Chapter 21

1) Which of the following describes the EMT's MOST important role in the ideal provision of emergency cardiac care?

A) Recognition and activation of emergency response system

B) Early advanced cardiac life support

C) Immediate high-quality CPR and rapid defibrillation

D) Postarrest care following advanced life support

C) CORRECT. For all the highly technical advances in medicine, the two interventions this patient needs to survive this event are ultimately provided within the EMT scope of practice. Quality chest compressions and early defibrillation are the only chance and really the only interventions ever proven to alter outcomes.

2) Blunt and penetrating injuries can damage chambers of the heart or cause conditions like:

A) asphyxial cardiac arrest.

B) ventricular fibrillation.

C) ventricular tachycardia.

D) pericardial tamponade.

D) CORRECT. Blunt and penetrating injuries can damage chambers of the heart or cause conditions like pericardial tamponade.

3) Which of the following BEST describes the continued need for prehospital advanced cardiac life support, even when EMTs in the community carry AEDs?

A) Not all cardiac arrests are due to problems that respond to defibrillation.

B) The patient may need medications to support his cardiac rhythm and blood pressure prior to attempting defibrillation.

C) Before attempting defibrillation, it may be necessary to obtain a 12-lead ECG on the patient.

D) All of the above

A) CORRECT. Although most cardiac arrest is associated with an electrical problem, and defibrillators are specifically geared to identify electrical dysfunction, not every cardiac arrest case is caused by an electrical problem.

4) What does ventricular fibrillation do?

A) Forces the heartbeat to become quite rapid

B) Causes asphyxial cardiac arrest

C) Prevents the heart muscle from contracting normally

D) Initiates commotio cordis

C) CORRECT. Ventricular fibrillation is a condition in which the heart's electrical impulses are disorganized, preventing the heart muscle from contracting normally.

5) You are on the scene of a 68-year-old male patient complaining of severe chest pain for the last 20 minutes. He has a previous history of myocardial infarction and states it feels "just like the last time." You have applied oxygen and assisted him in administering aspirin and nitroglycerin with no reduction in the chest pain. Your nearest facility is 5 minutes away, a Level III Trauma Center is 10 minutes away, and a hospital with cardiac catheterization capabilities is 20 minutes away. The patient is requesting to be transported to his cardiologist's hospital, which is 30 minutes away. Which hospital is the best destination?

A) The nearest facility

B) The trauma center

C) The hospital the patient requests

D) The nearest hospital with cardiac catheterization

D) CORRECT. The patient is at high risk for having a myocardial infarction. He needs a facility with invasive cardiac capabilities, including cardiac catheterization.

6) All of the following are elements of adult high-performance CPR, EXCEPT:

A) compression rate of at least 100 per minute.

B) placing the heel of one hand on the center of the victim's chest.

C) maintaining a 2:30 ratio of ventilations to compressions.

D) compressing the patient's chest to no more than 1 inch in depth before allowing full relaxation.

D) CORRECT. High-performance CPR on adult patients calls for chest compressions that are at least 2 inches deep.

7) Once an EMT has begun resuscitative efforts, when may the EMT cease those efforts?

A) The patient has no pulse after 1 minute.

B) Spontaneous circulation and breathing occur.

C) No other rescuer is available to relieve the EMT.

D) The EMT's partner gives the order to cease.

B) CORRECT. The EMT may cease resuscitative efforts if spontaneous circulation and breathing occur.

8) If an EMT is tasked with managing the family of a patient who is deceased after termination of resuscitation, what is an effective care strategy?

A) Minimize the family's time with the deceased patient.

B) Prevent the family from seeing the deceased patient.

C) Tell the family the EMT knows how they feel.

D) Be straightforward and use direct language.

D) CORRECT. If notifying the family of an unsuccessful resuscitation, be straightforward and use direct language. Do not attempt to soften the moment with vague terms.

9) Which of the following should NOT be done during defibrillation?

