Chapter 16 Flashcards by Gail I

EMS can help reduce deaths by: 
encouraging … 
early access to … 
more .. training of laypeople
increased use of … in dispatch and response

healthy lifestyle; medical care; CPR training; evolving technology

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EMS can help reduce deaths by (cont.):
public access to … devices
recognizing need for ..
the use of … centers when they are available

defibrillation;
advanced life support
cardiac specialty

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heart’s job is to .. to supply oxygen-enriched red blood cells to tissues
the heart is divided down the middle into left and right sides, each with an upper chamber (…) to receive incoming blood and a lower chamber (..) to pump outgoing blood

pump blood; atrium; ventricle

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atria receives … blood, and ventricles pump … blood
… keep blood flowing in the proper direction
aorta, body’s main artery, receives blood ejected from …

incoming; outgoing; one-way valves; left ventricle

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heart’s electrical system controls … and coordinates … and … –> the heart generates its own electrical impulse, starting at the sinus node. The impulse passes from the atria to the ventricles

heart rate; atria; ventricles

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… allows spontaneous contraction without a stimulus from a nerve source–> if impulses come from the SA node, the other myocardial cells will …
If no impulse arrives, the other cells are capable of … and stimulating a …

automaticity; contract; creating their own impulses; contraction

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… controls involuntary activities. It has two parts:
… nervous system
… nervous system

autonomic nervous system; sympathetic; parasympathetic

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the … must have a continuous supply of oxygen and nutrients to pump blood
increased oxygen demand by myocardium is supplied by … (widening) of coronary arteries
… is the volume of blood ejected with each ventricular contraction–> increased stroke volume results in increased …

dilation; stroke volume; cardiac output

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… arteries are blood vessels that supply blood to heart muscle–> they start at the first part of the aorta, just above the aortic valve
the … coronary artery supplies blood to the right atrium and right ventricle and, in most people, the inferior wall of the left ventricle. The … coronary artery supplies blood to the left atrium and left ventricle and divides into two major branches, just a short distance from the aorta

coronary; right; left

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arteries supply oxygen to different parts of the body:
the right and left … arteries supply the head and brain
the right and left … arteries supply the upper extremities
the … artery supplies the arms
the … and … arteries supply the lower arms and hands
the right and left … arteries supply the groin, pelvis, and legs
the right and left … arteries supply the legs
the anterior and posterior … and … arteries supply the lower legs and feet

carotid; subclavian; brachial; radial; ulnar; iliac; femoral; tibial; peroneal

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arterioles and capillaries are smaller vessels that receive blood from the arteries–> capillaries are … thick and exchange nutrients and oxygen for waste at the cellular level and connect … to …

one cell; arterioles; venules

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… are the smallest branches of the veins and receive blood from the capillaries
.. return ox-poor blood to the heart–> … (upper) vena cava carries blood from the head and the arms back to the right atrium, … (lower) vena cava carries blood from the abdomen, kidneys, and legs back to the right atrium

venules; vena cavae; superior; inferior

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blood consists of: 
…, which carry oxygen and remove CO2
…, which fight infection 
…, which help blood to clot
… is the fluid that cells float in

red blood cells
white blood cells
platelets
plasma

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blood pressure is the force of … against artery walls
… blood pressure is the max pressure generated in the arms and legs during the contraction of the left ventricle during the time period known as systole
… blood pressure is the pressure against artery walls while the left ventricle relaxes

circulating blood; systolic; diastolic

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a … is felt when the blood passes through an artery during systole–> .. pulses felt in the extremities, … pulses felt near the body’s trunk

pulse; peripheral; central

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… is the volume of blood that passes through the heart in 1 minute: heart rate x volume of blood ejected with each contraction (….)
… is the constant flow of oxygenated blood to tissues

cardiac output; stroke volume; perfusion

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good perfusion requires the following:
a well-functioning …
an adequate … of “fluid” or blood
blood vessels must be appropriately … to match the volume of blood available
if perfusion fails, ..occurs, and eventually, the patient will die

heart; volume; constricted; cellular death

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chest pain usually stems from ..,. which is decreased blood flow to the heart or inefficient supply of oxygen and nutrients
… heart disease involves a decreased blood flow to one or more portions of the heart
if the blood flow is not restored, the tissue …

