Ch17: Cardiovascular Emergencies Flashcards
Cardiac chest pain is usually felt in the jaw and the left arm. This is known as:
a. Point tenderness
b. Referred pain
c. Associated pain
d. Sympathy pain
b. Referred pain
Which of the following is the correct sequence for using an AED on an unresponsive, pulseless patient who has been in cardiac arrest for 1-2 minutes?
a. Attach the AED, turn it on, and analyze.
b. Provide two minutes of CPR prior to attaching the AED.
c. Attach the AED, turn it on, and provide CPR as the AED analyzes the patient’s EKG.
d. Attach the AED, provide two minutes of CPR, and then analyze.
A: The correct sequence for using an AED is as follows: Turn it on, attach the leads, analyze the rhythm, and then defibrillate. Defibrillation should not be delayed to provide CPR if the downtime is less than 4 minutes. If the downtime exceeds 4-5 minutes, then two minutes of CPR should be provided before AED utilization.
cardiac muscle has automaticity. what does automaticity mean?
ability of cardiac muscle cells to contract without any stimulation from the nervous system. (purely from SAN)
what NS controls the sinoatrial node?
automatic NS (part of peripheral NS).
parasympathetic NS controls during relaxation
sympathetic NS controls during fight-or-flight response
their effects oppose each other (e.g. sympathetic constricts blood vessels in GI tract while parasympathetic dilates them)
what is ischemia?
lack of oxygen and nutrients because fully or partially obstruced blood flow; reversible because permanent damage hasn’t occurred yet
atherosclerosis
when calcium and cholesterol build up in the artery walls. as the person ages, more cholesterol builds up and calcium is deposited. this makes the vessel wall more brittle and less flexible, making it less able to accommodate increased blood flow when needed.
thromboembolism
when a blood clot blocks a vessel. could be caused by a rip in the plaque of the artery wall, activating the blood-clotting system like a wound.
acute myocardial infarction
when a coronary artery is blocked, preventing cardiac tissue from getting oxygen and nutrients. heart attack!
can infarction cause cardiac arrest
yes
what is number 1 cause of death in the US
coronary artery disease
risk factors of AMI (acute myocardial infarction)
can be controlled (9):
cigarette smoking
hypertension
diabetes
high cholesterol
lack of exercise
obesity
stress
excessive alcohol
poor diet
cannot be controlled (5)
old age
family history of coronary artery disease
race
ethnicity
male sex
acute coronary syndrome (ACS)
group of symptoms caused by myocardial ischemia:
angina pectoris
myocardial infarction
angina vs AMI
angina is brief chest pain that occurs with a stressor like a large meal or exercise that needs increased blood flow. usually when the stressor is gone, the pain also recedes. It is a symptom of coronary artery disease (CAD) but not as severe as AMI.
AMI is when heart tissue die and cannot be resuscitation, forming a scar on the heart that will become a burden to it.
after ___ minutes, heart cells start to die during an AMI
30
after 2 hours, about ___% of total heart cells are dead
50
after 4-6 hours, about ___% of total heart cells are dead
90
is AMI more likely to happen on the right or left side
left, because it has thicker walls
signs and symptoms of AMI
chest pain or discomfort
dyspnea
irregular heartbeat
syncope
nausea/vomiting
pink/frothy sputum because of pulmonary edema
pain of AMI vs pain of angina
may or may not be caused by exertion but can occur anytime –> ask what the patient was doing at the time + OPQRST!!!
