NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 68-year-old female presents with acute onset of shortness of breath, orthopnea, and bilateral crackles. Her blood pressure is 180/100 mmHg, heart rate 110 bpm, and SpO2 88% on room air. She has a history of congestive heart failure. Which of the following interventions is most appropriate to initiate FIRST?
- AApply continuous positive airway pressure (CPAP).
- BAdminister furosemide 40 mg IV.
- CAdminister sublingual nitroglycerin 0.4 mg.
- DInitiate IV dopamine infusion.
Show answer & explanationAnswer & explanation
Correct answer: A. Apply continuous positive airway pressure (CPAP).
This patient is in acute decompensated heart failure with signs of significant respiratory distress (shortness of breath, orthopnea, crackles, SpO2 88%). CPAP is a non-invasive ventilation strategy that rapidly improves oxygenation, reduces preload and afterload, and decreases the work of breathing, making it the most appropriate initial intervention to address the respiratory compromise.
Why the other options are wrong
- B. Furosemide is indicated to reduce fluid overload but takes time to act and doesn't immediately address severe hypoxemia.
- C. Nitroglycerin is indicated for preload and afterload reduction, but CPAP will more rapidly improve oxygenation and respiratory distress.
- D. Dopamine is a vasopressor and inotrope, not indicated as a first-line treatment for acute pulmonary edema with hypertension.
Acute Pulmonary Edema Management
Acute pulmonary edema from congestive heart failure occurs when fluid accumulates in the lungs due to increased hydrostatic pressure. Management focuses on improving oxygenation, reducing preload and afterload.
- Symptoms: severe dyspnea, orthopnea, pink frothy sputum, crackles.
- High blood pressure is common due to compensatory mechanisms.
- CPAP is highly effective for rapid symptom relief and oxygenation.
- Medications include diuretics (furosemide) and vasodilators (nitroglycerin).
Memory trick: Can't Breathe? CPAP is Key!