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EMT230 > EMT230 > Flashcards

EMT230 Flashcards

1
Q

A medic notes deep and symmetrically inverted T waves—what does this indicate?

A

Cardiac ischemia

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2
Q

10 leads—4 on the limbs and 6 on the chest—is called what?

A

12-lead

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3
Q

50 year-old patient who has diabetes, is overweight, and smokes—asks you about his risk of cardiovascular disease. What do you tell him?

A

He can modify his risk for cardiovascular disease by losing weight and not smoking.

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4
Q

Pt has regular bradycardia rhythm with a rate of 40, no P waves, and a QRS greater than 0.12. Medic should diagnose what rhythm?

A

Ventricular escape rhythm

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5
Q

Pt with SVT begins to develop chest pain, and bp drops to 100/60. What treatment is next?

A

Synchronous cardioversion

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6
Q

Right axis shift of the ECG is noted when the QRS deflection has what characteristic?

A

Negative in lead I, negative or positive in lead II, and positive in lead III

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7
Q

After an initial defibrillation, what should the second and subsequent defibrillations for pediatric patients be set at?

A

4 j/kg

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8
Q

After medics administer nitro 0.4 mg SL to a pt with chest pain who has ST elevation in leads II, III and AVF, pt’s bp drops to 78/50. Where is the most likely location of cardiac muscle damage?

A

Inferior wall and right ventricle, which increases the dependence on preload

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9
Q

ECG strip shows a regular rhythm with a QRS complex of .08, rate 145, PR interval of .12 and one upright P-wave before each QRS complex. What rhythm should the medic suspect?

A

Sinus tachycardia

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10
Q

ECG strip shows a rhythm with a rate of 45, QRS of .08, and P wave that appears after the QRS. What rhythm should the medic suspect?

A

Junctional

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11
Q

Inferior-wall MI is usually caused by occlusion of the ___ artery.

A

Right coronary

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12
Q

During assessment, medic discovers a carotid bruit. What underlying condition should the medic suspect?

A

Atherosclerosis

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13
Q

Each small square of graph paper represents ___ mV.

A

0.1 mV

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14
Q

Each square on ECG paper is __ mm in height and width.

A

1

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15
Q

ECG analysis reveals that each P wave has different shape. Heart rate is 80 bpm. What rhythm should the medic suspect?

A

Wandering pacemaker

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16
Q

How can you help reduce impedance of the electrical current?

A

Ensure that excessive chest hair is shaven before patch placement

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17
Q

How is an aortic dissection usually described?

A

Ripping or tearing sensation

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18
Q

How does ACh affect the heart?

A

Decreases heart rate

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19
Q

How does atropine affect the ventricular rate of 3rd degree heart block?

A

Has no effect on the rate

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20
Q

How is preload defined?

A

Ventricular end-diastolic volume

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21
Q

How should a second degree type II heart block be considered?

A

Serious arrhythmia regardless of s&s

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22
Q

How will parasympathetic stimulation affect the heart?

A

A decreased rate

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23
Q

If a pt is in cardiogenic shock, when should signs of cardiogenic shock develop?

A

After hypovolemia and dysrhythmias have been corrected

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24
Q

If a pt with cardiac tamponade becomes hypotensive in the field, what should we do?

A

Administer a fluid bolus

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25
Q

If a-fib has been present for 48 hours+, conversion of the rhythm may lead to what?

A

Release of emboli

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26
Q

If a ventricle loses 25% of its muscle mass because of MI, what effect will it have?

A

The heart can still pump effectively

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27
Q

In a 12-lead ECG, what cardiac position are the leads V1 and V2?

A

Septal

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28
Q

In lead II placement, where is the positive lead located?

A

Left leg

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29
Q

In order to determine ST segment elevation, what is the amount that the ST segment must be elevated?

A

My more than 0.1 mV in at least 2 leads (more than 1 small box)

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30
Q

In the event of a coronary artery blockage, how could the muscle of the heart still receive blood?

A

Anastomoses

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31
Q

In what pt position should jugular vein distension in cardiac pt’s be evaluated?

A

With head elevated 45 degrees

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32
Q

Lead I looks at the heart from what view?

A

Lateral

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33
Q

Of what branch is the circumflex artery?

A

Left coronary artery

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34
Q

On an ECG, how will pulseless electrical activity present?

