NREMT Paramedic Cognitive ExamCardiology & ResuscitationHard
A 55-year-old male presents with sudden onset of severe, tearing chest pain radiating to his back. He has a history of uncontrolled hypertension. His blood pressure is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. His heart rate is 110 bpm. Which of the following is the most appropriate initial management for this patient?
- AAdminister sublingual nitroglycerin 0.4 mg.
- BAdminister aspirin 325 mg orally.
- CInitiate IV fluids wide open to support blood pressure.
- DPrepare for rapid transport to a cardiac specialty center.
Show answer & explanationAnswer & explanation
Correct answer: D. Prepare for rapid transport to a cardiac specialty center.
This patient's presentation with sudden tearing chest pain, radiating to the back, uncontrolled hypertension, and a significant blood pressure differential between arms is highly suggestive of an aortic dissection, a life-threatening emergency. Rapid transport to a facility capable of definitive surgical intervention is paramount.
Why the other options are wrong
- A. Nitroglycerin is contraindicated as it can worsen aortic dissection by increasing the shear force on the aortic wall.
- B. Aspirin is indicated for acute coronary syndromes but is contraindicated in suspected aortic dissection due to increased bleeding risk.
- C. IV fluids wide open would increase blood pressure, which is detrimental in aortic dissection; blood pressure control is crucial.
Aortic Dissection Management
Aortic dissection is a tear in the inner layer of the aorta, leading to blood flow between the layers. It's a medical emergency requiring immediate definitive surgical intervention.
- Classic presentation: sudden, severe, tearing chest/back pain.
- Often associated with uncontrolled hypertension.
- Blood pressure differential between limbs is a key sign.
- Management focuses on rapid diagnosis, BP control (if not hypotensive), and immediate surgical consultation/transport.
Memory trick: Tear in the aorta, time is short, transport is key!