AAOS Emergency Care and Transportation of the Sick and Injured Eleventh Edition – Chapter 16 Cardiovascular Emergencies

atrium
one of two (right and left) upper chambers of the heart. the right atrium receives blood from the vena cave and delivers it to the right ventricle the left atrium receives blood from pulmonary veins and delivers it to the left ventricle.

ventricle
one of two (right and left) lower chamber of the heart. the left ventricle receives blood from the left atrium (upper chamber) and delivers blood to the aorta. the right ventricle received blood from the right atrium and pumps it into the pulmonary artery. 20-50 BPM

aorta
the body’s main artery, which receives blood from the left ventricle and delivers it to all other arteries that carry blood to the tissues of the body

automaticity
the ability of cardiac muscle cells to contract spontaneously without a stimulation from a nervous system

sinoatrial node
origination point of normal impulses in the heart 60-100 BPM

autonomic nervous system
the part of the nervous system (brain) that controls the involuntary activities of the body such as the heart rate blood pressure and digestion of food.

sympathetic nervous system
The part of the autonomic nervous system that controls active functions such as responding to fear (also known as “fight or flight” system) speeds up the heart rate, increases respiratory rate and depth, dialates blood vessels in the muscles and constricts blood vessels in the digestive system

parasympathetic nervous system
the part of the Autonomic Nervous System that controls vegetative functions such as digestion of food and relaxation. slows the heart and respiratory rates, constricts blood vessels in muscles and dilates blood vessels in the digestive system

myocardium
the heart muscle

stroke volume
volume of blood ejected with each ventricular contraction

coronary arteries
blood vessels that carry blood and nutrients to the heart muscle

aortic valve
the one way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta; one of the four heart valves

cardiac output
a measure of the volume of blood circulated by the heart in 1 minute calculated by multiplying the stroke volume by the heart rate.

ischemia
a lack of oxygen that deprives tissues of necessary nutrients resulting from partial or complete blockage of blood flow potentially reversible because permanent injury has not yet occurred

ischemic heart disease
disease involving a decrease in blood flow to one or more portions of the heart muscle

atherosclerosis
disorder in which calcium and cholesterol build up inside the walls of blood vessels eventually leading to partial or complete blockage of blood flow.

occlusion
a blockage usually of a tubular structure such as a blood vessel

lumen
inside diameter of the artery or other hollow structure

thromboembolism
a blood clot that has formed within a blood vessel and is floating within the bloodstream until it reaches an area too narrow to pass, causing it to block blood flow

acute myocardial infarction (AMI)
a heart attack, death of heart muscle following obstruction of blood flow to it. Acute in this context means “new” or “happening right now” caused by blockage in a coronary artery. onset of pain is gradual with additional systems

infarction
death of body tissue usually caused by interruption of it’s blood supply

cardiac arrest
a state in which the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest even if muscular and electrical activity continues in the heart. pulseless, apneic

acute coronary syndrome (ACS)
a term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction (decreased blood flow to the heart)

angina pectoris
transient (short lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle; also called angina. exertional chest pain relieved by nitro

syncope
a fainting spell or transientnt loss of conscious

signs and symptoms of acute myocardial infarction
– sudden onset of weakness, nausea and sweating without obvious cause
– chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath
– pain, discomfort, or pressure in the lower jaw, arms, back, abdomen or neck
– irregular heartbeat and syncope
– dyspnea
– pink, forthy sputum
– sudden death

pain of acute myocardial infarction
– may or may not be caused by exertion
– does not resolve within a few minutes
– may or may not be relieved by rest or nitroglycerin

ventricular tachycardia
a rapid heart rhythm, (150-200 BPM) in which the electrical impulse begins in the ventricle (instead of the atrium)which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.

ventricular fibrillation
disorganized ineffective quivering of the ventricles resulting in no blood flow and a state of cardiac arrest. AED is specifically programed to recognize this rhythm.

defibrillate
to shock a fibrillating (chaotically beating v-fib) heart with specialized electric current in an attempt to restore a normal rhythmic beat.

asystole
the complete absence of all heart electrical activity

cardiogenic shock
a state in which not enough oxygen is delivered to the tissues of the body, caused by a low output of blood from the heart. Can be a severe complication of a large acute mycardial infarction, as well as other conditions. heart lacks pumping power, low blood pressure. nitroglycerine can be used to treat.

