NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 45-year-old male complains of sudden onset of severe shortness of breath, anxiety, and a feeling of impending doom. He has a history of congestive heart failure (CHF). On examination, you note diffuse crackles (rales) in all lung fields, jugular venous distention (JVD), and peripheral edema. His blood pressure is 160/90 mmHg, heart rate is 110 bpm, and respiratory rate is 30 bpm. Oxygen saturation is 88% on room air. What is the MOST appropriate initial treatment for this patient?
- AAssist with a prescribed bronchodilator and encourage deep breaths.
- BAdminister epinephrine via intramuscular injection.
- CAdminister aspirin and prepare for immediate defibrillation.
- DAdminister sublingual nitroglycerin and high-flow oxygen via non-rebreather mask.
Show answer & explanationAnswer & explanation
Correct answer: D. Administer sublingual nitroglycerin and high-flow oxygen via non-rebreather mask.
This patient presents with classic signs and symptoms of acute decompensated congestive heart failure with pulmonary edema. High-flow oxygen is essential for hypoxia, and nitroglycerin helps reduce preload and afterload, thereby decreasing congestion and improving cardiac output. His blood pressure is adequate for nitroglycerin administration.
Why the other options are wrong
- A. Bronchodilators are for bronchospasm (e.g., asthma, COPD), not primarily for pulmonary edema from CHF. Deep breaths would be difficult and less effective given the severe pulmonary edema.
- B. Epinephrine is indicated for anaphylaxis or severe asthma, not acute CHF.
- C. Aspirin is for suspected cardiac ischemia, not the primary treatment for acute CHF. Defibrillation is for specific lethal dysrhythmias, not indicated here.
Acute Decompensated CHF Management
Emergency treatment for sudden worsening of congestive heart failure, characterized by fluid overload, pulmonary edema, and respiratory distress.
- Recognize signs: dyspnea, crackles, JVD, edema, high BP.
- Administer high-flow oxygen for hypoxia.
- Administer nitroglycerin (if BP allows) to reduce preload/afterload.
- Consider CPAP if available and indicated.
- Position patient upright.
Memory trick: Fluid overload, can't breathe, give O2 and Nitro to bring relief.