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98 Cards in this Set
- Front
- Back
If a pt is in cardiac arrest and in Asystole or PEA what is your Tx?
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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 |
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What 4 rhythms cause cardiac arrest?
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1. Pulseless Ventricular Tachycardia 2.Ventricular Fibrillation 3.Asystole 4.Pulseless Electrical Activity
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If you establish an advanced airway how often do you provide respirations?
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Every 6-8 seconds
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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? |
What is your Dx: Cardiac Syncope
What is your Tx: Treat underlying causes, treat arrhythmia, or if hypovolemic give fluids. |
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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? |
What is your DX: Cardiac Contusion
What is your TX: Rule out life threatening arrhythmias, ABCs, IV, O2, Monitoring, analgesics for pain |
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What are complications that arise from sustained elevations of BP?
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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 |
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What are the first line drugs to use in correcting hypertension?
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1. Diuretics Hydrochlorothiazide (HCTZ) 12.5-25mg daily
2. Other drugs to use B-Blockers, Calcium Channel Blockers, ACE inhibitors, ARBs |
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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.
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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. |
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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.
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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. |
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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.
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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) |
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What is a complication of Congestive Heart Failure?
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Acute pulmonary edema
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A patient presents with unilateral lower leg swelling with pain and redness. Shortness of breath, chest pain, tachycardia and decreased O2 stats.
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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 |
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If a patient has a pulmonary embolism what would you suspect that it started as?
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DVT
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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.
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What is your Dx? Pericardial tamponade
What is your Tx? ABCs,IV,O2,Monitor, IV bolus crystalloid(LR or NS0.9%) |
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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.
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What is your Dx? Angina
What is your Tx? Nitroglycerin 0.4mg SL q5m max |
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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.
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What is your Dx? Acute Inflammatory Pericarditis
What is your Tx? Asprin 325-625 q 4-6 hours or NSAIDS for 7days – 3 weeks |
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What is a common complication of pericarditis?
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Pericardial effucsion/tamponade
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What are the causes of obstructive shock?
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Cardiac tamponade, tension pneumothorax, pulmonary embolism
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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.
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What is your Dx? Acute Coronary Syndrome
What is your Tx? ABCs, Vitals and O2 sat, ECG and IV access. Administer MONA. |
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What is MONA?
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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 |
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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.
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What is your Dx? Occlusive Cerebrovascular Disease (TIA-stroke)
What is your Tx? Surgical intervention, stenting |
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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
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What is your Dx? Acute Arterial Occlusion of a limb
What is your Tx? Heparin sulfate 5000-10000u IV stat, revascularsation, surgical intervention |
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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?
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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 |
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What is the number 1 killer in the united states?
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Artherosclerotic Coronary Artery Disease
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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?
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Atherosclerotic Disease?
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Cyclic increase in normal heart rate with inspiration and decrease with expiration, no clinical significance common in both young and elderly
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characteristics of a sinus arrhythmia
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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. |
Sinus Bradycardia
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Heart rate >100bpm caused by rapid impulse from SA node and infrequently exceeds 150bpm
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characteristics of sinus Tachycardia
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What are some possible causes of Sinus Tachycardia?
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Fever, dehydtration, stimulants, infections
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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
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Paroxysmal Supraventricular Tachycardia
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Sudden change from NSR to _________, tachycardia>100 bpm, p wave maybe buried in narrow qrs.
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Paroxysmal Superventricular Tachycardia
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Most common chronic arrhythmia , caused by multipme areas of atrial myocardium continuously discharging at once, heart rate may vary and pattern is irregular
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What are the characteristics of Atrial Fibrillation?
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What is the Tx for Atrial Fibrillation?
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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
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Usually associated with COPD, the ECG will show a saw tooth flutter waves, anticoagulation not required<48 hrs complication is embolic event
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characteristics of Artial Flutter
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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
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characteristics of Premature Ventricular Contraction
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What is the tx for a patient with a frequent non-sustainedV-tach .3 consecutive beats?
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Beat blocker metoprolol
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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
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characteristics of Ventricular Tachycardia
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Fine to coarse zigzag pattern without p waves or QRS complexes. ACLS protocol
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characteristics of ventricular fibrillation
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exchange nutrients and waste between body cells and blood
-gas exchange |
Capillary function
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Venous return to the heart caused by what?