A) Pressing the defibrillation pads firmly to the chest to ensure good contact

B) Continued ventilation during the analysis phase to prevent hypoxia

C) Shaving the chest before placing the defibrillation pads to improve contact

D) Performing CPR while the AED is being attached

B) CORRECT. Ventilating the patient during the analysis phase can cause the AED to detect erroneous rhythms.

10) Which of the following is NOT a reason that an AED may indicate that there is "no shock advised"?

A) The patient's heart has no electrical activity; he is "flat line," or in asystole.

B) The patient's heart rhythm is normal.

C) The patient has organized electrical activity in the heart but no pulse.

D) The patient is in ventricular fibrillation or ventricular tachycardia.

D) CORRECT. When either ventricular fibrillation or pulseless ventricular tachycardia are detected by the AED, the device will recommend that a shock be delivered.

11) Your patient is a 44-year-old female who has collapsed while jogging. She has been unresponsive for 4 to 5 minutes by the time you arrive. Her husband appears to be performing high-quality CPR. Which of the following should be your FIRST action?

A) Insert an oropharyngeal airway and begin ventilations.

B) Load the patient into the ambulance for further assessment.

C) Apply the AED.

D) Stop CPR and check for a pulse.

C) CORRECT. Because high-quality CPR is being performed, the best option for this patient is to immediately utilize an AED.

12) When using an AED, which of the following people is responsible for calling to "clear" the patient before delivering a shock?

A) EMT supervising bystanders

B) EMT operating the defibrillator

C) EMT managing the airway

D) EMT doing chest compressions

B) CORRECT. Only the person who is activating the shock should be advising those present to be clear of the patient.

13) Which of the following people is allowed to continue providing patient care when the patient is to be "cleared" for delivery of a shock via the defibrillator?

A) The EMT performing bag-valve mask ventilations

B) The provider who is ventilating the patient, so long as the patient has been intubated by a paramedic so that the provider does not directly touch the patient

C) Anyone in contact with the patient below the level of the patient's knees

D) None of the above

D) CORRECT. No one should be touching or providing care for a patient from the time "clear" is called until after the shock is delivered.

14) Which of the following BEST describes an appropriate shock sequence for the patient in ventricular tachycardia?

A) Shock, 2 minutes of CPR, reanalyze, shock again if indicated

B) Shock, shock, shock, pulse check, 2 minutes of CPR, shock, shock, shock

C) Shock, pulse check, shock, pulse check, shock, pulse check

D) Shock, shock, shock, shock

A) CORRECT. Following the initial shock, CPR should be initiated for two minutes, and then the patient's rhythm should be reanalyzed and shocked again if appropriate.

15) You are transporting a 50-year-old male patient whom you successfully defibrillated at the scene. You are 5 minutes away from the hospital when the patient goes back into cardiac arrest. Which of the following is the BEST course of action?

A) Analyze the cardiac rhythm and deliver shocks as necessary.

B) Tell the driver to stop, analyze the cardiac rhythm, and deliver a shock as necessary.

C) Tell the driver to stop and assist you with CPR, and request another unit for assistance.

D) Initiate CPR and continue transporting.

B) CORRECT. Stopping the vehicle before analyzing the patient's rhythm and delivering a shock if necessary would be the best course of action.

16) You are on the scene of a 65-year-old female patient in cardiac arrest. CPR is in progress and the AED has been applied. The AED advises shock. After defibrillating the patient, what is your next intervention?

A) Place in the recovery position.

B) Insert a Combitube.

C) Check for a pulse.

D) Continue CPR.

D) CORRECT. A patient who has a shockable rhythm will require the immediate continuation of CPR even if the patient has been shocked into a perfusing rhythm. The heart will need the additional support of CPR to get necessary oxygen.

17) You are the first on the scene of a 72-year-old patient in cardiac arrest. You have your medical supply kit, oxygen, and an AED. At least 4 to 5 minutes of high-quality CPR has been provided by the police officer who arrived before you. You have confirmed an open airway, apnea, and pulselessness. Which of the following should you do next?

