AL-Ghad International Colleges for Applied Medical Sciences

Academic And Educational Affairs

Emergency Medical Program

Cardiac Emergencies EMSP

344
Log Book

Students' Name

Academic Number

Draft
 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Automatic External Defibrillator

You observed a person collapse on the floor. You arrive at the patient’s side with an AED. No
one is performing CPR. It has been less than 2 minutes since the person collapsed.
Points Points
Actions
Possible Awarded
1. Takes or verbalizes body substance isolation precautions 0.5
2. Assess
A. Place patient in a supine position on a dry surface.
B. Check for responsiveness.
3
C. Check breathing for minimum of 5 and a maximum of 10 seconds.
(0. 5/each)
D. Activate EMS.
E. Check carotid pulse for minimum of 5 and a maximum of 10 seconds.
F. Assess if patient is a candidate for the use of an AED. State to proctor, “AEDs
be used on patients who are unconscious, unresponsive with no pulse.”
mayAED
3. Prepare
A. Turn on AED.
B. Place pads on patient’s chest. Sternum pad is placed upper anterior right 1.5
side of chest just below the clavicle. Apex pad is placed on the left side of (0. 5/each)
the chest below the breast and toward the lateral aspect of the ribs as
shown by the pad diagrams.
4. Analyze
C. Confirm electrodes are plugged in.
A. Clear patient to analyze. Must be a visible check and then state “Everyone is 1
clear!”
B. Analyze
5. Shock Advisedpatient by pushing the analyze button.
A. Visually check that no one is touching the patient at the time shock is
delivered. State, “I’m clear, you’re clear, everyone clear!” as you observe the
patient prior to patient being shocked.
2.5
B. Press SHOCK button.
(0. 5/each)
C. Immediately initiate CPR beginning with chest compressions.
D. Complete 5 rounds of chest compressions and ventilations.
E. Return to Analyze

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
6. No Shock Advised
a. Check pulse.
b. If no pulse initiate CPR beginning with chest compressions. 1.5
Complete 5 rounds of chest compressions and ventilations. (0. 5/each)
Return to Analyze
c. If patient has a pulse, check breathing. If breathing is adequate,
provide oxygen via a non-Total
rebreather mask. If breathing is 10
inadequate or absent, ventilate the patient at the appropriate
rate.

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Adult and Child One-Rescuer CPR

Points Points
Actions
Possible Awarded

1. Takes or verbalizes body substance isolation precautions 0.5

2. Check for response 1

3. Check for no breathing or no normal breathing (minimum 5 seconds, maximum 10
1
seconds)

4. Activate emergency response system and call for an AED 1

5. Check carotid pulse (minimum 5 seconds, maximum 10 seconds) 1

6. Locate CPR hand position 1

7. Deliver first cycle of compressions at correct rate (>100 compressions per minute) 1

8. Give two breaths (one second each) 1

9. Deliver second cycle of compressions at correct rate and hand position 1

10. Give two breaths (one second each) 1

11. Deliver third cycle of compressions of adequate depth with full chest recoil 1

12. Give two breaths (one second each) 0.5

Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Cardiac Arrest Management / AED

Points Points
Actions
Possible Awarded
1. Takes or verbalizes appropriate body substance isolation precautions 0.5
2. Determines the scene/situation is safe 0.5
3. Attempts to question any bystanders about arrest events 0.5
4. Checks patient responsiveness 1*
5. Assesses patient for signs of breathing [observes the patient and determines the
absence of breathing or abnormal breathing (gasping or Agonal respirations)] 0.5

6. Checks carotid pulse [no more than 10 seconds] 1*

7. Immediately begins chest compressions [adequate depth and rate; allows the
0.5
chest to recoil completely]
8. Requests additional EMS response 0.5
9. Performs 2 minutes of high quality, 1-rescuer adult CPR
o Adequate depth and rate
o Correct compression-to-ventilation ratio
2.5*
o Allows the chest to recoil completely
o Adequate volumes for each breath
o Minimal interruptions of less than 10 seconds throughout
After 2 minutes (5 cycles), patient is assessed and second rescuer resumes compressions while candidate
operates AED.
10.Turns-on power to AED 0.5
11.Follows prompts and correctly attaches AED to patient 0.5
12.Stops CPR and ensures all individuals are clear of the patient during rhythm
0.5
analysis
13.Ensures that all individuals are clear of the patient and delivers shock from AED 0.5
14.Immediately directs rescuer to resume chest compressions 0.5
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Adult CHOKING
Points Points
Actions
Possible Awarded
1. Takes or verbalizes body substance isolation precautions 1
Responsive Patient
2. Airway
 Ask the victim, “Are you choking?”
 Determine whether complete airway obstruction is present:
 If the victim can talk or is coughing, it is a partial airway obstruction. 2
Encourage them to cough forcefully to dislodge the obstruction.
 If the victim cannot cough, has a very weak cough, or is cyanotic, treat the
patient as if there is a severe airway obstruction and begin abdominal thrusts.
3. Perform abdominal thrusts
 Position yourself behind the victim.
 Make a fist, and place the thumb side of this fist against the midline of the
patient’s abdomen between waist and rib cage.
 Grasp your properly positioned fist with your other hand and apply pressure 2
inward and up toward the patient’s head in a smooth, quick movement. Each
thrust should be distinct and be delivered with the intent of relieving the
airway obstruction.
 Give five abdominal thrusts.
4. Reassess
 If the obstruction is not relieved after a series of five thrusts, reassess your
position and the patient’s airway.
 Repeat the sequence of thrusts and assessments until the obstruction is
relieved or the patient loses consciousness.
1

