Cardo Flashcards
Shock is the result of:
hypoperfusion to the cells of the body
Capillary sphincters are:
circular muscular walls that regulate blood flow through the capillaries.
One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is:
carbon dioxide
To protect vital organs, the body compensates by directing blood flow away from organs that are more tolerant of low flow, such as:
To skin
Pulmonary edema and impaired ventilation occur during:
Cariogenic shock
Cardiogenic shock may result from all of the following, EXCEPT:
increased preload
Which of the following injuries would MOST likely cause obstructive shock?
Cardiac tamponade
Distributive shock occurs when:
widespread dilation of the blood vessels causes blood to pool in the vascular beds.
Which of the following MOST accurately describes septic shock?
Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
Patients develop septic shock secondary to:
poor vessel function and severe volume loss.
A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 90/64 mm Hg. Her skin is hot and moist. You should be MOST suspicious that she is experiencing:
Septic shock
Neurogenic shock occurs when:
failure of the nervous system causes widespread vasodilation.
In an acute injury setting, neurogenic shock is commonly accompanied by:
hypothermia
Which of the following statements regarding anaphylactic shock is correct?
Subsequent exposure after sensitization often produces a more severe reaction.
Which of the following clinical signs is unique to anaphylactic shock?
Wheezing
Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes:
psychogenic shock
Which of the following would MOST likely result in hemorrhagic shock?
Liver laceration
Hypovolemic shock caused by severe burns is the result of a loss of:
Plasma
When assessing a patient with signs and symptoms of shock, it is important to remember that:
blood pressure may be the last measurable factor to change in shock.
Hypotension in a child with blunt or penetrating trauma is particularly significant because:
it often indicates the loss of half of his or her blood volume.
Clinical signs of compensated shock include all of the following, EXCEPT:
absent peripheral pulses.
Which of the following patients is in decompensated shock?
A 20-year-old female with absent radial pulses and dilated pupils
In infants and children, a capillary refill time that is greater than ______ second(s) is a sign of poor peripheral perfusion.
2
When treating an 80-year-old patient who is in shock, it is important to remember that:
changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.
All of the following conditions should make you suspect shock, EXCEPT:
ischemic stroke.
A 59-year-old male presents with severe vomiting and diarrhea of 3 days’ duration. He is confused and diaphoretic, and his radial pulses are absent. His blood pressure is 78/50 mm Hg. After applying supplemental oxygen, you should:
prepare for immediate transport.
A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest chance for survival?
Rapid transport to a trauma center
You are transporting a 33-year-old male who was involved in a major motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:
reassess his condition in 5 minutes
A 27-year-old male was stabbed in the chest during a disagreement at a poker game. As you approach him, you see that a knife is impaled in his chest. Before you make physical contact with the patient, it is MOST important to:
follow standard precautions.
You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:
apply direct pressure to the wound.
A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient’s wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient’s present condition is:
acute myocardial infarction.
A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes:
assisted ventilation, thermal management, and elevation of the lower extremities.
A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:
repeat the epinephrine injection after consulting with medical control.
You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to:
determine if she was injured when she fainted.
A 20-year-old male has a large laceration to his wrist. He is holding a blood-soaked towel over the wound, but it continues to bleed rapidly. You should:
apply a tourniquet proximal to the wrist
Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to:
check her airway for obstructions.
Which of the following is the ONLY action that can prevent death from a tension pneumothorax?
Decompression of the injured side of the chest
Basic life support (BLS) is defined as:
noninvasive emergency care that is used to treat conditions such as airway obstruction, respiratory arrest, and cardiac arrest.
After ________ minutes without oxygen, permanent brain damage is possible.
4 to 6
After establishing that an adult patient is unresponsive, you should:
assess for breathing and a pulse.
Which of the following is NOT a BLS intervention?
Cardiac monitoring
Most prehospital cardiac arrests in adults occur as the result of:
a cardiac dysrhythmia
Which of the following statements regarding ventricular fibrillation (VF) is correct?
VF results in an absence of forward blood flow
You and your partner arrive at the side of a 60-year-old woman who collapsed about 7 minutes ago. She is unresponsive, apneic, and pulseless. You should:
begin CPR and apply the AED as soon as it is available.
Which of the following statements regarding the use of an AED in children is correct?
AEDs can be used safely on infants and children by using pediatric pads and an energy reducer.
Your partner is performing one-rescuer CPR on a middle-aged woman in cardiac arrest. When you apply the AED pads, you note that she has a medication patch over the same area where one of the AED pads will be placed. You should:
remove the medication patch, wipe away any medication residue, and apply the AED pad.
Which of the following maneuvers should be used to open a patient’s airway when a spinal injury is suspected?
Jaw thrust
Several attempts to adequately open a trauma patient’s airway with the jaw-thrust maneuver have been unsuccessful. You should:
carefully perform the head tilt-chin lift maneuver.
