Cardio Hell 2

Front 1

If a pt is in cardiac arrest and in Asystole or PEA what is your Tx?

Back 1

1. Cpr for 2 minutes/IV access/ Epinephrine 1mg q3-5minutes
2. Check rhythm
3. Cpr for 2 minutes, give 1mg of epinephrine IV
4. Check for reversible causes

Front 2

What 4 rhythms cause cardiac arrest?

Back 2

1. Pulseless Ventricular Tachycardia 2.Ventricular Fibrillation 3.Asystole 4.Pulseless Electrical Activity

Front 3

If you establish an advanced airway how often do you provide respirations?

Back 3

Every 6-8 seconds

Front 4

A patient presents with blurred vision, dizziness, pallor, nausea. And is reporting to medical because he lost consciousness suddenly.
What is your diagnosis?
What is your treatment?

Back 4

What is your Dx: Cardiac Syncope
What is your Tx: Treat underlying causes, treat arrhythmia, or if hypovolemic give fluids.

Front 5

A patient presents with chest wall pain and has a chest wall contusion after being involved in a motor vehicle accident. Pt is Tachycardic
Dx?
Tx?

Back 5

What is your DX: Cardiac Contusion
What is your TX: Rule out life threatening arrhythmias, ABCs, IV, O2, Monitoring, analgesics for pain

Front 6

What are complications that arise from sustained elevations of BP?

Back 6

1. Cardiovascular disease: CHF or left ventricular hypertrophy
2. Aortic Dissection
3. Ischemia or stroke
4. Kidney disease
5. Peripheral vascular disease
6. Eyes retinal damage

Front 7

What are the first line drugs to use in correcting hypertension?

Back 7

1. Diuretics Hydrochlorothiazide (HCTZ) 12.5-25mg daily
2. Other drugs to use B-Blockers, Calcium Channel Blockers, ACE inhibitors, ARBs

Front 8

A patient reports to medical with fever for 2 weeks, shortness of breath, cough, a new onset heart murmur and painless lesions on soles of feet.

Back 8

What is your Dx: Endocarditis
What is your Tx: IV,O2 monitor, Broad spec antibiotic therapy of Unasyn+Nafcillin+Gentamicin(amal), vancomycin 1g IV q 12plus cerfriaxone 2g IV qd. Lastly Tylenol 650-975mg q6 hours.

Front 9

A patient reports to medical with complaint of sudden chest pain 9/10 that radiates to the back, describes it as ripping or tearing pain, hypertension, diminished peripheral pulse.

Back 9

What is your Dx: Dissecting Aortic aneurysm
What is your Tx: Lower BP to SBP 100-120 until surgery, B-blockers, ACE inhibitors,ARBs, pain control with morphine 4-8mg IV. Surgery is definitive therapy.

Front 10

A patient reports to medical with complaints of exertional dyspnea, orthopena, nocturnal dyspnea, fatigue and swelling of the lower extremities. You notice JVD and crackles in the base of lungs.

Back 10

What is your Dx: Congestive heart failure
What is your Tx: Chronic Tx: lifestyle change, low sodium diet, EOTH reduction, smoking cessation. Medications: ACE inhibitors, long lasting nitrates, diuretics (HCTZ/Lasix)

Front 11

What is a complication of Congestive Heart Failure?

Back 11

Acute pulmonary edema

Front 12

A patient presents with unilateral lower leg swelling with pain and redness. Shortness of breath, chest pain, tachycardia and decreased O2 stats.

Back 12

What is your Dx? Pulmonary Embolism
What is your Tx? ABCs, IV, O2 Monitor, Aggressive anticoagulation Heparin 80units/kg IV, Enoxoparin 1mg/kg SC q 12hrs

Front 13

If a patient has a pulmonary embolism what would you suspect that it started as?

Back 13

DVT

Front 14

A patient reports to sick call with all three symptoms under BECKS TRIAD, muffled heart sounds, jugular vein distention, and hypotension unresponsive to fluid challenge.

