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EMT254 > EMT254 > Flashcards

EMT254 Flashcards

1
Q

What is the MOST important drug that any pt with chest pain should receive?

A

Oxygen

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2
Q

The definition of myocardial ischemia is…?

A

Deprivation of oxygen and other nutrients to the heart muscle with the tendency to produce repolarization abnormalities

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3
Q

Pain associated with angina pectoris is temporary—yes/no?

A

Yes

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4
Q

The primary goal of management of the pt with symptomatic chest pain is to ___?

A

Interrupt the infarction process

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5
Q

ST segment elevation is a primary indicator of ___?

A

Myocardial injury

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6
Q

The coronary arteries receive oxygenated blood from the ___?

A

Aorta

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7
Q

The most common cause of AMI’s is ___?

A

Thrombus formation

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8
Q

The SA node is located in the ___

A

Right atrium

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9
Q

When interpreting dysrhythmias, you should remember that the most important key is the ___

A

Patient’s clinical appearance

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10
Q

You respond to a 86 y/o female having substernal crushing chest pain. She is anxious, diaphoretic, pale, most likely having an MI and needing definitive care. What does this mean?

A

Thrombolytic treatment in the hospital

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11
Q

What are the 5 steps in an initial reading of an ECG?

A 
QRS complex
P-wave
Rate
Rhythm
PR interval
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12
Q

EKG changes of significance with myocardial ischemia include ST segment depression, T wave inversion, or ___?

A

Peaked T wave

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13
Q

The V2 electrode is placed where?

A

4th intercostal space, left of the sternum

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14
Q

A normal QRS measures how many seconds on the ECG?

A

0.08 - 0.12 (depending on source, could also be 0.08 - 0.10)

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15
Q

Augmented leads are defined as ___?

A

1 positive electrode and 2 or 3 negative electrodes

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16
Q

Name the two lead placements as related to lead II

A

(+) left leg

(-) right arm

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17
Q

Name the lead placements as related to aVF

A

(+) left leg

-) central terminal (right arm and left arm

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18
Q

A small box on the EKG paper equals how many seconds of time?

A

0.04 seconds

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19
Q

The normal PR interval is ___?

A

0.12 - 0.20 seconds

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20
Q

How many seconds is a large box on ECG paper?

A

0.20 seconds

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21
Q

What does ST segment elevation indicate on an ECG?

A

Injury

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22
Q

What is the significance of a pathological Q wave?

A

Infarct (either old or new)

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23
Q

Define Starling’s law

A

When the volume of blood in the ventricles is increased, stretching the ventricular myocardial fibers, it results in a more forceful contraction

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24
Q

Where is the positive electrode in lead III?

A

Left leg

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25
Q

What is the intrinsic rate of the ventricles?

A

20-40 bpm

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26
Q

What is the measurement of one small square on ECG paper?

A

1 mm

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27
Q

What are the two measurements on ECG paper?

A

Amplitude (vertical axis)

Time (horizontal axis)

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28
Q

What occurs during depolarization?

A

Sodium ions rush in, causing contraction

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29
Q

The movement of potassium through the cell membrane is what type of process?

A

Active transport

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30
Q

Is a foreign body obstruction a respiration or a ventilation problem?

A

Ventilation

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31
Q

Unstable atrial fibrillation should be electrically treated how?

A

Sync cardiovert @ 120J

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32
Q

What does the term “blue bloater” refer to?

A

A pt with chronic bronchitis

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33
Q

What size ET tube would you choose for a surgical cric?

A

6.0-7.0

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34
Q

Right or left coronary arteries larger?

A

Left

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35
Q

What is coronary circulation?

A

The process of oxygenated blood being distributed throughout the heart muscle

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36
Q

What are the two branches of the left coronary artery?

A

Left anterior descending

Left circumflex

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37
Q

What are the two branches of the right coronary artery?

A

Right marginal

Right posterior descending

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38
Q

Which artery is the major branch of the left coronary artery?

A

Left anterior descending

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39
Q

The posterior descending branch of the right coronary artery also supplies blood to what part of the heart?

A

The posterior and inferior part of the heart’s left ventricle

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40
Q

The short trunk that serves to receive deoxygenated blood from the veins of the myocardium is called the ___.

A

Coronary sinus

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41
Q

ST depression is indicative of ___.

A

Ischemia

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42
Q

Where is the carina located?

A

Under the angle of Louis

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43
Q

What is the innermost layer of the heart called?

