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178 Cards in this Set
- Front
- Back
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Define "cardiovascular system."
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The heart and the blood vessels.
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What is the most important drug in the treatment of heart problems?
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Oxygen
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What prescribed medication may you be able to assist patients in taking during a cardiac emergency?
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Nitroglycerin
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Define "defibrillation."
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The application of an electrical shock to the chest in order to restart the heart's normal action.
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Define "cardiac compromise."
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A blanket term that refers to a heart problem with a rapid onset.
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Define "acute coronary syndrome (ACS)"
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A blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle.
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Define "dyspnea"
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Shortness of breath, labored or difficult breathing.
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What are a few problems that the heart can experience?
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A coronary artery may become narrowed or blocked.
A one-way valve may stop working. The specialized tissue that carries electrical impulses may function abnormally. |
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Where are the walls of the heart thickest -- the right or left side?
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The left side.
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What are a few symptoms of heart problems?
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Pain in the center of the chest
Mild discomfort in the chest Difficulty breathing Sudden onset of sweating, nausea, and vomiting |
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What should an EMT assume when a patient is displaying signs of a cardiac emergency?
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Assume that the patient is having heart problems.
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Define "angina."
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Chest pain that occurs when blood supply to the heart muscle is reduced.
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How do most patients describe the pain associated with heart problems?
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A dull, crushing, heavy, or squeezing pain.
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Define "diaphoresis"
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A condition in which the patient sweats excessively.
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Define "ventricular fibrillation" or "V-Fib."
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Sporadic and ineffective contractions of the heart muscle due to damage to the heart.
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Where might pain inflicted by heart problems radiate?
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The upper abdomen, arms, or jaw.
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What are the two huge veins through which blood returns to the heart?
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The superior and inferior venae cavae
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Where would one find the tricuspid valve?
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Between the right atrium and the right ventricle.
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Where does the right ventricle propel blood?
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Through the pulmonary artery to the lungs.
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What blood vessels carry oxygenated blood from the lungs to the heart?
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The pulmonary veins
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Where does blood travel after becoming oxygen-rich at the lungs?
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The left atrium
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Where would one find the mitral (bicuspid) valve?
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Between the left atrium and the left ventricle
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What is the strongest part of the heart?
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The left ventricle -- it has to propel blood to all the distal parts of the body.
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Where does blood travel when it leaves the left ventricle?
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It leaves the heart through the aorta.
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What is the "apex" of the heart?
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It's the bottom of the heart.
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Where is the "base" of the heart?
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At the top.
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What is the epicardium?
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The outside layer of the heart
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What's the myocardium?
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The inner, muscular layer of the heart
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Define "infarction."
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localized necrosis resulting from obstruction of the blood supply
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What artery is commonly called the "widowmaker?"
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The left main coronary artery. When it's stenotic, it can become quickly obstructed and completely block the blood supply to the muscle of the heart, killing the heart.
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What part of the heart (the "pacemaker" of the heart) is responsible for originating the electrical impulse that contracts the heart?
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The Sinoatrial (SA) node.
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Where is the sinoatrial node (SA node) located?
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In the right atrium.
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Where is the atrioventricular node?
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At the junction of the right atrium and right ventricle.
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What happens if the sinoatrial node stops functioning?
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The atrioventricular node takes over, and pulse reduces typically to 40-60 BPM.
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Define "arteriosclerosis."
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Thickening of the arterial walls
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Define "atherosclerosis."
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A stage of arteriosclerosis involving fatty deposits (atheromas) inside the arterial walls, thus narrowing the arteries
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Define "aneurysm."
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A cardiovascular disease characterized by a saclike widening of an artery resulting from weakening of the artery wall
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Define "bradycardia."
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An electrical malfunction of the heart -- less than 60 beats per minute
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Define "tachycardia."
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An electrical malfunction of the heart --- pulse greater than 100 BPM
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What are some possible results of mechanical malfunctions of the heart?
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Cardiac arrest
Shock Pulmonary edema (fluids backing up in the lungs) Congestive heart failure |
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Define "pulmonary edema."
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An abnormal build up of fluid in the air sacs of the lungs
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Define "hypotension."
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Systolic blood pressure less than 90
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What causes angina pectoris (chest pain)?