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
Unresponsive patient
5. Establish Unresponsiveness
 Gently shake and shout, “Are you OK?”
 If you are not alone send someone to activate EMS, and then continue the
airway obstruction sequence.
 If you are alone with an Adult victim, activate EMS, and then continue the 2
airway obstruction sequence.
 If you are alone with a Child victim, activate EMS after you have either relieved
the obstruction or you have attempted the airway obstruction sequence for 2
minutes.
6. Airway Obstruction Sequence
 Open the airway.
 Remove objects from the mouth if they are visible.
 Attempt to ventilate.
 If unable to ventilate, reposition patient’s head and attempt to ventilate again. 3
 If unable to ventilate, perform CPR.
 Every time you open the airway to give breaths, open the victim’s mouth wide
and look for the object. If you see an object, remove it. If you do not see an
object, keep doing CPR.
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Infant One / Two Rescuer CPR

Points Points
Actions
Possible Awarded
1. Takes or verbalizes body substance isolation precautions 0.5
2. Check for response 0.5
3. Check for no breathing or no normal breathing (minimum 5 seconds, maximum
1
10 seconds)
4. Activate emergency response system and call for an AED 0.5
5. Check brachial pulse (minimum 5 seconds, maximum 10 seconds) 1
6. Locate CPR finger position 1
7. Deliver first cycle of compressions at correct rate (>100 compressions per
1
minute)
8. Give two breaths (one second each) with visible chest rise 1
9. Repeat for a total of five cycles 1
10. Recheck for a pulse
1
11. Proctor will act as a second rescuer and take over at airway
12. Deliver first cycle of compressions using the thumbs-hand encircling the chest
technique at the correct rate (>100 per minute) and ratio (15:2) Pause to allow
0.5
the proctor to give two breaths (one second each) Repeat for a total of two
cycles
13. Proctor states “After two minutes you assess the infant and there is a pulse, but
0.5
the baby is not breathing. Demonstrate what you need to do.”
14. Give breaths (one second each) at the correct rate (every three to five seconds)
0.5
with the majority of ventilations resulting in visible chest rise.
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Infant CHOKING
Points Points
Actions
Possible Awarded
1. Takes or verbalizes body substance isolation precautions 1
2. Student states, “some of the signs of severe airway obstruction are: poor or no air
exchange, weak, ineffective cough, high-pitched sounds while inhaling, turning 1
blue, unable to cry or make sounds, unable to move air”.
3. Airway Maneuver
 Kneel or sit with the infant in your lap. If easy to do, bare infant’s chest.
 Hold infant face down with head slightly lower than the chest, resting on you
forearm.
 Support head and jaw with your hand.
 Deliver up to five back slaps forcefully between the infant’s shoulder blades,
using the heel of your hand. 6
 Place your free hand on the infant’s back, supporting the back of the infant’s
head with the palm. Turn the infant as a unit while carefully supporting the
head and neck. Hold the infant on his back with your forearm resting on your
thigh. Keep the infant’s head lower than the trunk.
 Provide up to five quick downward chest thrusts in the same location as chest
compressions – just below the nipple line.
4. Assess
 Repeat until the object is dislodged or the victim becomes unresponsive. Do
not perform blind finger sweeps because the foreign body may be pushed back 2
into the airway causing further obstruction or injury.
 If the infant becomes unresponsive, stop back slaps and begin CPR.
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Performing ECG Monitoring

Points Points
Actions
Possible Awarded
1. Don appropriate standard precautions 0.5

