EMS Cardiovascular Emergency Management
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Questions and Answers

What is the primary tool for ECG monitoring in the field?

  • A combination ECG monitor/defibrillator that operates on a direct current (DC) battery source (correct)
  • A scope with a battery-powered heart rate monitor
  • A manual blood pressure monitor with ECG capabilities
  • A portable IV pump with ECG monitoring

    • What is the purpose of the synchronizer switch in a prehospital ECG monitor?

  • To record the patient's ECG data
  • To control the graphic display
  • To synchronize the defibrillator with the ECG rhythm (correct)
  • To monitor the patient's heart rate

    • What is the minimum number of electrodes required to monitor any of the bipolar leads (I, II, or III) in prehospital ECG monitoring?

  • Five
  • Four
  • Two
  • Three (correct)

    • What is the purpose of the defibrillator pads in a prehospital ECG monitor?

    <p>To deliver a defibrillatory shock</p> Signup and view all the answers

    What additional feature may some prehospital ECG monitors have?

    <p>A module for capnography (measuring exhaled carbon dioxide)</p> Signup and view all the answers

    What is the purpose of the graphic display in a prehospital ECG monitor?

    <p>To display the patient's ECG rhythm</p> Signup and view all the answers

    When is the precordial thump most effective?

    <p>Immediately after the onset of ventricular fibrillation or pulseless ventricular tachycardia</p> Signup and view all the answers

    What is the recommended dose of atropine sulfate?

    <p>0.5 mg, repeated every 3 to 5 minutes for a total dose of 3.0 mg</p> Signup and view all the answers

    What is the initial dose of adenosine for tachyarrhythmia?

    <p>6 mg, followed by a 20-mL saline flush</p> Signup and view all the answers

    What is the maximum dose of adenosine?

    <p>30 mg</p> Signup and view all the answers

    In what situations is adenosine contraindicated?

    <p>In patients with asthma or second- or third-degree blocks</p> Signup and view all the answers

    What is the recommended dose of amiodarone for cardiac arrest with shockable rhythm?

    <p>300 mg IV/IO</p> Signup and view all the answers

    What is a common side effect of amiodarone?

    <p>Hypotension</p> Signup and view all the answers

    What is the purpose of flushing with saline after administering adenosine?

    <p>To ensure medication delivery</p> Signup and view all the answers

    How should you deliver a precordial thump?

    <p>Strike the midsternum with the heel of your fist from a distance of 10 to 12 inches</p> Signup and view all the answers

    Why is a precordial thump not recommended in pediatric patients?

    <p>Because it may cause rib fractures</p> Signup and view all the answers

    What is the primary reason for using Modified Chest Lead 1 (MCL1) in ECG monitoring?

    <p>To determine the site of ectopic beats</p> Signup and view all the answers

    What is the typical placement of the positive electrode when using defibrillator pads to monitor the patient?

    <p>Left lower chest</p> Signup and view all the answers

    What is the primary reason for avoiding large muscle masses when placing ECG electrodes?

    <p>To reduce electrical interference</p> Signup and view all the answers

    What is the most common cause of poor ECG signals?

    <p>Faulty skin contact</p> Signup and view all the answers

    What is the purpose of adjusting the stylus heat properly when obtaining a paper printout?

    <p>To prevent overheating of the stylus</p> Signup and view all the answers

    What is the purpose of calibrating each ECG strip?

    <p>To ensure that 1 mV deflects the stylus 10 mm</p> Signup and view all the answers

    What is the Valsalva maneuver?

    <p>A technique to slow the heart rate</p> Signup and view all the answers

    What is the precordial thump used for?

    <p>To terminate monitored unstable ventricular tachyarrhythmias</p> Signup and view all the answers

    Why is it important to treat the patient, not the monitor?

    <p>Because the patient's signs and symptoms are not always reflected in the ECG monitor</p> Signup and view all the answers

    What is the purpose of comparing the rhythm on the monitor with the patient's signs and symptoms?

    <p>To ensure that the patient's clinical condition matches the ECG reading</p> Signup and view all the answers

    What is the initial dose of amiodarone given for other arrhythmias?

    <p>150 mg over 10 minutes</p> Signup and view all the answers

    What is the effect of alpha receptor stimulation?

    <p>Causes peripheral vasoconstriction</p> Signup and view all the answers

    What is the mainstay of cardiac arrest resuscitation?

    <p>Epinephrine</p> Signup and view all the answers

    What is the preferred route for the initial dose of epinephrine?

