NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 45-year-old male is experiencing sudden onset of palpitations, lightheadedness, and a feeling of impending doom. His pulse is 180 bpm and weak, respirations are 20 bpm, and blood pressure is 90/60 mmHg. He is conscious but anxious. What is the MOST appropriate initial management for this patient's cardiac rhythm?
- AAdminister aspirin and nitroglycerin.
- BPrepare for synchronized cardioversion.
- CAdminister high-flow oxygen and transport immediately.
- DAttempt vagal maneuvers.
Show answer & explanationAnswer & explanation
Correct answer: B. Prepare for synchronized cardioversion.
This patient is presenting with an unstable tachycardia (pulse 180 bpm, BP 90/60 mmHg, lightheadedness, feeling of impending doom). Unstable tachycardia requires immediate intervention, and for a conscious patient, synchronized cardioversion is the definitive treatment to restore a stable rhythm. While ALS performs this, the EMT must recognize the need and prepare for it.
Why the other options are wrong
- A. Aspirin and nitroglycerin are for ischemic chest pain, not primary treatment for unstable tachycardia.
- C. While oxygen and transport are important, they are supportive measures. The immediate life-threatening issue is the unstable rhythm requiring direct intervention.
- D. Vagal maneuvers might be attempted for stable SVT but are unlikely to be effective and delay definitive care for unstable tachycardia.
Unstable Tachycardia Management
Unstable tachycardia is a rapid heart rhythm (typically >150 bpm) that causes signs or symptoms of poor perfusion. Management focuses on immediate rhythm conversion.
- Defined by signs of hypoperfusion (hypotension, altered mental status, shock).
- Requires immediate intervention to restore stable rhythm.
- Synchronized cardioversion is the treatment of choice.
- EMT role is to recognize instability, provide supportive care, and prepare for ALS intervention.
Memory trick: Fast heart, bad signs? Shock to align!