NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 65-year-old female complains of sudden onset of severe shortness of breath, anxiety, and a productive cough with pink, frothy sputum. Her medical history includes hypertension and congestive heart failure. Auscultation reveals crackles (rales) in all lung fields. Her SpO2 is 88% on room air. Which of the following interventions is the MOST appropriate initial treatment?
- APrepare for immediate defibrillation.
- BInitiate continuous positive airway pressure (CPAP).
- CAdminister aspirin 325 mg orally.
- DAssist with nitroglycerin administration.
Show answer & explanationAnswer & explanation
Correct answer: B. Initiate continuous positive airway pressure (CPAP).
The patient's symptoms (severe SOB, pink frothy sputum, crackles, history of CHF) are classic for acute pulmonary edema secondary to congestive heart failure. CPAP is highly effective in improving oxygenation and reducing the workload on the heart in such cases.
Why the other options are wrong
- A. Defibrillation is for shockable rhythms in cardiac arrest; this patient is conscious and has a pulse, although in severe respiratory distress.
- C. Aspirin is indicated for suspected cardiac ischemia, but the primary issue here is pulmonary edema, not necessarily an acute coronary syndrome.
- D. Nitroglycerin can be helpful in CHF, but CPAP directly addresses the severe respiratory distress and hypoxia by improving oxygenation and reducing preload.
Acute Pulmonary Edema Management
Acute pulmonary edema, often a complication of congestive heart failure, is characterized by fluid accumulation in the lungs, leading to severe shortness of breath and hypoxia.
- Symptoms include dyspnea, orthopnea, pink frothy sputum, and crackles.
- Primary goal is to improve oxygenation and reduce cardiac workload.
- CPAP is a key intervention to push fluid out of alveoli and improve gas exchange.
Memory trick: Fluid in lungs? CPAP is the key, breathe easy!