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Partial blocking of a coronary artery, resulting in decreased (not absent) blood supply to an area of the heart muscle.
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Define "hypertension."
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Systolic BP above 150 or diastolic over 90.
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What percentage of patients having a heart attack report no chest discomfort whatsoever?
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10 to 20 percent
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It is important to have a high ____ __ _________ when dealing with a patient reporting symptoms indicative of heart problems.
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Index of suspicion
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What is congestive heart failure?
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A condition in which the heart can no longer pump enough blood to the rest of the body
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List some signs and symptoms of congestive heart failure
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Confusion
Anxiety Cyanosis Distended neck veins Tachypnea Crackles Pink sputum Rapid heart rate A desire to sit upright Shortness of breath (dyspnea) Pale, cool, clammy skin Abdominal distension Pedal and lower extremity edema |
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Define "edema."
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Swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities
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What does frothy pink sputum indicate?
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Pulmonary edema due to congestive heart failure
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Why must you pay special attention to the elderly, diabetics, and women that are having difficulty breathing?
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These patients may NOT experience chest pain or discomfort of any pain due to cardiac compromise. Weakness and difficulty breathing are the most common symptoms. Maintain a high index of suspicion.
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What are some common symptoms of cardiac compromise?
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Pain, pressure, or discomfort in the chest or upper abdomen (epigastrium)
Difficulty breathing Palpitations Sudden onset of sweating (diaphoresis) Sudden nausea or vomiting Anxiety (I'm gonna die!) Abnormal pulse Abnormal blood pressure |
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What is the number one intervention to take when you suspect cardiac compromise?
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Oxygen therapy!
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In what situations must you transport immediately?
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No history of cardiac problems
History of cardiac problems, but no nitroglycerin Systolic blood pressure is less than 100 (realistically, anybody presenting with chest pain should be transported ASAP) |
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Why do we transport patients immediately (preferably to a cardiac center) if they present with signs of cardiac compromise?
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Cardiac centers have clot busters and ability to perform angioplasty
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What MUST patients have before you can administer nitroglycerin?
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1) Chest pain
2) History of cardiac problems 3) Prescribed nitroglycerin with them 4) BP meets or exceeds local protocol requirements (usually 100 mmHg or higher) 5) Not recently taken Viagra or similar drug for erectile dysfunction REMEMBER: Medical direction authorizes administration of nitro |
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In what position do many hypotensive patients feel most comfortable?
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Lying down, because this allows more blood flow to the brain
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In what case is it very difficult to find a comfortable position for the patient?
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When the patient is hypotensive AND is having difficulty breathing
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What dosage does nitro always come in?
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0.4 mg
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What conditions must be met for a patient to receive a second dose of nitroglycerin?
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1) Patient experiences only partial relief or no relief at all
2) Systolic blood pressure remains greater than 90-100 systolic 3) Medical direction authorizes another dose of the medication. IF THESE CONDITIONS ARE MET, give a second dose 5 minutes after first dose. Administer a maximum of three doses, reassessing vital signs and chest pain after each dose. If BP falls below 100 systolic, treat for shock. FOLLOW PROTOCOL. |
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Generally, what is the maximum number of doses of nitro you can administer to a patient?
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Three
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What conditions must be met for you to assist the patient with taking aspirin?
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Chest pain
No allergies to aspirin No history of asthma No other anti-clotting medications No other contraindications to aspirin Patient is able to safely swallow Medical direction authorizes administration of the medication LOCAL PROTOCOL ALLOWS IT |
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What is the "chain of survival?"
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It is a concept coined by the American Heart Association that consists of:
Early Access Early CPR Early Defibrillation Early Advanced Care |
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Define "thrombus"
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A clot formed of blood and plaque attached to the inner wall of an artery or vein
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Define "coronary artery disease (CAD)"
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Diseases that affect the arteries of the heart
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Define "occlusion"
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blockage, as of an artery by fatty deposits
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Define "embolism"
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Blockage of a vessel by a clot or foreign material brought to the site by the blood current
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What's ACLS?
