EMS Cardiovascular Emergency Management

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?

To deliver a defibrillatory shock (B) Signup and view all the answers

What additional feature may some prehospital ECG monitors have?

A module for capnography (measuring exhaled carbon dioxide) (C) Signup and view all the answers

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

To display the patient's ECG rhythm (B) Signup and view all the answers

When is the precordial thump most effective?

Immediately after the onset of ventricular fibrillation or pulseless ventricular tachycardia (B) Signup and view all the answers

What is the recommended dose of atropine sulfate?

0.5 mg, repeated every 3 to 5 minutes for a total dose of 3.0 mg (B) Signup and view all the answers

What is the initial dose of adenosine for tachyarrhythmia?

6 mg, followed by a 20-mL saline flush (D) Signup and view all the answers

What is the maximum dose of adenosine?

30 mg (C) Signup and view all the answers

In what situations is adenosine contraindicated?

In patients with asthma or second- or third-degree blocks (D) Signup and view all the answers

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

300 mg IV/IO (A) Signup and view all the answers

What is a common side effect of amiodarone?

Hypotension (B) Signup and view all the answers

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

To ensure medication delivery (C) Signup and view all the answers

How should you deliver a precordial thump?

Strike the midsternum with the heel of your fist from a distance of 10 to 12 inches (B) Signup and view all the answers

Why is a precordial thump not recommended in pediatric patients?

Because it may cause rib fractures (B) Signup and view all the answers

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

To determine the site of ectopic beats (C) Signup and view all the answers

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

Left lower chest (C) Signup and view all the answers

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

To reduce electrical interference (D) Signup and view all the answers

What is the most common cause of poor ECG signals?

Faulty skin contact (C) Signup and view all the answers

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

To prevent overheating of the stylus (D) Signup and view all the answers

What is the purpose of calibrating each ECG strip?

To ensure that 1 mV deflects the stylus 10 mm (D) Signup and view all the answers

What is the Valsalva maneuver?

A technique to slow the heart rate (D) Signup and view all the answers

What is the precordial thump used for?

To terminate monitored unstable ventricular tachyarrhythmias (C) Signup and view all the answers

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

Because the patient's signs and symptoms are not always reflected in the ECG monitor (D) Signup and view all the answers

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

To ensure that the patient's clinical condition matches the ECG reading (D) Signup and view all the answers

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

150 mg over 10 minutes (B) Signup and view all the answers

What is the effect of alpha receptor stimulation?

Causes peripheral vasoconstriction (A) Signup and view all the answers

What is the mainstay of cardiac arrest resuscitation?

Epinephrine (B) Signup and view all the answers

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

IV (D) Signup and view all the answers

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

Seizures (D) Signup and view all the answers

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

2 to 10 mcg/kg/minute (C) Signup and view all the answers

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

Hypovolemic shock (D) Signup and view all the answers

What is the effect of beta receptor stimulation?

All of the above (D) Signup and view all the answers

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

8 to 10 mcg/minute (D) Signup and view all the answers

What is the effect of dobutamine on heart rate?

Has little effect on heart rate (B) Signup and view all the answers

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

Reducing preload, afterload, and dilating peripheral arteries and veins (A) 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?

Oxidative stress and potential tissue damage (D) Signup and view all the answers

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

Inhibiting the aggregation of platelets (A) Signup and view all the answers

What is the role of morphine in managing myocardial ischemia?

Relieving pain and reducing sympathetic nervous system discharge (C) Signup and view all the answers

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

100 mg (C) Signup and view all the answers

What is the main difference between fentanyl and morphine?

Fentanyl is shorter acting than morphine and has a better side effect profile (A) Signup and view all the answers

What is the benefit of tenecteplase over alteplase?

It is more fibrin specific (A) Signup and view all the answers

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

Life-threatening emergencies (C) Signup and view all the answers

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

Increases coronary perfusion pressure and vital organ blood flow (C) Signup and view all the answers

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

To reduce anxiety and apprehension (C) Signup and view all the answers

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

One tablet sublingually repeated every 5 minutes up to a total of three tablets (A) Signup and view all the answers

What is the typical adult dose of ondansetron?

4 to 8 mg (C) 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?

Increased risk of respiratory depression and CNS depression (A) Signup and view all the answers

What is the primary effect of dobutamine on the heart?

Increasing contractility and heart rate (A) Signup and view all the answers

What is the primary mechanism of action of defibrillation?

Depolarizing the heart cells (A) Signup and view all the answers

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

To increase blood’s oxygen content and aid oxygenation of peripheral tissues (C) Signup and view all the answers

What is the benefit of biphasic defibrillation waveforms?

They allow for the use of less energy (C) Signup and view all the answers

What is the purpose of the critical mass in defibrillation?

To suppress all ectopic foci (D) Signup and view all the answers

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

Vasopressin has been removed from current cardiac arrest management guidelines (D) Signup and view all the answers

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

Direct current (DC) (A) Signup and view all the answers

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

Chest wall resistance (B) Signup and view all the answers

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

Within 4 minutes after the onset of fibrillation (D) 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?

Condition of the myocardium (D) Signup and view all the answers

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

One pad to the right of the upper sternum, and one to the left of the left nipple (A) Signup and view all the answers

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

To minimize electrical resistance and heat production (A) Signup and view all the answers

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

10 cm (B) Signup and view all the answers

What is the recommended action to take after defibrillation?

Administer medications and resume CPR (C) Signup and view all the answers

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

Repeat defibrillation at maximum energy (B) Signup and view all the answers

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

To avoid damaging an implanted pacemaker or defibrillator (A) Signup and view all the answers

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

Inspect and test the machine regularly (C) Signup and view all the answers

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

To reduce the likelihood of delivering the cardioversion during the vulnerable period of the QRS cycle (D) Signup and view all the answers

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

As little as 10 joules (C) Signup and view all the answers

When is transcutaneous pacing (TCP) indicated?

When pharmacologic intervention has no effect and the patient is hypotensive or hypoperfusing (A) Signup and view all the answers

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

To suppress ventricular ectopy (B) Signup and view all the answers

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

Clearly explain the potential consequences and use every available means to convince the patient of the need for appropriate treatment (B) Signup and view all the answers

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

It reduces the likelihood of delivering the cardioversion during the vulnerable period of the QRS cycle (A) Signup and view all the answers

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

To reduce the pain and anxiety associated with TCP (B) Signup and view all the answers

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

Turn off the synchronizer switch and use the machine in the defibrillation mode (A) 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?

To provide a detailed description of the patient's condition (B) Signup and view all the answers

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

It allows for electrical pacing of the heart through the skin via specially designed thoracic electrodes (B) 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?

To reduce anxiety and provide emotional support (D) 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?

The patient's vital information, chief complaint, history, physical exam findings, and treatments rendered (B) Signup and view all the answers

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

To educate the patient on the risks and benefits of transport (C) 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?

To provide a complete picture of the patient's condition (B) Signup and view all the answers

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

To alleviate anxiety and distress (A) Signup and view all the answers

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

Providing pacing in cases of symptomatic bradycardia (C) Signup and view all the answers

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

To manage patient discomfort or anxiety (B) Signup and view all the answers

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

To suppress ventricular ectopy (C) Signup and view all the answers

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

The route of electrode placement (D) Signup and view all the answers

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

Set the output to its maximum setting and then decrease (C) Signup and view all the answers

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

Limited duration of pacing (B) Signup and view all the answers