NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 58-year-old male presents with sudden onset of crushing substernal chest pain radiating to his left arm and jaw. He is pale, diaphoretic, and complains of shortness of breath. His vital signs are BP 100/60 mmHg, HR 110 bpm, RR 22 bpm, SpO2 92% on room air. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following interventions should be prioritized for this patient?
- APrepare for immediate transport to a percutaneous coronary intervention (PCI) capable facility.
- BAdminister aspirin 325 mg orally.
- CAdminister a bolus of intravenous fluids.
- DInitiate continuous positive airway pressure (CPAP).
Show answer & explanationAnswer & explanation
Correct answer: A. Prepare for immediate transport to a percutaneous coronary intervention (PCI) capable facility.
The patient's presentation with crushing chest pain, radiating pain, and ST-segment elevation in inferior leads is indicative of an ST-elevation myocardial infarction (STEMI). Rapid transport to a PCI-capable facility is the most critical intervention to restore blood flow and minimize myocardial damage.
Why the other options are wrong
- B. Aspirin is appropriate, but transport to PCI is the highest priority for STEMI.
- C. Fluid bolus could worsen pulmonary edema in a cardiac patient and is contraindicated given the patient's likely cardiac compromise.
- D. CPAP might be considered for severe respiratory distress due to pulmonary edema, but not the primary intervention for acute STEMI.
STEMI Management Priority
For ST-elevation myocardial infarction (STEMI), rapid reperfusion therapy, typically via percutaneous coronary intervention (PCI), is the highest priority to minimize myocardial damage.
- STEMI indicates complete coronary artery occlusion.
- Time is muscle: faster reperfusion improves outcomes.
- PCI is preferred over fibrinolysis if available within a reasonable timeframe (e.g., 90-120 minutes door-to-balloon).
Memory trick: ST elevation means 'Send Them Immediately' to the cath lab!