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Advanced cardiac life support
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To manage a cardiac arrest you must be able to:
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Use an AED
Request ALS backup Use BVM and FROPVD Lift and move patient Suction the airway Use airway adjuncts Take standard precautions Interview family/bystanders |
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Where do the highest survival rates occur?
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In systems with strong links in the chain of survival
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In terms of the power and quality of the shock delivered, what two types of AEDs will you commonly find?
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Monophasic: Sends single shock from one pad to the other
Biphasic: Sends shocks in both directions, measures resistance, and adjusts energy -- causes less damage to the heart muscle |
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What type of AED will cause the least amount of damage to heart muscle?
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Biphasic AED
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Are all AEDs fully automated?
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No. You will find semi-auto/shock advisory AEDs as well as automated AEDs
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How often does an AED computer make a mistake?
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Very rarely. It's usually human error that causes mistakes
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What are two major causes of human error when using an AED?
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Touching the patient during analysis
Not stopping the ambulance to measure and analyze the rhythm |
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What two heart rhythms will an AED shock?
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Ventricular fibrillation (about 50% of cardiac arrest patients display this)
Ventricular tachycardia over certain rates (about 10% of cardiac arrest patients display then) |
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What WON'T an AED shock?
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Asystole (no pulse) (about 20-50% of patients)
Pulseless electrical activity (15-20% of patients) |
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Typically, what percentage of patients are in a shockable rhythm?
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60-70%
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Who are the ONLY patients that should have an AED applied?
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A patient who is unresponsive, apneic, and pulseless
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Define "apnea."
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Transient cessation of respiration
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Define "asystole."
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Lack of ventricular contraction (flatline)
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What must NOBODY do while the AED is analyzing a rhythm or delivering a shock?
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NOBODY may touch the patient (or the stretcher!)
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What's a three-letter abbreviation for nitroglycerin?
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NTG
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When is it appropriate to initiate up to 5 cycles of CPR before shocking the patient?
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When response time is greater than 4-5 minutes. You can do 5 cycles (2 minutes) of CPR.
Then shock. If a bystander is already there, doing high-quality compressions, just shock. |
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What do you do when you witness a cardiac arrest?
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Do not delay defibrillation to perform CPR. Defibrillate!
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What do you do when you come upon an unwitnessed cardiac arrest?
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Do not delay CPR to defibrillate. CPR is the main priority!
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What are the two main contraindications to AEDs?
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A patient under 1 year old
Trauma victim ---if either of these contraindications exist, do NOT use an AED |
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What do you do RIGHT before you shock a patient with an AED?
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Verbally and visually make sure that everybody is clear of the patient.
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What is the best-known symptom of a heart problem?
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Crushing/Squeezing chest pain
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What is the medical term for "trouble breathing?"
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Dyspnea
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What three forms does nitroglycerin come in?
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Tablet
Spray Patch |
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What term describes a medical condition in which calcium deposits harden arterial walls?
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Arteriosclerosis
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How long can an EMT cease CPR to use an AED?
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90 seconds
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What's the first step in assessing a patient in cardiac arrest?
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Verify pulselessness and apnea
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How frequently should the batteries of an AED on an ambulance or at the hospital be checked?
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Every shift
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Ideally, when does an EMT request ALS backup for a cardiac arrest patient?
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En route to the scene
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What should you do if there's no pulse after delivering three shocks from the AED?
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Begin/Resume CPR
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How frequently should an EMT attend a continuing education training session on AED use?
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Every three months
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If you are a single rescuer with an AED arriving at the scene of an unwitnessed arrest, you should:
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perform CPR for two minutes (5 cycles), and then apply the AED.
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If your patient who regained a pulse after being defibrillated goes back into cardiac arrest while en route to the hospital, you should:
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stop the vehicle and defibrillate if indicated.
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After delivering your first shock with an AED, the patient is still pulseless, you should next:
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After delivering the first shock with the AED, perform two minutes (5 cycles) of CPR, unless the patient wakes up. After two minutes, reanalyze using the AED.
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Chaotic electrical activity originating from many sites in the heart is called:
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V-Fib (Ventricular Fibrillation)
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One reason patients with cardiac compromise think they might have the "flu" is because the symptoms include:
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Nausea and sweating
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Automated defibrillators that advise the EMT to press a button that delivers the defibrillation shock are called:
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Semiautomatic (shock advisory)
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The two most common sites of aneurysms that you will encounter in emergency situations are those that occur in the:
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Aorta and the brain
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A thrombus which has broken loose, moving with blood flow, is called a(n):
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Embolism
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_______ AEDs use less power and may cause less damage to the patient's heart.
