NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 68-year-old male presents with sudden onset of severe, crushing chest pain radiating to his left arm and jaw. He is diaphoretic, pale, and short of breath. His blood pressure is 100/60 mmHg, heart rate is 110 bpm, and respiratory rate is 24 bpm. Oxygen saturation is 92% on room air. What is the MOST appropriate initial intervention?
- APrepare for immediate defibrillation.
- BAdminister nitroglycerin sublingually.
- CAdminister supplemental oxygen and assist with aspirin administration.
- DInitiate rapid transport without further intervention.
Show answer & explanationAnswer & explanation
Correct answer: C. Administer supplemental oxygen and assist with aspirin administration.
The patient's symptoms are highly suggestive of an acute myocardial infarction (heart attack). Administering supplemental oxygen to improve saturation and assisting with aspirin administration are critical initial interventions in the prehospital setting for suspected cardiac ischemia.
Why the other options are wrong
- A. Defibrillation is indicated for ventricular fibrillation or pulseless ventricular tachycardia, which are not currently indicated by the patient's vital signs or description.
- B. Nitroglycerin is contraindicated if the patient's systolic blood pressure is below 90-100 mmHg, and his BP is 100/60 mmHg, making it a relative contraindication here without further assessment.
- D. While rapid transport is important, essential initial interventions should not be delayed if possible and appropriate.
Acute Myocardial Infarction (AMI) Initial Management
The immediate prehospital care for a patient suspected of having a heart attack, focusing on oxygenation, pain relief, and reducing cardiac workload/ischemia.
- Recognize signs/symptoms of AMI (chest pain, radiation, diaphoresis, dyspnea).
- Administer oxygen if SpO2 <94% or signs of hypoxia/distress.
- Assist with aspirin administration (unless contraindicated).
- Consider nitroglycerin if BP allows and pain persists.
- Prepare for rapid transport.
Memory trick: Oxy-Aspirin for the chest pain fight, then transport in the fading light.