Quiz 05 Review.pdf

(1)

Handout 14-1 Student’s Name

C

HAPTER

14 Q

UIZ

Write the letter of the best answer in the space provided.

1. An EMT is permitted, with medical direction, to administer, or assist the patient in administering, all the following medications except

A. nitroglycerin. C. penicillin.

B. oxygen. D. oral glucose.

2. A drug or other substance that is used as a remedy for illness is called a(n)

A. elixir. C. medication.

B. treatment. D. prescription.

3. A chemical substance that is used to treat or prevent a disease or condition is called a

A. treatment. C. drug.

B. prescription. D. preparation.

4. The study of drugs is referred to as

A. pharmacology. C. pharmacodynamics.

B. pharmacokinetics. D. pharmacytology.

5. Epinephrine is an example of a drug’s

A. chemical name. C. generic name.

B. trade name. D. brand name.

6. The most common uses of a drug in treating a specific condition are known as

A. indications. C. protocols.

B. side effects. D. contraindications.

7. A thick slurry of activated charcoal is an example of a

A. gel. C. compressed powder.

B. suspension. D. sublingual spray.

8. Drugs meeting the requirements of the U.S. Pharmacopoeia or National Formulary are given a(n)

A. generic name. C. official name.

B. trade name. D. chemical name.

9. Medications administered sublingually are

A. swallowed. C. dissolved under the tongue.

B. inhaled. D. injected under the skin.

10. Drug actions that are not desired and that occur in addition to the desired therapeutic effects are referred to as

A. reactions. C. indications.

B. contraindications. D. side effects.

(2)

IN THE FIELD

Review the following real-life situation. Then answer the questions that follow.

You receive a call from a 6-year-old girl who states that her “grandma can hardly breathe.” When you arrive at the scene, you find a 68-year-old female with labored breathing. She can barely talk as she gasps for air. After several attempts, the woman indicates that she has just finished mowing the lawn. She thinks the exertion has triggered her respiratory condition.

1. Which type of medication do you suspect the patient might take?

You place the patient in a comfortable sitting position and administer supplemental oxygen. You ask your partner to take vital signs while you obtain a medical history. The patient indicates that her physician has prescribed an inhaler for her respiratory condition, but that she has not used it today. The woman tells her granddaughter to bring the medication to you.

2. What are some brand names of the prescribed inhalers that you might expect to see?

After examining the patient’s medication, you call medical direction for permission to assist the patient in self-administration.

3. In assisting the patient with her medication, what are the key steps that must be followed?

4. Which route of administration will be used with this medication?

(3)

C

HAPTER

14 R

EVIEW

Write the word or words that best complete each sentence in the space provided.

1. The study of drugs is called .

2. Medications have specific effects on the cells, organs, or body

systems.

3. is a suspension used to treat a

poisoning or an overdose emergency.

4. medications may be administered to

patients who can swallow.

5. The of a drug are the therapeutic effects

that a drug will have.

6. The of a drug is simply how much of the

drug should be given to the patient.

7. is a medication for anaphylaxis that

may be administered by the EMT through the intramuscular injection route.

8. The term refers to how a medication is given to

or taken by a patient.

9. An epinephrine __________________________ _________________________

may be prescribed for patients with a history of severe allergic reactions.

10. Each drug also has , or situations in which the drug

should not be administered because of the potential harm that could be caused to the patient.

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PHARMACOLOGY BASICS: LISTING

1. List the eight medications that an EMT may administer or help a patient to self-administer.

2. List the four types of names by which every drug is known.

3. List the four routes by which the EMT may administer or help a patient to self-administer medications.

4. List eight medication forms.

5. List two common sources from which to gather information about specific medications.

(5)

CHAPTER 14 ANSWER KEY

HANDOUT 14-1: Chapter 14 Quiz

1. C 4. A 7. B 9. C

2. C 5. C 8. C 10. D

3. C 6. A

HANDOUT 14-2: In the Field

1. A prescribed inhaler

2. Brand names might include Alupent, Ventolin, Proventil, Bronkosol, and Serevent.

3. Verify the patient’s prescription; check the expiration date; check for discoloration or impurities; verify form, route, and dose; and document the administration drug, dose, route, and time.