Back 14

What is your Dx? Pericardial tamponade
What is your Tx? ABCs,IV,O2,Monitor, IV bolus crystalloid(LR or NS0.9%)

Front 15

A patient reports to medical with complaint of burning,squeezing substernal chest pain and the pain radiates from the left shoulder to left jaw. The pain is in short duration and relieved by rest.

Back 15

What is your Dx? Angina
What is your Tx? Nitroglycerin 0.4mg SL q5m max

Front 16

A patient reports to medical with complain of pleuritic sharp pain, pain is worse when sitting down, patient is febrile and during auscultation of the lungs you hear Velcro/crunching snow.

Back 16

What is your Dx? Acute Inflammatory Pericarditis
What is your Tx? Asprin 325-625 q 4-6 hours or NSAIDS for 7days – 3 weeks

Front 17

What is a common complication of pericarditis?

Back 17

Pericardial effucsion/tamponade

Front 18

What are the causes of obstructive shock?

Back 18

Cardiac tamponade, tension pneumothorax, pulmonary embolism

Front 19

A patient reports to medical complaining of severe chest pain like an elephant is sitting on his chest that occurs at rest, and the patient looks anxious.

Back 19

What is your Dx? Acute Coronary Syndrome
What is your Tx? ABCs, Vitals and O2 sat, ECG and IV access.
Administer MONA.

Front 20

What is MONA?

Back 20

Oxygen 4L min, try to maintain O2 at =>94%
Asprin 165-325mg to chew, don’t give is allergic or GI bleed
Nitroglycerin 1 sl tab q3-5 min for ongoing symptoms max dose of 3 tabs
Morphine 4-8mg IV for chest discomfort when patient is unresponsive to nitro

Front 21

Patient presents with neurological deficits lasting 10 minutes, has motor deficit and right arm sensory loss, also has Amaurosis Fugax(unlilateral blindness), during your exam you assculatate a carotid bruits.

Back 21

What is your Dx? Occlusive Cerebrovascular Disease (TIA-stroke)
What is your Tx? Surgical intervention, stenting

Front 22

A patient reports to medical with sudden complaint of lower leg pain, right leg is numb, leg is cool to the touch and pulse is hard to find

Back 22

What is your Dx? Acute Arterial Occlusion of a limb
What is your Tx? Heparin sulfate 5000-10000u IV stat, revascularsation, surgical intervention

Front 23

A patient reports to you with complaint of cramping pain and tiredness in the thigh while walking, patient states that it feels better when hes at rest?

Back 23

What is your Dx? He is suffering from claudication from Atherosclerotic Peripheral Vascular Disease
What is your Tx? You need to convince them to make lifestyle changes such as stop smoking, exercise and eating healthier. Explain to them that worst outcome of this disease is amputation of limbs

Front 24

What is the number 1 killer in the united states?

Back 24

Artherosclerotic Coronary Artery Disease

Front 25

What generalized disease will lead to narrowing and occlusion of the arteries leading to increased risk of coronary artery disease, peripheral vascular disease, stroke, aortic dissection?

Back 25

Atherosclerotic Disease?

Front 26

Cyclic increase in normal heart rate with inspiration and decrease with expiration, no clinical significance common in both young and elderly

Back 26

characteristics of a sinus arrhythmia

Front 27

Heart rate<60bpm and severe <45

Monitor, unless patient is symptomatic and then administer Atropine 0.5mg bolus and repeat q 3-5 minutes, max dose 3mg, if atropine is ineffective then prepare for pacing, dopamine or epinephrine.

Back 27

Sinus Bradycardia

Front 28

Heart rate >100bpm caused by rapid impulse from SA node and infrequently exceeds 150bpm

Back 28

characteristics of sinus Tachycardia

Front 29

What are some possible causes of Sinus Tachycardia?

Back 29

Fever, dehydtration, stimulants, infections

Front 30

To treat this disorder, you can use a vagal response, if that fails look to drugs, if that fails cardioversion or catheter ablation is needed

Back 30

Paroxysmal Supraventricular Tachycardia

Front 31

Sudden change from NSR to _________, tachycardia>100 bpm, p wave maybe buried in narrow qrs.

Back 31

Paroxysmal Superventricular Tachycardia

Front 32

Most common chronic arrhythmia , caused by multipme areas of atrial myocardium continuously discharging at once, heart rate may vary and pattern is irregular

Back 32

What are the characteristics of Atrial Fibrillation?