2. Prepare Equipment 0.5

3. Select site : At least 10 cm from the heart for adults 0.5

4. Attach monitor cables to self-adhesive leads 0.5
5. Prepare patient
1. If possible, explain procedure to patient
2. Expose chest
3. Ensure skin is not broken or bleeding 1.5
4. Shave hair from site if particularly thick
5. Cleanse area with alcohol prep pad if dirty
6. Allow alcohol to dry before placing leads
6. Turn monitor on 0.5
Limb Lead Monitoring
7. Attach limb leads to appropriate limbs (May be 3 or 4 leads)
8. For MCL1 Attach LL lead to 4th intercostal space, just right of sternum)
1
9. Assess baseline rhythm
10. Print tape as necessary
12 Lead Monitoring
11. Attach the 4 limb leads to appropriate leads
12. Attach precordial (chest) leads
13. V1 = 4th intercostal space, right of the sternum
14. V2 = 4th intercostal space, left of the sternum
2
15. V4 = 5th intercostal space, midclavicular line
16. V3 = on a line midway between V2 and V4
17. V5 = anterior axillary line on same horizontal level as V4
18. V6 = midaxillary line at same level as V4 and V5
19. Connect cable for precordial leads to monitor, if necessary 0.5
20. Ask patient to remain still and “breathe normally” 0.5
21. Acquire ECG reading 0.5
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
22. If artifact or “noisy data”
 View each individual lead on monitor to find “ noisy” one 0.5
 Reposition lead, replace if necessary
23. Assess the rhythm strip for any abnormalities 0.5
24. Intervention according to patient condition and ECG interpretation 0.5
25. Remove electrodes and leads from the patient & clean its side on patient 0.5
26. Put patient on the position of comfort 0.5
27. Documentation (date, time, interpretation & intervention) 0.5
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Vagal Maneuvers: Valsalva maneuver

Points Points
Actions
Possible Awarded
Valsalva Maneuver: QRS <0.12 sec
1. BSI, Scene size up 1
2. Establish responsiveness. 1
3. Perform rapid primary A–B–C–D survey.
a. Patent airway?
b. Breathing adequate?
• Assess rate and depth of breathing.
• Measure oxygen saturation.
• Administer oxygen if oxygen saturation is <94%. Titrate to effect.
c. Circulation (perfusion) adequate?
1
• Attach cardiac monitor to identify rhythm.
– Obtain 12-lead ECG if available, but do not delay cardioversion if
patient is very unstable.
• Measure pulse and BP.
• Establish IV access.
• Differential diagnosis?
• Consider causes of unstable tachycardia.
4. Establish that patient is asymptomatic, or stable with minor symptoms 1
5. Document dysrhythmias before treating and monitor rhythm continuously 1
6. Explain procedure to the patient
7. Instruct patient to inhale & hold their breath and bear down as if to have a
2
bowel movement and to hold this position for 20-30 seconds
8. Blow forcefully through a straw for as long as possible (at least 20 seconds
9. Stop maneuver immediately if ( patient become flushed, HR drops below
1
100 BPM, Asystole occurs)
10. Document every thing 1
11. Transport with reassessment and detailed physical exam enroute. 1
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Vagal Maneuvers: Carotid Sinus massage

Points Points
Actions
Possible Awarded
1. BSI, Scene size up 0.5
2. Establish responsiveness. 0.5
3. Perform rapid primary A–B–C–D survey.
a. Patent airway?
b. Breathing adequate?
• Assess rate and depth of breathing.
• Measure oxygen saturation.
• Administer oxygen if oxygen saturation is <94%. Titrate to effect.
1
c. Circulation (perfusion) adequate?
• Attach cardiac monitor to identify rhythm.
Obtain 12-lead ECG if available, but do not delay cardioversion if patient is unstable.
• Measure pulse and BP.
• Establish IV access.
• Differential diagnosis? Consider causes of unstable tachycardia.
4. Establish that patient is asymptomatic, or stable with minor symptoms 0.5
5. Document dysrhythmias before treating and monitor rhythm continuously 0.5
6. Explain procedure to the patient
1
7. Put patient in supine position with slightly hyperextend the neck
8. Gently palpate for carotid pulses on one side, then the other (proceed only if
bilateral carotid pulses are palpable.
1.5
9. Auscultate for bruits over both carotid arteries
10. Turn patient's head to left side
11. Apply gentle firm steady pressure over the RT carotid & hold for 5-10 Seconds
1
but not occlude the blood flow
12. If no response; wait for 2-4 minutes and repeat procedure on other side 1
13. Stop maneuver immediately if ( patient become flushed, HR drops below 100
1
BPM, Asystole occurs)
14. Document every thing 0.5
15. Transport with reassessment and detailed physical exam enroute. 0.5
Total 10
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Manual Defibrillation
Points Points
Actions
Possible Awarded
1. Takes standard precautions. 0.5
2. Recognizes the need for defibrillation 1*
3. Ensures quality CPR is being performed while preparing monitor 0.5
4. Turns on monitor/defibrillator and selects paddles or pads lead. 0.5
5. Perform skin preparation (drying chest, shaving chest, applying conductive
1*
medium, removing medication patches, etc. if necessary).
6. Places pads or paddles correctly and demonstrates or verbalizes application of
0.5
firm pressure if using paddles.
7. Verbalizes identification of ventricular fibrillation or ventricular tachycardia
1*
on monitor.
8. Sets appropriate defibrillator energy level. 1
9. Charges defibrillator. (Compressions may continue throughout charge) 0.5
10.Says "CLEAR” and visually checks that other rescuers are clear of patient. and
1*
remove oxygen
11.Delivers shock. 0.5
12.Immediately directs assistants to resume CPR. 1
13.CPR consists of 30:2 for 2 minutes or compressions at least 100 b/min 1
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Synchronized Cardioversion
Points Points
Actions
Possible Awarded
1. Takes standard precautions. 0.5
2. Turn the monitor on and apply the pads to patient 0.5
3. Confirms the dysrhythmia 1*
4. Sedate the patient if time permits(Consider midazolam for sedation) 0.5
5. Ensure that the “SYNC” button is pressed. And there are markers on the R
1*
waves
6. Select appropriate cardioversion dose (monitor specific) 1
7. State, “stand clear, charging pads 1
8. Charge the defibrillator 0.5
9. Check personal, state all clear and do a visual check and reconfirm rhythm 1
10.Deliver the energy 1
11.Check pulse and reassess the patient 0.5
12.If patient does not convert, check that synchronization is still on, increase the
energy (120J, 150J, 200J) and shock again / continue with the appropriate 1*
protocol
13.Record the procedure 0.5
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Noninvasive Transcutaneous Cardiac Pacing