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Biphasic
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If the patient is not defibrillated within _______ minutes of a cardiac arrest, there is almost no chance for survival.
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8
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Half of all cardiac arrest patients will initially have a _______ rhythm.
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VF (Ventricular Fibrillation)
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If a cardiac arrest occurs within two hours of the onset of symptoms, it is called (a):
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Sudden death
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If an AED analyzes a patient and finds pulseless electrical activity, how is it programmed to respond?
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It will indicate "no shock advised."
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Your patient has a blood pressure of 152/96. This patient would be considered:
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Hypertensive
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Your patient has a blood pressure of 84/58. This patient would be considered:
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Hypotensive
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If a pediatric patient has a cardiac problem, it is most likely:
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Congenital
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What position should you place a cardiac patient in?
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A position of comfort
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Pertaining to lights, sirens, and driving, what must you keep in mind when transporting a cardiac patient?
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Sudden starts and stops and wailing sirens will add to a patient's fear and apprehension, and can put further stress on the heart. Drive carefully, use the lights, and just use the sirens when necessary.
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True or false: The quality of CPR done by untrained laypeople instructed by dispatchers is comparable to CPR done by laypeople who were trained in CPR previously.
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True.
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What is the main goal of "early access" as it pertains to the AHA's "Chain of Survival?"
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Early access means that the person who sees somebody collapse or finds somebody unresponsive quickly calls emergency dispatch (911 or local #)
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What is the main goal of "early CPR" as it pertains to the AHA's "Chain of Survival?"
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To get CPR-trained professionals to the patient faster, to train laypeople in CPR, and to train dispatchers in how to instruct callers on CPR.
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What is the main goal of "early defibrillation" as it pertains to the AHA's "Chain of Survival?"
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To get defibrillation to a patient as soon as possible, either by EMTs, first responders, or lay people
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What is the main goal of "early advanced care" as it pertains to the AHA's "Chain of Survival?"
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Getting patients to facilities or personnel with ACLS training and equipment ASAP
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Which two links of the "Chain of Survival" can an EMT directly provide?
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Early CPR and Early Defibrillation
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What is "controlled hypothermia?"
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It's an experimental intervention used to reduce brain damage in cardiac patients.
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What is "manual defibrillation?"
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Manual defibrillation is the "old-fasioned" way of defibrillating. An EMT must watch the patient's heart rhythm on a screen, decide when it's time to shock, and shock appropriately.
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Which is more common -- a semiautomatic defibrillator or a fully automatic defibrillator?
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Semiautomatic (Shock Advisory)
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What four things will greatly reduce the chance of making an error in defibrillating?
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1) Maintaining the AED in good working order
2) Attaching an AED only to unresponsive, apneic, pulseless patients 3) Practicing frequently 4) Following local protocols |
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What are the two most common conditions that result in cardiac arrest?
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Ventricular Fibrillation (V-Fib or VF)
Ventricular tachycardia (V-Tach or VT) |
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Define "pulseless electrical activity (PEA)"
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A condition in which the heart's electrical rhythm remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity, causing cardiac arrest.
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Define "Asystole."
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A condition in which the heart has ceased generating electrical impulses.
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What two cardiac rhythms will you find the vast majority of cardiac arrest patients to be in?
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V-Fib and Asystole
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What condition is commonly referred to as "flatline?"
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Asystole
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What are the steps to follow when using an AED on a patient after a witnessed cardiac arrest?
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1) Verify arrest -- unresponsive, pulseless, apneic
2) Have partner start CPR 3) Turn AED on 4) Apply AED and clear patient 5) Press "analyze" button (If shock is indicated, deliver one shock. If patient doesn't wake, perform 2 minutes (5 cycles) of CPR. Repeat sequence -- analyze, shock if indicated... if patient hasn't recovered after three shocks, transport.) (If no shock indicated [NSI], perform CPR for 2 minutes (5 cycles), press analyze, and if again NSI, perform two minutes of CPR. Then check pulse and transport) |
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What do you do when you receive an NSI (no shock indicated) message from an AED?
