Chapter 16-Cardiovascular Emergencies

Question 1

How does the heart control heart rate?

Answer 1

It has control over its own electrical impulses which allow the atria and ventricles to work together

Question 2

Where do the electrical impulses of the heart start?

Answer 2

Sinoatrial (SA) node

Question 3

After an electrical impulse starts at the SA node, where does it go?

Answer 3

Across the atria, causing them to contract

Question 4

Where does the electrical impulse of the heart go after causing the atria to contract?

Answer 4

The atrioventricular (AV) node

Question 5

What happens to the impulse at the AV node?

Answer 5

It gets slowed for 0.1-0.2 seconds to allow blood to pass from the atria to the ventricles

Question 6

After passing through the AV node, where does the heart’s electrical impulse go?

Answer 6

It spreads across the ventricles via the bundle of His, the right and left bundle branches, and the purkinje fibers

Question 7

How is the initial electrical impulse at the SA regulated?

Answer 7

By the brain via the autonomic nervous system

Question 8

What is blood made up of?

Answer 8

Red blood cells (move oxygen), white blood cells (fight infection), platelets (help with clotting), and plasma (fluid)

Question 9

What’s happening during diastole?

Answer 9

The aortic valve closes and blood flow between the left ventricle and aorta stops while the left ventricle refills with blood

Question 10

Where can peripheral pulses be felt?

Answer 10

Brachial, radial, posterior tibialis, and dorsis pedis arteries

Question 11

Where can central pulses be felt?

Answer 11

Carotid and femoral arteries

Question 12

What are the three components require for good perfusion?

Answer 12

Well-functioning heart
Adequate volume of blood
Appropriately-sized vessels

Question 13

What is atherosclerosis?

Answer 13

A condition in which calcium and cholesterol build up and form plaque inside a vessel

Question 14

When plaque build up, what part of the vessel decreases in size?

Answer 14

The lumen, or diameter

Question 15

What happens when an atherosclerotic plaque cracks?

Answer 15

It triggers a blood clotting response that can obstruct the vessel or cause the plaque to get dislodged and flow through the vessel

Question 16

What is it called when an atherosclerotic clot gets dislodged and starts flowing through a vessel?

Answer 16

Thromboembolism

Question 17

What is it called when a thromboembolism gets stuck in a coronary artery?

Answer 17

Acute myocardial infarction (AMI)

Question 18

What does infarction mean?

Answer 18

Tissue death

Question 19

What are controllable risk factors for AMI?

Answer 19

Cigarette smoking, high cholesterol, high blood pressure, high blood glucose, lack of exercise, obesity

Question 20

What are uncontrollable risk factors for AMI?

Answer 20

Old age, family history, race, ethnicity, sex (male)

Question 21

What is acute coronary syndrome?

Answer 21

a group of symptoms that are caused by myocardial ischemia?

Question 22

What is myocardial ischemia?

Answer 22

reduced blood flow to the heart

Question 23

What are the terms for the two types of myocardial ischemia?

Answer 23

Angina pectoris and acute myocardial infarction

Question 24

What are two causes for angina pectoris?

Answer 24

spasm of an artery or atherosclerotic coronary artery disease

Question 25

How is angina pectoris pain described?

Answer 25

A crushing/squeezing pain in chest that can radiate to jaw, left arm, center of back, or upper middle abdomen

Question 26

How long does angina pain usually last?

Answer 26

3-8 minutes

Question 27

What are two subcategories of angina

Answer 27

Unstable, occurs in absence of triggers and leads to AMI, and stable, occurs only in the presence of triggers and goes away when triggers are removed or nitroglycerin is administered

Question 28

What are triggers for angina?

Answer 28

exertion (physical or emotional), large meal, sudden fear

Question 29

What are three ways in which AMI pain differs from angina pain?

Answer 29

Lasts longer (30 min to several hours), Can't always be relieved by nitroglycerin, and can occur in absence of trigger

Question 30

What is the first thing you do for someone with chest pain?

Answer 30

Position: supine or Fowler's (remove or loosen tight clothing)

Question 31

After you have positioned a patient with chest pain, what other things do you have to do?

Answer 31

Administer oxygen and constantly reassess patient's oxygen saturation and breathing and administer low dose aspirin or nitroglycerin

Question 32

What does aspirin do for a patient with chest pain?

Answer 32

Reduces blood clots to prevent clots from getting bigger

Question 33

What is the recommended dose of aspirin?

Answer 33

2-4 81 mg tablets

Question 34

What do you have to make sure of before administering aspirin?

Answer 34

(1) patient isn't allergic (2) no history of internal bleeding

Question 35

What does nitroglycerin do for a patient with chest pain?

Answer 35

relaxes the muscles of vessel walls, dilates coronary arteries, increases blood flow and reduces the workload placed on the heart

Question 36

In what forms does nitroglycerin come?

Answer 36

Pill, sublingual spray, patch

Question 37

What are the side effects of nitroglycerin?

Answer 37

headache, low bp, changes in hr

Question 38

What do you do between doses of nitroglycerin?

Answer 38

Check bp 5 minutes after administering each dose and if systolic is under 100, do not continue administering

Question 39

What are some reasons to not give a patient nitroglycerin?

Answer 39

Head injury, they used erectile dysfunction drugs in the past 24 hours, or if you've already administered the maximum three doses

Question 40

Step 1 of administering nitroglycerin:

Answer 40

Obtain permission from medical control

Question 41

Step 2 of administering nitroglycerin:

Answer 41

Check bp to make sure it's under 100

Question 42

Step 3 of administering nitroglycerin:

Answer 42

Check expiration date, contamination, and prescription

Question 43

Step 4 of administering nitroglycerin:

Answer 43

Ask patient how many doses they've already taken

Question 44

Step 5 of administering nitroglycerin:

Answer 44

administer or help patient administer medicine, and warn them not to chew tablet

Question 45

What should you be doing throughout the entire time you're administering nitroglycerin?

Answer 45

Recording times of administration and checking bp 5 minutes after each dose

Question 46

Most AEDs regulate the _____ based on the _____

Answer 46

voltage, impedance

Question 47

What are shockable rhythms?

Answer 47

Ventricular fibrillation and ventricular tachycardia

Question 48

What are not shockable rhythms?

Answer 48

asystole, pulseless electrical activity

Question 49

What is the chain of survival for cardiac arrest?

Answer 49

``` Activation of EMS CPR AED Basic and Advanced EMS ALS and post arrest care ```

Question 50

What are 6 common mistakes/challenges associated with using a defibrillator?

Answer 50

- Failure of machine to detect shockable rhythm - Applying pads to a moving patient - Turning off AED before shock/analysis is complete - Not pushing the shock/analyze button when needed - Failing to keep battery charged - Using on a responsive patient with a pulse but whose hr is high enough to confuse the AED into thinking they're in V-tach

Question 51

What usually causes cardiac arrest in children?

Answer 51

respiratory failure

Question 52

How should you modify defibrillation of children if possible?

Answer 52

Use pediatric pads

Question 53

How should you modify defibrillation of infants if possible?

Answer 53

Use manual defibrillator if available, if not use AED with pediatric dose attenuator, if not use adult pads