A

Endocardium

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44
Q

Where is the SA node located?

A

In the right atrium

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45
Q

What is the normal pH of blood?

A

7.35 - 7.45

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46
Q

What is the quality of angina?

A

Constriction, narrowing

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47
Q

What is the most common cause of myocardial infarction?

A

Thrombus

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48
Q

What is the most appropriate intervention that assists as a dysrhythmic?

A

Oxygen

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49
Q

What leads picture the inferior part of the heart?

A

II, III, and aVF

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50
Q

What leads picture the lateral part of the heart?

A

I, aVL, V5, and V6

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51
Q

What leads picture the septal part of the heart?

A

V1 and V2

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52
Q

What leads picture the anterior part of the heart?

A

V3 and V4

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53
Q

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

A

Tricuspid valve

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54
Q

What is the first treatment of an MI?

A

Oxygen

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55
Q

Definition of reciprocal changes?

A

ECG changes that occur in reciprocal leads
Appear on an ECG as opposite changes in leads that visualize opposite sides of the heart (e.g. elevation in one set of leads vs depression in an opposite set of leads)

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56
Q

The anterior part of the heart is mostly supplied by what coronary artery?

A

Left anterior descending

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57
Q

The left anterior descending is also known as what due to its high incidence of mortality of occluded?

A

Widowmaker

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58
Q

Inferior wall infarctions are commonly associated with what artery?

A

Right coronary artery

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59
Q

The six branches off the left anterior descending are known as what?

A

Septal perforating arteries

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60
Q

Septal MIs will primarily involve what artery?

A

Left anterior descending

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61
Q

When using the R-R method, how do you calculate a rate based on the number of seconds?

A

Count the number of seconds between R-R, and divide into 60

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62
Q

When using the R-R method, how do you calculate a rate based on large boxes?

A

Count the number of large boxes between R-R, and divide into 300

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63
Q

When using the R-R method, how do you calculate a rate based on small boxes?

A

Count the number of small boxes between R-R, and divide into 1500

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64
Q

What is the term for 3x PVCs in a row?

A

Salvo

Or a run of v-tach

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65
Q

What does CHAPS stand for?

A 
Chest pain
Hypotension
Altered mental status
Pulmonary edema
Syncope/shock
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66
Q

What is the setting for cardioversion of SVT?

A

50J

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67
Q

What is the normal axis of the heart?

A

+90 degree to 0 degrees

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68
Q

The fibrous sac covering the heart, which is in contact with the pleura, is called the ___.

A

Pericardium

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69
Q

The heart chamber with the thickest myocardium is the ___.

A

Left ventricle

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70
Q

The pulmonic and aortic valves are open during ___.

A

Systole

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71
Q

The large blood vessel that returns unoxygenated blood from the head and neck to the right atrium is called the?

A

Superior vena cava

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72
Q

The innermost layer of the arterial wall is the ___.

A

Tunica intima

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73
Q

The most numerous blood vessels in the body are the ___.

A

Capillaries

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74
Q

Blood flow between the heart and the lungs comprises the ___.

A

Pulmonary circulation

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75
Q

___ are fine chords of dense connective tissue that attach to papillary muscles in the wall of the ventricles.

A

Chordae tendineae

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76
Q

The right and left coronary arteries branch off the ___.

A

Trunk of the aorta

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77
Q

The central section of the thorax is called the ___.

A

Mediastinum

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78
Q

The smooth outer surface of the heart is known as the ___.

A

Epicardium

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79
Q

An inflammation of the serous pericardium is called ___.

A

Pericarditis

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80
Q

T/F - The left side of the heart is referred to as a low-pressure pump.

A

False

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81
Q

Cardiac output is a product of which elements?

A

Heart rate x Stroke volume

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82
Q

The chief chemical neurotransmitter for the parasympathetic nervous system is ___.

A

Acetylcholine

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83
Q

The heart has ___ chambers.

A

Four

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84
Q

The chief chemical neurotransmitter for the sympathetic nervous system is ___.

A

Norepinephrine

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85
Q

Unoxygenated blood flows from the inferior/superior vena cavae into the ___.

A

Right atrium

86
Q

One cardiac cycle occurs every ___ seconds.

A

0.8

87
Q

What kind of receptors do the body’s blood vessels have? The only exception?

A

Alpha-adrenergic receptors

Exception: capillaries

88
Q

What kind of receptors do the heart and lungs have?

