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1

A middle-aged woman took three of her prescribed nitroglycerin tablets after she began experiencing chest pain. She complains of a bad headache and is still experiencing chest pain. You should assume that:

A: her nitroglycerin is no longer potent.
B: her blood pressure is elevated.
C: she has ongoing cardiac ischemia.
D: her chest pain is not cardiac-related.

C: she has ongoing cardiac ischemia.

Reason:

A headache and/or a bitter taste under the tongue are common side effects of nitroglycerin (NTG) that many patients experience. If the patient does not experience these side effects, the NTG may have lost its potency. However, if a patient with chest pain takes NTG and experiences these side effects, but still has chest pain, you should assume that his or her pain is the result of cardiac ischemia, a relative deprivation of oxygen to the heart. NTG is a vasodilator drug; if anything, three doses would lower her blood pressure, not raise it. Any patient with nontraumatic chest pain or pressure should be assumed to be experiencing cardiac ischemia, especially if the pain or pressure is not relieved with NTG.

2

Which of the following statements regarding the automated external defibrillator (AED) is correct?

A: AEDs will analyze the patient’s rhythm while CPR is in progress
B: AEDs can safely be used in infants and children less than 8 years of age
C: The AED should be applied to patients at risk for cardiac arrest
D: The AED should not be used in patients with an implanted defibrillator

B: AEDs can safely be used in infants and children less than 8 years of age

Reason:
According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), the AED can safely be used in infants and children less than 8 years of age. Although a manual defibrillator is preferred in infants, an AED can be used. When using the AED in infants and children, you should use pediatric pads and a dose-attenuating system (energy reducer); however, if these features are not available, adult AED pads should be used. The AED should only be applied to patients in cardiac arrest; if a patient is at risk for cardiac arrest, have the AED ready but not applied. The AED will not analyze the cardiac rhythm if the patient is moving (ie, CPR is in progress). AEDs can be used in patients with an automated implanted cardioverter/defibrillator (AICD) or implanted pacemaker; ensure that the pads are at least 1” away from the implanted device.

3

A middle-aged female with a history of hypertension and high cholesterol complains of chest discomfort. She asks you to take her to the hospital where her personal physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg, pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored. Which of the following actions is clearly NOT appropriate for this patient?

A: Taking her to her choice hospital
B: Allowing her to walk to the ambulance
C: Giving oxygen via nasal cannula
D: Contacting her physician via phone

B: Allowing her to walk to the ambulance

Reason:

You should NEVER allow a patient with a possible cardiac problem to walk to the ambulance. This causes exertion, which increases cardiac oxygen consumption and demand and could worsen his or her condition. Give the patient oxygen in a concentration sufficient to maintain his or her oxygen saturation equal to or greater than 94%. In general, you should transport patients to the hospital of their choice. However, transport to a closer hospital should be considered if you believe the patient is unstable or is at high risk for becoming unstable. If necessary, consult with the patient’s physician via phone to determine if he or she thinks the patient should go to a closer hospital.

4

Aspirin is beneficial to patients experiencing an acute coronary syndrome because it:

A: prevents a clot from getting larger.
B: effectively relieves their chest pain.
C: decreases cardiac workload by lowering the BP.
D: destroys the clot that is blocking a coronary artery.

A: prevents a clot from getting larger.

Reason:

Early administration of baby aspirin (160 to 325 mg) to patients with acute coronary syndrome (ACS) has clearly been shown to reduce mortality and morbidity. Aspirin (acetylsalicylic acid [ASA]) prevents the clot in a coronary artery from getting larger by inhibiting platelet aggregation; in other words, it makes the platelets less sticky, which means that they will have less of a tendency to clump together. Aspirin does not relieve the chest pain or discomfort associated with ACS, nor does it reduce blood pressure. Furthermore, aspirin does not destroy the clot that is blocking a coronary artery; fibrinolytic (clot-buster) drugs actually destroy the clot.

5

In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with:

A: profound cyanosis, dry skin, and a headache.
B: severe projectile vomiting and flushed skin.
C: ashen skin color, diaphoresis, and anxiety.
D: irregular breathing and low blood pressure.

C: ashen skin color, diaphoresis, and anxiety.

