Cardiac Emergencies, and how they're handled.

2. “Mr. Clark. Lowering your cholesterol
level NOW won’t do you a bit of good.”

6. Aortic &
Pulmonary
semilunar
valves
VALVES

7. 18-8.jpg
The Coronary ArteriesThe Coronary Arteries
Left
Coronary
Artery
Right
Coronary
Artery
Anterior Descending
Branch

8. CORONARYCORONARY
ARTERY: FIRSTARTERY: FIRST
BRANCH OFFBRANCH OFF
THE AORTATHE AORTA

12. Cardiac CompromiseCardiac Compromise
 Rapid or slow pulse withRapid or slow pulse with
no apparent causeno apparent cause
 Palpitation or flutteringPalpitation or fluttering
sensation in chestsensation in chest
 Suspect and treat for ifSuspect and treat for if
patient has:patient has:

13. Cardiac CompromiseCardiac Compromise
 Suspect and treat for ifSuspect and treat for if
patient has:patient has:
 Pain, pressure, or discomfortPain, pressure, or discomfort
in chest or upper abdomenin chest or upper abdomen
 Difficulty breathingDifficulty breathing

14. Cardiac CompromiseCardiac Compromise
 Sudden onset of sweating,Sudden onset of sweating,
nausea, and vomitingnausea, and vomiting
 Anxiety, irritabilityAnxiety, irritability
 Suspect and treat for ifSuspect and treat for if
patient has:patient has:

16. ANGINA PECTORIS
• The heart has to work
harder because of a disease
or a clot and the heart can
not get enough oxygen

17. Scanning electron micrograph showing
fibrin network of a blood clot
Platelet
Fibrin Network Red Blood Cell

18. Causes of Cardiovascular Compromise --Causes of Cardiovascular Compromise --
AtherosclerosisAtherosclerosis

19. Coronary Artery Disease
• Narrowing of the
coronary
arteries caused
by the
buildup of
cholesterol-
containing plaque

20. Postmortem specimen of large artery with
minimal atherosclerotic changes
Marked atherosclerotic changes which cause
turbulent blood flow and blood flow restriction

21. Coronary Artery
Disease
–Results in a
decreased
blood and oxygen
supply
to the heart

22. ANGINA PECTORIS
• This causes angina – pain
from insufficient oxygen

23. WITHWITH
EXERCISE,EXERCISE,
THE HEARTTHE HEART
RECEIVES ANRECEIVES AN
INSUFFICIENTINSUFFICIENT
BLOODBLOOD
SUPPLY.SUPPLY.
PAINPAIN
RESULTSRESULTS

24. Symptom of Cardiovascular Compromise --Symptom of Cardiovascular Compromise --
Angina PectorisAngina Pectoris
Partial blockage
producing
chest pain
Area of
decreased
blood
supply
Coronary
arteries

26. AMI
• A portion of the heart muscle
dies from lack of oxygen

27. A completeA complete
blockageblockage
results in noresults in no
blood flow toblood flow to
the heartthe heart

28. Causes of Cardiovascular Compromise --Causes of Cardiovascular Compromise --
Acute Myocardial InfarctionAcute Myocardial Infarction
AREA OF
INFARCT

31. NOTE THE
DIFFERENCE
IN
PERFUSION
TO THE
HEART
AFTER 2
STENTS
WERE
IMPLANTED

33. S & S OF MI
• Chest
discomfort
or pain
• “Funny
feeling”
• Pressure
sensation
• Squeezing
sensation

34. S & S OF MI
• Pain may
radiate to:
• Left arm
• Right arm
• Jaw
• Epigastrium
• Teeth

35. “I’M HAVING
CHEST PAIN!”
THE CALL FROM HELL

36. “WHOA! WE’RE LOOKING AT
AT LEAST A DOUBLE
BYPASS HERE.”

37. S & S OF HEART
ATTACK
• Shortness of breath
• Palpitations:
• “Heart is racing”
• “Heart is skipping beats”
• Aching in chest

38. OTHER S & S:OTHER S & S:
* DYSPNEA* DYSPNEA
* NAUSEA* NAUSEA
* DIAPHORESIS* DIAPHORESIS
* FEELING OF* FEELING OF
IMPENDINGIMPENDING
DOOMDOOM

39. “WAIT…OKAY
NOW TELL ME
AGAIN HOW
UNFAIR YOUR
HEALTH
PROBLEMS
HAVE BEEN.”