Points Points
Actions
Possible Awarded
1. Takes standard precautions. 0.5
2. Assess the patient for the need of pacing 1*
3. Gather the appropriate equipment 0.5
4. Explain the procedure to the patient including pain and discomfort 0.5
5. Sedate if necessary 0.5
6. Obtain rhythm strip 3 lead and 12 lead 0.5
7. Assess and record baseline vitals 0.5
8. Apply the pacing pads 0.5
9. Turn the pacer on 1*
10.Assure that the monitor can sense all intrinsic QRS complexes 0.5
11.Select appropriate pacing rate 60 – 80 bpm 1*
12.Select initial current setting 0.5
13.Increase pacer in 20 milliamps until capture 1*
14.Observe electrical capture (pacer spike followed by wide QRS and discordant
0.5
T wave)
15.Observe for mechanical capture (palpable pulse, ^ in BP, ^LOC) 0.5
16.Obtain rhythm strip and record vital signs, reassess patient and record
0.5
procedure
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Interpret the rhythm

These are not related to Exam or quizzes , those are only examples , Instructors
should show students other ECG,s

1.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

2. Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

3. Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

4. Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

5. Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

6. Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

7.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

8.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

9.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

10.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

11.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

12.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

13.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

14.
Rate: Rhythm:
P Wave: QRS complex:
PR Interval: Interpretation:

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Tachycardia with Pulse (Unstable)

Points Points
Actions
Possible Awarded
1. BSI, Scene size up 0.5
2. Establish responsiveness. 0.5
3. Perform rapid primary A–B–C–D survey.
b. Patent airway?
c. Breathing adequate?
• Assess rate and depth of breathing.
• Measure oxygen saturation.
• Administer oxygen if oxygen saturation is <94%. Titrate to effect.
d. Circulation (perfusion) adequate?
1
• Attach cardiac monitor to identify rhythm.
– Obtain 12-lead ECG if available, but do not delay cardioversion if
patient is very unstable.
• Measure pulse and BP.
• Establish IV access.
e. Differential diagnosis?
• Consider causes of unstable tachycardia.
4. Establish that serious signs and symptoms are related to the tachycardia.
a. If patient is unstable with serious signs and symptoms and a heart rate
– 150 bpm, prepare for immediate synchronized cardioversion.
b. Patients in good cardiac health are likely to be stable if the ventricular rate
1.5
is <150 bpm; however, patients with cardiac disease may be unstable with
heart rates <150 bpm.
c. It is important to assess the patient’s symptoms in addition to monitoring
heart rate as criteria for cardioversion.
5. Cardioversion
a. Premedicate with sedative plus analgesic whenever possible.
b. Place defibrillator in synchronized (Sync) mode.
3
c. Perform synchronized cardioversion:
• Regular narrow–QRS complex tachycardia (SVT or atrial fl utter)
generally requires less energy; 50–100 J biphasic is often sufficient.
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
For a monophasic device, initial energy is 200 J.
• A-fi b (irregular narrow-complex tachycardia) requires an initial energy
dose of 120–200 J biphasic or 200 J monophasic.
• Regular wide–QRS complex tachycardia (monomorphic VT) usually
responds well to initial energy of 100 J biphasic or monophasic.
6. Check monitor. If tachycardia persists:
a. Reset Sync mode on monitor-defibrillator.
b. Ensure adequate sedation/analgesia. 2
c. Increase energy and repeat cardioversion.
d. Reassess monitor and patient.
7. Drugs
a. For a regular narrow-complex reentry tachycardia in an unstable patient, if
cardioversion is not immediately available, consider administering
adenosine before cardioversion.
• Give adenosine 6 mg IV in the antecubital or another large vein rapidly
1.5
over 1–3 sec, immediately followed by a 20-mL bolus of normal saline.
• If the rhythm has not converted in 1–2 min, repeat adenosine at 12 mg
IV.
• If the rhythm still does not convert, a third dose of adenosine at 12 mg
IV may be given after another 1–2 min, maximum 30 mg.
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Tachycardia with a Pulse: / Narrow Complex (Stable)

