EMT cardiology practice questions

A. Move the patient away from standing water, dry the chest if needed, and apply the AED. The key clues are the patient is pulseless, CPR is already in progress, an AED is immediately available, and the patient is lying on a wet bathroom floor. Water near the patient creates an electrical safety concern, but it does not prevent AED use once appropriate precautions are taken. The patient should be moved away from standing water, the chest should be quickly dried if necessary so the pads adhere properly, and the AED should be applied as soon as possible while minimizing interruptions in CPR. Correcting the immediate water hazard allows early defibrillation to occur safely without unnecessarily delaying a potentially lifesaving shock.

B. Circulate oxygenated blood until the heart recovers. The key clues are the patient is unresponsive, not breathing normally, pulseless, and chest compressions have been initiated during cardiac arrest. High-quality chest compressions manually compress the heart between the sternum and spine, generating blood flow to the brain, heart, and other vital organs until the heart can effectively pump on its own. Maintaining adequate compression depth, rate, full chest recoil, and minimal interruptions maximizes perfusion and improves the likelihood of successful resuscitation. The primary purpose of chest compressions is to circulate oxygenated blood to vital organs until spontaneous circulation can be restored.

A. Upper right chest below the clavicle and lower left chest near the midaxillary line Effective defibrillation requires an electrical pathway that carries sufficient current through the ventricular myocardium. In the anterolateral configuration, the upper and lateral pad locations place the heart between the pads, helping maximize the amount of current that crosses the ventricles. Pads placed too close together or too far from the recommended landmarks may create a less effective current pathway through the heart. Use the patient's clavicle and midaxillary line as landmarks to create an effective transthoracic pathway through the ventricular myocardium.

B. The gasping respirations represent agonal breathing and should be treated as ineffective breathing. The key clues are unresponsiveness, absence of a carotid pulse, and occasional gasping respirations, which identify cardiac arrest with agonal breathing. Agonal gasps may be slow, irregular, and separated by long pauses. They are not effective respirations and should not be mistaken for signs of adequate breathing. Agonal gasping in a pulseless patient should be treated as cardiac arrest, with CPR and AED use initiated promptly.

D. Immediately assess for a carotid pulse and begin CPR if no pulse is present. The key clues are the patient has not yet been transferred to hospital staff, suddenly becomes unresponsive, and is only gasping while EMS is preparing to give report. Gasping respirations, also called agonal respirations, should not be mistaken for normal breathing and should immediately raise concern for cardiac arrest. The EMT should rapidly assess for a carotid pulse for no more than 10 seconds and, if no pulse is present, begin high-quality CPR immediately while requesting assistance from emergency department personnel. Resuscitation should begin without delay because EMS remains responsible for the patient's care until an appropriate handoff has occurred. Until patient care has been formally transferred, the EMT remains responsible for recognizing cardiac arrest and immediately initiating resuscitation regardless of the location.

B. Continue high-quality CPR while another rescuer retrieves the AED. The key clues are the patient is unresponsive, pulseless, and apneic, CPR was started immediately after collapse, another responder is available, and the AED is not yet at the patient's side. High-quality CPR should continue without interruption while the available responder retrieves the AED because both early CPR and early defibrillation are essential links in the Chain of Survival. Assigning separate tasks allows blood flow to the heart and brain to continue while minimizing the time until rhythm analysis and defibrillation can occur if indicated. Whenever enough rescuers are available, divide responsibilities so CPR continues uninterrupted while another rescuer retrieves the AED because continuous compressions and early defibrillation work together to improve survival.

C. Carotid pulse The key clues are the patient's unresponsiveness and the need to determine whether cardiac arrest is present. The carotid artery is the recommended pulse assessment site for unresponsive adults because it is a large central artery that is more likely to remain palpable during severe hypotension. EMTs should spend no more than 10 seconds checking for a pulse before beginning CPR if one is not definitely present. Prompt pulse assessment minimizes interruptions and improves the likelihood of successful resuscitation.

B. Acute coronary syndrome (ACS) Heavy substernal pressure occurring during exertion, accompanied by diaphoresis, pallor, and radiation into the left arm, is a classic presentation of acute coronary syndrome. ACS results from a sudden reduction in blood flow through a coronary artery, producing myocardial ischemia that may progress to infarction if not rapidly treated. Early recognition is essential because patients may benefit from aspirin, nitroglycerin when appropriate, rapid transport, and definitive reperfusion therapy. EMTs should promptly assess for contraindications to indicated medications, obtain a focused cardiac history, and provide early notification to the receiving facility.

A. Assist the patient with the prescribed nitroglycerin. The key clues are active chest pressure, prescribed nitroglycerin, an adequate blood pressure, and the absence of identified contraindications. At the EMT level, assisting a patient with prescribed nitroglycerin is appropriate when indications are present and protocol requirements are met. Nitroglycerin produces vasodilation, which can reduce cardiac workload and myocardial oxygen demand. When prescribed nitroglycerin is indicated and no contraindications are identified, the EMT should assist with its administration according to local protocol.

B. Nitroglycerin may be causing symptomatic hypotension. The patient's blood pressure has fallen from 142/90 mmHg to 96/60 mmHg, and the new onset of dizziness indicates that the decrease is producing symptoms of inadequate cerebral perfusion. Nitroglycerin causes venous and arterial vasodilation, reducing preload and myocardial oxygen demand, but excessive vasodilation may also produce clinically significant hypotension. When symptomatic hypotension develops after nitroglycerin administration, additional doses should be withheld while the patient's airway, breathing, circulation, and blood pressure are closely reassessed. EMTs should continue supportive care and promptly notify the receiving facility of the patient's response to treatment.

A. Perform a focused cardiac assessment and determine whether the patient is a candidate for aspirin and nitroglycerin. A focused cardiac assessment is the priority because it identifies findings that guide immediate treatment decisions while confirming whether the patient is a candidate for medications such as aspirin and nitroglycerin. The EMT should rapidly assess vital signs, blood pressure, pulse quality, respiratory status, oxygenation, medication history, allergies, and contraindications to treatment while continuing the primary assessment. This focused evaluation allows prompt recognition of acute coronary syndrome and ensures medications are administered safely. Early assessment, appropriate treatment, rapid transport, and ongoing reassessment provide the best opportunity to limit myocardial injury.

B. The patient has progressed to cardiac arrest and requires immediate resuscitation. The key clues are sudden unresponsiveness, absence of normal breathing, and no pulse detected within 10 seconds. These findings indicate cardiac arrest and require immediate initiation of high-quality CPR. An AED should be applied as soon as available, and interruptions in chest compressions should be minimized. The preceding heavy chest pain and shortness of breath also make an acute cardiac event a likely cause of the deterioration. An unresponsive patient who is not breathing normally and has no definite pulse within 10 seconds should be treated immediately for cardiac arrest.