40. WOMEN AND M.I. – S & S
• Weakness & fatigue
• Diaphoresis
• Nausea
• Dizziness

41. WOMEN & M.I. – S & S
• Rales
• Congestive heart failure
• Hot flash
• Nonspecific chest
discomfort

42. VARIATION
• Men typically
have M.I.
within 4 to 6
hours after
waking up
• Women do not
have this
pattern

43. VARIATION
• Women tend
to have an
M.I. more
frequently in
the autumn
& winter
• Men do not
have this
pattern
TAN YELLOW = DEADTAN YELLOW = DEAD
MUSCLE TISSUEMUSCLE TISSUE

44. INCREASED LIKELIHOOD
OF VAGUE SYMPTOMS
• Hypertension
(HTN)
• Diabetes
• Risk for M.I.
4 to 6 times
greater for
diabetic

45. ““I CALLED EMSI CALLED EMS
FOR YOU.FOR YOU.
YOU’RE GOINGYOU’RE GOING
TO HAVE ATO HAVE A
HEART ATTACKHEART ATTACK
IN ABOUTIN ABOUT
10 MINUTES.”10 MINUTES.”

50. ANEURYSM
• A weakened
section of an
artery bulges
outward
• Can burst

51. ANEURYSM
• Note weakened
arterial walls and
distention of
artery

52. Causes of Cardiovascular Compromise --Causes of Cardiovascular Compromise --
AneurysmsAneurysms

55. ANEURYSM
• Ruptured
aneurysm
results in
massive
bleeding

56. Patient Assessment -
Cardiac Compromise

57. Perform initial assessment.Perform initial assessment.

58. Perform focused history and physicalPerform focused history and physical
exam; take baseline vital signs.exam; take baseline vital signs.

59. INFORMATION ON
CHEST PAIN
• O - Onset
• P – Pain
• Q – Quality
• R – Region / Radiation
• S – Severity
• T - Time

60. ONSET
• When did the
pain start?
• What were
you doing
when the
pain started?

61. PAIN
• What makes pain better
• What makes pain worse

62. QUALITY
• What is the pain like?
• If they can’t answer that
question, ask is it: tearing,
sharp, burning, squeezing,
crushing, aching, etc.

63. REGION / RADIATION
• Where is the pain?
• Where does the pain go?

64. SEVERITY
• How bad is the pain?
• On a scale of 1 to 10

65. TIME
• When did the pain start?
• What were you doing when it
started?
• Have you ever experienced
a similar pain before?

66. Place patient in position of comfort;Place patient in position of comfort;
givegive
high-concentration oxygen byhigh-concentration oxygen by
nonrebreather mask.nonrebreather mask.

67. SAMPLE HISTORY
• S = Symptoms
• A = Allergies
• M = Medications
• P = Past history
• L = Last meal
• E = Events

68. “YOU
NEED TO
START
TAKING
YOUR
MEDS
MORE
SERIOUSLY.”

72.  Check the four rights.Check the four rights.
 Check the expiration date.Check the expiration date.

73. The Four RightsThe Four Rights
 Right patient?Right patient?
 Right drug?Right drug?
 Right dose?Right dose?
 Right route?Right route?

74. NITRO - PRECAUTIONS
• Do not
administer
nitroglycerine
if the pt. Is
taking viagra
• Deaths have
occurred from
this
interaction!

75. “DISPATCH
SAYS THE
PUPPY MAY
HAVE GOTTEN
INTO THE
PATIENT’S
VIAGARA.”

76. CLASSIFICATION:
• Nitrate
Coronary
vasodilator
• Antianginal

77. INDICATIONS:
• Myocardial
ischemia
• Angina
pectoris
• Congestive
heart failure

78. ACTIONS:
• Increases coronary blood
flow by relaxing smooth
muscle
• Vasodilation acts as an
antagonist against
vasospasm

79. ACTIONS:
• Vasodilation causes
venous pooling, resulting
in decreased blood return
to the heart (decreased
preload)

80. ACTIONS:
• Systemic vasodilation
causes decreased right
heart return which
decreases the heart’s
ventricular workload and
reduces myocardial oxygen
consumption

81. CONTRAINDICATIONS:
• Hypotension
• Hypersensitivity to nitrogen
• Head trauma
• Hypovolemia

82. CNS SIDE EFFECTS:
• Headache
• Weakness
• Dizziness

83. CARDIOVASCULAR SIDE
EFFECTS:
• Hypotension
• Tachycardia
• Fainting

84. GASTROINTESTINAL
SIDE EFFECTS:
• Nausea
• Vomiting
• Dry mouth

85. SUPPLIED AS:
• Tablet in air tight brown
bottle
• Nitroglycerine is
deactivated in sunlight

86. RATE / ROUTE / DOSE:
• 0.4 mg (1/150 grain)
• Sublingually
• Repeated every 5 minutes
• Maximum 3 doses
• Onset – 1 to 3 minutes
• Duration – 30 min.

