Medications
This antiarrhythmic blocks potassium channels.
What is amiodarone?
Which of the following is true of STEMI?
A. Blood flow through one or more coronary arteries is completely blocked, resulting in myocardial tissue death.
B. Subsequent laboratory tests will reveal normal levels of cardiac biomarkers, indicating no myocardial damage.
C. Most patients with STEMI do not experience chest pain or discomfort.
D. Blood flow through one or more coronary arteries is intermittently blocked because of coronary artery vasospasm.
A Blood flow through one or more coronary arteries is completely blocked, resulting in death of myocardial tissue.
Rationale: ACSs include unstable angina, NSTEMI, and STEMI. In STEMI, one or more coronary arteries is completely blocked, resulting in necrosis of part of the myocardium. The ECG will show ST-segment elevation in the leads facing the affected area, and subsequent cardiac biomarker results will be elevated, indicating acute myocardial damage. Chest pain or discomfort is not always present with ACSs.
When leads II, III, and/or aVF show evidence of ischemia, injury, or infarction, which coronary artery is usually involved?
A. Right coronary artery
B. Left anterior descending artery
C. Circumflex artery
D. Left coronary artery
A Right coronary artery
Rationale: Leads II, III, and aVF face the inferior surface of the left ventricle. This area is supplied by the RCA in most people. Although less common, it is supplied by the circumflex branch of the left coronary artery.
Your unit is transporting a patient on an interfacility transfer. The unresponsive patient had a blood transfusion reaction. The patient was given the transfusion 6 hours ago during elective surgery.
1. When you are assessing a patient whom you suspect is reacting to a blood transfusion, the signs and symptoms will be similar to those associated with:
A. asthma.
B. anaphylaxis.
C. acute myocardial infarction.
D. overdose.
Answer: B anaphylaxis.
Rationale: Blood reactions are similar to an anaphylactic reaction—they occur rapidly and can cause severe circulatory collapse and even death. When a patient receives a blood transfusion, it is important to monitor the patient very closely for the first 30 to 60 minutes because transfusion reactions typically begin within this time frame. In general, the severity of the reaction directly correlates with the amount of blood volume transfused.
Your unit is dispatched to an apartment building. Dispatch tells you the patient is 48 years old and is having difficulty breathing. When you arrive on the scene, the patient has slightly labored breathing and informs you she has a history of lupus. It is a cold, windy day outside.
1. What type of disease is systemic lupus erythematosus?
A. Cardiac
B. Endocrine
C. Autoimmune
D. Respiratory
C Autoimmune
Rationale: In patients with an autoimmune disease, the immune system cannot tell the difference between what it should attack and what it should leave alone. SLE is a multisystem autoimmune disease that causes systemic inflammation.
This calcium channel blocker slows AV conduction.
What is Cardizem?
The 12-lead ECG shows ST changes in leads II, III, and aVF. Which anatomic region of the heart reflects a condition associated with changes in these leads?
A. Anterior
B. Lateral
C. Septal
D. Inferior
D Inferior
Rationale: Leads II, III, and aVF view the inferior surface of the left ventricle.
Which signs and symptoms are most likely to occur with right ventricular failure?
A. Accessory muscle use, cough with frothy sputum
B. Dependent edema, weight gain, jugular venous distention
C. Orthopnea, speech limited to phrases or words
D. Restlessness, third heart sound, crackles
B Dependent edema, weight gain, jugular venous distention
Rationale: Dependent edema, weight gain, jugular venous distention, fatigue, ascites, and upper abdominal quadrant pain are among the signs and symptoms of RVF. The other signs and symptoms listed are more common in LVF.
What are the three goals of treatment for a transfusion reaction?
A. Stop the transfusion, counteract shock, provide cardioversion.
B. Stop the transfusion, counteract shock, provide kidney perfusion.
C. Stop the transfusion, counteract shock, provide liver perfusion.
D. Stop the transfusion, counteract shock, provide peripheral perfusion.
Answer: B Stop the transfusion, counteract shock, provide kidney perfusion.
Rationale: There is no specific antidote or remedy for a transfusion reaction; instead, care centers on immediately stopping the transfusion process, hemodynamic supportive care to counteract shock, and maximizing kidney perfusion. In a patient in a hemodynamically unstable condition, early invasive monitoring, vasopressors, and the promotion of diuresis with isotonic fluids and a loop diuretic (furosemide) are indicated.
Which of the following is a common finding in the early diagnosis of lupus?
A. Tightening of the skin
B. Butterfly rash to the face
C. Cardiac dysrhythmias
D. Bronchospasms
B Butterfly rash to the face
Rationale: A butterfly rash to the face over the nose and spread to the cheeks is a common finding in SLE patients. Not all patients have the rash, and other problems may cause a similar rash, but SLE should be considered if the rash is present.
This drug briefly blocks the AV node.
What is Adenosine?
When ECG changes are observed in leads II, III, aVF facing the heart, what action should you take next?
A. Administer nitroglycerin.
B. Administer morphine.
C. Apply right-side chest leads.
D. Apply posterior chest leads.
C Apply right-side chest leads
Rationale: When leads II, III, and/or aVF show ECG changes suggesting an inferior MI, your next action should be to apply right sided chest leads to assess for right ventricular infarction. Patients who have an RVI are typically preload dependent. Giving vasodilators such as NTG or morphine can result in significant hypotension. If there is not enough time to obtain all of the right chest leads, V4R is the lead of choice.
List the intrinsic rates of each of the heart’s normal pacemaker sites.