Front 33

What is the Tx for Atrial Fibrillation?

Back 33

For patients >48 they are at high risk for embolic events and should not be cardioverted until anticoagulated with warfarin/Coumadin don’t start underway

Front 34

Usually associated with COPD, the ECG will show a saw tooth flutter waves, anticoagulation not required<48 hrs complication is embolic event

Back 34

characteristics of Artial Flutter

Front 35

You will see a premature and wide QRS without a preceding P wave, caused most commonly by ischemic disease, these patients are at higher risk for vfib especially after AMI. For tx if patient is asymptomatic no tx needed. Complications of PVC are V-tach or V-fib

Back 35

characteristics of Premature Ventricular Contraction

Front 36

What is the tx for a patient with a frequent non-sustainedV-tach .3 consecutive beats?

Back 36

Beat blocker metoprolol

Front 37

wide QRS complex, tachycardic 160-240bpm, moderately regular. If the patient is unstable prepare to cardiovert with 100-360J, if stable request medadvice and administer anti-arrhythmic infusion (lidocaine) 0.5-0.75mg/kg repeat q5-10 minutes 3mg total

Back 37

characteristics of Ventricular Tachycardia

Front 38

Fine to coarse zigzag pattern without p waves or QRS complexes. ACLS protocol

Back 38

characteristics of ventricular fibrillation

Front 39

exchange nutrients and waste between body cells and blood
-gas exchange

Back 39

Capillary function

Front 40

Venous return to the heart caused by what?

Back 40

-contractions of the heart
-skeletal muscle pump
-respiratory pump

Front 41

All systemic blood vessels branch from________

Back 41

aorta

Front 42

________are most distinct basic heart sounds

Back 42

s1, s2

Front 43

Friction rub =

Back 43

Pericarditis

Front 44

BP should be measured while sitting at level _________

Back 44

of the heart

Front 45

Treatment for asymptomatic Bradycardia?

Back 45

-monitor and observe

Front 46

Abnormalities in cardiac rhythm and conduction

Back 46

cardiac arrhythmia

Front 47

Why is Cardiac Arrhythmia dangerous?

Back 47

Reduces cardiac output, brain perfusion, and myocardial perfusion

Front 48

Treatment for Asymptomatic Sinus Tachycardia?

Back 48

Monitor and observe

Front 49

Sinus Tachycardia can cause this type of hyperthyroidism

Back 49

thyrotoxicosis

Front 50

Use carotid massage for Sinus Tachy and _______

Back 50

PSVT

Front 51

Treatment for elderly retired male, irregular pulse, asymptomatic, “funny heart beat,” monitor reads fib/flutter?

Back 51

Coumadin to decrease clotting risk

Front 52

Afib complication?

Back 52

stroke and thrombolytic event

Front 53

Afib typically spontaneously coverts within __________.

Back 53

24 hours

Front 54

Identify A flutter look like on the ECG

Back 54

Sawtooth pattern

Front 55

Identify vtach or tach and provide what treatment?

Back 55

Amiodorone

Front 56

A 30 year old AD male appearing ill presents to the clinic after two days of vomiting and diahrrhea. He states that he has been unable to hold any food or liquid down. When you take his HR it is 125?
What caused the elevated heart rate? What is that heart rate called and how would you treat this patient?

Back 56

Tachycardia
Patient is Dehydrated
Give Fluids

Front 57

A 59 year old rider presents to ships clinic with complaints of new onset chest pain which he describes as a pressure like radiation to his left arm.
T 98.6 HR: 115 BP: 135/90 RR: 20 Sat 93%
What other information would you like from this patient?
What studies would you get?
What is you DX?
What is your TX

Back 57

Does your pain occur at rest and does it happen most often in the morning?
Are you experiancing any nausea or vomiting?
Anxiety weakness or dizzyness?

DX: Acute Coronary Syndrome

Studies: Listen for new murmurs
Check periperal pulses
Do and ECG and check the ST segment elevation
and a Chest x-ray

Labs: CK-MB, and Troponin T
Draw it every 8 hours

TX: MONA

Front 58

This protects and holds the heart in place

Back 58

pericardium

Front 59

What are the two parts of the pericardium?

