NREMT Paramedic Cognitive ExamCardiology & ResuscitationHard
A 65-year-old male with a history of hypertension and diabetes presents with sudden onset of severe, tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. His heart rate is 98 bpm and regular. Which of the following is the MOST appropriate initial medication to administer?
- ALabetalol 10 mg IV push
- BAspirin 325 mg orally
- CNitroglycerin 0.4 mg sublingually
- DFentanyl 50 mcg IV
Show answer & explanationAnswer & explanation
Correct answer: A. Labetalol 10 mg IV push
The patient's presentation with severe tearing chest pain radiating to the back, coupled with a blood pressure differential between arms, is highly suggestive of an aortic dissection. The primary goal in managing aortic dissection is to rapidly reduce blood pressure and heart rate to decrease aortic shear stress. Labetalol is an excellent choice as it provides both beta-blockade and alpha-blockade, effectively lowering both heart rate and blood pressure.
Why the other options are wrong
- B. Aspirin is indicated for acute coronary syndromes but is contraindicated or not indicated in aortic dissection as it can worsen bleeding.
- C. Nitroglycerin can cause vasodilation and reflex tachycardia, which can worsen aortic shear stress and is generally contraindicated in aortic dissection unless specific indications for blood pressure control without heart rate increase are present, which is not the initial goal here.
- D. Fentanyl is for pain management but does not address the underlying hemodynamic instability crucial in aortic dissection.
Aortic Dissection Initial Treatment
Rapid reduction of heart rate and blood pressure to decrease aortic shear stress and prevent further dissection.
- Beta-blockers are first-line to reduce HR and BP.
- Pain control is secondary to hemodynamic stability.
- Avoid medications that cause reflex tachycardia.
Memory trick: Dissecting Aorta: Don't Rush Blood, Relax the Heart!