NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 60-year-old male complains of sudden onset of severe, tearing back pain that radiates to his abdomen. He is pale, diaphoretic, and his radial pulses are weak and unequal. His vital signs are: BP 180/100 mmHg (right arm), BP 130/80 mmHg (left arm), HR 105 bpm, RR 20 breaths/min, SpO2 96% on room air. What is the MOST critical immediate action for the EMT to take?
- AAdminister aspirin 325 mg orally for suspected MI.
- BAdminister nitroglycerin to reduce blood pressure.
- CInitiate rapid transport to a trauma center.
- DApply a non-rebreather mask and assist ventilations.
Show answer & explanationAnswer & explanation
Correct answer: C. Initiate rapid transport to a trauma center.
The patient's presentation of sudden severe tearing pain, unequal blood pressures, and weak unequal pulses is highly suggestive of an aortic dissection. This is a life-threatening emergency requiring immediate surgical intervention. Rapid transport to a facility capable of managing such a critical condition (often a trauma center or a facility with cardiac surgery capabilities) is the most critical immediate action.
Why the other options are wrong
- A. While chest pain is present, the tearing pain and unequal pulses/BP point away from a typical MI. Aspirin is contraindicated if surgery is imminent.
- B. Nitroglycerin could lower blood pressure, but the primary concern is the dissection itself, and lowering BP too rapidly could compromise perfusion. Rapid transport is paramount.
- D. The patient's SpO2 is 96% and respiratory rate is normal. Oxygen and ventilation assistance are not immediately indicated and would delay critical transport.
Aortic Dissection Management
Aortic dissection is a surgical emergency characterized by sudden severe tearing pain, often with unequal pulses/blood pressures; immediate rapid transport is critical.
- High mortality if not treated surgically.
- Key signs: sudden severe tearing pain, pulse/BP deficits.
- Prehospital care focuses on rapid identification and transport.
Memory trick: Aorta tears, pulses unequal, time is a race – GO FAST!