A

Beta-adrenergic receptors

89
Q

The end-diastolic pressure reflective of volume in the ventricles during diastole is called ___.

A

Preload

90
Q

The nerve endings of the sympathetic nervous system are called ___.

A

Adrenergic

91
Q

Stroke volume is estimated as ___ cubic centimeters per beat.

A

70

92
Q

The primary functions of the myocardial working cells include: (2)

A

Contraction

Relaxation

93
Q

The ability of cardiac pacemaker cells to spontaneously generate their own electrical impulses without external (or nervous) stimulation is known as ___.

A

Automaticity

94
Q

Which of the characteristics of myocardial cells is specific to the pacemaker cell sites of the electrical conduction system?

A

Conductility

95
Q

The ability of cardiac cells to respond to an electrical stimulus is known as ___.

A

Excitability

96
Q

Excitability is also referred to as ___.

A

Irritability

97
Q

The ability of cardiac cells to receive an electrical stimulus and to then transmit the stimulus to other cardiac cells is known as ___.

A

Conductivity

98
Q

T/F - Conductivity is a characteristic shared by all cardiac cells.

A

True

99
Q

Cardiac muscle cell groups that function collectively as a unit are known as ___.

A

Syncytia

100
Q

T/F - Repolarization is a slower process than depolarization.

A

True

101
Q

The period during which repolarization is almost complete and the cardiac cell can be stimulated to contract prematurely if the stimulus is stronger than normal is known as ___.

A

Relative refractory period

102
Q

The relative refractory period is also known as the ___ period.

A

Vulnerable

103
Q

A decrease in sodium blood levels is called ___.

A

Hyponatremia

104
Q

An increase in calcium blood level is called ___.

A

Hypercalcemia

105
Q

The resting state of a cardiac cell, wherein the inside of the cell is electrically negative relative to the outside of the cell, is called ___.

A

Polarized state

106
Q

The point at which a stimulus will produce a cell response is called the ___.

A

Threshold

107
Q

The AV node is located in the ___.

A

Atrioventricular septum

108
Q

The intrinsic firing rate of the AV junction is ___.

A

40-60 bpm

109
Q

The intrinsic firing rate of the SA node in the adult is ___.

A

60-100 bpm

110
Q

The ECG is used to ___.

A

Evaluate electrical activity in the heart

111
Q

The primary pacemaker of the heart is the ___.

A

SA node

112
Q

The bundle of His is also traditionally referred to as the ___.

A

Common bundle

113
Q

T/F - The fibers of the Purkinje network can only be identified with the aid of a microscope.

A

True

114
Q

A group of interatrial fibers contained in the left atrium is referred to as ___.

A

Bachmann’s bundle

115
Q

The interventricular septum is the wall between the ___.

A

Right and left ventricle

116
Q

T/F - Purkinje’s network fibers are smaller in diameter than ordinary cardiac muscle fibers.

A

False

117
Q

The SA node receives its blood supply primarily from the ___.

A

SA artery

118
Q

Ventricular diastole refers to ventricular ___.

A

Relaxation

119
Q

The single-lead ECG primarily is used to ___.

A

Evaluate electrical activity in the heart

120
Q

The PR interval should normally be ___ seconds or smaller.

A

0.20

121
Q

The QRS interval should normally be ___ seconds or smaller.

A

0.12

122
Q

The point at which the QRS complex meets the ST segment is known as the ___.

A

J point

123
Q

How many cardiac monitor pads are utilized when obtaining a 12-lead ECG?

A

10

124
Q

The change of the QRS complex from a negative deflection to a positive deflection in the V leads is called ___.

A

R wave progression

125
Q

In the aVR lead, the T waveforms are ___ deflected.

A

Negatively

126
Q

In the aVL lead, the T waveforms are ___ deflected.

A

Biphasic

127
Q

In the aVF lead, the T waveforms are ___ deflected.

A

Positively

128
Q

The augmented leads may be referred to as ___.

A

Unipolar

129
Q

The intrinsic firing rate of the AV node is ___.

A

40-60 bpm

130
Q

The 12-lead ECG cannot be used to evaluate ___.

A

Valvular dysfunction

131
Q

The T wave on the ECG strip represents ___.

A

Rest period

132
Q

The development of pathologic Q waves indicates ___.

A

Irreversible tissue damage

133
Q

The right and left coronary arteries branch off of the ___.

