NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 50-year-old male presents with acute onset of severe substernal chest pain that began 30 minutes ago. He is diaphoretic and anxious. His ECG shows ST elevation in leads V2-V4. His blood pressure is 130/80 mmHg, HR 90 bpm, RR 18 bpm, SpO2 97% on room air. What is the MOST appropriate initial medication to administer for pain relief, assuming no contraindications?
- ANitroglycerin 0.4 mg sublingually
- BAspirin 325 mg orally
- CMorphine sulfate 2-4 mg IV
- DFentanyl 25-50 mcg IV
Show answer & explanationAnswer & explanation
Correct answer: A. Nitroglycerin 0.4 mg sublingually
The patient's presentation is indicative of an acute anterior ST-elevation myocardial infarction (STEMI). Nitroglycerin is the primary medication for pain relief in STEMI, as it causes vasodilation, reduces preload and afterload, and improves coronary blood flow, thereby decreasing myocardial oxygen demand and relieving ischemia. It should be administered first, assuming no contraindications like hypotension or PDE5 inhibitor use.
Why the other options are wrong
- B. Aspirin is crucial for antiplatelet effects in STEMI but is not administered primarily for pain relief.
- C. Morphine is used for pain relief if nitroglycerin is ineffective or contraindicated, but it's not the first-line agent.
- D. Fentanyl is an alternative opioid for pain relief, but nitroglycerin is still the initial choice for ischemic pain.
STEMI Pain Management Priority
For acute ST-elevation myocardial infarction (STEMI), initial pain management prioritizes nitroglycerin to reduce myocardial oxygen demand and improve coronary blood flow.
- Nitroglycerin is a potent vasodilator, reducing preload and afterload.
- It helps relieve ischemic chest pain.
- Administered sublingually, transdermally, or intravenously.
- Contraindicated if hypotensive, bradycardic, or recent PDE5 inhibitor use (e.g., Viagra).
Memory trick: Nitro First, Then Opioids for STEMI Pain!