Name the layers of the heart from the outside in.
Answer(s): C
The layers of the heart from the outermost to the innermost layer are epicardium, myocardium, endocardium. The pericardium is actually the protective sac which surrounds the heart. The heart is covered with a thin layer of slippery tissue called the epicardium, it provides a surface which can move inside the pericardium without causing friction. The myocardium is the muscle tissue of the heart which conducts electricity which causes the muscle to squeeze pumping blood. The endocardium is made of the same type of tissue as the epicardium. The endocardium is very smooth to prevent clots from forming and adhering to the valves.
Which of the following complaints is often used to describe chest pain resulting from a cardiac event?
Answer(s): B
Typical cardiac related chest pain is often referred to as a pressure, like “a ton of bricks on my chest” or an elephant sitting on their chest. You can rule out a cardiac event on type of chest pain described alone. Some patients will have atypical chest pain which could be described as anything from sharp pain to a pulled muscle to a tooth ache. Sharp stabbing pain which can be located with one finger is often a pulmonary embolism.
Which artery carries deoxygenated blood and which vein carries oxygenated blood?
The pulmonary artery is the only artery to carry deoxygenated blood to the lungs for gas exchange. The pulmonary vein is the only vein to carry oxygenated blood back to the heart. Typically, the arteries carry oxygen rich blood away from the heart to the systemic circulation. Veins typically carry deoxygenated blood back to the heart. The aorta is the main artery exiting the left ventricle to the body and the vena cava returns blood back to the right side of the heart.
Which are not blood components that are responsible for clot formation?
Plaque is actually the buildup of fatty deposits on the artery walls which narrow and harden the arteries. While a clot often forms around plaque, especially around a plaque rupture, it is not a part of the clotting process. Platelets are the flat disks which stick together forming the thrombus. Fibrin is the small strands of fiber which make up the frame work of the clot making it stronger, like reinforcing rods in concrete. Thrombin is the protein chemo activator which signals the formation of a clotting process.
You are dispatched to a residence for a 46-year-old female patient complaining of nausea, vomiting, diarrhea, and abdominal cramping. She states that the onset occurred shortly after eating some cheesecake. Her only medical history is lactose intolerance. Her blood pressure is 136/88 mm Hg. Her radial pulse is 94 beats per minute and her respiratory rate is 18 breaths per minute. She vomited two times prior to your arrival. From what condition is this patient most likely suffering?
Answer(s): D
Acute gastroenteritis may be caused by bacterial or viral ingestion, toxic ingestion, or ingestion of lactose in a lactose intolerant patient. Signs and symptoms include nausea, vomiting, diarrhea, and abdominal cramping.
Your patient is a 32-year-old male who was complaining of a severe, crushing feeling in the center of his chest and shortness of breath that began while he was mowing his lawn 45 minutes prior to your arrival. He is now only responding to painful stimuli. Presently, his minute ventilation is still adequate, his pulse oximeter reads 95% on room air, and you find his skin to be pale, cool, and diaphoretic. What would be your initial action?
Answer(s): A
High flow oxygen would be indicated with extreme shortness of breath during the initial assessment, so long as ventilations are adequate. If the patient is breathing inadequately then positive pressure ventilation with oxygen should be immediately instituted.
You are called to a nursing home for a patient with swelling to her legs. Upon arrival, you find a 76-year-old patient sitting in a wheelchair. Assessment confirms pitting edema to both lower legs. You are able to palpate a dorsalis pedal pulse bilaterally. Her skin is warm, pink, and dry. Her lungs are clear bilaterally. Which of the following conditions do you suspect?
Edema to the legs or sacrum is often a result of right-sided congestive heart failure. Often, there may also be jugular vein distention and ascites present as well. The most common cause of right-sided heart failure is left-sided heart failure; therefore, you may also note signs and symptoms of left-sided heart failure such as a dry, hacking cough, or coughing up pink frothy sputum, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.
You are treating a 49-year-old patient who complains of an intense pain between his shoulder blades radiating to his lower back. Pain began 10 minutes prior to your arrival while he was eating and has been constant. He rates the pain as 10 out of 10. Pain is described as a sharp, tearing pain. He has no significant past medical history. Blood pressure is 130/76 mm Hg in the right arm and 78/48 mm Hg in the left arm, radial pulse in his right arm is 98 beats per minute and regular, and respiratory rate is 20 per minute and non-labored. What condition would you most likely suspect?
Differing blood pressures in each arm, as well as the description of a sharp, tearing pain between the shoulder blades, may indicate an aortic dissection. This is a definite medical emergency that warrants immediate transport to the emergency department.
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