NREMT Paramedic Cognitive ExamCardiology & ResuscitationEasy
A 75-year-old female is found unresponsive and pulseless. CPR is in progress. The cardiac monitor displays a rhythm with no electrical activity, appearing as a flat line. What is the most appropriate next step in management?
- ADefibrillate immediately.
- BAdminister atropine 1 mg IV.
- CPerform synchronized cardioversion.
- DContinue CPR and administer epinephrine 1 mg IV.
Show answer & explanationAnswer & explanation
Correct answer: D. Continue CPR and administer epinephrine 1 mg IV.
The patient is in asystole, a non-shockable rhythm. The management for asystole involves confirming the rhythm (checking leads), continuing high-quality CPR, and administering epinephrine. Defibrillation and cardioversion are ineffective for asystole.
Why the other options are wrong
- A. Defibrillation is for shockable rhythms (VF/pVT), not asystole.
- B. Atropine is no longer recommended for asystole in current ACLS guidelines.
- C. Synchronized cardioversion is for unstable tachycardias, not asystole.
Asystole Management
Asystole is a cardiac arrest rhythm characterized by the absence of electrical and mechanical cardiac activity (a 'flat line' on ECG). It is a non-shockable rhythm.
- Patient is unresponsive, apneic, and pulseless.
- Always confirm rhythm and lead placement to rule out technician error.
- Management focuses on high-quality CPR and epinephrine.
- Prognosis is generally poor.
Memory trick: Flat Line? CPR and Epi, Don't Stop Trying!