Points Points
Actions
Possible Awarded
1. BSI, Scene size up 0.5
2. Establish responsiveness. 0.5
3. Perform rapid primary A–B–C–D survey.
d. Patent airway?
e. Breathing adequate?
• Assess rate and depth of breathing.
• Measure oxygen saturation.
• Administer oxygen if oxygen saturation is <94%. Titrate to effect.
f. Circulation (perfusion) adequate?
1
• Attach cardiac monitor to identify rhythm.
– Obtain 12-lead ECG if available, but do not delay cardioversion if
patient is very unstable.
• Measure pulse and BP.
• Establish IV access.
• Differential diagnosis?
• Consider causes of unstable tachycardia.
4. Establish that patient is asymptomatic, or stable with minor symptoms 1
5. Vagal Maneuvers
a. QRS <0.12 sec:
b. Attempt vagal maneuvers.
i. Hold ice to patient’s face.
ii. Have patient hold breath while bearing down.
iii. Have patient blow through an obstructed straw
iv. Perform carotid sinus massage (only by a qualified physician). 2.5

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
6. Drugs
a. QRS <0.12 sec and tachycardia persists:
i. Administer adenosine 6 mg IV over 1–3 sec in antecubital or another
large vein.
1. Immediately follow with 20-mL bolus of normal saline.
ii. If rhythm converts, it was probably SVT.
iii. If rhythm remains regular and has not converted in 1–2 min, repeat 2.5
adenosine at 12 mg IV.
iv. If rhythm still does not convert, a third dose of adenosine at 12 mg IV
may be given after another 1–2 min, maximum 30 mg.
v. If rhythm still does not convert or is irregular, it may be A-fl utter, atrial
tachycardia, MAT, junctional tachycardia, or A-fib.
1. Consider rate control using IV diltiazem or IV beta blockers.
7. Obtain expert consultation. 1
8. If the rhythm converts, observe the patient and treat any recurrence with
1
adenosine, diltiazem, or beta blockers. Obtain expert consultation.
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Tachycardia with a Pulse: /Wide Complex (Stable)

Points Points
Actions
Possible Awarded
1. BSI, Scene size up 1
2. Establish responsiveness. 1
3. Perform rapid primary A–B–C–D survey.
a. Patent airway?
b. Breathing adequate?
• Assess rate and depth of breathing.
• Measure oxygen saturation.
• Administer oxygen if oxygen saturation is <94%. Titrate to effect.
c. Circulation (perfusion) adequate? 1
• Attach cardiac monitor to identify rhythm.
Obtain 12-lead ECG if available, but do not delay cardioversion if patient unstable.
• Measure pulse and BP.
• Establish IV access.
• Differential diagnosis?
• Consider causes of unstable tachycardia.
4. Establish that patient is asymptomatic, or stable with minor symptoms 1
5. Drugs
a. QRS ≥0.12 sec:
b. If monomorphic VT, administer Amiodarone 150 mg IV/IO over 10 min.
i. May repeat every 10 min if needed.
ii. Start infusion at 1 mg/min for 6 hr, followed by 0.5 mg/min for 18 hr.
iii. Do not exceed 2.2 g in 24 hr.
5
c. If regular, monomorphic, and suspected to be SVT with aberrancy, administer
adenosine 6 mg IV over 1–3 sec in the antecubital or another large vein.
i. Immediately follow with 20-mL bolus of normal saline.
ii. If rhythm transiently slows or converts to sinus rhythm, it probably SVT.
iii. If adenosine has no effect, rhythm is probably monomorphic VT or atrial
fibrillation with pre-excitation and should be treated with Amiodarone.
6. Obtain expert consultation 1
Total 10
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

PATIENT ASSESSMENT – MEDICAL

Point Point
Skills
possible awarded
1. Takes or verbalizes body substance isolation precautions 0.5
SCENE SIZE-UP
2. Determines the scene/situation is safe 0.5
3. Determines nature of illness 0.5
4. Determines the number of patients 0.5
5. Requests additional help if necessary 0.5
6. Considers stabilization of spine 0.5
PRIMARY SURVEY
7. Verbalizes general impression of the patient 0.5
8. Determines responsiveness/level of consciousness -AVPU 0.5
9. Determines chief complaint/apparent life-threats 0.5*
10. Assesses airway and breathing
A. Assessment(look-listen-feel)
0.5
B. Assures adequate ventilation
C. Initiates appropriate oxygen therapy
11. Assesses circulation
A. Assesses/controls major bleeding
0.5
B. Assesses skin [color, temperature, condition]
C. Assesses pulse
12. Identifies priority patients/makes transport decision 0.5*
HISTORY TAKING AND SECONDARY ASSESSMENT
13. History of present illness
A. Onset
B. Severity
C. Provocation
0.5
D. Time
E. Quality -Clarifying questions of associated signs and symptoms as related
to OPQRST
F. Radiation