4. Inhalation

HANDOUT 14-3: Chapter 14 Review

1. pharmacology

2. physiological

3. Activated charcoal

4. Oral

5. actions

6. dose

7. Epinephrine

8. route

9. auto-injector

10. contraindications

HANDOUT 14-4: Pharmacology Basics: Listing

1. Activated charcoal, oral glucose, oxygen, aspirin, metered-dose inhaler, nitroglycerin, epinephrine, naloxone.

2. Generic, chemical, trade (brand), and official.

3. Oral, sublingual, inhalation, injection.

4. Compressed powder or tablet, liquid for injection, gel, suspension, fine powder for inhalation, gas, spray, and liquid/vaporized fixed-dose nebulizer.

5. Any two: American Hospital Formulary Service; AMA Drug Evaluation; Physicians’ Desk Reference (PDR); package inserts; poison control centers; EMS pocket drug reference guide.

(6)

C

HAPTER

15 Q

UIZ

1. Shock is simply defined as inadequate

A. oxygen perfusion. C. tissue perfusion.

B. heart rate. D. blood pressure.

2. All of the following are basic etiologies of shock except

A. inadequate volume. C. inadequate vessel tone.

B. inadequate pump function. D. inadequate respiratory rate.

3. How many major categories of shock are there?

A. 1 C. 3

B. 2 D. 4

4. Hypovolemic shock is due to

A. fluid loss. C. infection.

B. cardiac muscle failure. D. spinal injuries.

5. The medication of choice in the treatment of anaphylactic shock is

A. epinephrine. C. Benadryl.

B. albuterol. D. atropine.

6. All of the following are effects of sympathetic nervous system stimulation except

A. increased heart rate.

B. increased respiratory rate.

C. vasoconstriction.

D. release of epinephrine and norepinephrine.

7. What are the two stages of shock?

A. Nonclinical and clinical C. Compensatory and decompensatory

B. Precompensated and postcompensated D. Nonprogressive and terminal

8. Which of the following is a sign of early shock?

A. Bradycardia C. Hypertension

B. Bradypnea D. Tachycardia

9. Sudden death is defined as a patient who dies within how many hours of the onset of symptoms?

A.½ C. 2

B. 1 D. 3

10. The circulatory phase of cardiac arrest typically lasts how long?

A. 10 minutes C. 8 minutes

B. 2 minutes D. 2 minutes

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C

HAPTER

15 R

EVIEW

1. Shock is a critical condition that results in inadequate perfusion.

2. Distributive shock is associated with a decrease in volume.

3. Anaphylactic shock is a type of shock.

4. Neurogenic shock is commonly referred to as shock.

5. In compensated shock, the body is able to maintain a near-normal

and perfusion of the vital organs.

6. shock is the condition in which the body can maintain near-normal vital signs despite some fluid/blood loss.

7. The three phases that the body goes through following cardiac arrest are the electrical phase, the

circulatory phase, and the .

8. The Chain of Survival has links.

9. The most frequent initial rhythm in cardiac arrest is

.

10. The lower energy level delivered by the biphasic defibrillator is thought to cause less

damage.

11. The most common source of infection in sepsis is ______________ _______________.

(8)

Chapter 15: TRUE OR FALSE

Indicate if the following statements are true or false by writing T or F in the space provided.

1. Asystole is the absence of electrical activity and pumping action in the heart.

2. An AED could be used on a patient of any age who is in ventricular fibrillation

.