congestive heart failure (CHF)
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 into the lungs. swollen ankles, rales

dependent edema
swelling in the part of the body closest to the ground caused by collection of fluid in the tissues; a possible sign of congestive heart failure

hypertensive emergency
an emergency situation created by excessively high blood pressure which can lead to serious complications such as stroke or aneurysm occurs with a systolic pressure greater than 160 mm Hg. severe headache, bounding pulses, ringing in the ears

aortic aneurysm
weakness in the wall of the aorta which makes it susceptible to rupture. feels like a tearing sensation

dissecting aneurysm
condition in which the inner layers of an artery , such as the aorta, become separated, allowing blood (at high pressure) to flow between the layers. sudden tearing, separation of lining, potential for great blood loss. the onset of pain is abrupt without additional systems

tachycardia
a rapid heart rate more than 100 beats BPM

superior
the part of the body or any body part nearer to the head

return of spontaneous circulation (ROSC)
the return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.

posterior
the back surface of the body the side away from you in the standard anatomic position.

perfusion
the flow of blood through body tissues and vessels

dysrhythmia
an irregular or abnormal heart rhythm

dilation
widening of a tubular structure such as a coronary artery

bradycardia
a slow heart rate less than 60 BPM

anterior
the front surface of the body; the side facing you in the standard anatomic position

artifact
a tracing on an ECG that is the result of interference such as patient movement rather than the hearts electrical activity

inferior
the part of the body or any body part nearer to the feet

heart organ
it has to pump blood to supply oxygen-enriched red blood cells to the tissues of the body.

the heart is divided down the middle into two sides (left and right) by a wall called?
the septum

atrioventricular node (AV) 40-50 BPM
the impulses cross a bridge of special electrical tissue called?

The right coronary artery
supplies blood to the right atrium and right ventricle and in most people the bottom part of inferior wall of the left ventricle.

The left coronary artery
supplies blood to the left atrium and left ventricle and divides into two major branches just a short distance from the aorta.

The right and left carotid arteries
supplies the head and brain with blood

the right and left subclavian arteries (under the clavicles)
supplies blood to the upper extremities

the right and left iliac arteries
supplies blood to the groin, pelvis and legs

the tibial and peroneal arteries
supplies blood to the lower legs and feet

six steps in treatment of CHF
-take vital signs, give oxygen by NBM 10-15L/min medical control may order the use of CPAP
-allow the patient to remain sitting in an upright position with the legs down
-be reassuring many patients with CHF are quite anxious because they cannot breath
-gather the specific medication for the treatment of CHF and take them to the hospital
-nitro may be a value if patients systolic BP is greater than 100mmHg
-prompt transport to ER is essential

blood enters the right atrium from the body through the?
vena cava

the only vein(s) in the body that carry oxygenated blood is/are the?
pulmonary veins

normal electrical impulses originate in the sinus node, just above the?
atria

dilation of the coronary arteries does what?
increases blood flow

what are the tiny blood vessels that are approximately one cell thick?
capillaries

which blood cells carries oxygen to the body’s tissues and then remove carbon dioxide?
red blood cells

what is the maximum pressure exerted by the left ventricle as it contracts?
systolic blood pressure

atherosclerosis can lead to a complete what?
occlusion of a coronary artery

the lumen of an artery may be partially or completely blocked by the blood-clotting system due to a ______________ that exposes the inside of the atherosclerotic wall
crack

tissues downstream from a blood clot will suffer from lack of oxygen. if the blood flow is resumed in a short time, the ___________________________tissues will recover
ischemic (lack of oxygen)

risk factors for a myocardial infarction include all of the following except?
a – male gender
b – high BP
c – stress
d – increased activity level
increased activity level

when for a brief period of time, heart tissues do not get enough oxygen, the pain is called?
angina

angina pain may be felt in the?
epigastrium (upper middle region of the abdomen)

the underlying cause of a dissecting aortic aneurysm is
uncontrolled hypertension

true or false
because the oxygen supply to the heart is diminished with angina, the electrical system can be compromised putting the person at risk for significant cardiac rhythm problems
true

about how many minutes after blood flow is cut off that some of the heart muscle cells begin to die?
30 minutes

an acute myocardial infarction is more likely to occur in larger thick-walled left ventricle which needs more ____________________ than the right ventricle
blood and oxygen

it can be caused by diseased heart valves, can be treated with nitroglycerin and ankle edema is a common finding
congestive heart failure

cardiogenic shock can occur within 24 hours of an?
acute myocardial infarction

true or false
sudden death is usually the result of cardiac arrest in which the heart fails to generate an effective blood flow
true

disorganized, ineffective quivering of the ventricles is known as?
ventricular fibrillation (Vfib)

heart valve damage, myocardial infarction and long-standing high BP are the cause of what?
congestive heart failure

elevated heart rate, pale clammy skin and air hunger are symptoms of what?
shock

which of the following changes in heart function occur in patients with congestive heart failure?
enlargement of the left ventricle

physical findings of AMI include skin that is ___________ because of poor cardiac output and the loss of perfusion
gray

all patients assessments begin by determining whether the patient is
responsive

to access chest pain use the mnemonic
OPQRST

when administering nito to a patient you should make sure the patient has not taken any medications for ____________________in the last 24 hours
erectile dysfunction

true of false
in general, a maximum of three does of nitro are given for any ONE episode of chest pain
true

these are inserted when the electrical control system of the heart is so damaged that it cannot function properly
pacemakers

when the battery wears out in the pacemaker the patient may experience?
syncope (fainting)