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
14. Past medical history
A. Allergies
B. Past pertinent history
0.5
C. Events leading to present illness
D. Medications
E. Last oral intake
15. Performs secondary assessment for Cardiovascular 0.5
16. Vital signs
A. Pulse
0.5
B. Respiratory rate and quality
C. Blood pressure
17. Diagnostics [must include application of ECG monitor for dyspnea and chest
0.5
pain]
18. Verbalizes treatment plan for patient and calls for appropriate intervention(s) 0.5
19. Transport decision re-evaluated 0.5
REASSESSMENT
20. Repeats primary survey, vital signs, & secondary assessment regarding patient 0.5
complaint or injuries
21. Evaluates response to treatments 0.5

Time: less than 10 min 0.5*

Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Chest Pain Assessment

Points Points
Actions
Possible Awarded
1. Takes or verbalizes body substance isolation precautions 0.5
2. Scene Size-up (5 questions)
 Is the scene safe?
 What is the nature of illness (NOI)?
0.5
 What is the number of patients?
 What additional resources do I need?
 Do I need to take C-spine precautions?
3. Initial Assessment
 Verbalize general impression of patient. (big sick or little sick)
0.5
 Determine level of consciousness. (AVPU & A&OX4)
 Determine chief complaint.
4. ABCs
 Manage problems associated with the airway, breathing and circulation. 0.5
 Administer high concentration of oxygen, if necessary.
5. Decide Patient priority for immediate transport. 1
6. Chest Pain Assessment OPQRST:
Onset: “Did the symptoms come on suddenly or gradually?”
Provocation: “Are there moments (such as during inhalation), or positions
where the pain is better or worse?”
Quality: “Describe the pain, what does it feel like?”
1.5
Region/Radiation: “Point to where it hurts. Does the pain go anywhere
else?”
Severity: “On a scale of 1 to 10 with 10 being the worst pain you have ever
felt, what number would you give this pain?”
Time: “When did your chest pain begin?”

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
7. SAMPLE History
Signs and symptoms: “What’s wrong?”
Allergies: “Are you allergic to medications, foods, or environmentals?”
Medications: “What medications are you currently taking (prescription,
over-the-counter, herbal supplements, or recreational)?”
Past pertinent history: “Have you been having any medical problems? Have 1.5
you been feeling ill, or had any recent surgery or injuries? Have you been
seeing a doctor (what’s your doctor’s name)?”
Last oral intake: “When did you last eat or drink? What did you have?”
Events leading to present illness: “What sequence of events led up to
today’s problem?”
8. Perform Focused Physical Exam
 Look for signs of breathing difficulty, auscultate lung sounds, palpate chest
(look, listen and feel) and check for JVD, surgical scars and pedal edema. 1.5
 Ask patient if they have nausea, have vomited or feel dizzy.
 Ask patient if they are taking medication for erectile dysfunction.
9. Obtain baseline vital signs. 1
10. Interventions
 Place patient in position of comfort.
1
 Obtain medical direction or verbalize standing order for assisting patient with
their own nitroglycerin if systolic BP is above 100mmHg
11. Transport with reassessment and detailed physical exam enroute. 0.5
Total

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Chest Auscultation
Actions Points Points
Takes or verbalizes body substance isolation precautions Possibl Awarde
1
e d
Direct patient to breathe deeply through an open mouth. 1
Place stethoscope diaphragm directly on patient’s skin. 1
Listen
In a minimum of 4 fields anterior (front) and posterior (back):
Anterior
 3 fingers breadth below the clavicle at the midclavicular line, on right and
left sides.
 Just below the nipple line (6th intercostals space) midaxillary, on right and 7
left sides.
Posterior
 Upper back, 3 fingers breadth below the shoulder (not over the scapular
bone), on right and left sides.
 3 fingers breadth below the scapular bone, on right and left sides.
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Pulse Assessment
Points Points
Actions
Possible Awarded
1. Don appropriate standard precautions 1*
2. Choose site & Palpate Pulse
1) Carotid (lateral to thyroid cartilage and trachea)
2) Brachial (medial aspect of upper arm parallel to humerus)
3) Radial (thumb side of wrist)
4) Ulnar (little finger side of wrist)
1
5) Femoral (medial aspect of the inguinal fossa; two-thirds the distance
between the hip and groin)
6) Popliteal (behind knee)
7) Dorsalis pedis (top of foot)
8) Posterior tibial (behind medial malleolus)
3. Press lightly over area with fingertips of index, middle and ring fingers
1*
(Certain sites may require more pressure as the arteries lie deeper)
Evaluate Pulse
4. Evaluate rate
 Count pulse beats for 30 seconds and multiply by 2 to obtain beats per minute, or
2*
 Count pulse beats for 15 seconds and multiply by 4 to obtain beats per minute
 If pulse is irregular, count for 60 seconds
Descriptors: normal, tachycardic, bradycardic
5. Evaluate regularity: Pattern and equality of intervals between beats
2
Descriptors: regular, regularly irregular, irregularly irregular
6. Evaluate quality 1
7. Strength of pulse 1
8. Compare a central pulse (femoral, carotid) to a peripheral one (e.g., radial or
1
brachial) Descriptors: bounding, strong, normal, weak, thready
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Cardiac Arrest: Pulseless Electrical Activity (PEA)

