NREMT Paramedic Cognitive ExamOperationsMedium
A paramedic is evaluating a 65-year-old male with a history of heart failure who presents with acute dyspnea, orthopnea, and bilateral crackles on auscultation. His blood pressure is 160/90 mmHg, heart rate 110 bpm, and SpO2 88% on room air. The patient is anxious and states he feels like he's drowning. Which of the following medications is MOST appropriate to administer to reduce preload and improve respiratory effort in this patient?
- AAtropine
- BNitroglycerin
- CDopamine
- DEpinephrine
Show answer & explanationAnswer & explanation
Correct answer: B. Nitroglycerin
The patient's presentation is consistent with acute pulmonary edema, likely due to left-sided heart failure. Nitroglycerin is a potent vasodilator that reduces both preload and afterload, thereby decreasing the workload on the heart and improving pulmonary congestion. Other options are inappropriate for this condition.
Why the other options are wrong
- A. Atropine is used for bradycardia, which is not the primary issue here.
- C. Dopamine is a vasopressor and inotrope, typically used for hypotension, which is not present, and would increase cardiac workload.
- D. Epinephrine would worsen the patient's heart rate and blood pressure, increasing cardiac workload.
Acute Pulmonary Edema Management
Emergency treatment for fluid accumulation in the lungs, often due to left-sided heart failure, focusing on improving oxygenation, reducing cardiac workload, and removing fluid.
- Commonly caused by acute left ventricular failure.
- Symptoms include severe dyspnea, orthopnea, crackles, and often hypertension.
- Treatment involves oxygen, vasodilators (e.g., nitroglycerin), diuretics, and sometimes CPAP.
Memory trick: Oxygen, Sit Up, Nitro, Push the Fluid Out, Don't Drown.