3. Downtime is the time from when the patient goes into cardiac arrest until CPR is started.

4. The metabolic phase starts 10 minutes after cardiac arrest.

5. Cardiac output multiplied by stroke volume equals blood pressure.

6. Norepinephrine stimulates beta cells.

7. Cardiogenic shock is caused by massive bleeding from the heart.

8. Septic shock is a form of distributive shock.

9. There are three major etiologies or causes of shock.

10. Decreased blood volume increases afterload.

(9)

CHAPTER 15 ANSWER KEY

1. C

4. A

7. C 10. A

2. D

5. A

8. D

3. D

6. B 9. B

1. tissue

2. intravascular

3. distributive

4. vasogenic

5. blood pressure

6. Compensatory

7. metabolic phase

8. five

9. ventricular fibrillation

10. heart cell

11. respiratory infection

HANDOUT 15-3: Pharmacology: True or False

1. T 4. T 7. F 10. F

2. T 5. F 8. T

3. T 6. F 9. T

(10)

CHAPTER 16 QUIZ

1. The condition that causes breathing difficulty, and in which the bronchioles of the lower airway are significantly narrowed from constriction of the muscle layer, is known as

A. hypoxia. C. bronchoconstriction.

B. apnea. D. bronchodilation.

2. The normal range of breaths per minute for most adults is

A. 25 to 50. C. 15 to 30.

B. 20 to 40. D. 12 to 20.

3. All of the following could be signs of inadequate breathing except

A. equal bilateral breath sounds. C. cyanotic skin color.

B. restlessness. D. retractions.

4. A condition in which the cells in the body are not getting an adequate supply of oxygen is known as

A. hypoxia. C. hypervolemia.

B. hypovolemia. D. hypopnea.

5. A musical whistling sound that is heard in all lung fields upon auscultation of the chest is

A. rales. C. wheezing.

B. crackles. D. rhonchi.

6. In an infant or a child with dyspnea, bradycardia is often a sign of

A. circulatory collapse. C. respiratory failure.

B. cardiac arrest. D. fatigue.

7. If a patient is experiencing breathing difficulty but is still breathing adequately, he or she should be placed in

A. sniffing position. C. prone position.

B. Trendelenburg position. D. a position of comfort.

8. Which of the following is an example of a commonly encountered obstructive lung disease?

A. Emphysema C. Pneumonia

B. Pulmonary edema D. Pneumothorax

9. A medication commonly prescribed for the patient with a history of breathing problems is a(n)

A. beta-blocker. C. bronchodilator.

B. antiarrhythmic. D. antihistamine.

10. A condition indicating extreme inspiratory effort in infants and small children, in which the chest is drawn inward while the abdomen moves outward, is called

A. nasal flaring. C. retractions.

B. seesaw breathing. D. grunting.

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Handout 16-1 (continued)

11. All of the following are early signs of breathing difficulty in infants and children except

A. retractions. C. bradycardia.

B. nasal flaring. D. anxiety.

12. All of the following are examples of medications delivered via prescribed metered-dose inhalers except

A. albuterol. C. isoetharine.

B. epinephrine. D. metaproterenol.

13. All of the following are medications commonly used for respiratory problems except

A. Tornalate. C. Alupent.

B. Serevent. D. Prozac.

14. A possible side effect from a prescribed inhaler is

A. tachycardia. C. cyanosis.

B. hypotension. D. altered mental status.

15. The total number of MDI doses that an EMT can deliver to a patient with breathing difficulty is

A. one. C. three.

B. two. D. determined by medical direction.

(12)

I

N THE

F

IELD

Your unit has just received a call from the emergency medical dispatcher. A 68-year-old woman at 181 Shadow Lane reports difficulty breathing. You and your partner head to the scene, arriving 12 minutes after you received the call. Upon entry into the house, you find the patient sitting in a chair, leaning forward with her hands on her knees. She appears anxious and has difficulty speaking in full sentences without gasping for breath. She tells you, “I can’t seem to get enough air.” As she struggles to catch her breath, the patient adds, “My chest is so tight.”

You position yourself at eye level with the patient and try to calm her fears. You introduce yourself and explain that you will need to ask some questions before beginning treatment. From your questions, you learn that the patient has a history of emphysema and that she takes Lasix, theophylline, and Ventolin. However, she has not taken these medications for several days in an effort to prolong the prescriptions. “Refills are so expensive,” she explains.

Upon physical examination, you find the patient alert, but restless. Her pulse rate is 120 beats per minute; her blood pressure is 110/68 mmHg; her respiratory rate is 20 breaths per minute; pulse oximetry is 88%. Breathing is labored and somewhat noisy. The patient’s skin is warm and pale.

