NREMT Paramedic Cognitive ExamOperationsEasy
A paramedic is called to a local high school for a 16-year-old male who collapsed during a soccer game. The patient is unresponsive, apneic, and pulseless. Bystander CPR is in progress. The AED advises 'No Shock Advised.' What is the MOST appropriate next step for the paramedic?
- ACheck for a pulse and if none, resume CPR.
- BContinue CPR and prepare for immediate transport.
- CDeliver a shock immediately, overriding the AED's advice.
- DAttach advanced cardiac monitoring and administer epinephrine.
Show answer & explanationAnswer & explanation
Correct answer: A. Check for a pulse and if none, resume CPR.
When an AED advises 'No Shock Advised' on an unresponsive, apneic, pulseless patient, it indicates a non-shockable rhythm (asystole or PEA). The appropriate action is to confirm pulselessness and immediately resume high-quality CPR without interruption, while simultaneously attaching advanced monitoring if available.
Why the other options are wrong
- B. While CPR continues, a quick pulse check confirms the rhythm and guides further actions; immediate transport without further intervention is premature.
- C. Never override an AED's 'No Shock Advised' message; doing so could deliver an inappropriate and harmful shock.
- D. Advanced monitoring and epinephrine are appropriate, but the priority after 'No Shock Advised' is to resume CPR after confirming pulselessness.
AED 'No Shock Advised'
An AED message indicating that the patient's cardiac rhythm is not shockable (e.g., asystole or pulseless electrical activity), requiring immediate continuation of CPR.
- Means the rhythm is either asystole or PEA.
- Do NOT deliver a shock.
- Immediately resume high-quality chest compressions.
- Check pulse, if none, continue CPR.
Memory trick: Shock If Advised, Otherwise Pump Hard and Fast.