A patient should be placed in the recovery position when he or she:
is unresponsive, uninjured, and breathing adequately.
When performing chest compressions on an adult, the EMT should compress:
It least 2 inches
When ventilating an apneic adult with a bag-mask device, you should deliver each breath:
while watching for adequate chest rise.
Gastric distention will MOST likely occur:
if you ventilate a patient too quickly.
If gastric distention begins to make positive-pressure ventilation difficult, you should:
reposition the patient’s airway
CPR will NOT be effective if the patient is:
Prime
You should deliver chest compressions to an unresponsive adult patient in cardiac arrest by:
compressing the sternum between the nipples.
Complications associated with chest compressions include all of the following, EXCEPT:
gastric distention
A 60-year-old man is found to be unresponsive, pulseless, and apneic. You should:
begin CPR until an AED is available.
To ensure that you will deliver the appropriate number of chest compressions during one-rescuer adult CPR, you should compress the patient’s chest at a rate of:
100 to 120 compressions per minute.
In two-rescuer adult CPR, you should deliver a compression to ventilation ratio of:
30:2
After an advanced airway device has been inserted during two-rescuer CPR, you should:
deliver one rescue breath every 6 seconds.
While rescuer one is finishing his or her fifth cycle of 30 compressions, rescuer two should:
move to the opposite side of the patient’s chest.
The impedance threshold device (ITD) may improve circulation during active compression-decompression CPR by:
limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling.
The main benefit of using a mechanical piston device for chest compressions is:
the elimination of rescuer fatigue that results from manual compressions.
In most cases, cardiopulmonary arrest in infants and children is caused by:
respiratory arrest.
The proper depth of chest compressions on a 9-month-old infant is:
one third the diameter of the chest, or about 1½ inches.
What is the minimum number of chest compressions that should be delivered per minute to a 4-month-old infant?
100
When assessing the pulse of an unresponsive infant, you should palpate the ________ artery.
brachial
What is the correct ratio of compressions to ventilations when performing two-rescuer child CPR?
15:2
When performing CPR on a child, you should compress the chest:
with one or two hands.
Which of the following is considered an obvious sign of death and would not require the initiation of CPR?
Dependent blood pooling
CPR should be initiated when:
a valid living will is unavailable.
Which of the following is NOT an indication to stop CPR once you have started?
Care is transferred to a bystander.
The MOST appropriate treatment for a patient with a mild upper airway obstruction includes:
administering oxygen and transporting immediately.
Signs of a sudden severe upper airway obstruction include all of the following, EXCEPT:
forceful coughing.
Abdominal thrusts in a conscious child or adult with a severe upper airway obstruction are performed:
until he or she loses consciousness.
Which of the following techniques should you use to dislodge a foreign body airway obstruction in a patient who is in an advanced stage of pregnancy or who is very obese?
Chest thrusts
Your initial attempt to ventilate an unresponsive, apneic 30-year-old man is met with resistance and you do not see the chest rise. Your second ventilation attempt is also unsuccessful. You should:
perform 30 chest compressions.
Initial treatment to dislodge a severe foreign body airway obstruction in a responsive infant involves:
Back slaps
CPR is in progress on a pregnant woman. Shortly after manually displacing her uterus to the left, return of spontaneous circulation occurs. Which of the following would MOST likely explain this?
Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness.
A team of EMTs and paramedics are attempting to resuscitate a man who is in cardiac arrest while his wife and son are present. Which of the following should occur during the resuscitation attempt?
One EMT should update the family on the interventions that have been performed and how the patient has responded.
CPR retraining is the MOST effective when it:
involves hands-on practice.
You should attempt to maintain a chest compression fraction of at least:
80%
You are off duty at a park when you witness an apparently healthy 12-year-old child suddenly collapse. There are no bystanders around, and your mobile phone is in your car. After confirming that the child is in cardiac arrest, you should:
call 9-1-1 and then return to begin CPR on the child.
Deoxygenated blood from the body returns to the:
right atrium.
Blood that is ejected from the right ventricle:
flows into the pulmonary arteries.
Which of the following blood vessels transports oxygenated blood?
Pulmonary veins
What is the function of the left atrium?
It receives oxygenated blood from the lungs
The left ventricle has the thickest walls because it:
pumps blood into the aorta and systemic circulation.
The electrical impulse generated by the heart originates in the
sinoatrial node
When an electrical impulse reaches the AV node, it is slowed for a brief period of time so that
blood returning from the body can fill the atria
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called
automaticity
The electrical stimulus that originates in the heart’s primary pacemaker is controlled by impulses from the brain that arrive by way of the
autonomic nervous system.
Which of the following is NOT a function of the sympathetic nervous system?