Reason:

Chest pain, pressure, or discomfort is the most common symptom of acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction); it occurs in approximately 80% of cases. Patients with ACS are usually anxious and may have a feeling of impending doom. Nausea and vomiting are common complaints; however, projectile vomiting, which is typically associated with increased intracranial pressure, is uncommon. The skin is often ashen gray and clammy (diaphoretic) because of poor cardiac output and decreased perfusion. Less commonly, the patient’s skin is cyanotic. Respirations are usually unlabored unless the patient has congestive heart failure, in which case respirations are rapid and labored; irregular breathing, however, is not common. Blood pressure may fall as a result of decreased cardiac output; however, most patients will have a normal or elevated blood pressure. If the patient complains of a headache, it is usually a side effect of the nitroglycerin they took before your arrival; ACS itself usually does not cause a headache.

6

You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. This patient's primary problem is MOST likely:

A: chronic hypertension.
B: left heart failure.
C: pulmonary edema.
D: right heart failure.

D: right heart failure.

Reason:

If the right side of the heart is damaged, fluid collects in the body (edema), often showing in the feet and legs. The collection of fluid in the part of the body that is closest to the ground is called dependent edema. The swelling causes relatively few symptoms other than discomfort. Another feature of right heart failure is jugular venous distention, which is an indication of blood backing up into the systemic circulation. Left heart failure typically presents with shortness of breath due to fluid in the lungs (pulmonary edema), which indicates blood backing up from the left side of the heart into the lungs. In severe pulmonary edema, the patient may cough up pink, frothy sputum. Right heart failure and/or left heart failure are also referred to as congestive heart failure (CHF). Chronic hypertension cannot be established on the basis of a single blood pressure reading.

7

Which of the following questions would be the MOST effective in determining if a patient's chest pain radiates away from his or her chest?

A: Do you also have pain in your arm, jaw, or back?
B: Does the pain stay in your chest or move anywhere else?
C: Is there any other part of your body where you have pain?
D: Is there anything that makes the pain better or worse?

B: Does the pain stay in your chest or move anywhere else?

Reason:

When assessing a patient with any type of pain, you should avoid asking leading questions; instead, ask open-ended questions whenever possible. For example, instead of asking the patient if his or her pain is dull, crushing, or sharp, ask him or her to describe the pain using his or her own words. Patients with radiating pain often state that the pain moves or travels away from its point of origin, with pain in between point A and point B. Patients with referred pain complain of pain in more than one location, without a trail of pain in between. You should also ask the patient if anything makes the pain worse (provokes) or better (palliates).

8

A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies the AED. What should you do if you receive a no shock message?

A: Assess for a carotid pulse for up to 10 seconds.
B: Reanalyze his cardiac rhythm after 30 seconds of CPR.
C: Resume CPR, starting with chest compressions.
D: Ensure that the AED electrodes are properly applied.

C: Resume CPR, starting with chest compressions

Reason:

If the AED gives a no shock advised message, you should immediately resume CPR, starting with chest compressions. After 2 minutes of CPR, reanalyze the patient’s cardiac rhythm and follow the AED voice prompts. You should not assess for a pulse if the AED gives a no shock message; this will only cause an unnecessary delay in performing chest compressions. Rarely, if ever, does CPR alone restore a normal cardiac rhythm and pulse. If the AED electrodes are improperly applied, it will not analyze the patient’s cardiac rhythm; instead, you will receive a "check patient" or "check electrodes" message. Continue CPR, rhythm analysis every 2 minutes, and defibrillation (if indicated) until ALS personnel arrive or the patient starts to move.

9

The MOST important initial treatment for a patient whose cardiac arrest was witnessed is:

A: high-quality CPR.
B: cardiac drug therapy.
C: rapid transport.
D: defibrillation.

A: high-quality CPR.

Reason:

Regardless of whether a patient's cardiac arrest is witnessed or unwitnessed, the single most important initial treatment is high-quality CPR. Delays in performing CPR have been clearly linked to poor patient outcomes. After CPR has been initiated, apply the AED as soon as it is available. Cardiac drug therapy and rapid transport enhance the patient's chance of survival, but are useless without minimally-interrupted, high-quality CPR.

10

Which of the following is a common side effect of nitroglycerin?

A: Hypertension
B: Anxiety
C: Nausea
D: Headache

D: Headache

Reason:

Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following the administration of NTG. This often causes a pounding headache for the patient. As uncomfortable as it is for the patient, headaches are a common and expected side effect of the drug. The vasodilatory effects of nitroglycerin could result in hypotension; therefore, the patient’s blood pressure should be carefully monitored. Nausea and anxiety are common symptoms of acute coronary syndrome; they are not common side effects of nitroglycerin.