87. INFORMATION:
• Unstable and rapidly
deteriorates when exposed
to light, air, or temperature
extremes
• Needs to be stored in a
dark, room-temperature
area

88. ‘HE GETS CONFUSED
WHEN HE TRIES TO
PUT HIS TOUPEE
AND NITRO PATCHES
ON AT THE SAME
TIME.”

89. INFORMATION:
• Tablets taste bitter and may
sting the tongue
• If the tablet does not have a
bitter taste, it may have lost
its strength
• Check the expiration date

90. “YOU MIGHT FEEL
A SLIGHT
BURNING
SENSATION
UNDER YOUR
TONGUE FROM
THE NITRO.”

91. INFORMATION:
• Hypotension caused by nitro is
usually reversible with proper
positioning and volume infusion
• Patients should always be
sitting down or lying down prior
to administration

92. “HEY, MARK … DID YOU
KNOW THAT OUR RIG’S
NITRO SPRAY LOOKS
A LOT LIKE BREATH
FRESHENER?”

93. DRUG INTERACTION:
• May produce additive
hypotension effects in the
presence of alcohol, beta-
adrenergic blockers, and
calcium channel blockers

94. NITRO
SPRAY?

95. Remove oxygen mask and ask patientRemove oxygen mask and ask patient
to open mouth and lift tongue.to open mouth and lift tongue.

96. Place tablet or spray medicationPlace tablet or spray medication
under tongue.under tongue.

97. Have patient close mouth. Replace oxygenHave patient close mouth. Replace oxygen
mask. Reassess patient, document findings.mask. Reassess patient, document findings.

99. • Administer 2
chewable
baby aspirin
• 162 MG
RATE / ROUTE / DOSE:

100. CONTRAINDICATION:
• All ready
taking aspirin
• On “blood
thinners”
• Sensitivity to
ASA

102. MORPHINE
MINTS?

103. MORPHINE
• Classification:
• Narcotic analgesic
• Indications:
• Treat pulmonary edema
• Relieve pain of M.I. & other
circumstances

104. “YEAH, DOC? THE
PARAMEDIC WANTS ME
TO TELL YOU THAT
I’M GONNA NEED LOTS
OF MORPHINE
FOR THE PAIN.”

105. MORPHINE ACTIONS
• Powerful CNS depressant
• Depresses sensory area of
cerebral cortex
• Depresses pain impulse
transmission at spinal cord
level by interacting with
opioid receptors

106. MORPHINE ACTIONS
• Painful stimuli continue to be
received but are no longer
interpreted as pain
• Decreases systemic vascular
resistance
• This aids in reducing oxygen
requirements of the heart

107. “WOULD YOU LIKE A LITTLE
SOMETHING FOR THE PAIN
MR. WILKINSON?”

108. MORPHINE ACTIONS
• Increases the capacity of
venous circulation
• Pools blood
• Decreases blood return to the
heart
• Reduces O2 consumption
• Relieves lung congestion

109. MORPHINE
CONTRAINDICATIONS
• Hypersensitivity to the drug
• Hypotension
• Respiratory depression except
that caused by CHF where
morphine may be used if
ventilatory support is provided

110. MORPHINE
CONTRAINDICATIONS
• Head injury
• Undiagnosed abdominal
pain
• Patients taking depressant
drugs including alcohol