does not resolve within few minutes (can last 30 mins or a couple hours)
not relieved by rest or nitroglycerin
physical signs of AMI
1) skin - cold, pale, ashen, maybe cyanotic
2) pulse - dysrhythmias or bradycardia in affected area
3) blood pressure - patients usually have normal or elevated BP
4) respiration - usually normal unless patient has CHF in which they will have tachypnea and sometimes frothy sputum
5) mental status - agitation, confusion and sense of impending doom
3 consequences of AMI
1) sudden death
2) cardiogenic shock
3) congestive heart failure
what does defibrillation do to a heart experiencing ventricular tachycardia or fibrillations
VT = rapid contraction of ventricle so it doesn’t fully fill with blood
VF = disorganized, effective quivering
defibrillation shocks the heart so the electrical impulses start over again in an orderly and effective manner
what happens if VT and VF are left untreated
asystole - complete cessation of heart electrical impulses
whats the difference between cardiogenic shock and myocardial infarction
cardiogenic shock is a severe consequence of AMI
symptoms of cardiogenic shock
anxiety or restlessness, bc of “air hunger”
patient says they cannot breathe even though they are ventilating
pale, cool skin because blood is redirected to more important organs/tissues
high HR
tachypnea
decompensated shock - BP falls
symptoms of congestive heart failure
orthopnea, paroxysmal nocturnal dyspnea
–> easier to breathe when sitting up
dependent edema
JVD
pulmonary edema + crackles
high BP
high RR
high HR
pale, cool, cyanotic skin
cardiogenic shock treatment
- position patient comfortably
- administer oxygen - make sure SpO2 is 95-99%
- assist with ventilations if needed
- cover patients with blankets, layers to preserve heat
- transport to ED asap
congestive heart failure treatment
- position patient - sitting upright so they can breathe comfortably
- administer oxygen with CPAP to get fluid out of lungs. if not tolerated, use nasal cannula or bag mask device - make sure SpO2 is 95-99%
- a patient with CHF problems may have meds for it so gather them
- ask medical control and administer nitroglycerin if blood pressure is above 100 mmHg
- transport to ED assap
causes of CHF
any condition that weakens the pumping of the heart e.g:
1) AMI
2) heart valve disease
3) chronic hypertension
how does AMI cause congestive heart failure
AMI causes damaged/dead heart tissue.
the heart compensates by 1) increasing HR and 2) enlarging.
when these mechanisms no longer compensate for damaged heart tissue, congestive heart failure develops:
left-sided failure - pulmonary edema
right-sided failure - dependent edema
hypertension
blood pressure higher than 130/80
hypertensive emergency
signs and symptoms experienced because of extremely high blood pressure that can have serious effects e.g. aneurysm or stroke
symptoms of hypertensive emergency
severe headache - none like what they’ve experienced before
strong bounding pulse
ringing in ears
nosebleed
dizziness
nausea
sudden development of pulmonary edema (bc of pressure of blood pushing fluid into lungs)
altered mental status
what to do if someone is in hypertensive emergency
1) make sure they’re COMFORTABLE
2) monitor BP
3) get patient to ED asap
4) consider ALS support if hospital ride is long
aortic aneurysm
expanding of aortic wall because of weakness
dissecting aortic aneurysm
rupture in the aortic wall that causes to blood flow in between the layers of the wall
differentiating between dissecting aortic aneurysm and AMI
both chest pain BUT
AMI: pressure or tightness
aneurysm: tearing or stabbing pain
AMI: gradual escalation of pain
aneurysm: sudden full-force onset
AMI: pain may wax and wane
aneurysm: pain doesn’t stop
AMI is preceded by other symptoms e.g. nausea, weakness
AMI: peripheral blood pressure normal
aneurysm: BP discrepancy between two sides or extremities
what is the recommended dose for aspirin tablets
2-4 tablets
how many mg is a low-dose aspirin tablet
81 mg
contraindications for aspirin
recent bleeding e.g. internal bleeding, stomach ulcers
contraindications for nitroglycerin
severe hypotension
use of erectile dysfunction med within last 24h
how to assist a patient in administering nitroglycerin
1) obtain order from MED CONTROLLL
2) only administer if BP >100mmHg
3) check medication and exp. date
4) explain sublingual route
5) have patient lift tongue while you spray or put the tablet under
6) caution patient not to chew or swallow tablet
7) reassess BP every 5 mins
how to maximize skin contact for ECG electrodes?
