EMT FISDAP Cardiology Exam

Which intervention or interventions would have the MOST positive impact on the cardiac arrest patient's outcome?

Early CPR and defibrillation

The AED gives "no shock" message to a patient who is in cardiac arrest. You should:

Resume chest compressions

What is the maximum amount of time that should be spent checking for spontaneous breathing in an unresponsive child?

10 seconds

When performing CPR on an adult, you should compress the chest to a depth of ___ at a rate of ___.

2.0-2.4 in, 100-150BPM

What is the appropriate compression to ventilation ratio for adult two-rescuer CPR?

30:2

When checking for a pulse in an infant, which artery should you palpate?

Brachial

When performing CPR on an adult or child, you should reassess the patient for return of respirations/circulation every ____ minutes.

2

What is the preferred method of removing a foreign body in an unresponsive child?

Chest compressions

Cardiogenic shock is caused by:

Inadequate function of the heart muscle

Pericardial effusion

Collection of fluid between the pericardial sac and the myocardium

Cardiac tamponade

Occurs when blood leaks into the space between the pericardium and the pericardial sac

Signs and symptoms of cardiac tamponade:

Beck triad: the presence of jugular vein distention, muffled heart sounds, and a narrowing pulse pressure where the systolic and diastolic blood pressures start to merge.

Signs of cardiogenic shock:

-Skin may be cool, clammy, and ashen
-High BP
-Rapid, shallow breathing
-Weak, irregular pulse
-Anxiety, nausea

You arrive on scene to find a conscious 58YOF sitting up and reporting severe chest pain and SOB. She is anxious and "feels like she's going to die." Her skin is pale, cool, and clammy and her pulse is rapid, weak, and irregular. Her breathing is labored, with a RR of 28 breaths/min. Her SpO2 is 90%. Lung sounds show crackles in all fields, and BP is 92/60 mmHg. What is your differential diagnosis of the patient?

Cardiogenic shock

The heart is divided down the middle into left and right sides by the:

Septum

Which chamber of the heart receives incoming unoxygenated blood?

Atrium

Which chamber of the heart pumps oxygenated blood?

Ventricles

Normal electrical impulses begin in the:

Sinoatrial (SA) node

What characteristic allows a cardiac muscle cells to contract spontaneously without an external stimulus?

Automaticity

The sympathetic nervous system acts on the body by:

-increasing HR and RR
-constricting blood vessels in the muscles

The parasympathetic nervous system acts on the body by:

(directly opposes the sympathetic NS)
-decreases HR and RR
-constricts blood vessels in muscles

Increased oxygen demand in a normal heart is supplied by of the coronary arteries.

Dilation

The heart itself is supplied by blood through what vessels?

Coronary vessels

The iliac arteries descend into the:

femoral arteries

Which veins bring blood back to the right atrium?

Venae cavae

Systolic pressure is the:

maximum pressure generated in the arteries during contraction of the left ventricle

Pulses felt in the extremities are called:

Peripheral pulses

Pulses felt near the trunk of the body are called:

Central pulses

Decrease in blood flow to the heart is called:

ischemia

Disorder in which calcium an cholesterol build up and form a plaque inside the walls of the blood vessels is called:

Athersclerosis

Occlusion:

Complete blockage of an artery

A blood clot that floats through blood vessels until it reaches an area too narrow to pass, causing it to stop and block blood flow is called:

Thromboembolism

If a blockage occurs in a coronary artery, the condition is known as:

Acute myocardial infarction (AMI)

Acute Coronary Syndrome is a group of symptoms caused by:

MI

ACS can be caused by:

1. Angina pectoris
2. Acute myocardial infarction

Angina is most often a symptom of:

Athersclerotic coronary artery disease

Angina occurs when:

The heart's need for oxygen exceeds the supply

Signs and symptoms of angina:

-crushing, squeezing, "like somebody standing on their chest"
-Usually felt in midportion of chest under sternum, can radiate to jaw, back, or epigastrum
-Pain goes away after 3-8 min
-Associated with SOB, nausea, vomiting

Stable angina can be relieved with:

rest, NTG, supplemental oxygen

Unstable angina is characterized by:

pain in the chest of coronary origin that stays regardless of rest/NTG/O2

Signs and symptoms of AMI:

-sudden onset of weakness, nausea, sweating
-chest pain, discomfort, or pressure that is either crushing or squeezing and doesn't change with each breath
-Pain, discomfort, pressure in lower jaw, arms, back, abdomen, neck
-irregular HR
-Syncope

Dysrythmia:

Abnormal heart rhythm

Tachycardia:

HR of greater than 100 BPM

Bradycardia:

HR of less than 60 BPM

Rapid heart rhythm, usually at a rate of 150-200BPM.