1. Is the patient’s breathing adequate or inadequate?

2. When you elicited a focused history of the condition, which questions should you have asked the patient?

3. Which steps would you take to treat this patient?

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4. Which oxygenation adjunct would you use if you decided to start administering oxygen to the patient?

5. In which position should this patient be transported to the hospital?

(14)

CHAPTER 16 REVIEW

1. Respiratory emergencies may range from shortness of breath, or , to complete respiratory arrest, or .

2. The medication known as a(n) is designed to directly relax and

open the bronchioles, resulting in increased effectiveness of breathing.

3. During the

, the EMT should seek clues to determine whether the patient’s

breathing difficulty is due to trauma or to a medical condition.

4. Inadequate oxygenation of the brain causes

, which, in turn, can cause the

patient to be disoriented or to talk incomprehensibly or mumble.

5. is an ominous and late sign of respiratory distress observable on the

patient’s skin.

6. Most bronchodilators begin to work almost immediately, and their effects may last up to

hours or more.

7. Whenever you have administered a bronchodilator to a patient, you must perform a(n)

of the patient’s respiratory status.

8. The term refers to a condition in which the cells of the body are not

getting an adequate supply of oxygen.

9. A patient with breathing difficulty who is sitting upright and leaning slightly forward and supporting

herself with her arms by holding onto the seat is in the position.

10. Emphysema, chronic bronchitis, and asthma are examples of

.

11. Two devices that can be attached to an MDI to hold medication until it is inhaled are a(n)

and a(n) .

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12. Metered-dose inhalers can be administered by the EMT only with the approval of

through on-line or off-line orders.

13. A pulse oximeter reading of less than in a patient with any breathing

difficulty is a sign of hypoxia.

14. If upon assessment you find the patient’s breathing rate or tidal volume to be inadequate, you should begin

.

15. The patient with breathing difficulty is a(n) patient, so you

should consider calling for advanced life support backup.

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P

RESCRIBED

I

NHALER

Write in the missing information on the medication flash card below, and save the completed card for future reference.

Prescribed Inhaler

Medication Names:

1. Generic:

2. Trade:

Indications:

1.

2.

3.

Contraindications:

1.

2.

3.

4.

Medication Form:

Dosage:

Action:

Side Effects: 1.

2.

3.

4.

5.

(17)

CHAPTER 16 ANSWER KEY

1. C 5. C 9. C 13. D

2. D 6. C 10. B 14. A

3. A 7. D 11. C 15. D

4. A 8. A 12. B

1. Adequate, but with the potential to progress to inadequate.

2. OPQRST: What were you doing when the breathing difficulty started? Did anything seem to trigger the breathing difficulty? Was the onset gradual or sudden? Was the onset accompanied by chest pain or any other symptoms? Was there a sudden onset of pain? Does lying flat make the breathing difficulty worse? Does sitting up make the breathing difficulty less severe? Is there pain that occurs or increases with breathing? Do you have more trouble breathing in or out? Is the pain sharp (knifelike) or dull? If there is pain associated with breathing difficulty, does it radiate to the back, up the neck, down the arms, or to any other part of the body? How bad is this breathing difficulty on a scale of 1 to 10, with 10 being the worst breathing difficulty you have ever experienced? When did the breathing difficulty start? How long have you had it? If this is a recurring problem, how long does the breathing difficulty usually last? If the breathing difficulty started other than today, could you recall the exact day and time when this started?

3. Perform a primary assessment; administer oxygen titrated to an SpO2 of 94% or higher; perform a focused history and physical exam; contact medical direction for permission to assist the patient with her prescribed inhaler; and begin transport to the hospital.