A

Any electrical activity other than the ventricular fibrillation or ventricular tachycardia

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35
Q

Pacemakers are usually set to a rate of ___ bpm beginning with ___ milliamps?

A

70-80 bpm, 50 mA

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36
Q

Medics are evaluating a 40 y/o woman in an airport who began to experience pain in her left lower leg after a 12 hour flight. Leg is warm, swollen, painful. What should you suspect?

A

Deep vein thrombosis

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37
Q

ECG tracing: wide QRS complexes that were produced with supraventricular activity. On MCL1 you see a QS pattern, what should you suspect?

A

Left bundle branch block

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38
Q

Which lead is placed on the 4th intercostal space just to the right of the sternum?

A

V1

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39
Q

An ECG exam of a 65 year-old man: ventricular heart rate is 56, more P waves than QRS complexes. PR interval is constant when a QRS follows a P wave. QRS complexes are widened. What type of heart block should you suspect?

A

Second degree type II

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40
Q

Medics are evaluating a pt who is complaining that his heart is “skipping beats.” On ECG evaluation, paramedics see frequent PVCs that are occurring in groups. BP is 100 systolic. What should treatment include?

A

Withhold treatment until serious signs and symptoms develop

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41
Q

Medics are treating a pt who is in PEA following home dialysis. What drug might be indicated?

A

Sodium bicarb

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42
Q

Medics discover a pt in asystole. In regards to electrical therapy, how should the medic proceed?

A

Electrical therapy is not recommended

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43
Q

Medics have determined that a pt is in a-fib, unstable, and requires electrical therapy. They should perform ___ countershock with ___ joules.

A

synchronized

120-200

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44
Q

Patients with pulseless v-tach should be treated in the same way as what other dysrhythmia?

A

V-fib

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45
Q

Phase 1 of the action potential represents which period?

A

Early rapid repolarization

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46
Q

Second degree type II heart block occurs when the impulse is not conducted through what portion of the cardiac electrical system?

A

Bundle branches

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47
Q

How much time does each small block on the ECG represent?

A

0.04 second

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48
Q

Stroke volume depends on preload, afterload, and what other factor?

A

Myocardial contractility

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49
Q

The AV junction is formed by the AV node and what other part of the cardiovascular electrical system?

A

Bundle of His

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50
Q

The left circumflex mainly supplies blood to what part of the cardiac muscle?

A

Left atrium

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51
Q

The duration of the QRS complex should be ___ second.

A

0.08 - 0.10

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52
Q

The intrinsic rate for the ventricular pacemaker is ___ beats per minute.

A

20 to 40

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53
Q

The left anterior descending coronary artery mainly supplies blood to what part of the cardiac muscle?

A

Septum

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54
Q

The majority of acute myocardial infarctions involve what section of the heart?

A

Left ventricle

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55
Q

The patient’s ST segment elevation is seen in leads II, III, and aVF. What should the paramedic suspect?

A

Inferior-wall MI

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56
Q

The PR interval represents the time that it takes an electrical impulse to do which action?

A

Be conducted through the atria and the AV node

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57
Q

The resting membrane potential is determined primarily by the difference between the intracellular potassium and what ion level?

A

Extracellular potassium

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58
Q

The right atrium receives blood from the systemic circulation and the ___.

A

Coronary veins

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59
Q

The right coronary artery and the left anterior descending artery supply most of the blood to what part of the cardiac muscle?

A

Right atrium and ventricle

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60
Q

The ST segment is elevated because the damaged muscle is ___.

A

Constantly depolarized

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61
Q

The three characteristics of Wolff-Parkinson-White syndrome are a short PR interval, QRS widening, and a ___.

A

Delta wave

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62
Q

To increase cardiac output, which action must take place?

A

Increase both heart rate and stroke volume

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63
Q

Under normal conditions, what is the dominant pacemaker of the heart?

A

SA node

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64
Q

What are aneurysms most commonly the result of?

A

Atherosclerotic disease

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65
Q

What are most MI’s caused by?

A

Acute thrombotic occlusion

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66
Q

What can an ECG help determine?

A

Whether there is ischemic cardiac muscle

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67
Q

What does a depressed ST segment suggest?

A

Ischemia

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68
Q

What does an elevated ST segment suggest?

