Quiz - 14 Cardiac Emergency Care & Responding to the Field Code Flashcards
Defibrillation of a patient who is in asystole is detrimental to the patient because it:
A. makes ruling out underlying causes impossible.
B. causes an unnecessary interruption in chest compressions.
C. has been shown to render epinephrine ineffective.
D. stops the cardiac cells from spontaneously depolarizing.
B. causes an unnecessary interruption in chest
While applying the defibrillator pads, you note that the patient has a transdermal nitroglycerin patch on the
right anterior chest. You should:
A. move the patch to the left anterior chest.
B. place the pads at least 1 inch from the patch.
C. place the second pad in between the scapulae.
D. remove the patch and wipe away any residue.
D. remove the patch and wipe away any residue.
Which of the following statements regarding the use of vasopressin during cardiac arrest is correct?
A. Vasopressin may be substituted for the second dose of epinephrine.
B. Vasopressin has been shown to be clinically superior to epinephrine.
C. If used during cardiac arrest, vasopressin is given in a dose of 20 units.
D. If the patient is in asystole, vasopressin can be given every 5 minutes.
A. Vasopressin may be substituted for the second dose of epinephrine.
You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a “stomach bug.” He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
A. apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.
B. administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
C. give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport.
D. advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician.
B. administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect?
A. Positive end-expiratory pressure ventilation
B. 0.4 mg sublingual nitroglycerin, up to three doses
C. Supplemental oxygen via nonrebreathing mask
D. IV or IO access and 20 to 40 mg of furosemide
A. Positive end-expiratory pressure ventilation
A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on:
A. providing mild hyperventilation.
B. transcutaneous cardiac pacing
C. establishing a peripheral IV line
D. searching for reversible causes.
D. searching for reversible causes.
Hyperventilation of a patient who is in cardiac arrest:
A. causes a marked decrease in intrathoracic pressure.
B. increases preload and enhances cardiac output.
C. has been shown to reduce coronary artery perfusion.
D. is indicated if the arrest interval exceeds 10 minutes.
C. has been shown to reduce coronary artery perfusion.
You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should:
A. administer 2 to 4 mg of morphine.
B. reassess her blood pressure.
C. give her a 250-mL saline bolus.
D. repeat the nitroglycerin.
B. reassess her blood pressure.
You receive a call to a residence for a 44-year-old man who is “ill.” The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient’s vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is:
A. hypocalcemic.
B. hyperkalemic.
C. having an acute myocardial infarction.
D. hypernatremic.
B. hyperkalemic.
During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient’s end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should:
A. suspect inadvertent tube dislodgement.
B. increase the rate of your ventilations.
C. assess for a pulse for up to 10 seconds.
D. decrease the rate of your ventilations.
C. assess for a pulse for up to 10 seconds.
Which of the following roles would the code team leader MOST likely perform?
A. Managing the airway
B. Chest compressions
C. Establishing IV access
D. Interpreting the ECG
D. Interpreting the ECG
You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next:
A. push the synchronize button on the defibrillator and cardiovert with 200 joules.
B. give 300 mg of amiodarone via rapid IV or IO push.
C. give 1 to 2 g of magnesium sulfate without interrupting chest compressions.
D. give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes
C. give 1 to 2 g of magnesium sulfate without interrupting chest compressions.
A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to:
A. defibrillate one time in case she is in V-Fib.
B. attempt transcutaneous cardiac pacing.
C. transport at once with CPR continuing en route.
D. seriously consider ceasing resuscitative efforts.
D. seriously consider ceasing resuscitative efforts.
You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should:
A. direct your partner to deliver one breath every 3 to 5 seconds as the EMT-B continues chest compressions.
B. instruct the EMT-B to pause after 30 compressions so your partner can deliver two ventilations.
C. perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.
D. administer 2.5 mg of epinephrine via the ET tube and hyperventilate the patient to ensure drug dispersal.
C. perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min.
If a cardiac arrest patient’s airway is maintained with an oral airway and ventilation with a bag-mask device is producing adequate chest rise, then:
A. a King LT or Combitube is preferred over tracheal intubation.
B. there should be no pause in chest compressions to deliver a breath.
C. the paramedic should deliver one breath every 5 to 6 seconds.
D. insertion of an advanced airway device is not a high priority.
D. insertion of an advanced airway device is not a high priority.
You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:
A. resume CPR at once.
B. check the carotid pulse.
C. attempt cardiac pacing.
D. assess breathing effort
A. resume CPR at once.
You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of “breathing problem,” for which he uses a prescribed inhaler and takes a “heart pill.” You should suspect:
A. reactive airway disease.
B. acute COPD exacerbation.
C. right ventricular failure.
D. left-sided heart failure.
D. left-sided heart failure.
A 56-year-old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats/min. After administering high-flow oxygen, you should:
A. attempt to slow his heart rate with vagal maneuvers and then start an IV line.
B. establish vascular access and administer 150 mg of amiodarone over 10 minutes.
C. obtain a 12-lead ECG tracing to determine the origin of his tachycardic rhythm.
D. establish IV access, consider sedation, and perform synchronized cardioversion.
D. establish IV access, consider sedation, and perform synchronized cardioversion.
You are assessing a conscious and alert middle-aged male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm Hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient’s past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer?
A. Aspirin
B. Morphine
C. Nitroglycerin
D. Fentanyl
C. Nitroglycerin
A 55-year-old man complains of severe pain between his shoulder blades, which he describes as “ripping” in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain?
A. ST-segment depression on the 12-lead ECG tracing
B. Difference in blood pressure between the two arms
C. Bruits to both carotid arteries during auscultation
D. Disappearance of radial pulses during inspiration
B. Difference in blood pressure between the two arms
An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition?
A. No pulse with CPR and jugular venous distention
B. Profoundly cyanotic skin and collapsed jugular veins
C. Unilaterally absent breath sounds and mottled skin
D. Bilaterally absent breath sounds and severe pallor
A. No pulse with CPR and jugular venous distention
When practicing a “code,” whether in the prehospital or in-hospital setting, the primary focus should be on:
A. independent performance and drug administration.
B. timely defibrillation and early tracheal intubation.
C. teamwork and minimal interruptions in CPR.
D. the use of technology during a cardiac arrest.
C. teamwork and minimal interruptions in CPR.
Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac
care?
A. Artificial ventilation
B. Tracheal intubation
C. Defibrillation
D. Chest compressions
D. Chest compressions
You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient’s blood pressure is 96/60 mm Hg, and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient includes:
A. 0.5 mg of atropine sulfate.
B. a 20-mL/kg crystalloid bolus.
C. a low-dose dopamine infusion.
D. an infusion of amiodarone.
D. an infusion of amiodarone.