4. Begin treatment utilizing a nasal cannula to deliver oxygen.

5. In a position of comfort, most typically Fowler or semi-Fowler position.

1. dyspnea, apnea

2. bronchodilator

3. scene size-up

4. altered mental status

5. Cyanosis

6. 8

7. reassessment

8. hypoxia

9. tripod

10. obstructive lung diseases

11. spacer; valved holding chamber

12. medical direction

13. 94 percent

14. positive pressure ventilation

15. priority

HANDOUT 16-4: Prescribed Inhaler

1. Generic: albuterol, isoetharine, metaproterenol, bitolterol mesylate, salmeterol xinafoate

2. Trade: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel, Tornalate, Serevent

Indications:

1. Patient exhibits signs and symptoms of breathing difficulty.

2. Patient has physician-prescribed metered-dose inhaler.

3. Medical direction gives specific authorization, whether on-line or off-line, to administer the medication.

1. Patient is not responsive enough to use the device.

2. MDI is not prescribed for the patient.

3. Medical direction has not authorized its use.

4. Patient has already taken the maximum allowed dosage prior to the EMT’s arrival.

Aerosolized in a metered-dose inhaler.

Dosage:

The total number of times the medication can be administered is determined by medical direction.

Action:

Beta agonist that relaxes the bronchiole smooth muscle and dilates the lower airways. This reduces the airway

resistance.

Side Effects: 1. Tachycardia

2. Tremors, shakiness

3. Nervousness

4. Dry mouth

5. Nausea, vomiting

(18)

C

HAPTER

17 Q

UIZ

1. The valve located between the right atrium and the right ventricle that prevents blood from returning to the right atrium is the

A. mitral valve. C. tricuspid valve.

B. aortic valve. D. bicuspid valve.

2. The right atrium receives deoxygenated blood from the inferior and superior

A. aorta. C. pulmonary arteries.

B. vena cava. D. pulmonary veins.

3. The electrical impulse that causes the heart to contract is generated in the right atrium at the

A. bundle of His. C. sinoatrial node.

B. Purkinje fibers. D. atrioventricular node.

4. The arteries that branch off the base of the aorta and supply the heart with oxygen-rich blood are called

A. pulmonary arteries. C. carotid arteries.

B. tibial arteries. D. coronary arteries.

5. Blood components respond to injury by forming a clot, or _____ , in an effort to stop bleeding.

A. plasma C. platelet

B. thrombus D. plaque

6. The delivery of oxygen and nutrients from the blood, through the thin capillary walls into the cells, and the removal of carbon dioxide and other waste products, is known as

A. hypoperfusion. C. metabolism.

B. shock. D. perfusion.

7. In cases involving a patient who complains of chest discomfort or chest pain and difficulty breathing, the EMT should initially suspect

A. cardiac problems. C. lung cancer.

B. trauma. D. hypovolemia.

8. While patients with known cardiac problems may take a variety of medications, a commonly prescribed medication for anginal chest pain is

A. nitroglycerin. C. epinephrine.

B. Lasix. D. Digoxin.

9. If a patient experiences no relief after one dose of nitroglycerin, another dose may be administered after 3 to 5 minutes if authorized by medical direction, up to a maximum of

A. three doses. C. two doses.

B. five doses. D. six doses.

(19)

10. Because nitroglycerin lowers blood pressure, it must not be given to a patient whose systolic blood pressure is lower than

A. 130 mmHg. C. 100 mmHg.

B. 120 mmHg. D. 90 mmHg.

11. One contraindication to the administration of nitroglycerin is

A. recent use of Viagra. C. an excessive respiratory rate.

B. use of aspirin. D. extremity injury.

12. Death of a portion of the heart muscle because of an inadequate supply of oxygenated blood is called

A. angina pectoris. C. acute myocardial infarction.

B. cardiac ischemia. D. pulmonary edema.

13. The tiny blood vessels that connect arterioles to venules are

A. valves. C. capillaries.

B. arteries. D. veins.

14. The measured force within the blood vessels exerted during the contraction of the heart is the

A. systolic blood pressure. C. diastolic blood pressure.

B. systemic blood pressure. D. myocardial blood pressure.

15. A common side effect of the administration of nitroglycerin is

A. headache. C. altered mental status.

B. hypovolemia. D. diaphoresis.

16. During cardiac arrest, instead of smooth contractions, the heart may display a different type of electrical activity, most commonly the uncoordinated twitchings known as