Points Points
Actions
Possible Awarded
1. BSI 0.5
2. Establish unresponsiveness:
0.5
A. No respirations or only agonal respirations and no pulse.
3. Call for help.
4. C–A–B: Compressions, airway, breathing:
0.5
B. Begin CPR, starting with compressions.
C. Provide oxygen.
5. Attach AED or manual monitor-defibrillator as soon as available without
interrupting compressions.
A. When device is attached, stop CPR to assess rhythm.
0.5
• AED: No shock advised.
• Manual monitor-defibrillator: Organized rhythm (PEA). Do not
defibrillate.
6. Immediately resume CPR, beginning with compressions.
A. Provide 5 cycles (2 min) of uninterrupted CPR.
1.5
B. During CPR, establish IV or IO access.
C. Prepare vasopressors dose (epinephrine or vasopressin).
7. Stop CPR. Assess rhythm.
A. AED: No shock advised.
1
B. Manual monitor-defibrillator: Organized rhythm (PEA). Do not
defibrillate.
8. If PEA persists, immediately resume CPR, beginning with compressions.
A. Provide 5 cycles (2 min) of uninterrupted CPR.
B. Insert an advanced airway (ET tube, LMA, King LT, or Combitube) if basic
airway management is inadequate.
1
• Confirm correct tube placement without interrupting CPR.
• After correct placement is confirmed, deliver uninterrupted chest
compressions, at least 100/min for 2 min. Deliver 8–10 breaths/min at a
rate of 1 breathe every 6–8 sec.
9. Drugs 1.5
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
A. Administer epinephrine 1 mg.
• 10 mL of 1:10,000 IV/IO.
• Follow with 20 mL IV flush.
• Repeat every 3–5 min as needed.
B. A single dose of vasopressin 40 units IV/IO can replace the first or second
dose of epinephrine.
C. If no IV/IO access is available and the patient has an ET in place, stop
compressions and inject 2.0–2.5 mg (1:1,000) epinephrine diluted in 5–10
mL normal saline or sterile water directly into the ET every 3–5 min until
IV/IO access is available. Follow ET drug administration with 5 consecutive
ventilations to disperse drug into small airways for absorption into
pulmonary vasculature and resume compressions.
10. Continue CPR, check rhythm every 2 min.
A. If PEA persists, immediately resume CPR; check rhythm every 2 min. 1
B. Administer epinephrine every 3–5 min.
11. During CPR, consider and treat potentially reversible causes of PEA (Hs and Ts) 0.5
12. If rhythm changes to VF, pulseless VT, or asystole; follow algorithm for VF,
0.5
pulseless VT, or asystole
13. If rhythm converts to a stable ECG rhythm with ROSC:
A. Monitor and reevaluate the patient.
1
B. Arrange for transport to a critical care unit. The patient will need a
comprehensive care plan.
Total 10

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________

Cardiac Emergencies scenarios

You are called to a business office for a 38-year-old male complaining of indigestion. Coworkers tell you
that the pain started suddenly and he clutched his chest and vomited. He insists that he will be all right,
1.
and that it is probably something he ate. He is pale and diaphoretic. How would you best manage this
patient?
You are dispatched to a local personal care home for an elderly woman complaining of shortness of
breath. She is gasping for breath and is extremely anxious. Her legs are very swollen and she says she
took her "water pill" this morning. The staff tells you that she has a history of diabetes, congestive heart
2. failure, and hypertension. How would you best manage this patient?
A: Sit the patient upright with legs down. Administer high-flow oxygen and be prepared to ventilate
with BVM if needed. Monitor vital signs closely. Take her medications along to the hospital. Rapid
transport.
A person has high blood pressure. a medication that can effectively serve to lower his blood pressure is
3.
one that:
Your patient has chest pain, and you have just assisted him in taking his nitroglycerin table. Which one
4.
of the following patient statements is the cause for greatest concern?
You are caring for an alert and oriented patient with chest pain. He is receiving high-flow oxygen, and
two nitroglycerin tablets and an aspirin have been administered. Vital signs are stable, but he states
5.
that the chest pain seems to be worsening. When transporting him on the stretcher, which position is
best?
If a patient has a clot occluding the blood flow through his left coronary artery, which one of the
6.
following will occur first?
You are transporting a patient who had an episode of chest pain. On scene you assisted him in taking
his nitroglycerin, which completely, alleviated the chest pain. En route to the hospital, he asks you why
7.
the nitroglycerin takes the chest pain away. Which one of the following is the most appropriate
response?
You have been called for a 58-year-old male with an unknown medical emergency. On scene you find
the alert and oriented patient to be complaining of headaches as well as weakness and "tingling" to his
right arm and leg. He is diabetic and suffers from high blood pressure, for which he takes the
8. appropriate medications. When asked, he states that he thinks he may have passed out earlier in the
day, immediately after taking his morning dose of insulin. His pulse is 96, 16 and blood pressure 146/90
mmHg. Based on this presentation, you should treat the patient for:

