NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 68-year-old male presents with acute onset of shortness of breath, orthopnea, and bilateral crackles on auscultation. His blood pressure is 180/100 mmHg, heart rate 110 bpm, and SpO2 is 88% on room air. He has a history of congestive heart failure. Which of the following is the most appropriate initial pharmacological intervention?
- AAdenosine 6 mg IV push
- BNitroglycerin 0.4 mg sublingually
- CAspirin 325 mg orally
- DAtropine 0.5 mg IV
Show answer & explanationAnswer & explanation
Correct answer: B. Nitroglycerin 0.4 mg sublingually
This patient is presenting with signs and symptoms of acute pulmonary edema secondary to congestive heart failure. Nitroglycerin is indicated to reduce preload and afterload, thereby decreasing myocardial oxygen demand and improving pulmonary congestion. His blood pressure is also elevated, making nitroglycerin a safe and effective choice.
Why the other options are wrong
- A. Adenosine is used for stable narrow-complex tachycardia, not for this presentation.
- C. Aspirin is indicated for acute coronary syndromes, not the primary treatment for acute pulmonary edema.
- D. Atropine is used for symptomatic bradycardia, which this patient does not have.
Acute Pulmonary Edema Management
Acute pulmonary edema is a life-threatening condition characterized by fluid accumulation in the lungs, often due to left ventricular failure.
- Often presents with severe dyspnea, orthopnea, and crackles.
- Management focuses on reducing preload and afterload.
- Nitroglycerin, diuretics, and CPAP are common interventions.
Memory trick: Fluid in the lungs, heart's in a bind, Nitro and CPAP, relief you will find.