A. asystole. C. ventricular fibrillation.

B. ventricular tachycardia. D. atrial fibrillation.

17. Cardiac arrest in children is most often the result of

A. hypoxia. C. trauma.

B. bradycardia. D. ventricular fibrillation.

18. When the heart has a rhythm but is so weakened that it fails to pump, or it does not respond to the electrical activity, or there is so much blood loss that there is nothing to pump, the rhythm is called

A. asystole. C. pulseless electrical activity.

B. ventricular fibrillation. D. ventricular tachycardia.

19. The absence of electrical activity and pumping action in the heart is called

A. pulseless electrical activity. C. ventricular fibrillation.

B. ventricular tachycardia. D. asystole.

20. When both atria contract, the process is known as atrial

A. systole. C. diastole.

B. work. D. arrest.

21. Electrical impulses travel from the sinoatrial node to the atrioventricular node by way of the

A. Purkinje fibers. C. bundle of His.

B. internodal tract. D. the right and left bundle

branches.

(20)

22. Which waveform of the ECG is the “P” wave?

A. First C. Third

B. Second D. Fourth

23. In acute coronary syndrome, the word “acute” refers to

A. severity. C. sudden onset.

B. affecting the arteries. D. duration.

24. Which of the following is not a sign or symptom of angina pectoris?

A. Anxiety C. Diaphoresis

B. Dyspnea D. Diarrhea

25. All of the following are true about aortic dissection except

A. initially pain is less severe, but then progresses.

B. pain is commonly described as sharp or tearing.

C. syncope may be the only sign in some patients.

D. it is a tear in the inner lining of the aorta.

(21)

I

N THE

F

IELD

You and your EMT partner respond to a call at the Wilson Corporation. The dispatcher reports a conscious male approximately 50 years of age who is complaining of chest pain. When you arrive at the scene, the patient’s assistant leads you into an office. There you see a man sitting on the sofa next to his desk. He is alert with labored respirations. He is pale and diaphoretic. Your pulse check reveals a weak and rapid radial pulse, and you note the patient’s skin to be cool and moist to the touch. He is complaining of a squeezing tightness in the center of his chest.

1. What should be your first action in providing emergency medical care if proper indications exist?

2. During the focused history and physical exam, you determine that the patient has a history of heart disease and has physician-prescribed nitroglycerin. Which actions must you take prior to assisting the patient with his prescribed medication?

3. Which reassessment steps should follow the administration of nitroglycerin?

(22)

C

HAPTER

17 R

EVIEW

1. An unresponsive patient with no respiration and no pulse is in

.

2. The are the top two chambers on each side of the heart.

3. The blood in the left atrium is ejected through the valve and into

the left ventricle upon contraction of the heart.

4. The most common symptom of cardiac compromise is

.

5. As an EMT, you should not take the time to try to the type or

cause of a cardiac emergency.

6. can be administered as either a sublingual tablet or a sublingual

spray.

7. The three drugs that an EMT may administer to a cardiac patient, with the approval of medical

direction, are , , and

.

8. The aim when administering nitroglycerin is to the blood vessels in the

heart.

9. If the responsive patient with chest discomfort or chest pain is breathing adequately and has an SpO2 of

92%, you would administer oxygen at __________________ liters per minute via a(n) .__________________

10. In general, the EMT should provide the ____________ emergency treatment for patients with heart

failure and for those with an acute myocardial infarction.

11. Several components of blood are involved in clot formation:

, , and

.

12. The pressure represents the pressure exerted against the arterial

walls during relaxation of the left ventricle.

(23)

13. If a patient experiences no relief after one dose of nitroglycerin, another dose may be administered after

to minutes if authorized by

medical direction, to a maximum of _____________________ doses.

14. The heart contains a specialized conductive tissue system, known as the ______________________

______________________ _______________________, that allows it to generate electrical impulses.

15. The circulatory, or cardiovascular, system has three major components: the

, the

, and the .

16. occurs when the heart, for any of a variety of reasons, is not pumping

effectively or at all, and no pulses can be felt.

