NREMT Paramedic: Cardiology Latest Updated Questions and CORRECT Answers

You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision. As you are assessing him, he tells you that he has congestive heart failure and atrial fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely responsible for this patient's clinical presentation? - Digoxin. This patient has classic signs of digitalis toxicity. Digoxin is commonly prescribed to patients with congestive heart failure and atrial fibrillation (A-Fib) or atrial flutter (A-Flutter). Its positive inotropic effects increase cardiac contractility and maintain cardiac output, while its negative chronotropic effects control the ventricular rate of the A-Fib or A-Flutter. Digitalis preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic index—that is, there is a fine line between a therapeutic and toxic dose. You should suspect digitalis toxicity in any patient who takes Digoxin or Lanoxin and presents with complaints such as nausea, vomiting, abdominal pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac dysrhythmia can be caused by the toxic effects of digitalis. Treatment involves the administration of Digibind, which is given at the hospital. Which of the following is an absolute contraindication for fibrinolytic therapy? - Subdural hematoma 3 years ago. According to current emergency cardiac care (ECC) guidelines, absolute contraindications for fibrinolytic therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural, intracerebral hematoma); known structural cerebrovascular lesion (ie, arteriovenous malformation); known malignant intracranial tumor (primary or metastatic); ischemic stroke within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours; suspected aortic dissection; active bleeding or bleeding disorders (except menses); and significant closed head trauma or facial trauma within the past 3 months. Relative contraindications (eg, the physician may deem fibrinolytic therapy appropriate under certain circumstances) include, a history of chronic, severe, poorly-controlled hypertension; severe uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago; dementia; traumatic or prolonged (> 10 minutes) CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding; noncompressible vascular punctures; pregnancy; prior exposure (> 5 days ago) or prior allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of anticoagulants (ie, Coumadin). A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you should: - Administer up to 325 mg of aspirin. Since oxygen has already been administered to this patient and your partner is attaching the ECG leads, you should administer aspirin (160 to 325 mg, non-enteric-coated). Early administration of aspirin has clearly been shown to reduce mortality and morbidity in patients experiencing an acute coronary syndrome (ACS). After establishing vascular access, you should assess his vital signs and then administer 0.4 mg of nitroglycerin (up to 3 doses, 5 minutes apart), provided that his systolic BP is greater than 90 mm Hg. If 3 doses of nitroglycerin fail to completely relieve his chest discomfort, consider administering 2 to 4 mg of morphine IV, provided that his systolic BP remains above 90 mm Hg. Which of the following ECG lead configurations is correct? - To assess lead II, place the negative lead on the right arm and the positive lead on the left leg. According to the Einthoven triangle, lead I is assessed by placing the negative (white) lead on the right arm and the positive (red) lead on the left arm. Lead II is assessed by placing the negative lead on the right arm and the positive lead on the left leg. Lead III is assessed by placing the negative lead on the left arm and the positive lead on the left leg. A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes ago. He is diaphoretic, anxious, and rates his pain as an an 8 over 10. His past medical history is significant for hypertension, type II diabetes, and coronary stent placement 2 months ago. He takes lisinopril, Plavix, and Glucophage, and is wearing a medical alert bracelet stating "allergic to salicylates." His blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and respirations are 22 breaths/min. The 12-lead ECG shows sinus tachycardia with 3-mm ST segment elevation in leads V1 through V5. Which of the following treatment modalities is MOST appropriate for this patient? - Supplemental oxygen, vascular access, up to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is greater than 90 mm Hg and he is still experiencing pain. The patient is experiencing an acute coronary syndrome (ACS). His 12-lead ECG indicates anteroseptal injury with lateral extension (ST elevation in leads V1 through V5). Appropriate treatment includes oxygen (maintain an SpO2 of greater than 94%), vascular access, up to three 0.4 mg doses of nitroglycerin (NTG), and 2 to 4 mg of morphine if NTG fails to relieve his pain and his systolic BP is above 90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for analgesia. Aspirin, a salicylate, is also given to patients with ACS; however, this patient is allergic to salicylates. Obtain a right-sided 12-lead ECG in patients with signs of inferior wall injury (ST elevation in leads II, III, aVF). Inferior wall infarctions may involve the right ventricle; a right-sided 12-lead ECG will help confirm this. Apply the multipads to the patient, not because he is at risk for bradycardia (more common with inferior infarctions), but because he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach. You and your team are performing CPR on a 70-year-old male. The cardiac monitor reveals a slow, organized rhythm. His wife tells you that he goes to dialysis every day, but has missed his last three treatments. She also tells you that he has high blood pressure, hyperthyroidism, and has had several cardiac bypass surgeries. Based on the patient's medical history, which of the following conditions is the MOST likely underlying cause of his condition? - Hyperkalemia. Although any of the listed conditions could be causing this patient's condition, the fact that he missed his last three dialysis treatments should make you most suspicious for hyperkalemia. Dialysis filters metabolic waste products from the blood in patients with renal insufficiency or failure. If the patient is not dialyzed, these waste products, including potassium and other electrolytes, accumulate to toxic levels in the blood. In addition to performing high-quality CPR, managing the airway, and administering epinephrine, your protocols may call for the administration of calcium chloride and sodium bicarbonate if hyperkalemia is suspected. Albuterol also has been shown to be effective in treating patients with hyperkalemia becauses it causes potassium to shift back into the cells; it can be nebulized down the ET tube or administered intravenously. Follow your local protocols regarding the treatment for suspected hyperkalemia. Which of the following represents the MOST appropriate initial drug and dose that is given to all adult patients in cardiac arrest? - 10 mL of epinephrine 1:10,000 every 3 to 5 minutes. Once vascular access has been obtained (IV or IO), the first drug and dose given to all patients in cardiac arrest—regardless of the rhythm on the cardiac monitor—is epinephrine 1 mg (10 mL) of a 1:10,000 solution, repeated every 3 to 5 minutes. You may consider a onetime dose of vasopressin (40 units) to replace the first or second dose of epinephrine, but not both. Higher doses of epinephrine may be necessary if special circumstances exist (ie, severe beta-blocker toxicity). Consult with medical control as needed. The MOST appropriate initial action for a 54-year-old man who presents with the following cardiac rhythm should consist of: - Assessing the patient's clinical status. When assessing the cardiac rhythm of any patient, you must interpret it in the context of his or her clinical status. Before you reach for atropine or a pacemaker, determine if the bradycardia is causing hemodynamic compromise (ie, hypotension, altered mental status,