15

No, never control, give medication or cardiovert a pt. that has a HR that is believed to be compensatory in nature.

Question 16

Do you need vascular access before attempting the Modified Valsalva Maneuver?

Answer 16

No, you can attempt it while looking/gaining vascular access.

Question 17

When should a paramedic use caution when they are wanting to cardiovert atrial fib?

Answer 17

Pt. that are in atrial fib >48hrs have a high risk for embolization, this is to be weighted against the physical findings of the pt. and a clinicall discussion.

Question 18

What are the procedures to cardiovert a SVT?

Answer 18

1. Is the pt. stable (convey to hospital) or unstable (Ischemic CP, SOB, SBP<90, ALOC, Heart Failure (pulmonary Edema))
2. Modified Valsalva while printing
3. Adenosine 6mg rapid iv push, IV to be place as proximal to heart
4. Adenosine 12 mg
5. Synchronized Electrical cardiovert with use of procedural sedation

Question 19

What kinds of Narrow Complex Tachycardias are there?

Answer 19

SVT, Atrial FIb, Atrial Flutter, Ectopic Atrial Tachycardia

Question 20

What is the Dx. of a Narrow Complex qrs on the ecg?

Answer 20

<.12ms

Question 21

What is the Dx. of a QRS >.12ms at a rate of >100bpm?

Answer 21

Wide Complex Tachycardia

Question 22

What is the safest and most reliable mechanism to convert Ventricular Tachycardia?

Answer 22

Electrical cardioversion

Question 23

Why does VT occur in pt.s?

Answer 23

Most often is caused by hypoxia, ischemia, hyperkalemia or increased sympathetic tone. It could develop by itself, yet this is more unlikely.

Question 24

When can you administer amiodarone infusion to a WCT if the pt. is stable? What would be the dose/ time?

Answer 24

> 20min transport time, clinicall is required, 150mg over 10mins

usually these pt.’s can be monitored and conveyed to hospital, be prepared with plans set and tools at the ready.

Question 25

What is your treatment for a unstable monomorphic WCT?

Answer 25

synchronized cardioversion for monomorphic WCT, starting with 100j, then 200j, then 300j then 360j if the rhythm is not terminated.

Changing of vectors is warranted if VT is refractory

Question 26

What is your treatment for a stable polymorphic WCT?

Answer 26

Clinicall required: magnesium sulfate 2g over 15mins infusion

Question 27

What is your treatment for a unstable polymorphic WCT?

Answer 27

unsynchronized cardioversion starting with 200j, possible procedural sedation required

Question 28

What are the common symptoms of a acute aortic dissection?

Answer 28

Sudden onset of chest, back and abdo pain with desciptor words of “sharp” or “Tearing” are highly indicitive of AAD, as well as tachycardia/ DLOC, focal neurological deficits, stroke like symptoms. (C05 - essentials)

Question 29

What are the mainstay treatments for acute aortic dissection?

Answer 29

map of 65
fentanyl
transport to nearest hospital

Question 30

What is the main cause of pulmonary edema in out of hospital environment?

Answer 30

CHF (C06 - introduction)

Question 31

Treatment modalities for pulmonary edema?

Answer 31

-High flow O2/ NODSAT
-CPAP/BVM w/ PEEP
-Find underlying cause of the pulmonary edema (ACS, Bradycardia, Narrow complex tachy, wide complex tachy)
-Nitro (for pre load reduction with a MAP >65 and systolic >110
-Consideration for salbutamol
-Induction and intubation