111. MORPHINE SIDE EFFECTS:
• CNS:
• Confusion
• Sedation
• Headache

112. MORPHINE SIDE EFFECTS:
• Cardiovascular:
• Hypotension
• Bradycardia

113. MORPHINE SIDE EFFECTS:
• Respiratory:
• Respiratory depression
• Eyes:
• Dry eyes
• Blurred vision

114. MORPHINE SIDE EFFECTS:
• Gastrointestinal:
• Nausea
• Vomiting
• Skin:
• Rash

115. MORPHINE:
• Supplied as:
• 1 cc tubex
• 2 mg / cc
• Total 2 mg
• 2 mg IV repeated as needed
• Maximum 10 mg

116. MORPHINE:
• Dose in children:
• 0.1 mg/kg
• Maximum dose = 10 mg

117. MORPHINE
INFORMATION:
• Use with caution in
patients with COPD as it
may depress respirations
& suppress the cough
reflex

118. MORPHINE
INFORMATION:
• Less likely to cause serious
respiratory depression if
given slowly & in small
amounts

119. NALOXONE (NARCAN):
• Classification:
• Narcotic antagonist
• Indications:
• Overdose of known or
suspected natural or synthetic
narcotics
• Coma of unknown etiology

120. NALOXONE ACTIONS:
• Competes with narcotic drugs
opiate receptors in CNS.
• This competitive action
displaces narcotic analgesics
from their receptor sites

121. NALOXONE (NARCAN):
• Contraindications:
• Hypersensitivity to the
drug

122. NALOXONE SIDE
EFFECTS:
• Cardiovascular:
• Ventricular tachycardia
• Ventricular fibrillation
• Hypotension
• Hypertension

123. NALOXONE (NARCAN):
• Supplied as:
• 1 cc ampule
• 2 cc prefilled syringe
• 0.4 mg / cc
• Total 0.4 mg

124. NALOXONE (NARCAN):
• Route &
dose:
• 2 mg
• IV
• IM
• ET
NARCAN: 2 MG
IV/IM/ET

125. NARCAN INFORMATION:
• Use caution in administering
to patients with:
• Supraventricular arrhythmias
• Head injury

126. NARCAN INFORMATION:
• Use caution in administering to
patients with:
• Increased ICP
• Seizure disorder
• Narcan can cause seizures

127. NARCAN INFORMATION:
• Duration of Narcan is shorter
than narcotics, repeat doses
may be necessary
• Use caution in administering to
addicted patients because
Narcan can precipitate
withdrawal syndrome

128. NARCAN INFORMATION:
• Patients may become violent if
they become conscious
following administration of
narcotics for a narcotics
overdose
• Give enough Narcan to correct
respiratory depression only

129. SOB:
• 78 y/o male seated upright in
obvious distress
• Speaks 3 to 4 words in a row
• Swelling to legs
• Crackles ¾ of lungs
• Hx. Emphysema & heart trouble
• What do you suspect?

131. CONGESTIVE HEART
FAILURE (CHF):
• The heart can no longer
pump effectively causing
blood to back up into the
lungs and other parts of the
body

132. LEAKED FLUID
HEART

133. COLOR-ENHANCED
CHEST X-RAY
HYPERTROPHY

134. LEFT HEART FAILURE:
• Left side of the
heart is
pumping
ineffectively
causing blood
to back up into
the lungs

135. BACK
UP INTO
THE
LUNGS
BACK
UP INTO
THE
LUNGS

136. S & S – LEFT HEART
FAILURE:
• Dyspnea
• Rales or
possibly
wheezing
• Pink frothy
sputum
Pulmonary Edema

137. S & S – LEFT HEART
FAILURE:
• Tachycardia
• Tachypnea

139. NORMAL ALVEOLAR /
CAPILLARY UNIT
PULMONARY EDEMA
INTERSTITIAL SPACE
IMPAIRED GAS EXCHANGE

140. RIGHT HEART FAILURE:
• The right side of the heart is
pumping ineffectively
causing blood to back up
into the body

141. BACK UP INTO THE BODY
BACK UP INTO THE BODY

142. S & S – RIGHT HEART FAILURE
• Pedal
edema

143. S & S – RIGHT HEART FAILURE
• Distended
neck veins
(JVD)

144. S & S – RIGHT HEART FAILURE
• Ascites –
swollen
abdomen
• Enlargened
liver

145. S & S – RIGHT HEART
FAILURE:
• Distended
neck veins
(JVD)
• Pedal edema
• Ascites –
swollen
abdomen
• Enlargened
liver

146. MEDICATIONS:
• Nitroglycerine
• Lasix
• Morphine

148. LASIX (FUROSEMIDE):
• Classification:
• Loop diuretic
• Indications:
• Pulmonary
edema
• Congestive
heart failure
(CHF)

149. “BEING
TERRITORIAL AGAIN,
MR. WILKS?”