ischemia; ischemic; dies

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… is the buildup of calcium and cholesterol in the arteries: can cause … of arteries; … material accumulates with age, resulting in the narrowing of the lumen (inside diameter of the artery)–> the inner wall of the artery becomes rough and brittle. if a brittle plaque develops a crack, the ragged edge of the crack activates the blood-clotting system, resulting in a blood clot that will partially or completely block the lumen of the artery

occlusion; fatty

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a … is a blood clot floating through blood vessels

if clot lodges in coronary artery, … results

thromboembolism; acute myocardial infarctions

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… is the leading cause of death in the United States

there are .. and … risk factors for an AMI

coronary artery disease; controllable; uncontrollable

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… is caused by myocardial ischemia. this includes temporary myocardial ischemia, resulting in … or an ..

acute coronary syndrome (ACS); angina pectoris; AMI

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angina pectoris occurs when the heart’s need for oxygen exceeds .., usually during physical/emotional stress
it can result from a spasm of an artery, but is most often a symptom of atherosclerotic coronary artery disease.
typically described as … or … pain–> usually felt in …. of chest, under sternum and can radiate to jaw, arms, midback, or epigastrum

supply; crushing; squeezing; midportion

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angina cont:
usually lasts from 3-8 mins but rarely longer than 15 mins
may be associated with …, …, or ..
usually disappears promptly with .., …, or … although angina does not usually lead to death/permanent heart damage, it is a warning sign that should be taken seriously

shortness of breath; nausea; sweating; rest; supplemental oxygen; nitro

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… angina: in response to fewer stimuli than normal … angina: is relieved by rest/nitro patients experiencing chest pain/discomfort should always be treated as if they are having an AMI

unstable; stable

AMI pain signals actual … in heart muscle: once dead, the cells cannot be revived--> they will turn to scar tissue and become a burden to the beating heart. about 30 mins after blood flow is cut off, some heart muscles begin to die; after about 2 hrs, as many as ...of the cells in the area may be dead; after 4 to 6 hrs, more than 90% of the cells will be dead

death of cells; half;

AMI cont. opening the coronary artery with either .. (thrombolytic) drugs or … (mechanical clearing of the artery) can prevent permanent damage if it is done within the first few hours after the onset of symptoms immediate transport is essential it is more likely to occur in the …

clot-busting; angioplasty; left ventricle

the pain of ami differs from the pain of angina in three ways: not always due to … lasts … mins to several hours not always relieved by … or … when called to a scene where the chief complaint is chest pain, complete a thorough assessment, no matter what the patient says

exertion; 30; rest; nitro

``` physical findings of AMI and cardiac compromise include: gen appearance … … .. .. ```

pulse blood pressure respirations mental status

three serious consequences of AMI: .. … …

sudden death cardiogenic shock congestive heart failure

…: heart rhythm abnormalities … are extra beats in a damaged ventricle … … … describes a very rapid heart rhythm--> may deteriorate into ventricular fibrillation … describes the disorganized, ineffective quivering of ventricles--> no blood is pumped through the body, and the patient usually becomes unconscious within seconds; defib may convert this arrhythmia

``` dysrhythmia; premature ventricular contractions tachycardia bradycardia ventricular tachycardia ventricular fibrillation ```

defibrillation restores … by shocking the heart--> can save lives; initiate CPR until a defib is available--> chances of survival diminish approx. 10% each min until defib is accomplished … is the absence of all heart electrical activity--> usually reflects a long period of …; nearly all patients with this will die

cardiac rhythms; asystole; ischemia

cardiogenic shock: often caused by … heart lacks power to force enough blood through circulatory system inadequate oxygen to body tissues causes organs to malfunction heart lacks the power to … it is more common in an AMI affecting the inferior and posterior regions of the …

heart attack; pump; left ventricle

congestive heart failure: often occurs a few days after heart attack increased … and … of left ventricle no longer make up for decreased heart function lungs become congested with … --> occurs suddenly/slowly over months may cause …, where fluid collects in other parts of the body in acute-onset CHF, severe pulmonary edema is accompanied by pink, frothy sputum and severe dyspnea