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Begin 2 minutes (5 cycles) of CPR
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What do you do when the patient regains a pulse after CPR/AED?
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Check breathing and ventilate
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When attempting to resuscitate a patient using an AED, what conditions must be fulfilled before transport?
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1) Three shocks have been administered
OR 2) You have received 3 consecutive NSI messages and gone through 3 rounds of CPR OR 3) Patient regains a pulse |
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What is the proper power does (in joules) for a monophasic defibrillator?
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360 joules
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What is the proper power does (in joules) for a biphasic defibrillator?
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120-200 joules
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Is it safe to defibrillate in a moving ambulance?
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No.
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What happens if the ALS team arrives before you have completed a shock with the AED?
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They should allow you to complete the shock, then begin advanced care.
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What will ALS first do when assisting a cardiac arrest patient?
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1) Obtain IV access to administer emergency medications
2) Pass an advanced airway (ET tube, LMA, Combitube) |
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When a patient is in the care of ALS and has an advanced airway inserted, how will their ventilations/compressions change?
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Two EMTs will work together to simultaneously compress and ventilate. Compressions will go at 100 BPM consistently, and ventilations will go at a rate of 8-10 per minute, for 1 second per breath
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What should you do if you come upon a lay person/first responder operating an AED on a patient?
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Allow them to complete the first shock (or get a "no shock advised message,") then work with the operator to bring about an orderly transfer of care.
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Should you ever bring an AED with you from the scene to the hospital?
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In some jurisdictions, yes. The data contained on the AED might be necessary.
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You're transporting a patient after trying an AED, and they still have no pulse. What do you do?
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Continue CPR en route
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You're transporting a patient after trying an AED, and the AED (still attached) is advising you to analyze for a shock. The patient never regained a pulse during treatment. What do you do?
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Continue CPR. Do not analyze or defibrillate in a moving ambulance.
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You're transporting a patient that recovered their pulse after use of an AED on the scene. They suddenly lapse back into cardiac arrest. What do you do? (5 steps)
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1) Stop the vehicle
2) Have partner start CPR if AED isn't ready 3) Analyze the rhythm 4) Deliver a shock if indicated 5) Continue with two shocks separated by two minutes (5 cycles) of CPR, or follow local protocols |
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You're transporting a patient who is conscious, and suddenly they lapse into cardiac arrest. What do you do?
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Pull over the ambulance and grab the AED. Treat him like any other patient in cardiac arrest.
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What are the steps taken to care for a patient if you're the only rescuer present and you come upon a patient in cardiac arrest?
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1) Perform initial assessment
2) Ensure pulselessness and apnea. Attempt ventilation, preferably with pocket face mask. Perform CPR for two minutes if downtime is prolonged, otherwise defibrillate immediately if arrest was witnessed. 3) Turn on AED 4) Attach device 5) Initiate analysis 6) Deliver shock 7) Call for help (if you receive a no shock message, the patient receives a pulse, or you have delivered three shocks already) 8) Start CPR, follow your protocols |
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Besides infants and trauma victims, what possible exception to immediate defibrillation exists?
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Hypothermia. These patients are often warmed in a controlled environment before shocked. Follow local protocols.
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Do infants go into shockable rhythms more or less often than adults?
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Less often
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What are the best ways to resuscitate an infant?
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Aggressive airway management and artificial ventilation with chest compressions.
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What do you do if you're about to defibrillate a patient and you find a nitroglycerin patch on their chest?
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Remove it carefully before defibrillating. Do not touch the medicine on the patch!
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What do you do if you find a pacemaker on a patient you're about to defibrillate?
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Do not put patches directly over pacemaker.
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Should the presence of an internal defibrillator change the way an EMT cares for a patient?
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No -- treat like any cardiac patient
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Should emergency care for a patient who has undergone bypass surgery be any different from any other cardiac arrest patient?
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No
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What four intervals make up the time that elapses from the moment of collapse until the start of defibrillation?
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1) EMS access interval
2) Dispatch interval 3) Ambulance response interval 4) Assessment and shock interval |
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Define "EMS Access interval."