A) Perform one-rescuer CPR until additional personnel arrive.

B) Apply the defibrillator pads and shock as indicated.

C) Perform bag-valve mask ventilations with supplemental oxygen for 30 seconds before applying the defibrillator pads.

D) Contact medical direction before taking any action.

B) CORRECT. Early defibrillation is key to cardiac patient survival; utilizing the AED as soon as possible is always indicated.

18) Your patient is a 66-year-old female who has regained a pulse after a shock with an AED; however, she remains unresponsive and is not breathing adequately. Which of the following should be done next?

A) Ventilate the patient with high-concentration oxygen and transport immediately.

B) Deliver a fourth shock to improve the patient's respiratory status.

C) Remove the AED, assist the patient's ventilations with a bag-valve mask and supplemental oxygen, and keep reassessing the pulse.

D) Apply a nonrebreather mask with high-concentration oxygen and keep reassessing the pulse.

A) CORRECT. If breathing is adequate, provide high-concentration oxygen by nonrebreather mask. If breathing is inadequate, ventilate the patient with high-concentration oxygen. Transport without delay.

19) You are on the scene of a 65-year-old female patient in cardiac arrest. CPR is in progress and the AED has been applied. The AED does not advise shock. What is your next intervention?

A) Stop CPR and place the patient in the recovery position.

B) Insert a Combitube.

C) Continue CPR.

D) Replace the malfunctioning AED.

C) CORRECT. Continuation of CPR should be the next step after the AED advises that no shock is required.

20) In which of the following ways does cardiac arrest in children differ from cardiac arrest in adults?

A) Cardiac arrest in children is more likely to be due to respiratory failure.

B) Ventricular fibrillation is common in children.

C) Ventricular fibrillation is not common in adults.

D) Cardiac arrest in adults is more likely to be due to respiratory failure.

A) CORRECT. In infants and children, only about 20 percent of cardiac arrests are caused by sudden dysrhythmias, and very few are caused by blockages of the coronary arteries. In children, cardiac arrests are generally asphyxial in nature.

21) EMTs arrive at the scene of a cardiac arrest to see a police officer beginning to defibrillate the patient. At what point should the EMTs take over?

A) After the shock is delivered or a "no shock indicated" message is received

B) After a "no shock indicated" message is received but otherwise not until the patient is resuscitated

C) Immediately, even if interrupting the police office in the middle of shocking the patient

D) Only if the EMTs feel the police office is incompetent to administer the AED correctly

A) CORRECT. The EMTs should take over care after the first shock is delivered or a "no shock indicated" message is received.

22) Which of the following patients should have an automated external defibrillator applied?

A) A 67-year-old man with severe, crushing chest pain that is not relieved by nitroglycerin

B) A 6-month-old in severe respiratory distress

C) A 19-year-old college athlete who collapsed during football practice and is pulseless and apneic

D) A 40-year-old female in cardiac arrest due to chest injuries sustained in a motor vehicle crash

C) CORRECT. An adult patient who collapsed and is now pulseless and apneic should have an AED applied.

23) You are preparing a patient in cardiac arrest for an AED when you palpate a small lump below the patient's right clavicle. How should this modify your placement of the AED?

A) Place the AED as you would for any patient.

B) Do not place the AED but transport the patient immediately.

C) Place the AED pads over the patient's abdomen.

D) While placing the pads in the general area you need them, keep them several inches away from the lump.

D) CORRECT. If you notice a lump under a clavicle, this is likely a pacemaker device. Do not put a defibrillation pad over it. Try to put the pad at least several inches away while staying in the general area where you want the pad.

24) Mechanical CPR devices are used by EMS agencies in order to provide:

A) a 100% success rate.

B) a faster response time to the scene.

C) high-quality compressions.

D) better quality of care with less training.

C) CORRECT. Mechanical CPR devices are chosen by some EMS agencies because they assist the EMTs with providing high-quality compressions.