- shave chest hair if needed
- wipe with antiseptic to remove any dirt, dust, and oils. Wait to dry or wipe with 10x10 inch gauze pad. also wipe any sweats with the gauze pad
patient position during cardiac monitoring
supine or semi-fowler
crossing arms or legs during cardiac monitoring?
no
types of devices to help with cardiac function
pacemaker
(automatic implantable) cardiac defib
external defib vest
left ventricular assist device (LVAD)
non-shockable rhythms in patients with cardiac arrest (AED will not shock)
AED does not fix dysrhythmias
1) asystole - complete cessation of electrical activity
2) pulseless electrical activity (PEA) - electrical activity is too weak to stimulate heart function
3 most common errors in using AED
1) applying AED to moving, conscious patient
2) failed AED equipment
3) turning off AED before shock delivered or another operational defect
procedure for a pulseless, apneic patient
Begin chest compressions until AED is available - 30:2
Apply AED as soon as available - analyze & shock
After shock, continue giving 5 cycles of 30:2 compressions BEFORE reassessing pulse (no more than 10 seconds)
If it doesn’t shock, keep doing chest compressions
when to transport a patient
1) ROSC
2) after 6-9 AED shocks but no ROSC
3) AED has given 3 consecutive messages of no shock advised
what to do if an unconscious patient goes into cardiac arrest during transport
- check pulse at least every 30 seconds
- if pulseless STOP THE VEHICLE
- immediately apply AED. if not ready yet, begin chest compressions
- AED + shock
- continue chest compressions
A dissecting aortic aneurysm occurs when:
A. all layers of the aorta suddenly contract.
B. the inner layers of the aorta become separated.
C. the aorta ruptures, resulting in profound bleeding.
D. a weakened area develops in the aortic wall.
B. the inner layers of the aorta become separated.
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
A. Oxygen
B. Furosemide (Lasix)
C. Aspirin
D. Metoprolol (Toprol)
C. Aspirin
The AED is MOST advantageous to the EMT because:
A. it delivers prompt defibrillation to patients with ventricular fibrillation.
B. its use does not require the presence of advanced life support personnel.
C. it delivers an unlimited number of shocks with the same amount of energy. D. it is lightweight, easy to use, and safe for the EMT who is using it.
A. it delivers prompt defibrillation to patients with ventricular fibrillation.
Angina pectoris occurs when:
A. one or more coronary arteries suddenly spasm.
B. myocardial oxygen supply exceeds the demand.
C. a coronary artery is totally occluded by plaque.
D. myocardial oxygen demand exceeds supply.
D. myocardial oxygen demand exceeds supply.
What is the time frame in which cardiogenic shock can occur after an acute myocardial infarction (AMI)?
A. immediately and up to 24 hours after onset of AMI
B. immediately and up to 48 hours after the onset of AMI
C. between 24 hours and 48 hours after the onset of AMI
D. immediately and up to a week after the onset of AMI
Which could be a reason that acetylsalicylic acid (ASA) was not administered to a patient in a cardiovascular emergency?
A. documented allergy
B. all of these
C. stomach ulcer
D. bleeding condition
B. all of these
Which of the following populations is most likely to show atypical signs of a heart attack, like shortness of breath and dizziness?
a. White, middle-aged men
b. Individuals with diabetes
c. Younger-aged individuals
d. People who are overweight
b. Individuals with diabetes
How are rescue actions for cardiac arrest due to drowning different from the rescue actions for sudden cardiac arrest?
a. Unlike sudden cardiac arrest, the priority in a drowning is to give the person CPR.
b. Unlike sudden cardiac arrest, the priority in a drowning is to give the person oxygen.
c. Unlike sudden cardiac arrest, the priority in a drowning is to locate an ambulance.
d. Unlike sudden cardiac arrest, the priority in a drowning is to give chest compressions.
b. Unlike sudden cardiac arrest, the priority in a drowning is to give the person oxygen.
What NOT to do in a patient who has experienced drowning
- Abdominal thrusts to try and get rid of water
- Attempt to clear airway of aspirated water
You are dispatched for a report of breathing difficulty. Upon arrival you find an 80 year old male being held upright in a chair at the table. Family members relate that he began coughing, then couldn’t talk after that. The patient is breathing normally when you assess him. He is unable to speak, and appears to be unable to stand. What would you consider as causes of his condition?
? Acute Stroke
? Foreign Body Airway Obstruction
? Bronchospasms
? Sudden Onset of Congestive Heart Failure
Acute Stroke
Your patient is a 77-year-old female who is complaining of dyspnea, nausea, weakness, and
you notice that she is sweating profusely. What medication is indicated?
? Albuterol
? Nitroglycerin
? Oral glucose
? Benadryl
Nitroglycerin. not all cases of myocardial infarction present with chest pain, especially in geriatric patients