AED’s should only be applied to an unresponsive patient with no?
pulse

this usually refers to a state of cardiac arrest despite an organized electrical complex
pulseless electrical activity

true of false
the links in the chain of survival include rapid defibrillation
false

defibrillation works best if it takes place within how many minutes of the onset of cardiac arrest
2 minutes

when operating an AED what is the first step in the defibrillation sequence?
turn on the AED

after applying an AED to the patient, the AED states “no shock advised” what is your next step of action
start chest compressions for 2 minutes then have the AED reanalyze.

you are 6 blocks away from the hospital when the patient stops breathing again and no longer has a pulse. you should?
stop the vehicle and analyze the rhythm

true of false
the right side of the heart pumps oxygen rich blood to the body
false

true of false
in the normal heart the need for increased blood flow to the myocardium is easily met by an increase in heart rate
false

true of false
atherosclerosis results in narrowing of the lumen of coronary arteries
true

true of false
infarction is a temporary interruption of the blood supply to the tissue
false

true of false
angina can result from a spasm of the artery
true

true of false
the pain of angina and the pain of AMI are easily distinguishable
false

true of false
nitro works in most patients within 5 minutes to relieve the pain of AMI
false

true of false
if an AED malfunctions during use you must report that problem to the manufacturer and to human resources
false

true of false
angina occurs when the hearts need for oxygen exceeds its supply
true

true of false
white blood cells are the most numerous cells in the blood and help blood to clot
false

true of false
cardiac arrest in younger children is less common than in older children and is usually caused by a breathing problem
true

true of false
an AED with special pediatric pads may be used on pediatric medical patients between the ages of 1 month to 8 years who have been assessed to be unresponsive not breathing and pulseless
true

true of false
dissecting aortic aneurysms are rarely considered life threatening
false

true of false
heart disease is the number one killer of woman in the united states
true

true of false
if a patient complaining of chest pain and has a history of a previous AMI you should ask if this pain feels similar to the previous AMI
true

the heart is divided down the middle by a wall called the?
septum

true of false
the aorta is the body’s main artery
true

what ventricle pumps blood in through the pulmonary circulation
the right

electrical impulses spread from what node to the ventricles
Atrioventricular (AV)

blood supply to the heart is increased by
dilation of the coronary arteries

what blood pressure reflects the pressure on the walls of the arteries when the ventricle is at rest
diastolic

the heart has how many chambers
four

what side of the heart is more muscular because it pumps blood into the aorta and all the other arteries in the body
left side

what breathing apparatus is the most effective way to assist a person with CHF to breathe effectively and to prevent an invasive airway management technique
CPAP

the collection of fluid in the part of the body that is closest to the ground is called
dependent edema

true of false
a hypertensive emergency usually occurs only with a systolic pressure greater than 180mm Hg
true

in CHF where does the blood tend to back up in increasing the pressure in the capillaries of the lungs
pulmonary veins

true or false
a late finding in cardiogenic shock would be a systolic blood pressure of less than 90mm Hg
true

damage to the inferior area of the heart often presents with
bradycardia (slow heart rate)

stable angina
characterized by pain in the chest of coronary origin that is relieved by rest or nitro

unstable angina
characterized by pain in the chest of coronary origin that occurs in response to progressively less exercise or few stimuli than ordinarily required to produce angina

3 serious consequences of AMI
-sudden death
-cardiogenic shock
-congestive heart failure

what type of resource is typically required for someone with chest pain?
ALS – advanced life support

a patient taking medications such as Lasix or digoxin is likely to have which of the following underlying medical conditions?
congestive heart failure

when a patient has a pacemaker implanted in the upper left chest, care for this patient should include
making sure the AED patches are not directly over the pacemaker device

Where is the saphenous vein located
in the leg

What is the one case you would call 911 first before providing CPR
If you are by yourself and witness a cardiac arrest

the aorta bifurcates where
at the midline / umbilicus

what is the conduction system
sinoatrial node (where electric impulses begin)
atrioventricular node (cross the bridge special electrical tissue.
Ventricles (spreads throughout both ventricles through the bundle of his

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