    <p>IV</p> Signup and view all the answers

    What is the side effect of lidocaine that can be life-threatening?

    <p>Seizures</p> Signup and view all the answers

    What is the dose of dopamine used to treat symptomatic bradycardias refractory to atropine?

    <p>2 to 10 mcg/kg/minute</p> Signup and view all the answers

    What is the contraindication for the use of dopamine in shock?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is the effect of beta receptor stimulation?

    <p>All of the above</p> Signup and view all the answers

    What is the dose of norepinephrine used to treat symptomatic bradycardias refractory to atropine?

    <p>8 to 10 mcg/minute</p> Signup and view all the answers

    What is the effect of dobutamine on heart rate?

    <p>Has little effect on heart rate</p> Signup and view all the answers

    What is the primary mechanism of action of nitroglycerin in reducing myocardial oxygen demand?

    <p>Reducing preload, afterload, and dilating peripheral arteries and veins</p> Signup and view all the answers

    What is the potential consequence of administering 100 percent oxygen to a patient who is not in cardiac arrest?

    <p>Oxidative stress and potential tissue damage</p> Signup and view all the answers

    What is the primary mechanism of action of aspirin in treating coronary ischemia?

    <p>Inhibiting the aggregation of platelets</p> Signup and view all the answers

    What is the role of morphine in managing myocardial ischemia?

    <p>Relieving pain and reducing sympathetic nervous system discharge</p> Signup and view all the answers

    What is the typical dose of alteplase (tPA) administered over 1.5 to 2 hours?

    <p>100 mg</p> Signup and view all the answers

    What is the main difference between fentanyl and morphine?

    <p>Fentanyl is shorter acting than morphine and has a better side effect profile</p> Signup and view all the answers

    What is the benefit of tenecteplase over alteplase?

    <p>It is more fibrin specific</p> Signup and view all the answers

    What is the primary indication for the use of furosemide in a cardiovascular emergency?

    <p>Life-threatening emergencies</p> Signup and view all the answers

    What is the effect of vasopressin on coronary perfusion pressure when given during CPR?

    <p>Increases coronary perfusion pressure and vital organ blood flow</p> Signup and view all the answers

    What is the purpose of diazepam or lorazepam in the management of a cardiovascular emergency?

    <p>To reduce anxiety and apprehension</p> Signup and view all the answers

    What is the dose of nitroglycerin for angina or myocardial infarction?

    <p>One tablet sublingually repeated every 5 minutes up to a total of three tablets</p> Signup and view all the answers

    What is the typical adult dose of ondansetron?

    <p>4 to 8 mg</p> Signup and view all the answers

    What is the potential consequence of administering nitrous oxide to a patient who is intoxicated with alcohol or other drugs?

    <p>Increased risk of respiratory depression and CNS depression</p> Signup and view all the answers

    What is the primary effect of dobutamine on the heart?

    <p>Increasing contractility and heart rate</p> Signup and view all the answers

    What is the primary mechanism of action of defibrillation?

    <p>Depolarizing the heart cells</p> Signup and view all the answers

    What is the purpose of administering oxygen in emergency cardiac care?

    <p>To increase blood’s oxygen content and aid oxygenation of peripheral tissues</p> Signup and view all the answers

    What is the benefit of biphasic defibrillation waveforms?

    <p>They allow for the use of less energy</p> Signup and view all the answers

    What is the purpose of the critical mass in defibrillation?

    <p>To suppress all ectopic foci</p> Signup and view all the answers

    What is the current recommendation regarding the use of vasopressin in cardiac arrest management?

    <p>Vasopressin has been removed from current cardiac arrest management guidelines</p> Signup and view all the answers

    What is the type of current used in most modern defibrillators?

    <p>Direct current (DC)</p> Signup and view all the answers

    What is the primary factor that affects the amount of energy delivered to the heart during defibrillation?

    <p>Chest wall resistance</p> Signup and view all the answers

    What is the recommended time frame for defibrillation to yield significantly improved resuscitation rates?

    <p>Within 4 minutes after the onset of fibrillation</p> Signup and view all the answers

    What is the primary factor that influences the success of defibrillation in the presence of acidosis, hypoxia, or electrolyte imbalance?

    <p>Condition of the myocardium</p> Signup and view all the answers

    What is the recommended placement of the defibrillator pads for adults in the emergency setting?

    <p>One pad to the right of the upper sternum, and one to the left of the left nipple</p> Signup and view all the answers

    Why is it important to ensure maximum contact between the defibrillator pads and the patient's skin?