A

Injury

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69
Q

What does an increase in peripheral vascular resistance cause?

A

Decreased stroke volume

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70
Q

What does T wave inversion suggest?

A

Ischemia

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71
Q

What does the medication atropine inhibit?

A

Parasympathetic response

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72
Q

What does the ST segment reflect?

A

Early repolarization of the ventricles

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73
Q

What does the Starling law state?

A

Myocardial fibers contract more forcefully when they are stretched

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74
Q

What drug may improve the symptoms of cardiogenic shock patients in the field?

A

Dopamine

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75
Q

What is a blood pressure reading of 180/110 in an adult considered?

A

Stage 3 hypertension

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76
Q

What is a characteristic of a left bundle-branch block?

A

A Q wave is seen instead of an R wave in MCL1

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77
Q

What is a characteristic of chest pain associated with MI?

A

Is constant

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78
Q

What is a characteristic of ischemia caused by unstable angina?

A

Responds well to treatment with antiplatelet agents

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79
Q

What is a characteristic of junctional escape rhythm?

A

Occurs when the SA node fails to fire

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80
Q

What is a characteristic of normal sinus rhythm?

A

Electrical impulse originates from SA node

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81
Q

What is a characteristic of Prinzmetal angina?

A

Coronary arteries spasm

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82
Q

What is a characteristic of Wolff-Parkinson-White syndrome?

A

Preexcitation syndrome

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83
Q

What is a compensatory mechanism of the heart in the presence of chronic hypertension?

A

Enlarge the muscle mass of the heart

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84
Q

What is a hallmark trait of a-fib?

A

An irregularly irregular rhythm

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85
Q

What is a major effect of norepinephrine?

A

Vasoconstriction

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86
Q

What is a patient in left ventricular failure expected to have?

A

Activation of the renin-angiotensin-aldosterone system

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87
Q

What is a sign of a cardiac tamponade?

A

Muffled heart tones

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88
Q

What is a typical characteristic of third-degree heart block?

A

Regular but independent atrial and ventricular rhythms

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89
Q

What is an undesirable side effect of atropine?

A

Increased myocardial oxygen demand

90
Q

What is characteristic of atherosclerosis?

A

Progressive narrowing of the lumen of medium and large arteries

91
Q

What is emergency care for a bundle-branch block?

A

Aimed at the cause of the block if it is identifiable

92
Q

What is parasympathetic control of the heart provided by?

A

Vagus nerve

93
Q

What is right ventricular failure most often the result of?

A

Left ventricular failure

94
Q

What is the activation of myocardial tissue more than one time by the same impulse called?

A

Reentry

95
Q

What is the class I intervention for all symptomatic bradycardia?

A

There are no class I interventions

96
Q

What is the definitive treatment for second degree type II?

A

Transvenous pacemaker insertion

97
Q

What is the desired action of prehospital medications when treating a patient with left ventricular failure?

A

Reduce afterload

98
Q

What is the first medication a paramedic should aminister to a patient with angina?

A

Oxygen

99
Q

What is the first recommended treatment for SVT?

A

Valsalva maneuver

100
Q

What is the first upward deflection on an ECG tracing?

A

P wave

101
Q

What is the group of nerves that innervates the atria and ventricles known as?

A

Cardiac plexus

102
Q

What is the initial pediatric defibrillation joule setting?

A

2 J/kg

103
Q

What is the joule setting for the initial synchronous cardioversion of SVT?

A

100J

104
Q

What is the major neurotransmitter for the parasympathetic system?

A

ACh

105
Q

What is the meaning of sinus bradycardia?

A

The heart rate is less than 60 bpm

106
Q

What is the most common arrhythmia in sudden cardiac arrest?

A

Ventricular fibrillation

107
Q

What is the most common cause of death following MI?

A

Fatal dysrhythmia

108
Q

What is the most important factor in determining stroke volume in a healthy heart?

A

Preload

109
Q

What is the most likely cause of atrial flutter?

A

Rapid reentry

110
Q

What is the most likely cause of second degree type II heart block?

A

Septal MI

111
Q

What is the movement function of the sodium-potassium pump?

A

Potassium ions into the cell and sodium ions out of the cell

112
Q

What is the position of comfort for a patient with left ventricular failure?

