CH 7: Circulatory Emergencies

Question 1

Cardiac disease: CHD - Coronary Heart disease v Cerebrovascular disease

Answer 1

Disease of the arteries supplying blood to the heart

Disease of the arteries supplying blood to the brain

Question 2

Cardiac Disease: Congenital heart disease

Answer 2

Genetic defects of the heart that are present at birth

Question 3

Cardiac Disease: Deep Vein Thrombosis

Answer 3

Clots that occur far in the periphery of the legs that can be knocked loose and travel anywhere else in the body.

Question 4

Cardiac Disease: Pulmonary Embolism

Answer 4

A blood clot that was knocked loose and ended up in a vessel in the lungs, cutting off bloody supply.

Question 5

Cardiac Disease: Peripheral Arterial Disease

Answer 5

Disease of the blood vessels that reduces circulation to the extremities, especially in the legs.

Question 6

What are the 2 types of cerebrovascular accidents?

Answer 6

Ischemic Stokes & Hemorrhagic Stokes

Both disrupt blood and therefore O2 flow to brain.

Ischemic strokes are blockages of the vessels that can be thrombotic or embolic in nature.
Hemorrhagic strokes are damaged vessels and blood leaks into the intracerebral and subarachnoid spaces, causing flooding and brain cell death.

Either can range from minor to catastrophic depending on location and extent of damage.

Question 7

Blood flow through the heart

Answer 7

Deoxygenated blood arrives in Right Atrium via Sup. & Inf. Vena Cava
Blood flows into Right Ventricle then towards the lungs to be re-oxygenated
Reoxygenated blood returns to the heart via pulmonary veins into left atrium
Left Atrium flows into left Ventricle and then into the Aortic Arch to re enter the system.

Question 8

What is Arterioscelrosis?

Answer 8

When arteries become hardened, narrowed and less elastic gradually over time, fat deposits/plaque build up on the inside narrowing the internal diameter of the vessel and reducing volume of blood flow.

When this occurs in a coronary artery, it becomes coronary heart disease.

Question 9

What are the 7 rules for effective chest compressions?

Answer 9

1) Patient is flat and supine on a firm surface
2) Hand positioned correctly over xiphoid process
3) Responder is positioned comfortably over patient
4) Compressions are given at a rate of 100-120bpm
5) Compression depth is 5cm or 1/3rd of chest in children
6) Chest is allowed to recoil
7) Off-chest time is minimized at all costs

Question 10

What are the 3 situations in which an AED should NOT be used?

Answer 10

1) A person is directly contacting the patient or a surface that is conductive to electricity
2) The patient is in a motor vehicle
3) You are in the presence of flammable materials (Like an O2 tank)

Question 11

What are some special resuscitation situations to consider before applying an AED?

(10)

Answer 11

1) Pregnancy
2) Transdermal patches (nicotine etc)
3) Pacemakers
4) Body jewelery
5) Trauma to torso
6) Patients in water
7) Rain or snow
8) Neonatal
9) Excessive hair
10) Wire bras

Question 12

How are Cardiovascular diseases related to myocardial infarctions?

Answer 12

Most cardiovascular diseases cause partially blocked coronary arteries that provide poor O2 delivery to the myocardium, producing chest pain.

When the coronary arteries become completely blocked, no O2 can make it to the myocardium causing muscle death in the area, resulting in a Myocardial Infarction.

Question 13

What is Angina Pectoris?

Answer 13

Some patients with coronary heart disease experience intermittent chest pain or pressure, which can be exacerbated by some factors. This occurs when the oxygen demands of the heart exceed the available supply of oxygen saturated blood.

Can be brought on by:
- Physical activity
- Stress
- Extreme hot or cold temps
- After heavy meals
- Smoking or alcohol consumption

Question 14

What are the 2 types of Angina Pectoris?

Answer 14

Stable Angina:
- Follows a predictable pain pattern
- Can be relieved with medication and reduction in activity
- Usually not life threatening
- Lasts less than 10 minutes

Unstable Angina:
- Pain is atypical
- Pain last longer than 10 minutes
- Does not respond to medication
- Is a warning sign that an MI is imminent

Question 15

How do you treat Angina?

Answer 15

1) Place in position of comfort
2) Assist with prescribed medications (nitroglycerin) (Max 3 doses, 1 dose every 5 mins) (Check any doses of meds already taken)
3) If patient has unstable angina or no medications, chew 2 80mg or 1 325mg tab of ASA
4) Administer O2 as needed - monitor vitals and prepare for CPR/AED deployment

Question 16

What are the characteristics of Left/Right sided congestive heart failure?

Answer 16

Left side failure: Left ventricle fails -> Blood backs up into alveoli -> results in increased respiratory rate, shortness of breath.

Usually occurs as a result of an MI or chronic hypertension

Right side failure: Right ventricle fails -> blood backs up into venous system -> pooling of fluid in tissues + swelling in extremities

Usually occurs as a result of Left sided heart failure.

Question 17

What is a TIA?

Answer 17

Transient Ischemic Attack.

Often referred to as a “warning stroke”, it is caused by partial blockages of blood flow to brain. The body can clear the blockage naturally within minutes to hours.

Question 18

What are some of the most common S/S of TIA’s and Stokes?

Answer 18

• Sudden weakness or numbness of face/arm/leg on one side of body
• Slurred speech
• Blurred vision
• Pupils of unequal size
• Sudden severe headache
• Dizziness
• Confusion
• Mood changes
• Ringing in ears
• Changes in LOR
• Loss of bowel/bladder control

Question 19

What is the timeline that denotes when both Clinical and Biological death occur?

Answer 19

Clinical death is the cessation of respiration and circulation.
Occurs between 0 and 4 minutes without O2. Reversible with early detection and immediate intervention.

Biological death occurs sometime after 4 minutes without O2. Brain death occurs here and is irreversible.

Question 20

When a person is in cardiac arrest, what 2 things will the heart do?

Answer 20

1) Stop beating entirely. This is called asystole and is a non-shockable rhythm.

2) It will have 2 possible arrhythmia’s known as Fibrillations that are rhythms that cannot circulate blood effectively.
- Ventricular Tachycardia is when the heart is beating too fast for the ventricles to fill and eject O2 saturated blood.
- Ventricular fibrillation is when the heart is quivering and cannot contract with enough power to circulate blood.

Question 21

What is the primary function of CPR?

Answer 21

To artificially replicate the functions of the heart and lungs when they are not working.

This increases chances of survival by keeping the brain supplied with O2 (preventing biological death) until patient can receive advanced care.

Question 22

What is the compression fraction and off chest time?

Answer 22

Compression fraction = % of total CPR time that the patient is receiving compressions.

Conversely,

Off-chest time is the remaining time. I.E. time spent applying AED pads, assessing ABC’s etc.

Question 23

When can you stop CPR/rescue breaths?

Answer 23

1) When another responder with equal or higher skill takes over
2) Physically too exhausted to continue
3) Scene becomes unsafe
4) Pulse/breathing becomes present

Question 24

What is good practice for performing CPR on a pregnant person?

Answer 24

Placing a pillow or soft rigid object under the right hip to allow ease in blood flow to heart.