NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 70-year-old female with a history of congestive heart failure (CHF) presents with sudden worsening of shortness of breath, orthopnea, and a productive cough with pink, frothy sputum. Her vital signs are BP 160/90 mmHg, HR 110 bpm, RR 28 bpm, SpO2 88% on room air. Lung sounds reveal diffuse crackles (rales). What is the most appropriate initial oxygen delivery method for this patient?
- ANon-rebreather mask at 15 L/min
- BBag-valve mask ventilation
- CNasal cannula at 2-4 L/min
- DSimple face mask at 6 L/min
Show answer & explanationAnswer & explanation
Correct answer: A. Non-rebreather mask at 15 L/min
This patient is experiencing acute pulmonary edema due to CHF, characterized by severe shortness of breath, low SpO2 (88%), and diffuse crackles. A non-rebreather mask at 15 L/min provides the highest concentration of supplemental oxygen and is indicated for patients with severe hypoxia and respiratory distress, like this one.
Why the other options are wrong
- B. Bag-valve mask ventilation is used for patients who are apneic or have inadequate breathing, not for spontaneously breathing patients with severe hypoxia who can still maintain their airway.
- C. Nasal cannula provides low flow oxygen and is insufficient for severe hypoxia (SpO2 88%).
- D. A simple face mask provides moderate oxygen concentration but is generally insufficient for severe respiratory distress and hypoxia.
Oxygen Delivery for Acute Pulmonary Edema
Patients with acute pulmonary edema and severe hypoxia require high-flow oxygen, typically delivered via a non-rebreather mask, to improve oxygenation.
- Acute pulmonary edema causes severe hypoxia.
- Non-rebreather mask delivers highest FiO2.
- Monitor SpO2 and adjust oxygen as needed.
Memory trick: Severe Shortness? Non-Rebreather's Best!