NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesMedium
A 22-year-old female presents with sudden onset of severe, crushing chest pain that radiates to her left arm. She is pale, diaphoretic, and complaining of shortness of breath. Her friends state she has been using cocaine all night. What is the most critical immediate intervention for this patient?
- APrepare for rapid transport to a cardiac center.
- BObtain a 12-lead ECG.
- CAdminister nitroglycerin sublingually.
- DAdminister aspirin 324 mg orally.
Show answer & explanationAnswer & explanation
Correct answer: B. Obtain a 12-lead ECG.
While the patient's symptoms are highly suggestive of an acute coronary syndrome (ACS), and cocaine use increases this risk, the most critical immediate diagnostic intervention is to obtain a 12-lead ECG. This will differentiate between STEMI (ST-elevation myocardial infarction), NSTEMI, or unstable angina, which guides subsequent treatment. Aspirin is likely indicated, but the ECG is crucial for determining the immediate path of care.
Why the other options are wrong
- A. Rapid transport is essential, but obtaining an ECG en route (if possible) or immediately upon arrival at the hospital is still a priority for definitive diagnosis and treatment planning.
- C. Nitroglycerin is generally contraindicated in cocaine-induced chest pain as it can worsen coronary vasoconstriction and may lead to profound hypotension, or it may be cautiously given if BP is adequate and STEMI is ruled out.
- D. Aspirin is often indicated for ACS, but a 12-lead ECG is needed first to guide treatment decisions and identify STEMI.
Cocaine-Induced Chest Pain Management
Management of acute chest pain in patients with recent cocaine use, which can lead to myocardial ischemia or infarction due to coronary vasoconstriction and increased myocardial oxygen demand.
- Cocaine increases risk of MI/ACS.
- 12-lead ECG is crucial for diagnosis.
- Nitroglycerin use is cautious/contraindicated.
- Benzodiazepines may be used for agitation and to reduce cardiac workload.
Memory trick: ECG First, Then Treat