Constriction of blood vessels in the muscles
In contrast to the sympathetic nervous system, the parasympathetic nervous system:
slows the heart and respiratory rates
When the myocardium requires more oxygen
the arteries supplying the heart dilate.
The myocardium receives oxygenated blood from the __________, which originate(s) from the __________.
coronary arteries, aorta
Which of the following would cause the greatest increase in cardiac output?
Increased heart rate and increased stroke volume
The right coronary artery supplies blood to the:
right ventricle and inferior wall of the left ventricle
The head and brain receive their supply of oxygenated blood from the:
carotid arteries.
The descending aorta divides into the two iliac arteries at the level of the
umbilicus
Which of the following veins is located inferior to the trunk
Saphenous
The iliac arteries immediately subdivide into the
femoral arteries
The inferior vena cava returns deoxygenated blood to the right side of the heart from all of the following areas, EXCEPT the
Brain
Which of the following is the MOST reliable method of estimating a patient’s cardiac output?
Assess the heart rate and strength of the pulse
Cardiac output may decrease if the heart beats too rapidly because
there is not enough time in between contractions for the heart to refill completely.
Cardiac output may decrease if the heart beats too rapidly because:
there is not enough time in between contractions for the heart to refill completely.
The posterior tibial pulse can be palpated:
behind the medial malleolus, on the inside of the ankle.
Ischemic heart disease is defined as:
decreased blood flow to one or more portions of the myocardium.
Narrowing of the coronary arteries caused by a buildup of fatty deposits is called:
atherosclerosis
A patient with atherosclerotic heart disease experiences chest pain during exertion because:
the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
An acute myocardial infarction (AMI) occurs when:
myocardial tissue dies secondary to an absence of oxygen.
Major risk factors for AMI include all of the following, EXCEPT:
hypoglycemia
Risk factors for AMI that cannot be controlled include:
family history.
Acute coronary syndrome (ACS) is a term used to describe:
a group of symptoms that are caused by myocardial ischemia.
Angina pectoris occurs when:
myocardial oxygen demand exceeds supply.
Which of the following is a major difference between angina pectoris and AMI?
Anginal pain typically subsides with rest.
When treating a patient with chest pain, you should assume that he or she is having an AMI because:
the cause of the pain cannot be diagnosed in the field.
Prompt transport of a patient with a suspected AMI is important because:
the patient may be eligible to receive thrombolytic therapy
Common signs and symptoms of AMI include all of the following, EXCEPT:
pain exacerbated by breathing.
Which of the following statements regarding the pain associated with AMI is correct?
It can occur during exertion or when the patient is at rest.
The MOST common reason that many people experiencing AMI do not seek immediate medical attention is because they:
are in denial.
When documenting a patient’s description of his or her chest pain or discomfort, the EMT should:
use the patient’s own words.
Rapid, labored breathing in a patient with signs and symptoms of AMI should make you suspicious for:
congestive heart failure
Sudden death following AMI is MOST often caused by:
ventricular fibrillation
Ventricular tachycardia causes hypotension because
the left ventricle does not adequately fill with blood
Which of the following cardiac dysrhythmias has the greatest chance of deteriorating into a pulseless rhythm
Ventricular tachycardia
The purpose of defibrillation is to:
stop the chaotic, disorganized contraction of the cardiac cells.
Cardiogenic shock following AMI is caused by:
decreased pumping force of the heart muscle.
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?
Hypotension and flat jugular veins
You are dispatched to a residence for a 56-year-old male with an altered mental status. Upon arrival at the scene, the patient’s wife tells you that he complained of chest pain the day before, but would not allow her to call EMS. The patient is semiconscious; has rapid, shallow respirations; and has a thready pulse. You should:
begin ventilatory assistance.
A 67-year-old female presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has been prescribed nitroglycerin. She is conscious and alert with adequate breathing. Her blood pressure is 94/64 mm Hg and her heart rate is 120 beats/min. Treatment for this patient includes:
placing her in an upright position
You are assessing a 49-year-old man who complains of chest pressure that began the night before. He is conscious, but anxious, and tells you he has a history of angina and hypertension. You expose his chest to auscultate his lungs and note that he has a nitroglycerin patch on his right upper chest. His skin is cool and pale, his blood pressure is 78/50 mm Hg, and his pulse is 110 beats/min and irregular. You should
remove the nitroglycerin patch, administer oxygen, and place him in a supine position
Which of the following signs is commonly observed in patients with right-sided heart failure?
Dependent edema
Signs and symptoms of a hypertensive emergency would MOST likely be delayed in patients who:
have chronic hypertension
Common signs and symptoms of a hypertensive emergency include:
a bounding pulse, a severe headache, and dizziness.
A dissecting aortic aneurysm occurs when:
the inner layers of the aorta become separated
In contrast to AMI, a dissecting aortic aneurysm:
often presents with pain that is maximal from the onset.
