Chapter 18 Cardiac Emergencies

Question 1

Acute Coronary Syndrome

Answer 1

A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle. Also called cardiac compromise

Question 2

What are some typical sxs someone with ACS may experience?

Answer 2

Crushing, dull, heavy or squeezing.
Pain radiating into arms or lower abdomen
anxiety or sense of impending doom
Dyspnea
Nausea, epigastric pain
Unusual generalized weakness

Question 3

Dyspnea

Answer 3

Shortness of breath; labored or difficulty breathing

Question 4

What are some signs someone with ACS may display?

Answer 4

Sudden onset of sweating
Bradycardia or tachycardia and/or an irregular pulse
Hypotension or hypertension
Palpitations

Question 5

Approximately ____ to ____ of people do not have the typical chest discomfort presentation when suffering from ACS?

Answer 5

1/2 to 1/3

Question 6

What is the next steps after performing scene size up and primary assessment on the responsive patient experiencing chest pain?

Answer 6

History (HPI and PMHx)
Physical exam
Vital signs

Question 7

How should you position a patient when you suspect ACS?

Answer 7

Position of comfort, usually sitting up, may prefer lying down if hypotensive

Question 8

When should you administer O2 in a patient suspected is having an ACS?

Answer 8

Hypoxic - SpO2 less than 94%

Altered mental status, respiratory distress or pale skin

Question 9

In the patient you suspect of having ACS; what are some indications that call for immediate transport?

Answer 9

No hx of cardiac problems
Hx of Cardiac problems but does not have nitro
SBP

Question 10

What does STEMI stand for?

Answer 10

ST elevation myocardial infarction

Question 11

What term describes the obstruction of blood supply to an organ or region of tissue causing local death of the tissue?

Answer 11

Infarction

Question 12

What is PCI?

Answer 12

Percutaneous coronary intervention

Question 13

What conditions must be met prior to administering nitroglycerin?

Answer 13

Pt c/o chest pain
Hx of cardiac problems
Rx'd NTG
Pt has NTG on him/her
SBP > 90
Pt has not taken ED med in last 48-72 hrs
Med direction authorization

Question 14

When would you give a repeat dose of NTG?

Answer 14

No relief with previous dose
SBP remains > 90
Med Direction authorization

Question 15

What is the maximum number of times you can administer NTG?

Answer 15

3

Question 16

What should you do if you administer NTG and the SBP drops below 90-100

Answer 16

Treat for shock and transport

Question 17

What are the side effects of NTG?

Answer 17

Hypotension
Headache
Pulse rate change

Question 18

What are some contraindications of NTG use?

Answer 18

SBP

Question 19

What conditions must be met prior to administering asprin?

Answer 19

Pt c/o chest pain
Pt has no allergy to asprin
No Hx of asthma
Not taking a medication to prevent clotting
No other contraindications
Able to swallow
Med direction authorization

Question 20

Coronary artery disease

Answer 20

Diseases that affect the arteries of the heart

Question 21

Thromubs

Answer 21

A clot formed of blood and plaque attached to the inner wall of an artery or vein

Question 22

Occlusion

Answer 22

Blockage, as of an artery by fatty deposits

Question 23

Embolism

Answer 23

Blockage of a vessel by a clot or foreign material brought to the site by the blood current

Question 24

What are the non-modifiable risk factors for CAD?

Answer 24

RASH
Race
AGE
Sex
Heredity

Question 25

What are the modifiable risk factors for CAD?

Answer 25

``` SHEDS Smoking HTN Exercise Diet -DM - cholesterol - triglycerides Stress ```

Question 26

Which patient populations usually experience atypical MI sxs?

Answer 26

Geriatric patients Women Diabetics

Question 27

What are some complications of MI?

Answer 27

Cardiac dysrhythmias Sudden cardiac arrest CHF (pump inefficiency) Cardiogenic shock (pump failure)

Question 28

Aneurysm

Answer 28

The dilation or ballooning of a weakened section of the wall of an artery

Question 29

Dysrhythmia

Answer 29

a disturbance in heart rate and rhythm

Question 30

What are the two most common sites of aneurysms that you will encounter in emergency situations?

Answer 30

Aorta | Brain

Question 31

What are the causes of cardiac conditions covered in this chapter?

Answer 31

``` Coronary artery disease Aneurysm Electrical malfunctions Mechanical malfunctions Angina pectoris Acute Myocardial Infraction Congestive Heart Failure ```

Question 32

Angina Pectoris

Answer 32

Pain in the chest occurring when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough O2

Question 33

How does angina pectoris usually present?

Answer 33

Pain with exertion, relief with rest

Question 34

Acute Myocardial Infarction (AMI)

Answer 34

the condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by laypersons

Question 35

Sudden death

Answer 35

A cardiac arrest that occurs within 2 hours of the onset of sxs. Pt may have no prior cardiac Hx

Question 36

What are some way's patients are treated for AMI at hospitals?

Answer 36

with fibrinolytics | Balloon angioplasty or balloon catheterization

Question 37

What are some meds a Pt may be prescribed upon discharge from a Hospital after an MI?

Answer 37

Aspirin | Beta-blockers (slow HR and make it beat less strongly)

Question 38

Congestive heart failure

Answer 38

the failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body or both

Question 39

Edema

Answer 39

swelling resulting from a buildup of fluid in the tissues

Question 40

Pulmonary edema

Answer 40

accumulation that of fluid in the lungs

Question 41

what might you hear when listing to the lungs of a patient with pulmonary edema?

Answer 41

crackles (rales)

Question 42

CHF on what side of the hear might lead pedal edema?

Answer 42

right sided

Question 43

what are some s/sxs of a Pt with CHF?

Answer 43

Tachycardia, dyspnea, normal BP or HTN, cyanosis, diaphoresis, Pulmonary edema, coughing up white or pink sputum, anxiety or confusion, pedal edema, engorged pulsating neck veins, enlarged liver with abdominal distention

Question 44

What are the five elements in the chain of survival?

Answer 44

``` Immediate recognition and activation Early CPR Rapid Defibrillation Effective advance life support Integrated post cardiac arrest care ```