NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 68-year-old male with a history of congestive heart failure (CHF) presents with acute onset of shortness of breath, orthopnea, and bilateral crackles. His blood pressure is 160/90 mmHg, heart rate 110 bpm, respiratory rate 28 bpm, and SpO2 88% on room air. After administering oxygen and establishing IV access, which of the following is the MOST appropriate next intervention?
- AAdminister Aspirin 325 mg orally
- BAdminister Furosemide 40 mg IV
- CAdminister Lidocaine 1.5 mg/kg IV
- DInitiate transcutaneous pacing
Show answer & explanationAnswer & explanation
Correct answer: B. Administer Furosemide 40 mg IV
The patient's presentation (shortness of breath, orthopnea, crackles, history of CHF, hypertension, tachycardia, and hypoxia) is classic for acute pulmonary edema secondary to congestive heart failure. The primary goal is to reduce fluid overload and improve oxygenation. Furosemide, a loop diuretic, is indicated to rapidly excrete excess fluid and reduce preload, thereby alleviating pulmonary congestion.
Why the other options are wrong
- A. Aspirin is for acute coronary syndromes, not primary management of acute pulmonary edema from CHF.
- C. Lidocaine is an antiarrhythmic used for ventricular arrhythmias, not indicated for acute pulmonary edema.
- D. Transcutaneous pacing is for symptomatic bradycardia, not for acute pulmonary edema.
Acute Pulmonary Edema Management
Treatment focuses on reducing fluid overload, improving oxygenation, and decreasing cardiac workload.
- Oxygenation (CPAP/BiPAP often needed).
- Diuretics (Furosemide) to reduce preload.
- Vasodilators (Nitroglycerin) to reduce preload/afterload.
Memory trick: Puffy Lungs Need 'DRIP' Relief!