NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
An 82-year-old male is experiencing sudden onset of dizziness, weakness, and fatigue. His pulse is 48 bpm, regular, and strong. His skin is warm and dry, and he denies chest pain or shortness of breath. His blood pressure is 118/76 mmHg. What is the MOST appropriate initial management for this patient?
- AInitiate transcutaneous pacing.
- BAdminister atropine 0.5 mg IV.
- CAdminister oxygen via nasal cannula and monitor.
- DPrepare for synchronized cardioversion.
Show answer & explanationAnswer & explanation
Correct answer: C. Administer oxygen via nasal cannula and monitor.
This patient presents with bradycardia (pulse 48 bpm) but is hemodynamically stable (BP 118/76 mmHg, warm/dry skin, no serious symptoms like chest pain or altered mental status). For stable bradycardia, the initial management is supportive care, including oxygen and close monitoring, while preparing for potential deterioration.
Why the other options are wrong
- A. Transcutaneous pacing is for unstable bradycardia, where the patient shows signs of shock, altered mental status, or ischemic chest pain due to the slow heart rate. This patient is stable.
- B. Atropine is an ALS medication used for symptomatic bradycardia; this patient is stable, making it not immediately indicated by EMT scope.
- D. Synchronized cardioversion is for unstable tachyarrhythmias, not bradycardia.
Stable Bradycardia Management
Bradycardia (heart rate <60 bpm) is considered stable when the patient exhibits no signs of hypoperfusion (e.g., normal mental status, adequate blood pressure, no chest pain).
- Initial management focuses on assessment, supportive care, and monitoring.
- Oxygen administration and IV access (if allowed by scope) are common initial steps.
- Avoid aggressive interventions unless the patient becomes symptomatic/unstable.
Memory trick: Slow heart? Check stability first, then decide the next burst!