NREMT Paramedic Cognitive ExamOperationsEasy
A 45-year-old male presents with severe chest pain. During transport, the patient becomes unresponsive and pulseless. The cardiac monitor shows ventricular fibrillation. After initiating CPR, what is the most appropriate next intervention for this patient?
- ADefibrillate immediately at the appropriate joule setting
- BAdminister 1 mg Epinephrine IV/IO
- CInitiate rapid fluid bolus of normal saline
- DEstablish advanced airway and continue ventilation
Show answer & explanationAnswer & explanation
Correct answer: A. Defibrillate immediately at the appropriate joule setting
For an adult patient in ventricular fibrillation, immediate defibrillation is the critical intervention to convert the rhythm. High-quality CPR should precede and follow defibrillation, but defibrillation itself is the priority for this rhythm.
Why the other options are wrong
- B. Epinephrine is administered after initial defibrillation attempts and CPR, not as the immediate first intervention for V-fib.
- C. Fluid bolus is not indicated for ventricular fibrillation unless hypovolemia is suspected as the cause, which is not stated here.
- D. Airway management is important but takes secondary priority to defibrillation in a shockable rhythm.
Ventricular Fibrillation (V-fib) Management
A chaotic electrical activity in the ventricles causing them to quiver uselessly instead of contracting effectively, leading to immediate cardiac arrest. The primary treatment is rapid defibrillation.
- Life-threatening arrhythmia requiring immediate intervention.
- Characterized by irregular, uncoordinated electrical activity.
- Defibrillation is the definitive treatment.
Memory trick: Shock the heart, save the start!