NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesMedium
A 55-year-old male is experiencing sudden, severe, tearing back pain that radiates to his abdomen. He is pale, diaphoretic, and his radial pulses are weak and unequal. His blood pressure is 90/60 mmHg and heart rate is 110 bpm. What is the most appropriate initial management for this patient?
- AAdminister nitroglycerin sublingually.
- BEncourage the patient to walk slowly to the ambulance.
- CRapid transport to a facility capable of vascular surgery.
- DAssist with administration of his prescribed albuterol.
Show answer & explanationAnswer & explanation
Correct answer: C. Rapid transport to a facility capable of vascular surgery.
The patient's symptoms (sudden, tearing back pain radiating to the abdomen, weak and unequal pulses, hypotension, and tachycardia) are highly suggestive of a dissecting aortic aneurysm. Rapid transport to a specialized facility is critical as this condition is life-threatening and requires immediate surgical intervention.
Why the other options are wrong
- A. Nitroglycerin is contraindicated in hypotension and would worsen the patient's condition.
- B. Encouraging the patient to walk would exacerbate the condition and is inappropriate given the suspected severity.
- D. Albuterol is used for respiratory distress, not for abdominal/back pain or suspected aortic dissection.
Dissecting Aortic Aneurysm
A serious condition in which the inner layer of the aorta tears, allowing blood to surge through the tear and separate the inner and middle layers of the aorta.
- Sudden, severe, tearing pain (chest, back, abdomen)
- Pulse deficits or unequal blood pressures between extremities
- Rapidly fatal if not surgically managed
Memory trick: Tear and Transport, Time is Tissue