heart rate; enlargement; fluid; dependent edema

``` hypertensive emergencies: systolic pressure greater than … mm Hg or a rapid increase in the systolic pressure … is a common sign common symptoms include … and … if untreated, can lead to … or … transport patients quickly and safely ```

180; sudden severe headache; altered mental status; pulmonary edema; stroke; dissecting aortic aneurysm;

aortic aneurysm is weakness in the … of the aorta: susceptible to …--> if it does, blood loss will cause the patient to die almost immediately a … aneurysm occurs when inner layers of aorta become separated … is primary cause transport patients quickly and safely

wall; rupture; dissecting; uncontrolled hypertension;

primary assessment: if dizziness or fainting has occurred due to cardiac compromise, consider the possibility of a … from a fall ox sat less than 95%: apply ox with NRB at 15 L/min pulmonary edema: use … or ...

spinal injury; BVM; CPAP

Primary assessment cont: circulation--> consider treatment for … position the patient in a comfortable position, usually … and well supported patients with cardiac problems should be transported in the most gentle, … manner possible

cardiogenic shock; sitting up; stress-relieving

secondary assessment: focus on … and … systems--> circulation, respirations measure and record the patient's vital signs: pulse, respirations, systolic and diastolic blood pressures in … if available, use pulse ox. if continuous blood pressure monitoring is available, use it in patients with chest pain, it is very valuable to have a ... tracing from as early as possible after the onset of pain

cardiac; respiratory; both arms; 12-lead ECG

… is always a risk with patients experiencing a cardiovascular emergency. if cardiac arrest occurs: if an AED is immediately available, use it communication and documentation: alert the ED about the patient's condition and …; follow instructions of medical control and document your assessment and treatment of the patient

sudden cardiac arrest; estimated time of arrival

Emergency med car for chest pain/discomfort: ensure a proper position of comfort … tight clothing give ox if indicated depending on protocol, prepare to administer … and assist with ...

loosen; low-dose aspirin; prescribed nitroglycerin

Emergency med car for chest pain/discomfort: administering nitro ensure medication is not … nor … ensure medication is … for patient wear gloves when administering medication

expired; contaminated; prescribed

for an ECG to be reliable and useful, electrodes must be placed in … positions basic principles should be followed to achieve the best … and minimize … in the signal

consistent; skin contact; artifact

cardiac monitoring guiding principles: may need to … rub the electrode site with an … before application attach electrodes to … before placement confirm electrode placement--> confirm that the appropriate electrode now attached to the cable is placed at the correct location on the patient's chest or limbs

shave body hair alcohol swab ECG cables

cardiac monitoring cont: once electrodes are in place, … --> print a … if strip shows artifact, confirm electrodes are … and cable is ...

switch on the monitor; sample rhythm strip; firmly applied; plugged in

in a …, a blood vessel from the chest/leg is sewn directly from the aorta to a coronary artery beyond the point of obstruction …: a tiny balloon is attached to the end of a long, thin tube. the tube is threaded into the narrowed coronary artery and inflated. the balloon is then deflated, and the tube and balloon are removed. sometimes a stent in placed inside the artery

coronary artery bypass graft; percutaneous transluminal coronary angioplasty

patients who have had open-heart procedures may/may not have a long .. treat chest pain in a patient who has had any of these procedures the same as a patient who has never had heart surgery some people have cardiac ...

chest scar; pacemakers

cardiac pacemakers: maintain regular cardiac … and … deliver … through wires in direct contact with the … implanted under a heavy muscle or fold of skin in the upper left portion of the chest

rhythm; rate; electrical impulse; myocardium

cardiac pacemakers cont: this tech is very reliable pacemaker malfunction can cause …, .., or … due to an excessively … heart rate (pulse will ordinarily be less than 60 beats/min) transport these patients promptly when an AED is used, the patches should not be placed directly over the pacemaker

syncope; dizziness; weakness; slow

automatic implantable cardiac defibrillators: used by some patients who have survived cardiac arrest due to … monitor … and … as needed treat chest pain patients with these devices like other patients having an AMI electricity is...; it will not affect rescuers

ventricular fibrillation; heart rhythm; shock; low

external defibrillator vest: a vest with built-in monitoring … and … worn by the patient attached to a monitor uses … shocks--> do not touch the patient if devices warns it is about to deliver a shock vest should … while CPR is being performed unless it interferes with compressions --> if it is necessary to remove it, simply remove the battery from the monitor and then remove the vest

electrodes; defibrillation pads; high-energy; remain in place

left ventricular assist devices: used to enhance the pumping of the … in patients with severe heart failure or in patients who need a temporary boost due to an MI may be … or … the patient/family can tell you more about the device transport all LVAD supplies and battery packs with the patient

left ventricle; pulsatile; continuous

cardiac arrest: the complete .. of cardiac activity--.., .., or both it is indicated in the field by the absence of a … cardiac arrest was almost always terminal until the advent of CPR and external defib in the 1960s

complete cessation; electrical; mechanical; carotid pulse

AED involves use of a small computer that analyzes … from the heart it identifies … and administers .. to the heart when needed

electrical signals; ventricular fibrillation; a shock

AED models: all models require some operator interaction--> operator must apply pads, turn on machine, and … to deliver an electrical shock many use a computer voice synthesizer to advise the EMT which steps to take most of the AEDs are ...

push a button; semiautomated

