NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 70-year-old male complains of sudden onset of dizziness, weakness, and fatigue. His pulse is irregular and slow, approximately 40 bpm. His blood pressure is 80/50 mmHg, and he appears pale and diaphoretic. What is the MOST appropriate initial intervention?
- APrepare for transcutaneous pacing.
- BAdminister 6 mg Adenosine intravenously.
- CEncourage the patient to cough vigorously.
- DAdminister 0.4 mg sublingual nitroglycerin.
Show answer & explanationAnswer & explanation
Correct answer: A. Prepare for transcutaneous pacing.
The patient presents with symptomatic bradycardia (slow heart rate) accompanied by signs of instability (dizziness, weakness, hypotension, pallor, diaphoresis). Transcutaneous pacing (TCP) is the primary prehospital treatment for unstable bradycardia, as per ACLS guidelines, after attempts with atropine (if appropriate and available).
Why the other options are wrong
- B. Adenosine is used for supraventricular tachycardia (fast heart rhythms), not bradycardia.
- C. Coughing vigorously is sometimes a vagal maneuver that can transiently slow a fast heart rate, but it's not appropriate for symptomatic bradycardia and certainly not for hypotension.
- D. Nitroglycerin is a vasodilator and would worsen hypotension in this patient.
Unstable Bradycardia Management
Emergency treatment for a slow heart rate (usually <50 bpm) that causes signs of instability (e.g., hypotension, altered mental status, signs of shock, ischemic chest discomfort, acute heart failure).
- Recognize symptomatic bradycardia with instability.
- Administer Atropine (if available and not contraindicated).
- Prepare for transcutaneous pacing (TCP) if Atropine is ineffective or not indicated.
- Consider epinephrine or dopamine infusion if pacing fails or is unavailable.
Memory trick: Slow and low, if they're crashing, start the pacing, get them flashing!