    <p>To minimize electrical resistance and heat production</p> Signup and view all the answers

    What is the recommended minimum diameter of defibrillator pads for adults?

    <p>10 cm</p> Signup and view all the answers

    What is the recommended action to take after defibrillation?

    <p>Administer medications and resume CPR</p> Signup and view all the answers

    What is the recommended action to take if the rhythm is still shockable after the first defibrillation attempt?

    <p>Repeat defibrillation at maximum energy</p> Signup and view all the answers

    What is the primary reason to ensure that the defibrillator pads are not placed over the sternum?

    <p>To avoid damaging an implanted pacemaker or defibrillator</p> Signup and view all the answers

    What is the recommended method to ensure that the defibrillator is functioning properly?

    <p>Inspect and test the machine regularly</p> Signup and view all the answers

    What is the purpose of synchronized cardioversion in patients with organized cardiac activity?

    <p>To reduce the likelihood of delivering the cardioversion during the vulnerable period of the QRS cycle</p> Signup and view all the answers

    What is the recommended energy level for synchronized cardioversion in patients with atrial arrhythmias?

    <p>As little as 10 joules</p> Signup and view all the answers

    When is transcutaneous pacing (TCP) indicated?

    <p>When pharmacologic intervention has no effect and the patient is hypotensive or hypoperfusing</p> Signup and view all the answers

    What is the purpose of overdrive pacing in torsades de pointes?

    <p>To suppress ventricular ectopy</p> Signup and view all the answers

    What should you do if the patient refuses transport to a hospital?

    <p>Clearly explain the potential consequences and use every available means to convince the patient of the need for appropriate treatment</p> Signup and view all the answers

    What is the benefit of synchronized cardioversion in comparison to defibrillation?

    <p>It reduces the likelihood of delivering the cardioversion during the vulnerable period of the QRS cycle</p> Signup and view all the answers

    What is the purpose of administering an analgesic or anxiolytic prior to or during transcutaneous pacing (TCP)?

    <p>To reduce the pain and anxiety associated with TCP</p> Signup and view all the answers

    What should you do when ventricular fibrillation occurs during synchronized cardioversion?

    <p>Turn off the synchronizer switch and use the machine in the defibrillation mode</p> Signup and view all the answers

    What is the purpose of a formal verbal briefing when transferring care of the patient to the receiving facility staff?

    <p>To provide a detailed description of the patient's condition</p> Signup and view all the answers

    What is the benefit of transcutaneous pacing (TCP) in the prehospital setting?

    <p>It allows for electrical pacing of the heart through the skin via specially designed thoracic electrodes</p> Signup and view all the answers

    What is the primary goal of explaining the treatment to the patient and their family in a cardiovascular emergency?

    <p>To reduce anxiety and provide emotional support</p> Signup and view all the answers

    What information should be included in a formal verbal briefing when transferring care of the patient to the receiving facility staff?

    <p>The patient's vital information, chief complaint, history, physical exam findings, and treatments rendered</p> Signup and view all the answers

    Why is it important to clearly explain the potential consequences of refusing transport to a hospital?

    <p>To educate the patient on the risks and benefits of transport</p> Signup and view all the answers

    What is the primary importance of including ECG findings in the verbal briefing when transferring care of the patient?

    <p>To provide a complete picture of the patient's condition</p> Signup and view all the answers

    What is the primary purpose of emotional support in cardiovascular emergencies?

    <p>To alleviate anxiety and distress</p> Signup and view all the answers

    What is the primary benefit of transcutaneous pacing in the prehospital setting?

    <p>Providing pacing in cases of symptomatic bradycardia</p> Signup and view all the answers

    What is the purpose of administering an analgesic or anxiolytic prior to or during transcutaneous pacing?

    <p>To manage patient discomfort or anxiety</p> Signup and view all the answers

    What is the primary indication for overdrive pacing in torsades de pointes?

    <p>To suppress ventricular ectopy</p> Signup and view all the answers

    What is the primary difference between transcutaneous pacing and permanent pacemaker placement?

    <p>The route of electrode placement</p> Signup and view all the answers

    What is the recommended approach when managing a patient in asystole using transcutaneous pacing?

    <p>Set the output to its maximum setting and then decrease</p> Signup and view all the answers

    What is the primary limitation of transcutaneous pacing compared to permanent pacemaker placement?

    <p>Limited duration of pacing</p> Signup and view all the answers

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