A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate?
Dissecting aortic aneurysm
Upon arriving at the residence of a patient with a possible cardiac problem, it is MOST important to:
assess the scene for potential hazards
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should
assess the adequacy of his respirations.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours’ duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should:
administer oxygen, give her 324 mg of aspirin, and assess her further.
Which of the following is LEAST important when obtaining a medical history from a patient complaining of chest discomfort?
Family history of hypertension
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
Aspirin
Nitroglycerin relieves cardiac-related chest pain by:
dilating the coronary arteries and improving cardiac blood flow
Common side effects of nitroglycerin include all of the following, EXCEPT:
hypertension
Nitroglycerin is contraindicated in patients:
who have experienced a head injury
Prior to assisting a patient with his or her prescribed nitroglycerin, the EMT must
obtain authorization from medical control
Which of the following statements regarding nitroglycerin is correct?
Nitroglycerin usually relieves anginal chest pain within 5 minutes
It would be MOST appropriate for a patient to take his or her prescribed nitroglycerin when experiencing
chest pain that does not immediately subside with rest
Most patients are instructed by their physician to take up to _______ doses of nitroglycerin before calling EMS.
3
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?
Administer the medication sublingually and allow it to dissolve or absorb.
After assisting your patient with prescribed nitroglycerin, you should
reassess his or her blood pressure within 5 minutes to detect hypotension
Which of the following is the MOST likely cause of artifact on an ECG tracing?
Excessive movement of the patient
When obtaining a 12-lead ECG, the patient should be
in a supine position with legs uncrossed.
When preparing to obtain a 12-lead ECG, the LL and RL electrodes should be placed
on the thighs or ankles
When preparing to obtain a 12-lead ECG, the V 1 and V 2 electrodes should be placed:
on either side of the sternum
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by
dilating the affected coronary artery with a small inflatable balloon
Which of the following is NOT a common sign or symptom associated with malfunction of an implanted cardiac pacemaker
Rapid heart rate
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient’s wife tells you that he has an automatic implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do
Deliver the shock followed by immediate resumption of CPR.
In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest
delivers high-energy shocks, similar to an AED
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:
remove the battery from the monitor and then remove the vest.
A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced?
Acute myocardial infarction
A patient with a left ventricular assist device (LVAD) tells you that the device’s pump flow is continuous. Which of the following should you expect to encounter during your assessment?
Absence of a palpable pulse
The EMT should use an AED on a child between 1 month and 8 years of age if:
Correct!
pediatric pads and an energy-reducing device are available.
Most AEDs are set up to adjust the voltage based on the impedance, which is the:
resistance of the body to the flow of electricity
The AED is MOST advantageous to the EMT because:
it delivers prompt defibrillation to patients with ventricular fibrillation
During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a “no shock advised” message. This indicates that:
she is not in ventricular fibrillation
The MOST common error associated with the use of the AED is:
failure of the EMT to ensure the battery is charged
Which of the following statements regarding the AED and defibrillation is correct?
The AED will not analyze the rhythm of a moving patient
The main legal risk in using the AED is:
failing to deliver a shock when one is needed
Prior to defibrillating a patient with an AED, it is MOST important that you:
ensure that no one is touching the patient.
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
dry the chest if it is wet.
You are dispatched to a convenience store for a patient who passed out. Upon arriving at the scene, you find two off-duty EMTs performing CPR on the patient, a 58-year-old male. Your initial action should be to:
feel for a pulse while compressions are ongoing
Defibrillator pads are placed on the patient’s chest:
with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.
You and your partner arrive at the scene of a middle-aged man who collapsed about 5 minutes ago. He is unresponsive, apneic, and pulseless. Bystanders are present, but have not provided any care. You should:
begin high-quality CPR and apply the AED as soon as possible.
Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a “no shock advised” message. You should:
perform CPR for 2 minutes and reassess
After the AED has delivered a shock, the EMT should:
immediately resume CPR
The AED has delivered a shock to an elderly male in cardiac arrest. Following 2 minutes of CPR, you re-analyze the patient’s cardiac rhythm and receive a “no shock advised” message. After further resuscitation, you restore a palpable carotid pulse. Your next action should be to:
reassess airway and breathing and treat accordingly.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:
stop the ambulance, begin CPR, and attach the AED as soon as possible.
You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man. Your assessment reveals that he is apneic and pulseless. A paramedic unit is en route to the scene and will arrive in approximately 5 minutes. You should:
Correct!
begin CPR, apply the AED, and deliver a shock if it is indicated.
You and your partner have achieved return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest. An ALS unit will arrive in less than 2 minutes. The patient remains unresponsive and has slow, irregular breathing. Further treatment for this patient should include:
bag-mask ventilation at 10 breaths/min and assessment of oxygen saturation.