A

Proximal portion of the aorta

134
Q

Collateral circulation allows for ___.

A

Alternate path of blood flow in the event of occlusion

135
Q

Myocardial infarction is due to ___.

A

Myocardial cell death

136
Q

T/F - In acute MIs, chest pain is long in duration and not relieved by nitroglycerin.

A

True

137
Q

T/F - Patients experiencing an AMI will always complain of chest pain.

A

False

138
Q

Timely assessment and management including immediate O2 administration must be rapidly completed within a ___ minute time interval.

A

10

139
Q

The function of the chordae tendineae and papillary muscles is to ___.

A

Prevent backflow of blood into the atrium

140
Q

The right atrium receives deoxygenated blood from the myocardium via the ___.

A

Great cardiac vein

141
Q

The coronary sinus returns deoxygenated blood from the ___.

A

Myocardium

142
Q

Most cardiac dysrhythmias are caused by ischemia secondary to hypoxia; therefore, the most appropriate drug to give a patient with any dysrhythmia is ___.

A

Oxygen

143
Q

Defined as death of the myocardial tissue, a myocardial infarction commonly results from ___.

A

Myocardial necrosis

144
Q

One ECG change you would not expect to see as a result of myocardial ischemia/injury/necrosis is ___.

A

PR interval prolongation

145
Q

The development of pathologic Q waves often begins within the first 2 hours after the MI and, in most cases, is complete within ___ hours.

A

24

146
Q

T/F - ST segment depression may be evident on a 12-lead ECG strip following both angina and strenuous exercise.

A

True

147
Q

With myocarcial injury, the most significant and frequently identifiable change is ___.

A

ST segment elevation

148
Q

A Q wave is considered abnormal when? (width and height)

A

If it is greater or equal to 0.04 seconds (one small box) in width
And has a depth of greater than 1/3 of the height of the succeeding R wave

149
Q

Inferior wall infarctions are associated with which artery:

A

Right coronary artery

150
Q

A pt with JVD and hypotension may be indicative of what type of infarct?

A

Right ventricular infarction

151
Q

The anterior surface of the heart is supplied oxygen and blood from the:

A

Left anterior descending

152
Q

The lateral wall of the left ventricle is supplied oxygen and blood from the:

A

Left marginal branch

153
Q

The posterior wall of the heart is supplied oxygen and blood from the:

A

Right posterior descending

154
Q

The coronary artery that is the largest of the coronary arteries and is termed the “Widowmaker” is the ___.

A

Left anterior descending

155
Q

What do “crackles” heard during assessment of the lungs signify?

A

Congestive heart failure

156
Q

Which of the types of blocks are more common with anterior MIs?

A

Mobitz type II
Third degree AV block
Bundle branch blocks

157
Q

Which of the types of blocks are more common with lateral MIs?

A

Mobitz type II
Third degree AV block
Bundle branch blocks

158
Q

Which leads are facing leads for the septal wall of the myocardium?

A

V1, V2

159
Q

Which leads are facing leads for the lateral wall of the myocardium?

A

I, aVL, V5, V6

160
Q

Which leads are facing leads for the anterior wall of the myocardium?

A

V3, V4

161
Q

Two primary structures that are responsible for delivering oxygen-rich blood to the myocardium are the ___.

A

Coronary arteries

162
Q

There are ___ main coronary arteries.

A

Two

163
Q

Myocardial infarctions may be classified as either transmural or ___.

A

Subendocardial

164
Q

Subendocardial infarctions are commonly referred to as ___.

A

Nontransmural

165
Q

T/F - ECG findings of infarction may occur in a single lead or in a combination of leads.

A

True

166
Q

If the pt is hypotensive and is exhibiting ECG changes consistent with an inferior MI, you should consider ___.

A

Right ventricular MI

167
Q

Reciprocal leads for the inferior MI are leads:

A

I and aVL

168
Q

When obtaining a right-sided ECG, the leads that should be moved are:

A

V3, V4, and V5

169
Q

A non-Q wave MI is consistent with:

A

Nontransmural

170
Q

T/F - Generally, anterior MIs tend to involve a larger muscle mass than do inferior MIs.

A

True

171
Q

The ___ branch of the left coronary artery supplies blood to the lateral wall of the left ventricle.

A

Marginal

172
Q

The ___ branch of the left coronary artery extends around to the posterior side of the heart and its branches supply blood to much of the posterior wall of the heart.