Ventricular tachycardia

Disorganized, ineffective quivering of the ventricles.

Ventricular defibrillation

If a defibrillator is not immediately available for a patient in ventricular fibrillation, you should:

Initiate CPR until an AED arrives

If uncorrected, unstable VT or VF will lead to:

Asystole

A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid in the lungs/body.

Congestive heart failure

Signs and symptoms of CHF:

-JVD (right side)
-Dependent edema (right side)
-Use of accessory muscles (left side)
High BP, rapid HR, rapid RR
-Fluid in the lungs (crackles) (left side)

One of the most common signs of a hypertensive emergency:

Sudden, severe headache

Signs and symptoms of a hypertensive emergency:

-strong, bounding pulse
-ringing in the ears
-nausea/vomiting
-dizziness

Untreated hypertensive emergencies can lead to:

stroke or dissecting aortic aneurysm

A weakness in the wall of the aorta:

Aortic aneurysm

Occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers.

Dissecting aortic aneurysm

What is the primary cause of dissecting aortic aneurysms?

Uncontrolled hypertension

Signs and symptoms of a dissecting aortic aneurysm:

Very sudden chest pain located in the anterior part of the chest or in the back between the shoulder blades

Nitroglycerin action:

Activates the sympathetic NS, relaxes the muscles of blood vessel walls, dilating coronary arteries, increasing blood flow and the supply of oxygen to the heart

Contraindications of NTG:

Use of ED drugs within the past 24-48 hours, maximum dose has already been given, BP is below 100

Non-shockable rhythms:

Asystole, pulseless electrical activity

Only apply the AED to:

Pulseless, unresponsive patients

After the shock is delivered to a cardiac arrest patient, you should:

Continue CPR for 5 cycles (2 minutes) and analyze rhythm again.

If ALS is not responding to the scene and your local protocols agree, you should begin transport when:

1. The patient regains a pulse
2. 6-9 shocks have been delivered
3. the machine gives 3 separate messages that no shock is advised

If you are traveling to the hospital and a pulse is not present:

1. Stop the vehicle
2. If the AED is not available, perform CPR
3. Call ALS
4. Analyze rhythm
5. Deliver one shock (if indicated) and resume CPR
6. Continue resuscitation according to protocol.

If you are en route with a conscious adult patient who is having chest pain and becomes unconscious:

1. Check for a pulse
2. Stop the vehicle
3. Perform CPR until the AED is ready
4. Analyze the rhythm
5. Deliver one shock (if indicated) and resume CPR
6. Begin compressions and continue resuscitation according to protocol

You are dispatched to a 60YOM with chest pain and SOB. The patient has angina and is taking NTG, furosemide, and atorvastatin. You hear crackles when listening to his breath sounds. The patient's difficulty breathing and crackles are due to blood backing up in which part of the body?

The lungs

What is the most effective way to assist a person with CHF to breathe effectively and avoid the use of an invasive airway management technique?

CPAP

You are treating a 50 YOF who has just finished a 10K run. She is complaining of crushing pain in the chest radiating down her left arm and nausea, which came on suddenly. She is sweating profusely. What condition should you suspect?

Angina pectoris

Which dysrhythmia is the most common cause of sudden death?

Vfib

You are treating a 63YOM male with the following vital signs: P 140BPM and irregular, RR 28, BP 90/50mmHg. He is complaining of chest pain. Given this information, why would NTG be contraindicated?

His blood pressure is too low

You are transporting a patient with angina, and he loses consciousness on the way to the hospital. When you check, you cannot feel a pulse. What should you do?

Have your partner pull over the ambulance

Cardiogenic shock following AMI is caused by:

Decreased pumping force of the heart muscle

Most patients are instructed to take up to ____ doses of NTG before calling EMS.

Three

A 60YOM is found to be unresponsive, pulseless, and apneic. You should:

Begin CPR until an AED is available

Why would an EMT give aspirin to a patient?

Aspirin reduces the blood's ability to clot and works to prevent further clot formation in patients with chest pain

What is the first medication that should be administered to a patient who's experiencing chest pain with difficulty breathing?

Oxygen

You are on the scene with a 60YOM who calls 911 for chest pains. He states he was about to go to bed when his chest pains wouldn't go away. He rates his pain as a 7/10 and is diaphoretic, but otherwise stable. He takes medications for hypertension, high cholesterol, and erectile dysfunction. After placing the patient on oxygen, you should call medical control and request:

To administer aspirin to the patient

A 76YOF complains of SOB and lower leg swelling. You see that she has JVD and crackles in her lungs. Her SpO2 is 90%. What is the cause of her heart failure?

Poor ejection of blood from the heart