NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 70-year-old male complains of sudden onset of dizziness, weakness, and fatigue. His pulse is 40 bpm and regular, blood pressure is 80/50 mmHg, and he is pale and diaphoretic. He is conscious but confused. What is the MOST appropriate initial management for this patient?
- AAdminister aspirin and nitroglycerin.
- BInitiate immediate rapid transport and monitor vital signs closely.
- CPrepare for transcutaneous pacing.
- DAdminister 15 L/min oxygen via non-rebreather mask and assist ventilations if needed.
Show answer & explanationAnswer & explanation
Correct answer: C. Prepare for transcutaneous pacing.
This patient is experiencing unstable bradycardia (HR 40 bpm) with signs of hypoperfusion (dizziness, weakness, fatigue, hypotension, confusion, pale, diaphoretic). The definitive treatment for unstable bradycardia is transcutaneous pacing (TCP), which is an ALS intervention. The EMT's role is to recognize this need, provide supportive care (e.g., oxygen), and prepare for or assist with pacing.
Why the other options are wrong
- A. Aspirin and nitroglycerin are for ischemic chest pain, not unstable bradycardia.
- B. Rapid transport is always important, but preparing for a definitive intervention like pacing is the 'most appropriate initial management' for the underlying rhythm issue.
- D. While oxygen is appropriate, assisting ventilations isn't indicated unless respiratory distress is primary. This patient's primary problem is their heart rate causing hypoperfusion.
Unstable Bradycardia Management
Unstable bradycardia is a slow heart rate (typically <50 bpm) that causes signs or symptoms of poor perfusion. Management focuses on increasing the heart rate.
- Defined by signs of hypoperfusion (hypotension, altered mental status, shock).
- Requires immediate intervention to increase heart rate.
- Transcutaneous pacing (TCP) is the treatment of choice (ALS).
- EMT role is to recognize instability, provide supportive care, and prepare for ALS intervention.
Memory trick: Slow heart, bad signs? Get ready to pace!