11

While assessing a patient with chest pain, you note that his pulse is irregular. This indicates:

A: a dysfunction in the left side of the patient’s heart
B: abnormalities in the heart’s electrical conduction system.
C: acute myocardial infarction or angina pectoris.
D: high blood pressure that is increasing cardiac workload.

B: abnormalities in the heart’s electrical conduction system

Reason:

An irregular pulse indicates abnormalities in the electrical conduction system of the heart. The electrical conduction system, beginning with the sinoatrial node as the primary pacemaker, is responsible for initiating the electrical impulses that stimulate the myocardium to contract. An irregular pulse could indicate potentially lethal arrhythmias that could result in cardiac arrest. You should document an irregular pulse and report this important finding to the emergency department.

12

In which of the following patients is nitroglycerin contraindicated?

A: 41-year-old male with crushing substernal chest pressure, a blood pressure of 160/90 mm Hg, and severe nausea
B: 58-year-old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol
C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra
D: 66-year-old female with chest pressure of 6 hours’ duration, lightheadedness, and a blood pressure of 110/58 mm Hg

C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra

Reason:

Nitroglycerin is contraindicated in patients who do not have a prescription for nitroglycerin, in those with a systolic BP less than 100 mm Hg, and in patients who have taken medications for erectile dysfunction (ED) within the previous 24 to 48 hours. Such medications include sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). Because ED drugs and nitroglycerin both cause vasodilation, concomitant use of these drugs may result in significant hypotension. Carbamazepine (Tegretol) is an anticonvulsant medication; there are no known interactions between Tegretol and nitroglycerin.

13

A 56-year-old man is found to be pulseless and apneic. His wife states that he collapsed about 5 minutes ago. As your partner gets the AED from the ambulance, you should:

A: begin CPR, starting with chest compressions.
B: open the airway and give 2 rescue breaths.
C: ask the wife if the patient has a living will.
D: provide rescue breaths until the AED is ready.

A: begin CPR, starting with chest compressions.

Reason:

When you arrive on scene and determine that a patient is in cardiac arrest, you should immediately begin CPR, starting with chest compressions. Perform 30 chest compressions and then open the airway and deliver 2 rescue breaths. Chest compressions are a crucial part of cardiopulmonary resuscitation and must be started without delay. Apply the AED as soon as it is available. In the interest of this patient, whose arrest interval is short, you should begin resuscitative efforts immediately. In some cases, it is appropriate to inquire about the presence of a living will; however, this should be done after resuscitative efforts have begun.

14

You have analyzed a cardiac arrest patient's rhythm three times with the AED, separated by 2-minute cycles of CPR, and have received no shock messages each time. You should:

A: continue CPR and transport at once.
B: request a paramedic unit at the scene.
C: consider terminating resuscitation.
D: remove the AED and continue CPR.

A: continue CPR and transport at once.

Reason:

Although protocols vary from system to system, it is generally agreed that if you receive three consecutive no shock messages, separated by 2-minute cycles of CPR, you should continue CPR and transport at once; it is unlikely that the patient will convert to a shockable rhythm (eg, V-Fib, pulseless V-Tach). En route, coordinate a rendezvous with a paramedic unit if possible; waiting at the scene would only delay further treatment. The decision to terminate resuscitative efforts is made by a physician, and in some cases, a paramedic, after adequately performed BLS and ALS have proven unsuccessful.

15

Which of the following would clearly be detrimental to a patient in cardiac arrest?

A: Ventilating just until the chest rises
B: Performing CPR before defibrillation
C: Interrupting CPR for more than 10 seconds
D: Using a pocket face mask without high-flow oxygen

C: Interrupting CPR for more than 10 seconds

Reason:

Major emphasis is placed on minimizing interruptions in CPR. Even brief interruptions cause a significant decrease in blood flow to the heart and brain. If you must interrupt CPR, do not exceed 10 seconds. It is preferable to ventilate a patient with a pocket face mask attached to high-flow oxygen, but failing to do so will not be nearly as detrimental as interrupting CPR for extended periods of time. You should ventilate the patient just until the chest visibly rises; ventilations that are too forceful or too fast can cause hyperinflation of the lungs, which may reduce blood return to the heart. When caring for any patient in cardiac arrest, you should immediately begin CPR, and then apply the AED as soon as possible.