17. ____________________ occurs when a weakened section of the aortic

wall dilates or balloons outward.

18. The electrical impulse generated by the sinoatrial node travels through the right and left atria by the way of

_________________________ _______________________.

19. Each mechanical contraction of the heart has two distinct components of electrical activity:

and .

20. The QRS complex represents depolarization of the .

21. The delivery of oxygen and nutrients to the cells and the removal of carbon dioxide and wastes is

known as .

22. Atherosclerosis is an disease that starts with the intimal lining of the

blood vessel.

23. The typical feeling or response a patient has from ischemia to the heart is commonly called ___________

______________________.

(24)

CARDIOVASCULAR EMERGENCIES: LISTING

1. List seven signs and symptoms often associated with cardiac compromise.

2. List emergency care steps for patients experiencing cardiac compromise.

3. List three conditions that must be met before the EMT can assist a patient with the administration of nitroglycerin.

4. List five contraindications to the administration of nitroglycerin.

5. List three trade names of nitroglycerin.

(25)

C

ARDIOVASCULAR

E

MERGENCIES

: M

ATCHING

Write the letter of the term in the space next to the appropriate description.

1. Major artery of the upper arm

2. Major artery of the thigh

3. Major artery in the neck

4. The force exerted during circulation of the blood against the arterial walls

5. Smallest artery, leading to a capillary

6. Smallest vein, leading from a capillary

7. Breastbone, located in the center of the chest

8. The two major veins that carry oxygen-depleted blood back to the heart

9. Depressed delivery of oxygen and nutrients to the cells resulting from inadequate circulation of blood through the capillaries

10. A fatty deposit within an artery

11. Force exerted against the arterial walls during relaxation of the left ventricle of the heart

12. The specialized contractile and conductive tissue of the heart that generates electrical impulses and causes the heart to beat

13. Major artery that starts at the left ventricle and carries oxygen-rich blood to the body

14. Network of arteries supplying the heart with blood

15. Medication often prescribed for patients with a history of heart problems for the relief of chest pain

16. One of the two lower chambers of the heart

17. Type of blood vessel that carries blood away from the heart

18. Component of the blood essential to the formation of blood clots

19. One of the two upper chambers of the heart

20. Tiny blood vessel connecting arterioles to venules; the site of gas and nutrient exchange

A. aorta

B. arteriole

C. artery

D. atrium

E. blood pressure

F. brachial artery

G. capillary

H. cardiac conduction system

I. carotid artery

J. coronary arteries

K. diastolic pressure

L. femoral artery

M. hypoperfusion

N. nitroglycerin

O. plaque

P. platelets

Q. sternum

R. venae cavae

S. ventricle

T. venule

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N

ITROGLYCERIN

Nitroglycerin

1. Generic:

2. Trade:

Indications: 1.

2.

3.

Contraindications: 1.

2.

3.

4.

5.

Dosage:

Actions: 1.

2.

3.

Side Effects: 1.

2.

3.

(27)

ASPIRIN

Aspirin

1. Generic:

2. Trade:

Indications:

1.

2.

Contraindication:

Medication Form: _______________________________________________________________________

Dosage:

Action:

Side Effects:

1.

2.

3.

(28)

CHAPTER 17 ANSWER KEY

1. C 8. A 15. A 22. A

2. B 9. A 16. C 23. C

3. C 10. D 17. A 24. D

4. D 11. A 18. C 25. A

5. B 12. C 19. D

6. D 13. C 20. A

7. A 14. A 21. B

1. Administer oxygen by nasal cannula if the SpO2 is less than 94%.

2. (a) Assess the patient’s blood pressure. Systolic blood pressure must be greater than 90 mmHg.

(b) Obtain orders from medical direction either on-line or off-line. (c) Check the medication to ensure that it is prescribed to the patient, that it is the proper medication, and that it has not expired.

3. (a) Reassess blood pressure within 2 minutes. (b) Question the patient about the effect of the

medication on relief of pain. (c) Record your actions, the patient’s response, and reassessment findings.