The intrinsic rate for the heart’s primary pacemaker, the SA node, is 60 to 100 beats/min. The AV junction’s intrinsic rate is 40 to 60 beats/min, and the intrinsic rate of the ventricles is 20 to 40 beats/min
. A hemolytic blood transfusion reaction is the result of:
A. decreased RBC production.
B. contamination of the blood product.
C. antibodies reacting against donor WBCs.
D. incompatible ABO or Rh blood type.
Answer: D incompatible ABO or Rh blood type.
Rationale: The primary cause is incompatibility between the recipient and the donor blood. Receiving a blood type that is different from the patient’s own—for example, if a patient with type A receives type B blood—will result in a transfusion reaction.
Also, if a patient with A– blood receives an A+ transfusion, a transfusion reaction could occur. This reaction is due to activation of the recipient’s immune system by the donor blood and destruction of the new RBCs.
6. As you collect a history, which of the following medication classes would you anticipate a patient with Lupus to be taking?
A. Bronchodilators, steroids, cough suppressants
B. Beta blockers, ACE inhibitors, diuretics
C. Narcotics, cholinergics, anticoagulants
D. Steroids, NSAIDs, and immunosuppressants
D Steroids, NSAIDs, and immunosuppressants
Rationale: Patients with SLE are undergoing an attack on their body from their own immune system, so they are prescribed medications to suppress the immune and inflammatory responses.
This loop diuretic reduces preload.
What is Bumex
You have observed ST changes in leads II, III, and aVF. Reciprocal changes may be seen in which of the following leads?
A. V1 and V2
B. I and aVL
C. V3 and V4
D. V5 and V6
B I and aVL
Rationale: Reciprocal changes are mirror image J-point, ST-segment, and T-wave changes seen on the ECG in ACS. For example, if ST-segment elevation is present in a given lead, ST-segment depression and T-wave inversion is often seen in the reciprocal leads. The presence of reciprocal changes provides supportive evidence of AMI; however, the absence of reciprocal changes is not diagnostic. Reciprocal changes for leads II, III, and aVF can be seen in leads I and aVL.
Electrolyte imbalances and their effect on T-waves
Hyperkalemia: Peaked, narrow T-waves
Hypokalemia: Flattened T-waves, U-waves
Hypercalcemia: Shortened QT interval
Hypocalcemia: Prolonged QT interval
Which blood type is the universal donor?
A. Type O
B. Type A
C. Type B
D. Type AB
Answer: A Type O
Rationale: With type O blood, there are no A or B surface antigens on the red blood cells. When a person is given type O blood, the lack of surface antigens means that the recipient does not “see” the foreign protein and, therefore, does not mount an immune response.
8. As you are completing your assessment, you notice this patient has small bruises in various stages of healing. Which of the following is most likely the cause?
A. The lupus is affecting her platelets.
B. She takes an anticoagulant.
C. The lupus is affecting her liver.
D. She is the victim of abuse.
A The lupus is affecting her platelets.
Rationale: Lupus patients are at risk for thrombocytopenia. This decrease in platelets causes bleeding in the lupus patient and commonly presents as bruising. Life-threatening bleeding is rare. Anemia and a decreased white count are also common hematologic findings of SLE.
Adenosine must be given using this administration method. What are the doses and how often can it be given?
What is rapid IV push followed by saline flush? 6mg rapid IV/IO followed by rapid IV flush. May repeat at 12 mg if no conversions, may repeat successful dose if rhythm recurs after conversion.
A member of your crew calls your attention to a rhythm change on the cardiac monitor. The monitor shows an irregular ventricular rhythm, regularly occurring P waves, and PRIs that lengthen before a P wave appears without a subsequent QRS complex. The pattern then starts again. The patient’s ventricular rate ranges from 60 to 72 beats/min. What rhythm do you suspect this is?
A. Sinus dysrhythmia
B. Sinus rhythm with premature atrial complexes
C. Third-degree AV block
D. Second-degree AV block type I
D Second-degree AV block type I
Rationale: Second-degree AV block type I is characterized by regularly occurring P waves, an irregular ventricular rhythm, and increasing PR intervals followed by a P wave without a QRS complex. This type of AV block is common with inferior MI.
Conditions that mimic STEMI’s
Pericarditis: ST elevation in multiple leads, PR depression
Early repolarization: Concave ST elevation, young patients
Left bundle branch block: Wide QRS, can mask STEMI
Hyperkalemia: Peaked T-waves, wide QRS
Brugada syndrome: Right bundle branch block pattern
Which of the standard treatments for infusion reactions is NOT beneficial for a patient experiencing transfusion-related lung injury?
A. Diuretics
B. Oxygen
C. Vasopressors
D. Diphenhydramine
Answer: A Diuretic
Rationale: Transfusion-related lung injury is a noncardiogenic pulmonary edema caused by increased capillary permeability posttransfusion. Treatment focuses on supporting the ABCs. Because this is not a cardiac failure or fluid overload issue, diuretics are generally not effective.
Which life threats are most common in the patient with systemic lupus erythematosus and what is the implication for EMS providers?
Patients with SLE may be on medications to suppress their immune system. Slight changes such as fever and/or cough should make you suspect pneumonia, one of the most common causes of death in patients with SLE. These patients are also at risk due to the stiffness of the lungs and blood vessels, resulting in pulmonary fibrosis and pulmonary hypertension. One of the major complications of scleroderma is damage to the heart muscle. Assessment for dysrhythmias, palpitations, and congestive heart failure is a priority when caring for these patients