16

A 50-year-old man's implanted defibrillator has fired twice within the last hour. He is conscious and alert and complains of a "sore chest." Further assessment reveals that his chest pain is reproducible to palpation and is localized to the area of his implanted defibrillator. In addition to supplemental oxygen, treatment for him should include:

A: deactivating his defibrillator by running a magnet over it.
B: prompt transport with continuous monitoring en route.
C: application of the AED and transport to the hospital.
D: up to three doses of nitroglycerin and prompt transport.

B: prompt transport with continuous monitoring en route.

Reason:

Patients who are high risk for lethal cardiac dysrhythmias (ie, V-Fib, V-Tach) may have an automated implantable cardioverter/defibrillator (AICD). This small device is usually implanted in the upper left chest, just below the left clavicle. The AICD detects cardiac dysrhythmias and rapidly delivers a shock. When treating a patient whose AICD has fired, you should determine the number of times the device fired, administer supplemental oxygen as needed, obtain vital signs, and transport to the hospital with continuous monitoring en route. Application of the AED is not indicated; however, if the patient develops cardiac arrest, you should use the AED as you normally would (remember to apply the pads at least 1" away from the implanted device). The pain that the patient is experiencing, which is reproducible and localized near his AICD, is likely musculoskeletal pain as the result of his AICD shocking him; therefore, nitroglycerin is not indicated. Because the AICD works so quickly (much faster than you can apply an AED), you should not make any attempt to deactivate it.

17

Which of the following statements regarding one-rescuer CPR is correct?

A: Ventilations should be delivered over a period of 2 to 3 seconds.
B: A compression to ventilation ratio of 15:2 should be delivered.
C: You should assess the patient for a pulse after 3 cycles of CPR.
D: The chest should be allowed to fully recoil after each compression.

D: The chest should be allowed to fully recoil after each compression.

Reason:

When performing CPR on any patient, you should allow the chest to fully recoil after each compression. Incomplete chest recoil causes increased intrathoracic pressure, which may impair blood return to the heart. Assess the patient's pulse after every 5 cycles (about 2 minutes) of CPR; take no longer than 5 to 10 seconds to do this. A compression to ventilation ratio of 30:2 should be performed during all adult and one-rescuer CPR (adult, child, and infant), except for newborns. A compression to ventilation ratio of 15:2 is used during two-rescuer infant and child CPR. Ventilations should be delivered over a period of 1 second each, just enough to produce visible chest rise.

18

Aspirin may be contraindicated in patients with:

A: ibuprofen allergy.
B: diabetes.
C: stomach ulcers.
D: glaucoma.

C: stomach ulcers.

Reason:

Aspirin (acetylsalicylic acid [ASA]) inhibits platelet aggregation, thus preventing clots from forming or preventing an existing clot from getting bigger. Aspirin, in a dose of 160 to 325 mg, should be administered to patients experiencing acute coronary syndrome (ie, unstable angina, acute myocardial infarction) as soon as possible. Aspirin is absolutely contraindicated for patients who are allergic to salicylates. Because aspirin prolongs bleeding time, it may be contraindicated for patients with stomach ulcers; therefore, you should contact medical control before giving aspirin to such patients. Aspirin is not contraindicated for patients with glaucoma or diabetes. Ibuprofen, the active ingredient in Motrin and Advil, is a nonsteroidal anti-inflammatory drug (NSAID), not a salycilate.

19

Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction?

A: 66-year-old male with angina
B: 72-year-old female with diabetes
C: 55-year-old obese female
D: 75-year-old male with hypertension

B: 72-year-old female with diabetes

Reason:

Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes.

20

Which of the following patients is the BEST candidate for the administration of nitroglycerin?

A: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg
B: An elderly man with crushing substernal chest pain and a blood pressure of 80/60 mm Hg
C: A woman who has taken three doses of prescribed nitroglycerin without relief of chest pain
D: A man with chest pain, expired nitroglycerin spray, and a blood pressure of 110/80 mm Hg

A: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg

Reason:

Nitroglycerin should be administered to patients who have the prescribed, unexpired drug with them and a systolic blood pressure of greater than 100 mm Hg. No more than three (3) nitroglycerin tablets or sprays should be administered to a patient in the prehospital setting. An expired medication should never be administered to any patient, even if the medication is otherwise indicated for his or her condition.

21

A patient who is experiencing an acute myocardial infarction:

A: often complains of a different type of pain than a patient with angina.
B: has chest pain or discomfort that does not change with each breath.
C: most often describes his or her chest pain as being sharp or tearing.
D: often experiences relief of his or her chest pain after taking nitroglycerin.