1. cardiac arrest

2. atria

3. mitral (bicuspid)

4. chest discomfort (or chest pain)

5. diagnose

6. Nitroglycerin

7. oxygen, nitroglycerin, aspirin

8. dilate

9. 2, nasal cannula

10. same (or similar)

11. platelets, thrombin, fibrin

12. diastolic

13. 3, 5, 3

14. cardiac conduction system

15. heart, blood vessels, blood

16. Cardiac arrest

17. Aortic aneurysm

18. Bachmann’s bundle

19. depolarization, repolarization

20. ventricles

21. perfusion

22. inflammatory

23. chest discomfort (or chest pain)

HANDOUT 17-4: Cardiovascular Emergencies: Listing

1. Any seven: pain or discomfort in any of the following areas—chest, neck, jaw, arm, or back; epigastric pain; sudden onset of sweating; cool, pale skin; difficulty breathing; lightheadedness or dizziness; anxiety or irritability; feelings of impending doom; abnormal or irregular pulse rate; abnormal blood pressure; nausea and/or vomiting.

2. (1) Administer oxygen by nasal cannula if the SpO2 is less than 94%. (2) Decrease the anxiety of the patient by providing calm reassurance and placing him in a position of comfort. (3) Assist the patient who has physician-prescribed nitroglycerin. (4) Administer aspirin, if medical direction orders it. (5) Consider calling for ALS backup; initiate early transport.

3. Any three:(1) The patient exhibits signs or symptoms of chest pain. (2) The patient has physician-prescribed nitroglycerin. (3) The patient’s systolic pressure is greater than 90mmHg. (4) The EMT has received approval from medical direction, either on-line or off-line, to give the medication.

4. (1) The patient’s baseline blood pressure is less than 90 mmHg systolic. (2) The patient has a suspected head injury. (3) The patient is an infant or a child. (4) Three doses have already been taken by the patient. (5) The patient has recently taken Viagra.

5. Nitrostat, Nitrobid, NitrolingualSpray

HANDOUT 17-5: Cardiovascular Emergencies: Matching

1. F 6. T 11. K 16. S

2. L 7. Q 12. H 17. C

3. I 8. R 13. A 18. P

4. E 9. M 14. J 19. D

5. B 10. O 15. N 20. G

HANDOUT 17-6: Nitroglycerin (completion)

Medication Names: 1. Generic: nitroglycerin

2. Trade: Nitrostat, Nitrobid, NitrolingualSpray

Indications:

1. Patient exhibits signs or symptoms of chest pain.

2. Patient has physician-prescribed nitroglycerin.

3. The EMT has received approval from medical direction, either on-line or off-line, to give the medication.

(29)

1. Patient’s baseline blood pressure is less than 90 mmHg.

2. Patient has a suspected head injury.

3. Patient is an infant or a child.

4. Patient has already taken three doses.

5. Patient has already taken Viagra.

Tablet, sublingual spray.

Dosage:

One tablet or one spray under the tongue. This dose may be repeated in 3–5 minutes if (1) the patient experiences no relief, (2) the blood pressure remains greater than 90 mmHg systolic, and (3) medical direction gives authorization. The total dose is three tablets or sprays, including what the patient took prior to the arrival of EMS.

Actions:

1. Dilates blood vessels.

2. Decreases workload of the heart.

3. Decreases cardiac oxygen demand.

Side Effects: 1. Headache.

2. Drop in blood pressure.

3. Changes in pulse rate as the body compensates for changes in blood vessel size.

HANDOUT 17-7: Aspirin (completion)

Medication Names: 1. Generic: aspirin

2. Trade: ASA, Bayer, Ecotrin, St. Joseph’s, Bufferin

Indications:

1. Patient exhibits chest discomfort suggestive of heart attack.

2. Medical direction has given approval, either on-line or off-line.

Contraindication:

A known allergy or hypersensitivity to aspirin.

Tablet.

Dosage:

160 mg to 325 mg as soon as possible after onset of symptoms.

Action:

Decreases ability of platelets to clump together.

Side Effects:

1. Stomach irritation.

2. Heartburn.

3. Nausea/vomiting.