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This is the time that passes between when a person collapses in cardiac arrest until somebody notifies the EMS system. Goal is one minute or less.
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Define "Dispatch interval."
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The time between the receipt of the emergency call and the dispatch of an ambulance crew. Goal is 30 seconds or less.
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Define "ambulance response interval."
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The time between dispatch and arrival of the ambulance. Usually this is fastest in towns and small cities that have a 24/7 ambulance service but little traffic. Goal is 3 minutes or less.
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When small towns don't have a 24/7 ambulance service, what might they do to improve response to cardiac emergencies?
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Station an EMT somewhere in the community with an AED for 24 hours a day. In one group of small communities, this reduced response time from 7.5 minutes to 2.5 minutes.
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Define "assessment and shock interval."
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This is the time that elapses between the arrival of the rescuer and the moment the first shock is delivered. Ideally this is 1 minute or less.
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What must an EMT do -- beyond receiving training on AEDs in an EMT course -- in order to be authorized to defibrillate?
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He must meet requirements of state laws and regulations, and requirements of the medical director
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Ideally, how long is the longest allowable pause in CPR?
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10 seconds
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What are the "thumper" and the "auto-pulse?"
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These are mechanical CPR devices.
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What are the steps to using a thumper?
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1) Take standard precautions
2) Ensure CPR is in progress and effective 3) Attach Thumper base plate to backboard 4) Stop CPR to slide long backboard under patient 5) Restart CPR and attach shoulder straps to patient 6) Slide Thumper piston plate into position on base plate (away frmo chest) 7) Stop CPR, move piston arm into place, measuring placement 8) Slowly adjust depth of compression 9) Adjust ventilations 10) Turn off compressions for pulse checks and defibrillation 11) Upon termination of arrest or return of spontaneous circulation, power down the unit |
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What are the steps to using an Auto-Pulse?
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1) Take standard precautions
2) Ensure CPR is in progress and effective 3) Align patient on Auto-pulse platform 4) Close the lifeband chest band over patient's chest 5) Press start 6) Provide bag mask ventilation at a rate of 2 ventilations for every 30 compressions. 7) Continue CPR as normal |
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What usually brings on angina pectoris?
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Stress and exertion
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Most heart problems in children are ____.
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Congenital
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What's another term for "cardiac compromise?"
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Acute coronary syndrome (ACS)
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What is the medical term for "pain in the upper abdomen?"
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Epigastric pain
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What are the eight steps in managing chest pain when dealing with a responsive patient with a nitro prescription?
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(always take standard precautions first)
1) Perform initial assessment 2) Provide high-concentration oxygen by nonrebreather mask. 3) Perform focused history and physical exam for a medical patient. 4) If the patient meets nitroglycerin criteria and has prescribed nitro, ask him about the last does taken. 5) Check the four rights: right patient, right drug, right dose, right route. Check expiration date. Consult medical direction before assisting patient with meds. 6) Remove oxygen mask. Ask patient to open mouth and lift tongue 7) Place nitro tablet under tongue or spray medication under tongue 8) Have patient close his mouth and hold the nitro under his tongue. 9) Reassess |
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What 7 pieces of emergency equipment need to be taken to every call involving a cardiac patient?
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1) Nonrebreather mask
2) Oxygen 3) Nasal cannula (in case patient refuses the mask) 4) Suction unit 5) Equipment to take vitals 6) Defibrillator 7) Bag-valve max w/ oxygen reservoir |
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Why does the medical director have a strong motivation to be involved in all aspects of an EMS system's defibrillation program?
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The EMT defibrillates under the medical director's license to practice medicine.
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Why is it important for an EMT to undergo refresher AED training every 90 days?
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Because an EMT rarely has to use an AED in the field.
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You can only interrupt CPR in order to defibrillate for a MAXIMUM of 90 seconds. How long can you interrupt compressions to do things such as reassessing the patient, checking pulse, or inserting an airway?
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10 seconds max
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What is the beneficial effect of a beta blocker?
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It slows the heart rate.
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Is low pressure a common sign of congestive heart failure?
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NO
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What is the MAIN role of the EMT as it applies to the Chain of Survival?
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Early Defibrillation
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