Back 59

Fibrous and Serous

Front 60

Which portion of the pericardium is touch inelastic and dense connective tissue that protects the heart, anchors it in place and prevents overstretching?

Back 60

Fibrous

Front 61

Which portion of the hearts anatomy makes up the majority?

Back 61

Myocardium

Front 62

Which part of the hearts 3 layers is cardiac muscle and is made up of two separate networks via gap junctions with intercalated discs?

Back 62

Myocardium

Front 63

What amount of the heart lies left to the midline?

Back 63

2/3

Front 64

What separates the two upper chambers of the heart?

Back 64

Interatrail septum

Front 65

The thickest part of the myocardium of the heart is located where?

Back 65

Left Ventricle

Front 66

What causes the wall chambers of the heart to develop their amount of thickness?

Back 66

Work load

Front 67

Which blood vessels deliver deoxygenated blood to the right atrium from the body?

Back 67

Superior and Inferior vena cava

Front 68

Blood from the right atrium empties into the

Back 68

Right Ventricle

Front 69

Blood from the right ventricle is pumped to what location of the heart?

Back 69

Pulmonary trunk

Front 70

The right and left pulmonary arteries pump their blood to what location of the heart?

Back 70

lungs

Front 71

Where does oxygenated blood from the lungs enter the heart

Back 71

Left Atrium

Front 72

The ascending aorta receives blood from where?

Back 72

Left Ventricle

Front 73

Where do the coronary arteries supply blood?

Back 73

Myocardial Wall

Front 74

Which valve lies between the left atrium and the left ventricle?

Back 74

Mitral/Bicuspid

Front 75

Blood flow through the vessels in the myocardium is called?

Back 75

Coronary Circulation

Front 76

What is referred to as the normal pacemaker?

Back 76

SA Node

Front 77

Where does cardiac electrical excitation begin?

Back 77

SA Node

Front 78

What is the function of the AV Node?

Back 78

Decrease incoming electrical potential

Front 79

On a an ECG what does the P wave indicate?

Back 79

Atrial depolarization

Front 80

On the EKG what does the T wave indicate?

Back 80

Ventricles repolarizing

Front 81

On an EKG what does the "QRS" Complex represent

Back 81

Ventricles depolarizing

Front 82

when reviewing an EKG what can the ST segment tell you especially if your patient is complaining of chest pain?

Back 82

Heart Attack

Front 83

On a EKG a NSR PRI is roughly?

Back 83

.12-.20 seconds

Front 84

The volume of blood pumped per minute by each ventricle is referred to as?

Back 84

Cardiac Output

Front 85

Heart Rate, Stroke Volume, and cardiac output can all influence the stabilization of your patients __________

Back 85

blood pressure

Front 86

Thick triple layered vessels that carry blood away from the heart are called?

Back 86

Arteries

Front 87

The vessels formed by arteries branching down in size are called?

Back 87

Arterioles

Front 88

Vessels that return deoxygenated blood to the heart to be oxygenated are?

Back 88

Veins

Front 89

The vessels that form when capillaries unite are called?

Back 89

Venuels

Front 90

The smallest vessels that functions as the site of gaseous exchange in our circulatory system are termed?

Back 90

Capillaries

Front 91

The cardiovascular system receives input fro what types of receptors to regulate blood flow and pressure?

Back 91

Proprioceptors
Barorecptors
Chemoreceptors

Front 92

__________monitors movements of joints and muscles

Back 92

Propriceptors

Front 93

This receptor is located in the aorta and carotid arteries and helps regulate blood pressure

Back 93

Baroreceptors

Front 94

What two arteries branch from the common iliac arteries

Back 94

unknown

Front 95

Define Pulse

Back 95

unknown

Front 96

________ is involved in the reabsorption of fluids and solutes out the interstitial fluid and back into the capillaries

Back 96

unknown

Front 97

_______can increase blood pressure

Back 97

water retention

Front 98

blood from this location empties into the subclavian veins

Back 98

External jugular