B: has chest pain or discomfort that does not change with each breath.

Reason:

The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with AMI.

22

Which of the following interventions would the EMT be the LEAST likely to perform while attempting to resuscitate a cardiac arrest patient?

A: Rhythm analysis with the AED
B: Ventilation with a bag-mask device
C: Insertion of a supraglottic airway device.
D: Assisting a paramedic with intubation

C: Insertion of a supraglottic airway device.

Reason:

The insertion of advanced airway devices (eg, endotracheal [ET] tube, multilumen airway, supraglottic airway) is generally outside the EMT’s scope of practice. However, he or she may be asked to assist a paramedic in the placement of such devices. For example, the paramedic may ask the EMT to retrieve the appropriate equipment or preoxygenate the patient before he or she inserts the device. Operation of the AED and ventilating with a bag-mask device are within the EMT’s scope of practice.

23

You arrive at the scene of a 56-year-old man who collapsed. The patient's wife tells you that he suddenly grabbed his chest and then passed out. Your assessment reveals that he is apneic and pulseless. As your partner begins one-rescuer CPR, you should:

A: obtain a SAMPLE history.
B: notify medical control.
C: prepare the AED for use.
D: insert an airway adjunct.

C: prepare the AED for use.

Reason:

Immediate treatment for a patient in cardiac arrest involves performing CPR and applying the AED as soon as possible. After applying the AED pads to the patient’s chest (around your partner’s compressing hands), analyze his cardiac rhythm, deliver a shock if indicated, and immediately resume CPR (starting with chest compressions). Management of the airway, including insertion of an airway adjunct, should occur during the 2-minute period of CPR in between cardiac rhythm analysis and defibrillation. While CPR is in progress, obtain as much of the patient’s medical history from his wife as possible, and notify medical control when it is practical (ie, you have more help at the scene).

24

While transporting an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should:

A: open her airway and ensure that it is clear.
B: feel for a carotid pulse for at least 5 seconds.
C: analyze her heart rhythm with the AED.
D: quickly look at her chest for obvious movement.

D: quickly look at her chest for obvious movement.

Reason:

If a patient is found unresponsive or becomes unresponsive in your presence, your first action should be to assess for breathing; this should be done by quickly (no more than 10 seconds) looking at the chest for obvious movement. If the patient is not breathing or only has agonal gasps, you should check for a pulse for at least 5 seconds but no more than 10 seconds. If the patient has a pulse but is not breathing, open the airway and provide rescue breathing. If the patient does not have a pulse, begin CPR (starting with chest compressions), and apply the AED as soon as possible. If you are transporting a patient who becomes unresponsive, pulseless, and apneic, you should begin CPR and instruct your partner to stop the ambulance and prepare the AED.

25

A 66-year-old female presents with an acute onset of confusion, slurred speech, and weakness to her right arm and leg. Her airway is patent and she is breathing adequately. The MOST important initial information to determine regarding this patient is:

A: her initial blood pressure reading.
B: when her symptoms were first noted.
C: whether or not her pupils are equal.
D: what she was doing when this began.

B: when her symptoms were first noted.

Reason:

This patient is experiencing signs of an acute ischemic stroke. She may be a candidate for fibrinolytic therapy, drugs that destroy the clot in the cerebral artery, if her symptoms are of less than 3 hours’ duration. It is vital to determine exactly (or as close to as possible) when the patient’s symptoms were first noted, and pass this information along to the receiving facility. Few, if any, current treatments are effective if they are started more than 3 to 6 hours after the stroke begins. Even if 3 hours have passed, prompt action on your part is essential. Assessment of the patient’s blood pressure, pupils, and events that preceded the symptoms are important; however, identifying the patient as a candidate for an intervention that may reverse the stroke is critical and will afford her the greatest chance for a positive outcome.

26

After delivering one shock with the AED and performing 2 minutes of CPR on a woman in cardiac arrest, you reanalyze her cardiac rhythm and receive a no shock advised message. This means that:

A: she is not in a shockable rhythm.
B: she has electrical activity but no pulse.
C: the first shock restored a rhythm and pulse.
D: her rhythm has deteriorated to asystole.

A: she is not in a shockable rhythm.