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
You are assessing a 73-year-old male complaining of altered mental status and shortness of breath. The
patient is conscious, but confused. He is breathing at a rate of 20 breaths per minute. His pulse is rapid
and weak, and his skin cool and diaphoretic. An Emergency Medical Responder provides you with the
9.
following vital signs: pulse 136, respirations 20, blood pressure 168/88, and SpO2 at 89%. Family states
that he is diabetic and takes insulin. He also has a history of hypertension, colon cancer, irregular
heartbeat, and transient ischemic attacks. Which one of the following should you do next?
10. Which one of the following patient statements should make an EMT suspect primary hypertension?
Which one of the following statements about cardiac compromise or acute coronary syndrome should
11.
the EMT recognize as true?
You are treating a patient complaining of altered mental status, shortness of breath, and chest pain. A
12. paramedic has just administered a medication that causes the sympathetic nervous system to increase
its influence in the body. Which one of the following actions should you anticipate?
13. Which one of the following is a typical statement made by a patient with unstable angina?
After being dispatched for a male patient experiencing shortness of breath, you arrive to find a 67-year-
old man sitting upright at his kitchen table in severe respiratory distress. He is responsive to verbal
14. stimuli, but confused, and has an open airway. His breathing is extremely labored and inadequate, and
hs skin is cool, diaphoretic, and dusky in color. Family states a history of hypertension and angina, for
which he takes nitroglycerin. Your immediate action in caring for this patient is to:
Which one of the following patient statements should cause the EMT to suspect an abdominal aortic
15.
aneurysm?
You suspect that a patient with a history of chronic obstructive pulmonary disease (COPD) is suffering
16. from right ventricular disease. From your assessment, which one of the following findings reinforces
your suspicion?
17. When treating a patient with chest pain in the prehospital setting, the primary goal of the EMT is to:
18. Regarding arteries, the EMT should recognize that all arteries:
Your patient is complaining of chest pain that radiates into his neck and arms. The primary assessment
19. reveals a patent airway, adequate breathing, and a strong, regular radial pulse. His skin is warm and dry,
and it reveals no signs of inadequate perfusion. Which one of the following should you do next?
20. The EMT shows she is correctly administering aspirin to a patient with chest pain when she provides:
You have been called for a patient with angina. On scene the 67-year-old man reports that he has a
history of angina and the pain started when he was moving firewood from the garage into his house.
21.
Unfortunately, the pain has yet to go away, despite three nitroglycerin tablets and 20 minutes of rest.
Your next action should be to:

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
An alert and oriented patient presents with shortness of breath, crackles in lungs, jugular venous
22. ditention, and edema to the feet and ankles. Her pulse is 132, respiration 24, blood pressure 160/86,
and SpO2 at 88%. Based on this, the EMT should suspect.
You are by the side of a patient complaining of severe chest pain that radiates into his right arm and
neck. He is alert and oriented with an open airway and adequate breathing. His radial pulse is strong,
and his skin is cool and diaphoretic. Your partner reports his pulse rate is 84, respirations are 18, blood
23. pressure is 86/62 mmHg, and SpO2 is 98% on a nonrebreather mask. You have obtained a medical
history and performed the secondary assessment. The patient states that he has had two heart attacks
in the past and is allergic to aspirin and sulfa medications. Which one of the following should you do
next?
24. Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that the:
When assessing a patient in the prehospital setting, which one of the following does the EMT recognzie
25.
as an indication for aspirin.
You are transporting a patient with chest pain to the hospital emergency department. In regards to
26. possible fibrinolytic therapy, which one of the following should you relay as a possible relative
contraindication to this therapy.
When obtaining a medical history, which one of the following patient statements seemingly indicates
27.
that he is suffering from classic angina?
A TV reporter has been assigned to your ambulance for a ride-along. He is doing a segment on the local
EMS services fro EMS week. In your down time at the station, he tells you that his wife was diagnosed
28.
with atherosclerosis. He is unsure what the condition is and asks you to explain it to him. Which one of
the following is the most appropriate response?
Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back
29.
up in and fill the lung tissue?
30. In the blood, which one of the following is responsible for the formation of blood clots?
A patient has a low platelet count in his blood. Based on this, for which one of the following is he at
31.
risk?

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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
Cardiac Emergencies scenarios - Answers
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
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 Cardiac Emergencies EMSP 344 Draft

Student's Name:_________________________________ AC. Number: _______________

Evaluator:________________________ Date:______________________
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