NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 70-year-old male with a history of congestive heart failure (CHF) presents with sudden worsening shortness of breath, orthopnea, and bilateral crackles in his lungs. His skin is pale and cool, and he has peripheral edema. His vital signs are: BP 100/60 mmHg, HR 115 bpm, RR 28 breaths/min, SpO2 88% on room air. Which of the following interventions is MOST appropriate for this patient PRIOR to transport?
- AInitiate rapid IV fluid bolus and prepare for synchronized cardioversion.
- BAdminister nitroglycerin 0.4 mg sublingually and elevate the patient's legs.
- CAdminister oxygen via non-rebreather mask and assist ventilations if needed.
- DAdminister aspirin 325 mg orally and prepare for defibrillation.
Show answer & explanationAnswer & explanation
Correct answer: C. Administer oxygen via non-rebreather mask and assist ventilations if needed.
This patient is presenting with acute decompensated heart failure with signs of significant respiratory distress and hypoxia (SpO2 88%). The priority is to improve oxygenation and ventilation. A non-rebreather mask will deliver high-flow oxygen, and assisted ventilations may be necessary if respiratory effort is inadequate.
Why the other options are wrong
- A. IV fluid bolus is contraindicated in CHF, as it would exacerbate fluid overload. Synchronized cardioversion is for unstable tachyarrhythmias, not primary respiratory distress from CHF.
- B. While nitroglycerin can be used in CHF to reduce preload, the immediate priority is oxygenation. Elevating the legs would worsen pulmonary congestion.
- D. Aspirin is not indicated for CHF exacerbation, and defibrillation is for pulseless rhythms, not for this conscious patient.
Acute Decompensated CHF Management
Management of acute decompensated CHF focuses on improving oxygenation, reducing fluid overload, and managing symptoms.
- Oxygenation is critical, often requiring high-flow oxygen.
- Diuretics and vasodilators (like nitroglycerin) can reduce fluid and preload.
- Positioning (sitting upright) helps reduce respiratory effort.
Memory trick: When the heart fails and lungs fill with fluid, think 'O2, Position, and 'NO' more fluid!'