EMD Cardiovascular & Respiratory Protocols 3 — Questions and Answers
Question 1: An EMD dispatcher receives a call about a patient on beta-blocker medication having chest pain with a heart rate of 48. This heart rate is best described as:
- Tachycardia requiring immediate defibrillation
- Bradycardia that may be medication-related (Correct answer)
- Normal sinus rhythm for an adult at rest
- Pulseless electrical activity
Correct answer: Bradycardia that may be medication-related
Beta-blockers reduce heart rate, and a rate of 48 bpm represents bradycardia that may be a known pharmacological effect.
Question 2: During a telephone-assisted CPR call, the caller says the patient 'took a breath.' The EMD should instruct the caller to:
- Stop compressions immediately and monitor the patient
- Continue compressions unless the patient is fully conscious and breathing normally (Correct answer)
- Switch to rescue breathing only for 2 minutes
- Check for a pulse before deciding whether to continue
Correct answer: Continue compressions unless the patient is fully conscious and breathing normally
Agonal breathing is common in cardiac arrest and should not be mistaken for effective respiration; compressions continue until the patient is clearly responsive and breathing normally.
Question 3: A caller reports that a 70-year-old woman is having difficulty breathing and her lips are turning blue. The blue discoloration is called:
- Pallor
- Diaphoresis
- Cyanosis (Correct answer)
- Mottling
Correct answer: Cyanosis
Cyanosis is the bluish discoloration of skin and mucous membranes caused by hypoxia and reduced oxygen saturation.
Question 4: In MPDS Protocol 11 (Choking), an adult patient who can speak in full sentences should be classified as:
- Complete airway obstruction requiring immediate Heimlich maneuver instructions
- Partial airway obstruction — monitor and send appropriate response (Correct answer)
- Full cardiac arrest — begin CPR instructions
- Anaphylaxis — ask about allergen exposure
Correct answer: Partial airway obstruction — monitor and send appropriate response
The ability to speak indicates partial obstruction with air movement; complete obstruction presents with inability to speak, cough, or breathe.
Question 5: Which EMD protocol key question best identifies a patient experiencing acute pulmonary edema?
- Is the patient coughing up pink or frothy sputum? (Correct answer)
- Does the patient have a fever above 101°F?
- Is the patient experiencing left-sided chest pain?
- Did the breathing problem begin after eating?
Correct answer: Is the patient coughing up pink or frothy sputum?
Pink, frothy sputum is a hallmark sign of pulmonary edema caused by fluid leaking into the alveoli from elevated pulmonary pressures.
Question 6: When a caller cannot determine if a patient is breathing, the EMD should instruct them to look for all of the following EXCEPT:
- Chest rise and fall
- Air movement felt on the cheek
- Skin color changes
- Capillary refill time greater than 2 seconds (Correct answer)
Correct answer: Capillary refill time greater than 2 seconds
Capillary refill assessment is a clinical test performed by responders on scene, not something an untrained bystander can reliably assess over the phone.
Question 7: A caller reports a patient with known COPD who is breathing but using accessory muscles and tripod positioning. This posture indicates:
- The patient is relaxed and resting comfortably
- Severe respiratory distress with maximized breathing effort (Correct answer)
- The patient is preparing to lose consciousness
- Normal compensatory breathing for COPD patients
Correct answer: Severe respiratory distress with maximized breathing effort
Tripod positioning (leaning forward on arms) allows accessory muscles to assist breathing and signals severe respiratory distress.
EMD Cardiovascular & Respiratory Protocols 3
An EMD dispatcher receives a call about a patient on beta-blocker medication having chest pain with a heart rate of 48.
This heart rate is best described as: