Chapter 16: Cardiovascular Emergencies

Question 1

Path of impulses in the heart

Answer 1

Brain, SA node, atria, AV node, bundle of His, Purkinje fibers, ventricles

Question 2

Automaticity

Answer 2

Feature of cardiac muscle that allows cells to contract without a nerve source.

Question 3

Stroke volume

Answer 3

Amount of blood ejected by each ventricular contraction

Question 4

Cardiac output

Answer 4

Volume of blood going through the circulatory system in one minute. SV times heart rate.

Question 5

Subclavian arteries

Answer 5

Supply blood to upper extremities, branch into brachial arteries

Question 6

Descending aorta

Answer 6

Divides into right and left iliac arteries at the umbilicus. As they enter the legs, they branch into femoral arteries, which branches into anterior and posterior tibial arteries at knee level.

Question 7

3 components of perfusion

Answer 7

Heart, blood vessels, blood

Question 8

Tachycardia

Answer 8

Doesn’t allow enough time for heart to refill completely

Question 9

Ischemia

Answer 9

Decreased blood flow. Often a cause of chest pain.

Question 10

Infarction

Answer 10

Death of tissue

Question 11

Occulism

Answer 11

Blockage

Question 12

Lumen

Answer 12

Inside diameter of artery

Question 13

Atherosclerosis

Answer 13

1. Calcium and cholesterol build up and form blockages in vessels. Eventually forms an occulism.
2. Plaque can develop a crack, which activates blood clotting. Blocks lumen of artery or forms a thromboembolism which causes hypoxia below it.
3. Blockage in a coronary artery is an AMI

Question 14

Atherosclerosis risk factors

Answer 14

Smoking, high blood pressure, high cholesterol, high blood glucose, obesity, older age, family history, sex (male).

Question 15

Acute Coronary Syndrome

Answer 15

1. Describes a group of symptoms caused by myocardial ischemia.
2. Angina pectoris- chest pain from lack of oxygen, symptom of acute coronary artery disease. Lasts less than 15 minutes. Crushing pain under sternum, radiating to jaw, arm, back, abdomen, nausea, sob

Question 16

AMI Symptoms

Answer 16

Sudden onset of weakness, nausea, and sweating without an obvious cause. Chest pain or pressure that is crushing/squeezing and does not change with each breath. Pain or pressure in lower jaw, abdomen, or neck. Shortness of breath, irregular heartbeat, syncope, nausea, pink frothy sputum. In older people or women, most common symptom could be fatigue or nausea.

Question 17

Ventricular tachycardia

Answer 17

Heart rate is 150-200 bpm. Electrical activity starts in ventricles and doesn’t allow the left ventricle to fill with blood. Blood pressure falls and pulse can be lost.

Question 18

Ventricular fibrillation

Answer 18

Disorganized quivering of ventricles that doesn’t allow blood to be pumped. Requires defibrillation. Begin CPR to prevent asystole.

Question 19

Cardiogenic Shock

Answer 19

Often caused by AMI. Heart lacks power to force blood through circulatory system, tissues don’t get enough oxygen. Can occur immediately to 24 hours after.

Question 20

Congestive Heart Failure

Answer 20

1. Occurs when ventricular myocardium is so damaged it can’t keep up with blood flow from the atria.
2. Can occur any time after a myocardial infarction or as a result of hypertension.
3. Causes increased heart rate, enlarged left ventricle, and pulmonary edema.

Question 21

Shock symptoms

Answer 21

1. Anxiety/restlessness/air hunger
2. Pale, cool, clammy skin
3. High pulse that can become weak or irregular
4. Rapid/shallow breathing, nausea, decreased body temp
5. Low blood pressure indicates late stage shock

Question 22

Shock treatment

Answer 22

Give oxygen, assist ventilations, comfortable position, cover with blankets

Question 23

CHF Symptoms

Answer 23

1. Breathing is easier when sitting up due to pulmonary congestion
2. Agitation, chest pain can be present
3. Distended neck veins, swollen ankles from dependent edema.
4. Accessory muscle use, pale cyanotic or sweaty skin
5. Fluid creates rales

Question 24

CHF Treatment

Answer 24

Give oxygen, might need CPAP, sitting up, might be able to give nitroglycerin, gather any meds, transport.

Question 25

Hypertension

Answer 25

Any blood pressure over 140/90. Becomes an emergency if systolic is higher than 180.

Question 26

Hypertensive Emergencies

Answer 26

1. Indicated by severe headache, strong pulse, ringing in ears, nausea, dizziness, warm skin, nosebleed, AMS, sudden pulmonary edema. 2. Can lead to hemorrhage. Transport immediately, monitor bp, keep head elevated.

Question 27

Dissecting aortic aneurysm

Answer 27

1. Inner layers are separated, and blood flows between them at high pressures. Causes aorta to rupture, leading to massive hemorrhage and sudden death. 2. Sx: Very sudden and severe sharp or tearing back or chest pain, difference in bp between arms, diminished bp in lower extremities.

Question 28

Patient Assessment: Scene size up

Answer 28

Ensure safety. Do not become fixated on a specific illness or condition.

Question 29

Patient Assessment: Primary Assessment

Answer 29

1. Determine if responsive. If not, start CPR and AED. 2. Responsive patients should have an open airway 3. Listen to breath sounds, determine rr, find pulse ox, give oxygen 4. PE might require CPAP.

Question 30

Patient Assessment: History Taking

Answer 30

SAMPLE, ask about symptoms and possible trauma

Question 31

Patient Assessment: Secondary Assessment

Answer 31

Vital signs, evaluate circulatory and respiratory systems

Question 32

Emergency Medical Care for chest pain

Answer 32

1. Proper positioning- some patients can't be supine 2. Give oxygen to reach 95-99% oxygenation 3. Can give aspirin or nitroglycerin, but first determine allergies and history of internal bleeding.

Question 33

Contraindications of nitroglycerin

Answer 33

Systolic blood pressure less than 100, head injury, use of erectile dysfunction drugs within 24-48 hours, or max dose has been given.

Question 34

Nitroglycerin

Answer 34

Relieves pain of angina. Increases blood flow to heart, reduces workload of heart, relaxes blood vessel walls and dilates coronary arteries.

Question 35

How to administer nitroglycerin

Answer 35

Get an order from medical control, wear gloves, administer sublingually.

Question 36

3 lead ECG

Answer 36

One on each shoulder, one on each side of lower abdomen near hips.

Question 37

12 lead ECG

Answer 37

1. 4 used for limb placement 2. v1- 4th intercostal space right sternal border 3. v2- 4th intercostal space left sternal border 4. v3- Between v2 and v4 5. v4- 5th intercostal space, midclavicular line 6. v5- lateral to v4, anterior axillary line 7. v6- lateral to v5 at midaxillary line Don't place a limb electrode over a bone.

Question 38

Don't place AED patches over a

Answer 38

Pacemaker

Question 39

Implantable defibrillator

Answer 39

Delivers shocks as needed

Question 40

External defibrillator vests

Answer 40

Works the same way as an AED, should not be removed unless they interfere with CPR.

Question 41

LVAD

Answer 41

Assist the left ventricle, shouldn't have to worry about them.

Question 42

Cardiac Arrest

Answer 42

1. Complete cessation of electrical or mechanical activity, or both. 2. Indicated by absence of a pulse 3. Apply AED only if patient is unresponsive and has no pulse.

Question 43

Chain of survival (cardiac arrest)

Answer 43

Recognition of early warning signs, immediate CPR, rapid defibrillation, basic and advanced EMS, ALS and post arrest care.

Question 44

Emergency Care for Cardiac Arrest

Answer 44

1. Apply AED pads to the right of the sternum just below the clavicle, other on the left lower chest with the top below the armpit. 2. If you feel a pulse, patient has experienced return of spontaneous circulation (effective blood flow). Continue to monitor and give oxygen.