Reason:

If the AED gives a no shock advised message, it has determined that the patient is not in a shockable rhythm (eg, V-Fib, pulseless V-Tach). It does not indicate that the patient has a pulse, nor does it indicate that a normal cardiac rhythm has been restored. The AED does not distinguish pulseless electrical activity (PEA) from asystole; it only recognizes them as nonshockable. PEA is a condition in which organized cardiac electrical activity is present despite the absence of a pulse. Asystole is the absence of all cardiac electrical and mechanical activity. If the AED gives a no shock advised message, immediately resume CPR, starting with chest compressions, until ALS arrives or the patient starts to move.

27

How can you help maximize cardiac output during CPR?

A: Allow the chest to fully recoil in between compressions
B: Compress the chest at a rate of no more than 100/min
C: Deliver rescue breaths until the chest expands widely
D: Ventilate the patient through an advanced airway device

A: Allow the chest to fully recoil in between compressions

Reason:

Cardiac output is the amount of blood ejected from the left ventricle per minute. Bearing in mind that even the best performed CPR produces only between 25% and 30% of what the patient's cardiac output would otherwise be, there are several actions that you must take to help maximize this. Allowing the chest to fully recoil in between compressions will help draw blood back to the heart; if more blood returns to the heart, more blood can be pumped from the heart with chest compressions. Delivering each rescue breath over a period of 1 second, just enough to produce visible chest rise, will also help maximize cardiac output. If ventilations are given to fast or too forcefully, intrathoracic pressure will increase, resulting in a decrease in the amount of blood that returns to the heart; as a result, cardiac output will decrease. Ventilations are delivered no differently if an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted. Deliver chest compressions at a rate of at least 100 per minute to a depth of at least 2" (at least one third the depth of the chest in infants and children).

28

After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. What cardiac rhythm is the patient MOST likely in?

A: Ventricular tachycardia
B: Pulseless electrical activity
C: Asystole
D: Ventricular fibrillation


D: Ventricular fibrillation

Reason:

Ventricular fibrillation (V-Fib) is the most common initial cardiac dysrhythmia in adult cardiac arrest patients, occurring in up to 75% of all cases. V-Fib is a chaotic quivering of the heart muscle that does not produce a pulse and is due to a massive, uncontrolled electrical discharge of the cardiac cells. The most effective treatment for V-Fib is defibrillation. Some patients are in ventricular tachycardia (V-Tach) without a pulse, which is also treated with defibrillation. Although asystole and pulseless electrical activity (PEA) do not produce a pulse, they are not treated with defibrillation.

29

Sudden cardiac arrest in the adult population MOST often is the result of:

A: accidental electrocution.
B: a cardiac arrhythmia.
C: myocardial infarction.
D: respiratory failure.

B: a cardiac arrhythmia.

Reason:

The most common cause of sudden cardiac arrest (SCA) in the adult population is a cardiac arrhythmia—usually ventricular fibrillation—in up to 70% of cases. This fact underscores the importance of early defibrillation to shock the heart back into a perfusing rhythm. Evidence has shown that cardiac arrest—again, most often the result of an arrhythmia—occurs in up to 40% of patients experiencing an acute myocardial infarction (AMI). The risk of cardiac arrest is highest within the first few hours following the onset of an AMI. Respiratory failure is the most common cause of cardiac arrest in children, not adults. Children generally have healthy hearts and rarely experience cardiac arrest due to a primary cardiac event.

30

Which of the following is an abnormal finding when using the Cincinnati stroke scale to assess a patient who presents with signs of a stroke?

A: One of the pupils is dilated and does not react to light.
B: One arm drifts down compared with the other side.
C: The patient’s face is symmetrical when he or she smiles.
D: Both arms drift slowly and equally down to the patient’s side.

B: One arm drifts down compared with the other side.

Reason:

The Cincinnati Stroke Scale is used to assess patients suspected of experiencing a stroke. It consists of three tests: speech, facial droop, and arm drift. Abnormality in any one of these areas indicates a high probability of stroke. To test arm drift, ask the patient to hold both arms in front of his or her body, palms facing upward, with eyes closed and without moving. Over the next 10 seconds, observe the patient’s arms. If one arm drifts down toward the ground, you know that side is weak; this is an abnormal finding. To test for facial droop, have the patient smile, showing his or her teeth. The face should be symmetrical (both sides of the face should move equally). If only one side of the face moves well, you know that something is wrong with the part of the brain that controls the facial muscles. You should assess the pupils of a patient with a suspected stroke; however, this is not a component of the Cincinnati Stroke Scale.