NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 58-year-old male is experiencing chest pain, diaphoresis, and nausea. He has a history of angina and takes prescribed nitroglycerin. His blood pressure is 140/90 mmHg, heart rate 92 bpm, and SpO2 96% on room air. After administering oxygen and assisting with aspirin, what is the NEXT MOST appropriate intervention?
- AAdminister 0.4 mg sublingual nitroglycerin.
- BAdminister immediate defibrillation.
- CPerform a 12-lead ECG immediately.
- DInitiate rapid transport without further medication.
Show answer & explanationAnswer & explanation
Correct answer: A. Administer 0.4 mg sublingual nitroglycerin.
Given the patient's symptoms suggestive of cardiac ischemia, history of angina, and stable blood pressure (140/90 mmHg), administering sublingual nitroglycerin is the next appropriate step after oxygen and aspirin, provided there are no contraindications (e.g., recent PDE5 inhibitor use, systolic BP <90 mmHg).
Why the other options are wrong
- B. Defibrillation is for pulseless ventricular rhythms; the patient is conscious with a pulse.
- C. A 12-lead ECG is important, but medication administration (nitroglycerin) for pain relief is often prioritized immediately after oxygen and aspirin in the field, especially if the patient is stable enough for it.
- D. While transport is important, appropriate medications should be administered en route or before if safe and indicated.
Angina/AMI Prehospital Meds
Sequence of medications administered in the field for suspected cardiac chest pain.
- Oxygen for hypoxia or respiratory distress.
- Aspirin (162-325 mg chewable) to inhibit platelet aggregation.
- Nitroglycerin (0.4 mg sublingual) for pain relief and vasodilation, if BP allows.
- Morphine for severe pain if NTG ineffective.
Memory trick: Oxy-Aspirin first, then Nitro for thirst!