150. LASIX - ACTIONS:
• Furosemide is a potent
diuretic
• Inhibits primary
reabsorption of sodium and
chloride in proximal and
distal tubules as well as
the loop of Henle

151. KIDNEYS & LOOP
OF HENLE
LOOP OF
HENLE

152. LASIX – ACTIONS:
• Stimulates the kidneys to
excrete water, sodium, &
potassium
• This leads to decreased
circulating blood volume

153. “YOU’RE NOT
TAKING YOUR
LASIX, ARE
YOU MRS.
SMITH?”

154. LASIX – ACTIONS:
• Causes vasodilation
• This reduces left
ventricular preload and
pulmonary congestion
• Venous dilation starts
within 2 – 5 min.

155. LASIX – ACTIONS:
• Onset of action IV:
• Within 5 min.
• Duration = 2 hours
• Metabolized by liver
• Excreted by kidneys
unchanged

156. “AND JUST HOW
MUCH %&#@! LASIX
DID YOU GIVE HIM?”

157. LASIX –
CONTRAINDICATIONS:
• Under 18 years of age
• Sulfa allergies
• Pregnancy
• Renal disease
• Liver disease

158. LASIX – SIDE EFFECTS
• Rash
• Numbness
• Hearing loss
• Transient hypotension

159. LASIX – SUPPLIED AS:
• 4 cc pre-loaded syringe
• 10 mg / cc
• Total 40 mg
• 4 cc ampule
• 10 mg / cc
• Total 40 mg

160. RATE / ROUTE / DOSE:
• 80 to 120 mg
over 1
minute
• Can be
repeated

161. “THIS SHOULD
HOLD YOU ‘TIL
YOU GET YOUR
LASIX REFILLED.”

162. LASIX - PRECAUTIONS:
• Dehydration & blood
volume depletion can
result from long term use
of potent diuretics & can
contribute to circulatory
collapse

164. LASIX - PRECAUTIONS:
• Potassium depletion is
common and may pose a
serious threat to the pt. with
acute heart disease as well
as the pt. on digitalis
therapy
• Hyperosmolity may occur

165. “WHAT? AGAIN? YOU JUST
WENT 20 MINUTES AGO.”

166. “LET’S GET
THE HELL
OUT OF
HERE!”
NURSE!

167. LASIX - INFORMATION:
• Onset of
diuresis after IV
administration
starts within
minutes
• Reaches a peak
within 30
minutes
• Lasts 2 hours

168. LASIX - INFORMATION:
• The venous dilatation starts
within 2 to 5 minutes
resulting in almost
immediate alleviation of
some symptoms

169. SYNCOPAL EPISODE:
• Dispatched to a 37 year old female who
became dizzy & fell while changing a
light bulb
• Hit her head and is c/o tenderness to
neck & headache
• Starts to c/o SOB

170. SYNCOPAL EPISODE:
• B/P = 200/116
• Pulse = 130 & regular
• Resp. = 28 & shallow
• Slight wheezes in lower lobes
• Hx. – Diabetes & heart attack 2 years
ago

171. SYNCOPAL EPISODE:
• As start to backboard pt., she doubles
over & starts to cough
• Continues coughing & very short of
breath
• Now has rales & pink sputum
• Glucose level = 146

172. SYNCOPAL EPISODE:
• What tx. is appropriate?
• Enroute resp rate decreases to 6 per
minute
• At hospital – continued tx. for CHF &
later undergoes open heart surgery for
severe coronary artery disease

174. HIATAL HERNIA
• Sliding of part of the stomach
into the chest cavity
• Slides through a natural hole
in the diaphragm where the
esophagus passes through to
the stomach

176. ABDOMINAL PAIN
• Dispatched to 68 y/o female
c/o moderate abdominal pain
• Feels weak & nauseous
• Hx. – HTN
• Note pulsating mass to
abdomen
• What do you suspect?

177. 


178. AAA
• Aortic
abdominal
aneurysm
• May rupture
with trauma
• May rupture
with no
trauma

180. S & S AAA
• May have
abrupt severe
pain
• Diffuse
abdominal
tenderness
• May have
pulsating
mass
Ruptured Aneurysm

182. BACK PAIN
• Dispatched to 73 y/o male c/o
severe, sharp, tearing
sensation to back
• Sudden onset
• Hx. – HTN
• What do you suspect?