A

Circumflex

173
Q

Because of its size and the large amount of myocardium that it supplies, massive infarction may result if the ___ becomes totally occluded.

A

Left anterior descending

174
Q

Leads V3 and V4 visualize the ___ wall of the heart’s left ventricle.

A

Anterior

175
Q

In addition to the occurrence of ST elevation, ___ and the evolution of significant Q waves in leads V3 and V4 may indicate anterior myocardial infarction.

A

T wave inversion

176
Q

Due to the large degree of myocardial muscle involvement, ___ MIs have a greater predisposition for the development of complications such as lethal ventricular dysrhythmias and cardiogenic shock.

A

Anterior

177
Q

T/F - Anterior infarctions tend to result in hyperactivity of the sympathetic nervous system.

A

True

178
Q

Anterior MIs are associated with the development of ___.

A

Third-degree heart blocks

179
Q

T/F - Loss of R wave progression rarely occurs with anterior MIs.

A

False

180
Q

The reciprocal lead changes in the anterior MI, though uncommon, are:

A

II, III, and aVF

181
Q

Generally, an MI that involves the interventricular septum will also involve the ___ of the heart.

A

Left ventricle

182
Q

The left anterior descending artery has six branches called:

A

Septal perforating arteries

183
Q

Other branches of the left anterior descending are called ___ arteries and supply blood to the anterolateral wall of the left ventricle.

A

Diagonal

184
Q

The left and right halves of the heart are divided by a wall called the ___.

A

Septum

185
Q

The ___ septum is located between and divides the two atria.

A

Interatrial

186
Q

The ___ septum is located between and divides the two ventricles.

A

Interventricular

187
Q

T/F - Pathologic Q waves are not an early indicator or ECG finding, but occur as later evidence of myocardial tissue damage.

A

True

188
Q

To diagnose an acute septal MI, evidence of ___ must be present in leads V1 and V2.

A

ST segment elevation

189
Q

T/F - Electrical conduction system dysrhythmias are a common occurrence in patients with septal MIs.

A

True

190
Q

ST elevation in leads V1, V2, V3, and V4 are indicative of ___ MI.

A

Anteroseptal

191
Q

T/F - The anatomy of some individuals varies slightly, especially with respect to the distribution areas of the coronary arteries.

A

True

192
Q

T/F - ST elevation that resembles the appearance of a tombstone signifies that the occurring ischemia and injury is massive in nature and is a very serious and acute finding.

A

True

193
Q

T/F - Myocardial infarctions of the lateral wall of the heart most commonly occur as a result of an extension of anterior and/or inferior wall MIs.

A

True

194
Q

Pathologic Q waves indicate:

A

Necrosis

195
Q

The concept of poor R wave progression refers to the absence of R waves in lead:

A

V2

196
Q

An example of a high-degree block is:

A

Third-degree block

197
Q

Placement of posterior lead V7 is where?

A

5th intercostal space, posterior axilla

198
Q

Placement of posterior lead V8 is where?

A

5th intercostal space, midscapula

199
Q

Placement of posterior lead V9 is where?

A

5th intercostal space, 2 cm left of the spine

200
Q

When conducting the mirror test, the mirror should be placed ___ the V leads of the 12-lead ECG

A

Above

201
Q

Which disease processes can be expected in left axis deviation?

A

Wolff-Parkinson-White syndrome

think not related to lungs

202
Q

Which disease process can be expected in right axis deviation?

A

COPD

think related to lungs

203
Q

Right bundle branch terminates where?

A

Papillary muscles

204
Q

Time measurement for incomplete BBBs? Complete BBBs?

A 
Incomplete = 0.10-0.11 seconds
Complete = 0.12 seconds or greater
205
Q

The maximum benefit of fibrinolytic therapy is best achieved when the agent is administered within ___ hours after onset.

A

6 hours

206
Q

The major complication associated with fibrinolytic therapy is:

A

Hemorrhage

207
Q

One common complication associated with transcutaneous pacing?

A

Pain

208
Q

Synchonized cardioversion is designed to deliver the shock when?

A

10 ms after the peak of the R wave

209
Q

Three routes of administration for lidocaine?

A

IV, IO, ET

210
Q

Verapamil is an:

A

Antidysrhythmic

211
Q

The administration of an IV solution by regulating its flow rate based upon observation or desired or undesired effects is called:

A

Titration

EMT254 (1 decks)

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