NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 65-year-old male with a history of heart failure complains of sudden onset of severe shortness of breath, orthopnea, and a productive cough with pink, frothy sputum. His vital signs are BP 160/90 mmHg, HR 115 bpm, RR 30 bpm with crackles bilaterally, and SpO2 88% on room air. Which of the following medications is indicated to improve this patient's condition?
- AAdenosine 6 mg IV rapid push.
- BAtropine 0.5 mg IV.
- CFurosemide 40 mg IV.
- DMagnesium sulfate 2 g IV.
Show answer & explanationAnswer & explanation
Correct answer: C. Furosemide 40 mg IV.
The patient's presentation is classic for acute decompensated heart failure with pulmonary edema, characterized by severe shortness of breath, orthopnea, crackles, and pink frothy sputum. Furosemide, a loop diuretic, is indicated to reduce fluid overload and improve respiratory status.
Why the other options are wrong
- A. Adenosine is used for supraventricular tachycardias (SVTs), not congestive heart failure.
- B. Atropine is used for symptomatic bradycardia, not acute heart failure.
- D. Magnesium sulfate is used for Torsades de Pointes or severe asthma, not acute heart failure.
Acute Pulmonary Edema Management
Acute pulmonary edema, often a complication of heart failure, is characterized by fluid accumulation in the lungs. Treatment focuses on reducing fluid overload, improving oxygenation, and decreasing cardiac workload.
- Diuretics (e.g., furosemide) are key to reduce fluid.
- Nitroglycerin can reduce preload and afterload.
- CPAP/BiPAP can improve oxygenation and reduce work of breathing.
Memory trick: Think 'LOAD' for the treatment: Lasix, Oxygen, ACE inhibitors, Diuretics.