184. BLOOD VESSEL WALLS
• 3 layers:
• Tunica intima
• Tunica media
• Tunica adventitia

185. TUNICA INTIMA
• Inner layer of blood
vessels
• Smooth, thin lining

186. TUNICA MEDIA
• Middle layer
• Thickest of the 3 layers
• Composed of elastic
tissue & smooth muscle

187. TUNICA MEDIA
• Allows blood vessels to
expand & contract in
response to changes in
blood pressure and tissue
demand

188. TUNICA ADVENTITIA
• Outer layer
• Consists of elastic & fibrous
connective tissue
• Provides strength to
withstand high blood pressure

189. LUMEN
• Cavity or channel within a tubular
organ
• Size or diameter changes with the
size of the organ
• Changes in the size of the lumen
in arteries play an important role
in regulating blood pressure

190. TUNICA INTIMA
TUNICA MEDIA
TUNICA ADVENTITIA
LUMEN

191. DISSECTING
AORTA
AORTA

192. DISSECTING
AORTA

193. S & S:
• Often C/O
tearing pain to
the back
• May have
decreased or
absent pulse
in one
extremity
• Hypotension

195. CHEST PAIN
• Dispatched to a possible heart
• 67 year old man sitting in a
chair holding onto his chest
• Appears gray in color
• What should you do?
• Put the pt. on oxygen as you
assess vital and sample history

196. CHEST PAIN
• What information do you need?
• Chest pain X 20 min. that
started while watching TV
• Pressure in the right side of
the chest going to the
shoulder
• 5 on a scale of 1 – 10

197. CHEST PAIN
• Similar to pain from heart
attack last year
• Took 1 Nitro with no relief
• Pulse = 148 and irregular
• Respirations = 22 and shallow
• B/P = 152/86
• Skin = cool, moist, & pale

198. CHEST PAIN
• Denies palpitations
• Mild SOB
• Some nausea but no
vomiting
• Has a bag of meds but no
allergies
• What do you do?

199. CHEST PAIN
• At hospital
diagnosed
with
dissection
& thrombus
of left
coronary
artery
Coronary angiogram of left
coronary artery = total
occlusion & dissection of
left anterior descending
artery
Left anterior
descending
artery
Left main
artery
Left
circumflex
artery

200. REVIEW:
• Chest pain from a decreased oxygen
supply is called:
• Angina
• Chest pain when a portion of the heart
muscle dies is:
• Myocardial infarction

201. REVIEW:
• A weakened section of the artery that
bulges outward is:
• Aneurysm
• What is the acronym for questions that
should be asked about chest pain?
• OPQRST

202. REVIEW:
• What do each of the letters stand for?
• O = Onset
• P = Pain
• Q = Quality
• R = Radiation
• S = Severity
• T = Time

203. REVIEW:
• What are the 4 rights for medication
administration?
• Right patient; Right drug; Right dose;
Right route
• How is nitroglycerine classified?
• Vasodilator

204. REVIEW:
• What are the indications for nitro?
• Cardiac ischemia; Angina; CHF
• What are contraindications for nitro?
• Hypotension; Viagra
• What are common side effects
• Hypotension; Headache

205. REVIEW:
• What is the rate, route, & dose of nitro?
• 0.4 mg. sl q 5 min. Maximum of 3 doses
• What is the rate, route, & dose of ASA?
• 162 mg. Chewable
• What is the rate, route, & dose of
morphine?
• 2 mg. Slow IV repeated as needed
maximum 10 mg

206. REVIEW:
• What is the most severe side effect of
morphine?
• Respiratory depression
• What drug counteracts morphine?
• Narcan (Naloxone)
• What is the rate, route, & dose of Lasix?
• 80 to 120 mg. IV over 1 minute

207. REVIEW:
• Dyspnea, rales, & pink frothy sputum
are classic signs of:
• Left heart failure
• What meds are used for CHF?
• Nitro, Lasix, Morphine
• Abrupt diffuse or severe abdominal pain
and a pulsating mass are s& s of:
• AAA

208. REVIEW:
• What is the name of the inner lining of
blood vessels?
• Tunica intima
• What is the term for the channel in a
tubular organ?
• Lumen

209. REVIEW:
• Severe stabbing back pain,
hypotension, & decreased pulses in one
lower extremity may indicate:
• Dissecting aorta