What do you think of this quiz question?

[word2yamutha]

The left side of the patients heart is in severe failure, causing blood to back up behind it. Which one of the following signs and symptoms are you most likely to see in this patient?

1. crackling in the lungs
2. swelling in the feet

I cant remember the other 2, but it was easy to narrow these two down.

 

[el Murpharino]

If you remember from A&P how the circulation of blood to and from the heart goes, you should be able to fairly quickly point out the answer they're looking for. You may be able to memorize the answer to this question, but are you learning the flow of blood around the body? Clues like these can provide valuable insight when doing patient assessment...

To make it simple, from the lungs, the pathway of blood is through the pulmonary vein to the left atrium, through the bicuspid valve and into the left ventricle.

 

[word2yamutha]

The left side is to the lungs and the right side is to the rest of the body. Well to my understanding I thought it was a trick question. The questions stats "what are you mostly likely to see." The last time I check I cant see crackling lungs

 

[Incyder38]

with the question relating specifically to a left sided failure, the answer is 1. As Mr. Murpharino stated, it makes a difference....good question for EMT students though...makes you think specifics.

 

[word2yamutha]

i knew it was crackling lungs but if the left side fails then ride side will eventually fail thus making swelling in the feet

 

[el Murpharino]

i knew it was crackling lungs but if the left side fails then ride side will eventually fail thus making swelling in the feet

Don't read too much into your questions....take what the question asks and answer that part of it only. Again, the original question is asking about left-sided failure only...which could lead to dependent edema, but your first symptom will be the rales. Had the question asked about right-sided failure, you'd be right to choose the answer about the swelling in the legs. Does that help any?

 

[word2yamutha]

Yeah i got it. I just think the question is poorly worded. It should say which should occur. I feel like im taking a reading comprehension test as well as an emt test.

 

[JPINFV]

1. Deciding answer 2 based on the word "see" is thinking to far into it.

2. Deciding answer 2 based on "eventually left side heart failure will cause right sided heart failure" is thinking to far into it.

This seems like a pretty basic question about CHF that one could expect to see at any level of health care education.

 

[Shishkabob]

The left side is to the lungs and the right side is to the rest of the body. Well to my understanding I thought it was a trick question. The questions stats "what are you mostly likely to see." The last time I check I cant see crackling lungs

No. The right ventricle is for pulmonic circulation (to the lungs) and the left ventricle is for systemic circulation (to the body[system]).

 

[JPINFV]

No. The right ventricle is for pulmonic circulation (to the lungs) and the left ventricle is for systemic circulation (to the body[system]).

...unless you're looking at where venous blood backs up to during CHF.

 

[Shishkabob]

If that's what he meant then he needs to word his post better, because the logical conclusion was that he got it wrong since he didn't know the answer to the original question to begin with.

 

[EMTinNEPA]

The left side of the heart receives blood from the pulmonary vein while the right side receives it from the superior and inferior vena cava. If the left side were to fail, you would see pulmonary edema before peripheral edema as the blood would back up into the lungs before it backed up further.

 

[8jimi8]

I think you are nit-picking on the wording of your question.

The answer is obvious. Let me ask you this which is likely to kill your patient first.

You need to be thinking that way when it comes to NR and Patient Care.

Are you gonna worry about elevating your patient's feet before giving him lasix, had you been out on a call and found only those two symptoms during your assessment??

 

[JPINFV]

Now trendelenburg... another fine piece of mythology that ranks up there with the golden hour.

 

[8jimi8]

sorry that the elevated feet was a nursing intervention. I realize it is of little use in a 5 minute ride to the ER. When you take care of patients who are laying in bed for 12 hours, you DO elevate their feet.

 

[JPINFV]

This isn't about nursing v medicine v EMS. It's about evidence based medicine. I'd like to see one piece of published evidence that trendelenburg works. Every single study on it I've seen has not been able to proove that it increases cardiac output. On the other hand, there are a few major, if rare, complications when full trendelenburg (body tilt vs leg lift) is performed.

 

[8jimi8]

This isn't about nursing v medicine v EMS. It's about evidence based medicine. I'd like to see one piece of published evidence that trendelenburg works. Every single study on it I've seen has not been able to proove that it increases cardiac output. On the other hand, there are a few major, if rare, complications when full trendelenburg (body tilt vs leg lift) is performed.

Before I prove your point, you must prove mine.

Where did i say t-berg???

I said elevate the feet. What I didn't say was "AND the Head." In nursing there is a concept known as dependent edema and the inference to which I was referring to was really to elevate ANY edematous extremity. If you go to a hospital you will notice that not many people are lying 180 degrees flat.

So please don't put words in my mouth

and please know that I too also understand the concept of tricking the "baroreceptor's into interpreting an increase in blood pressure :. reducing cardiac output."

 

[JPINFV]

Ahh... gotcha...

Essentially every time I've heard leg raising prior to this, it was for trendelenburg or "shock" position. Hence why I made the conection.

 

[8jimi8]

No worries, brother! Good on you for your assistance in destroying medical myths!

Honestly, I thought, only after pushing send... i shouldn't have just said elevate the feet, but then I was already walking away to bed!

** Oh and a correction to my statement about elevating ANY edematous extremity... (because you wouldn't want to elevate an edematous envenomation!)