A

Sitting with legs dependent

113
Q

What is the prehospital care for a patient in second degree type II heart block?

A

Transcutaneous pacing

114
Q

What is the treatment of choice for a severe symptomatic ventricular escape rhythm?

A

Pacing

115
Q

What is the valve between the right atrium and right ventricle?

A

Tricuspid valve

116
Q

What is typically found on an ECG with a bundle-branch block?

A

A widened QRS complex

117
Q

What kind of leads are II and III?

A

Inferior

118
Q

What lead is routinely used for monitoring dysrhythmias?

A

Lead II

119
Q

What may be a lethal treatment for a patient with a ventricular escape rhythm?

A

Lidocaine

120
Q

What medical device should the paramedic suspect if an outline of a small box implanted under the skin in the left upper chest is observed?

A

Implantable cardioverter-defibrillator

121
Q

What occurs during the period between action potentials?

A

There is excessive sodium in the cell

122
Q

What organ(s) are at most risk in a hypertensive crisis?

A

Kidneys

123
Q

What part of the ECG tracing is most important for detecting life-threatening arrhythmias?

A

QRS complex

124
Q

What property of dopamine causes an increased heart rate?

A

Beta agonist

125
Q

What sign is most indicative of a right ventricular infarct?

A

Peripheral edema

126
Q

What sound is heard when the AV valves close during ventricular systole?

A

S1

127
Q

What statement best describes the triplicate method of determining heart rate?

A

Accurate when the heart rhythm is regular and greater than 50 beats per minute

128
Q

What statement is true about most new AEDs?

A

Use waveforms that are more effective at lower energy settings

129
Q

What term describes relaxation of the heart?

A

Diastole

130
Q

What will occur after an implantable cardioverter-defibrillator has delivered five shocks?

A

Not deliver more shocks until a slower rate is restored for 30 seconds

131
Q

What will occur if the paddle positions are switched during defibrillation?

A

Defibrillation will occur as usual

132
Q

When analyzing an ECG tracing, you notice that the rhythm is highly irregular. What is the best method to calculate the rate?

A

Six-second count method

133
Q

When attempting to perform a vagal maneuver, what action is most appropriate?

A

Placing ice packs to the neck

134
Q

When contacting medical control to terminate resuscitation efforts, what information is most important for the medic to relay?

A

Any treatment provided

135
Q

When depolarization takes place, what action occurs?

A

Sodium ions rush into the cell

136
Q

When does synchronous cardioversion deliver the energy?

A

10 ms after the peak of the R wave

137
Q

When is fibrinolytic therapy contraindicated?

A

If patient has had recent laser eye surgery of less than 3 weeks

138
Q

When is fibrinolytic therapy for an MI patient most effective?

A

When administered within 12 hours after the onset of symptoms

139
Q

When is synchronized cardioversion most acceptable for patients with ventricular tacycardia?

A

If they have decreased cardiovascular function

140
Q

When performing CPR on an adult, how many inches should the medic compress the chest?

A

At least 2

141
Q

Where are dissections of the aorta typically found?

A

On the ascending aorta

142
Q

Which cardiac pacemaker has an intrinsic rate of 40-60 beats per minute?

A

AV junction

143
Q

Which class I (recommended) drug is used for the treatment of SVT?

A

Adenosine

144
Q

Which home medications would indicate that your patient has a strong risk factor for heart disease?

A

Metformin

145
Q

Which illness/complication may cause sinus bradycardia?

A

Intrinsic sinus node disease

146
Q

Which is a bipolar lead?

A

Lead II

147
Q

Which is a cause of PEA correctable in the field?

A

Tension pneumo

148
Q

Which is true of abdominal aortic aneurysm (AAA)?

A

AAA may be asymptomatic as long as it is stable

149
Q

Which of these nerve fibers mainly innervate the ventricles of the heart?

A

Sympathetic nerve fibers

150
Q

Which rhythm is an absolute indication for unsynchronized cardioversion?

A

Ventricular fibrillation

151
Q

Which statement best describes the firing characteristics of demand pacemakers?

A

When the patient’s rate drops below a preset number

152
Q

Which statement is true in regards to the identification of bundle-branch blocks?

A

Can only be determined with a 12-lead ECG

153
Q

Which statement is true of the coronary arteries?

