Free Paramedics Cardiology and Resuscitation Questions and Answers — Questions and Answers
Question 1: A 66-year-old male with a history of angina reports an episode of crushing chest pain that resolved before your arrival. He is now pain-free. His 12-lead ECG shows deeply inverted T-waves in leads V2 and V3, with minimal ST elevation (<1mm) and no pathological Q waves. What is this ECG pattern most indicative of?
- Benign early repolarization
- Wellens' Syndrome (Correct answer)
- Posterior wall myocardial infarction
- Pericarditis
Correct answer: Wellens' Syndrome
Wellens' Syndrome is characterized by specific T-wave changes (deeply inverted or biphasic) in the precordial leads (V2-V3) in a patient who is currently pain-free but has a history of recent angina. It is highly specific for a critical stenosis of the proximal left anterior descending (LAD) coronary artery and indicates a high risk of extensive anterior wall MI.
Question 2: You are treating a 55-year-old female for symptomatic bradycardia with a heart rate of 38 and signs of poor perfusion. She has a history of a heart transplant. Which of the following interventions is LEAST likely to be effective for this patient?
- Transcutaneous pacing
- Epinephrine infusion
- Atropine sulfate (Correct answer)
- Dopamine infusion
Correct answer: Atropine sulfate
Atropine works by blocking the vagus nerve's effect on the heart. In heart transplant patients, the nerve connections to the heart are severed (denervated), rendering atropine ineffective. Transcutaneous pacing and infusions of chronotropic drugs like epinephrine or dopamine are the appropriate treatments.
Question 3: A 72-year-old male patient with end-stage renal disease who missed his last two dialysis appointments is found in cardiac arrest. The monitor shows a wide-complex PEA. Which underlying cause is most likely, and what is the most appropriate initial medication to administer to stabilize the myocardium?
- Hypovolemia; Normal Saline bolus
- Tension Pneumothorax; Needle decompression
- Massive Pulmonary Embolism; Fibrinolytics
- Hyperkalemia; Calcium Chloride (Correct answer)
Correct answer: Hyperkalemia; Calcium Chloride
Patients with end-stage renal disease who miss dialysis are at high risk for life-threatening hyperkalemia. ECG changes associated with severe hyperkalemia include peaked T-waves, widening of the QRS complex, and sine-wave patterns, which can lead to PEA. The initial treatment is to stabilize the cardiac cell membrane with intravenous calcium chloride to reduce myocardial irritability, followed by measures to shift potassium into the cells.
Question 4: According to current ACLS guidelines for shock-refractory ventricular fibrillation (VF), after the third shock and administration of epinephrine, which of the following is an appropriate next step?
- Administer a 50 mEq bolus of sodium bicarbonate.
- Administer a 300 mg IV/IO bolus of amiodarone. (Correct answer)
- Deliver a fourth shock at the maximum energy setting.
- Immediately begin a lidocaine infusion at 2 mg/min.
Correct answer: Administer a 300 mg IV/IO bolus of amiodarone.
For ventricular fibrillation or pulseless ventricular tachycardia that is unresponsive to initial shocks and vasopressor therapy, current ACLS guidelines recommend administering an antiarrhythmic. Either amiodarone (initial dose 300 mg IV/IO) or lidocaine may be considered. Sodium bicarbonate is only indicated in specific situations like known hyperkalemia or tricyclic antidepressant overdose, not routinely in cardiac arrest. A lidocaine infusion is typically preceded by a bolus.
Question 5: You have successfully resuscitated a 50-year-old patient from cardiac arrest. The patient remains comatose and unable to follow commands. According to the most recent resuscitation guidelines, what is the primary goal of targeted temperature management (TTM) for this patient?
- Rapidly inducing deep hypothermia to 30°C.
- Warming the patient to 38°C to prevent infection.
- Actively preventing fever by targeting a temperature ≤ 37.5°C. (Correct answer)
- Alternating between periods of cooling and warming.
Correct answer: Actively preventing fever by targeting a temperature ≤ 37.5°C.
Recent guidelines have shifted the focus of post-cardiac arrest temperature management. The primary goal is now the active prevention of fever. It is recommended to target a core temperature of less than or equal to 37.5°C for patients who remain comatose after the return of spontaneous circulation (ROSC). While earlier protocols focused on inducing moderate hypothermia (32-34°C), current evidence suggests that actively preventing fever is a critical intervention.
Question 6: A paramedic is treating a patient in pulseless electrical activity (PEA). Which of the following is considered one of the reversible 'H' causes that should be immediately assessed and managed?
- Tension Pneumothorax
- Tamponade (cardiac)
- Hypoxia (Correct answer)
- Thrombosis (pulmonary)
Correct answer: Hypoxia
The reversible causes of PEA are often remembered by the 'H's and T's' mnemonic. Hypoxia is one of the 'H' causes, along with Hypovolemia, Hydrogen ion (acidosis), Hypo/hyperkalemia, and Hypothermia. Tension pneumothorax, Tamponade, and Thrombosis are all part of the 'T' causes.
Free Paramedics Cardiology and Resuscitation Questions and Answers
A 66-year-old male with a history of angina reports an episode of crushing chest pain that resolved before your arrival.
He is now pain-free.
His 12-lead ECG shows deeply inverted T-waves in leads V2 and V3, with minimal ST elevation (<1mm) and no pathological Q waves.
What is this ECG pattern most indicative of?