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-contractions of the heart
-skeletal muscle pump -respiratory pump |
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All systemic blood vessels branch from________
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aorta
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________are most distinct basic heart sounds
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s1, s2
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Friction rub =
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Pericarditis
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BP should be measured while sitting at level _________
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of the heart
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Treatment for asymptomatic Bradycardia?
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-monitor and observe
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Abnormalities in cardiac rhythm and conduction
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cardiac arrhythmia
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Why is Cardiac Arrhythmia dangerous?
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Reduces cardiac output, brain perfusion, and myocardial perfusion
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Treatment for Asymptomatic Sinus Tachycardia?
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Monitor and observe
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Sinus Tachycardia can cause this type of hyperthyroidism
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thyrotoxicosis
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Use carotid massage for Sinus Tachy and _______
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PSVT
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Treatment for elderly retired male, irregular pulse, asymptomatic, “funny heart beat,” monitor reads fib/flutter?
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Coumadin to decrease clotting risk
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Afib complication?
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stroke and thrombolytic event
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Afib typically spontaneously coverts within __________.
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24 hours
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Identify A flutter look like on the ECG
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Sawtooth pattern
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Identify vtach or tach and provide what treatment?
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Amiodorone
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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? |
Tachycardia
Patient is Dehydrated Give Fluids |
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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 |
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 |
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This protects and holds the heart in place
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pericardium
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What are the two parts of the pericardium?
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Fibrous and Serous
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Which portion of the pericardium is touch inelastic and dense connective tissue that protects the heart, anchors it in place and prevents overstretching?
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Fibrous
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Which portion of the hearts anatomy makes up the majority?
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Myocardium
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Which part of the hearts 3 layers is cardiac muscle and is made up of two separate networks via gap junctions with intercalated discs?
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Myocardium
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What amount of the heart lies left to the midline?
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2/3
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What separates the two upper chambers of the heart?
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Interatrail septum
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The thickest part of the myocardium of the heart is located where?
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Left Ventricle
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What causes the wall chambers of the heart to develop their amount of thickness?
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Work load
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Which blood vessels deliver deoxygenated blood to the right atrium from the body?
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Superior and Inferior vena cava
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Blood from the right atrium empties into the
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Right Ventricle
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Blood from the right ventricle is pumped to what location of the heart?
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Pulmonary trunk
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The right and left pulmonary arteries pump their blood to what location of the heart?
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lungs
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Where does oxygenated blood from the lungs enter the heart
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Left Atrium
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The ascending aorta receives blood from where?
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Left Ventricle
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Where do the coronary arteries supply blood?
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Myocardial Wall
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Which valve lies between the left atrium and the left ventricle?
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Mitral/Bicuspid
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Blood flow through the vessels in the myocardium is called?
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Coronary Circulation
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What is referred to as the normal pacemaker?
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SA Node
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Where does cardiac electrical excitation begin?
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SA Node
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What is the function of the AV Node?
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Decrease incoming electrical potential
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On a an ECG what does the P wave indicate?
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Atrial depolarization
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On the EKG what does the T wave indicate?
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Ventricles repolarizing
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On an EKG what does the "QRS" Complex represent
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Ventricles depolarizing
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when reviewing an EKG what can the ST segment tell you especially if your patient is complaining of chest pain?
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Heart Attack
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On a EKG a NSR PRI is roughly?
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.12-.20 seconds
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The volume of blood pumped per minute by each ventricle is referred to as?
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Cardiac Output
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Heart Rate, Stroke Volume, and cardiac output can all influence the stabilization of your patients __________
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blood pressure
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Thick triple layered vessels that carry blood away from the heart are called?
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Arteries
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The vessels formed by arteries branching down in size are called?
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Arterioles
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Vessels that return deoxygenated blood to the heart to be oxygenated are?
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Veins
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The vessels that form when capillaries unite are called?
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Venuels
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The smallest vessels that functions as the site of gaseous exchange in our circulatory system are termed?
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Capillaries
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The cardiovascular system receives input fro what types of receptors to regulate blood flow and pressure?
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Proprioceptors
Barorecptors Chemoreceptors |
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__________monitors movements of joints and muscles
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Propriceptors
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This receptor is located in the aorta and carotid arteries and helps regulate blood pressure
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Baroreceptors
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What two arteries branch from the common iliac arteries
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unknown
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Define Pulse
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unknown
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________ is involved in the reabsorption of fluids and solutes out the interstitial fluid and back into the capillaries
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unknown
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_______can increase blood pressure
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water retention
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blood from this location empties into the subclavian veins
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External jugular
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