A

The coronary arteries begin just above the aortic valve

154
Q

Which statement is true regarding v-tach?

A

It may be triggered by a PVC

155
Q

While analyzing an ECG, you cannot identify a Q wave. What does this most likely indicate?

A

The Q wave may not be visible in the lead you are viewing

156
Q

While assessing a pt, medics note a pulatile mass in the abdomen. Suddenly this mass is no longer palpable and the patient’s blood pressure begins to drop. What is the most likely cause?

A

Patient’s aneurysm has ruptured

157
Q

Wolff-Parkinson-White syndrome is of little clinical importance unless the patient is experiencing what condition?

A

Tachycardia

158
Q

You are called to evaluate a 64 year-old woman who complains of palpitations, weakness and dizziness. HEr heart rate is 160 bpm, bp 118/80, resp rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. Which rhythm should you suspect?

A

SVT

159
Q

You are treating a 75 year-old woman who has a history of diabetes and atherosclerosis. Her chief complaint is persistent heartburn. What should the medic suspect?

A

This may be a cardiovascular problem

160
Q

You are treating a pt who has a damaged SA node that is no longer pacing the heart. What cardiac finding should you expect to find?

A

Bradycardia

161
Q

You see an irregular rhythm on the monitor with a rate of 66-80, a normal PR interval, and a P wave for every QRS. The rate speeds up and slows down with the patient’s respiratory rate. What rhythm should you suspect?

A

Sinus dysrhythmia

162
Q

___ second is measured in each large box on ECG graph paper.

A

0.20 second

163
Q

The circumflex branch of the left coronary artery mainly supplies blood to what part of the cardiac muscle?

A

Left atrium

164
Q

Would a pt with acute CHF with pulmonary edema have stridor lung sounds?

A

No

165
Q

What could different blood pressures per arm indicate?

A

AAA

166
Q

Heart rate of 30, normal P wave, QRS less than 0.12—what rhythm?

A

Sinus bradycardia

167
Q

What would a pacer spike not followed by a QRS wave indicate?

A

Pacemaker failure

168
Q

Lasix is what type of drug?

A

Diuretic

169
Q

What is not part of the autonomic nervous system?

A

Spinal cord

170
Q

Inotrope definition?

A

Force of cardiac contraction

171
Q

Analysis of ST segment is not part of what?

A

Initial ECG

172
Q

ECG cannot read what?

A

CO

173
Q

Second degree type II is from what area?

A

Septal MI

174
Q

The circumflex is part of what coronary artery?

A

Left coronary artery

175
Q

What drug helps hypertension but has no effect on the heart?

A

ACE inhibitor

176
Q

What is one characteristic of an idioventricular rhythm?

A

QRS greater than 0.12

177
Q

A second degree type II block occurs when what happens?

A

Electrical impulse is not conducted through the bundle branches

178
Q

What lung sounds would you expect to hear in a pt with pulmonary edema?

A

Rales
Rhonchi
Wheezing

179
Q

A-fib responds well to what type of drug?

A

Calcium channel blocker

180
Q

Peaked T waves could indicate what condition?

A

Hyperkalemia

181
Q

Why do we push so hard and fast during CPR?

A

To maintain a good bp

182
Q

The apex of the heart is located where?

A

On the bottom (diaphragm) side of the heart

183
Q

Torsades de pointes is what kind of rhythm?

A

Polymorphic ventricular tachycardia

184
Q

Polymorphic ventricular tachycardia can degenerate into what rhythm?

A

Ventricular fibrillation

185
Q

Medication that may help with torsades de pointes?

A

Mag sulfate

186
Q

How do beta blockers work?

A

They work by decreasing cardiac output and inhibiting renin secretion from the kidneys, which results in lower bp

187
Q

How do ACE inhibitors work?

A

Inhibits the conversion of the precursor angiotensin I to angiotensin II, the renin-angiotensin-aldosterone system is suppressed and blood pressure is lowered

188
Q

What is a U wave?

A

Only sometimes visible

Thought to represent repolarization of the Purkinje fibers

189
Q

When using the R-R method, how do you calculate heart rate using the distance in seconds?

A

Measure the distance in seconds between two R waves

Divide this number into 60

190
Q

When using the R-R method, how do you calculate heart rate using large squares?