``` advantages of AED use: … delivery of shock easy to operate ALS providers do not need to be … remote, adhesive pads safe to use larger pad area = more … ```

quick; on scene; efficient shocks

AED--other considerations: though all cardiac arrest patients should be analyzed, not all require … all patients in cardiac arrest should be analyzed with an AED; some do not have shockable rhythms … (flatline) = no electrical activity … usually refers to a state of cardiac arrest that exists despite an organized electrical complex

shock; asystole; pulseless electrical activity

AED--early defib: few cardiac arrest patients survive outside a hospital without a rapid sequence of events CPR prolongs period during which … can be effective has resuscitated many patients with cardiac arrest from .. defib works best if it takes place within .. minutes of the onset of the cardiac arrest nontraditional first responders are being trained in AED use

defib; ventricular fib; 2

ALS and postarrest care: continue … maintain oxygen … assure blood pressure > … mm Hg maintain … levels int he patient who is hypoglycemic rapid transport it also includes cardiopulmonary and neurologic support at the hospital

ventilation; saturation; 90; glucose

work the AED and CPR in …; do not touch the patient while the AED is analyzing the heart rhythm and delivering shocks CPR must … while AED performs its job

sequence; stop

``` AED maintenance: maintain as manufacture recommends read the … document AED failure check equipment daily at … of shift make sure the … is properly maintained ask the manufacture for a maintenance checklist ```

operator's manual; beginning; battery

AED maintenance cont: report AED failures to manufacturer and the FDA … should approve written protocol for AED use the … and your service's … or quality improvement officer should review each incident in which the AED is used reviews should focus on … of def (i.e. the time from the call to shock) shocks should be delivered within … mins of the call continuing ed with skill competency review is generally required for EMS providers

medical direction; EMT team; medical director; speed; 1

preparation: make sure the electricity … no one do not defibrillate patients in .. --> you can defibrillate a soaking wet patient, but dry the patient's chest do not defibrillate patients …

injures; pooled water; touching metal

preparation contd: carefully remove … and wipe with dry towel before shocking to prevent ignition of the patch it is often helpful to … a hairy patient's chest to increase conductivity perform … for trauma patients call for ALS assistance in a tiered system

nitro patch; shave; spinal immobilization

After AED protocol is completed, one of the following si likely: … regained … regained and … advised … regained and … advised

pulse (ROSC); no pulse; no shock no pulse; shock

wait for ALS, and continue shocks and CPR on scene if ALS is not responding and protocols agree, begin transport when one of the following occurs: the patient … .. to … shocks are delivered (or as directed by protocol) the machine gives .. consecutive messages advising ..

regains a pulse; 6; 9; three; no shock

``` cardiac arrest during transport: .. the vehicle begin CPR if AED is not immediately available call for ALS support analyze … deliver … if indicated and resume CPR continue .. per local protocol ```

stop; rhythm; shock; resuscitation

``` coordination with ALS personnel: if AED available, do not .. for ALS notify ALS of .. do not delay defib follow local protocols for … ```

wait; cardiac arrest; coordination

management of return of spontaneous circulation: monitor for … provide … via … maintain ox sat between .. and ...% assess … see if patient can follow .. immediately begin transport if ALS is not en route per local protocol

respirations; oxygen; BVM; 95; 99; blood pressure; simple commands

Chapter 16 Flashcards

(69 cards)