A

Count the large squares between the R waves

Divide this number into 300

191
Q

When using the R-R method, how do you calculate heart rate using small boxes?

A

Count the small boxes between R waves

Divide this number into 1500

192
Q

Name one characteristic of an idioventricular rhythm

A

Wide (>0.12) QRS complex

193
Q

What will you see on an ECG to indicate potential ischemia?

A

ST depression

194
Q

Name some causes of pulseless electrical activity (PEA)

A 
Tamponade, cardiac
Tension pneumothorax
Pulmonary embolism
MI
Hypoxia
Hypo-/hyperkalemia
Overdoses
Hypovolemia
195
Q

What is one critical element of resuscitation in cardiac arrest situation with v-tach?

A

Defibrillation

196
Q

What is a second degree type II av block? When does it occur? How will you recognize it?

A

Occurs when impulses are not conducted from atria to ventricles
Distinct ECG pattern: consecutive P-waves with a constant PR interval with intermittent dropped QRS complex

197
Q

The right atrium receives blood from the systemic circulation and ___?

A

Coronary veins

198
Q

What does it mean when the monitor will not pace?

A

You don’t have capture

199
Q

What is the PR interval?

A

Indicates the time required for an electrical impulse to be conducted through the atria and AV node

200
Q

What occurs after the action potential peaks?

A

Repolarization

201
Q

How will hyperkalemia show on an ECG?

A

Peaked T waves

202
Q

What lung sounds will you hear with CHF?

A

Crackles
Rhonchi
Rales
Wet lung sounds

203
Q

What lab work will the hospital do to detect an MI?

A

Troponins
CK
CK-MB

204
Q

Symptomatic bradycardia - most important intervention?

A

Transcutaneous pacing

205
Q

Amiodarone doses for cardiac arrest? First/second?

A

First bolus = 300 mg
Second bolus = 150 mg
IV/IO

206
Q

Arteriosclerosis vs atherosclerosis

A 
Arteriosclerosis = thickening and hardening of the walls of the arteries
Atherosclerosis = lipid/cholesterol buildup in the inner walls of the arteries, causing narrowing
207
Q

What is Wolff-Parkinson-White syndrome?

What is a critical condition in it?

A

WPW is a genetic heart abnormality associated with early activation of the ventricles
In tachycardia, this preexcitation syndrome can be life-threatening

208
Q

Dopamine - when used? (2) What dosage?

A

When: second-line drug for symptomatic brady (after atropine), also for hypotension (

209
Q

How do we determine STEMI in 12-lead?

A

ST elev of 1mm+ in 2 contiguous leads

210
Q

CPAP is indicated for what patients?

A 
Used for pts with: 
Acute respiratory distress syndrome (ARDS)
Asthma
COPD
CHF
Pneumonia
Pulmonary edema

DO NOT use for unconscious pts, under 14 y/o, hypotension/shock, chest trauma, pneumo, GI bleeding

211
Q

Atropine given too slowly can do what?

A

Can cause a rebound bradycardia

212
Q

What is the mechanism of action of dopamine?

A

Stimulation of beta 1 receptors is primary effect, which increases cardiac output and only has a modest increase in systemic vascular resistance

213
Q

What kind of rhythm is a-fib?

A

Irregularly irregular

214
Q

What is an indication of a paced rhythm?

A

Presence of pacer spikes

215
Q

How do we listen for basic heart sounds S1 and S2?

A 
S1 = ask pt to breathe normally and hold the breath in expiration
S2 = ask pt to breathe normally and hold the breath in inspiration
216
Q

Which valve is located between the right atrium and right ventricle?

A

Tricuspid

217
Q

Which routes can atropine be administered?

A

IV, IO, ET tube

218
Q

Define preload

A

End-diastolic volume in the ventricles

219
Q

Define afterload

A

Pressure in the aorta before ventricular contraction; the total resistance against which blood must be pumped

220
Q

What nerves innervate the atria and ventricles?

A

Cardiac plexus

221
Q

What is the dosage for lidocaine in cardiac arrest from VF/VT? Initial and refractory dose?

A

Initial = 1 to 1.5 mg/kg IV/IO
Refractory = 0.5 to 0.75 mg/kg IV push
Repeat in 5-10 min, max 3 doses or 3 mg/kg

EMT230 (1 decks)

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