Paramedics Exam Cardiology and Resuscitation 4 — Questions and Answers
Question 1: A patient with atrial fibrillation has a ventricular rate of 140 bpm and a BP of 88/60 mmHg with altered mental status. What is the most appropriate intervention?
- Metoprolol 5 mg IV to control rate
- Amiodarone 150 mg IV over 10 minutes
- Synchronized cardioversion (Correct answer)
- Diltiazem 15-20 mg IV over 2 minutes
Correct answer: Synchronized cardioversion
Unstable atrial fibrillation with hemodynamic compromise requires immediate synchronized cardioversion to restore sinus rhythm.
Question 2: Which ECG finding is most associated with a hyperacute (very early) STEMI before ST elevation develops?
- Pathologic Q waves in the affected leads
- Peaked, tall T waves in the affected leads (Correct answer)
- ST depression in the affected leads
- PR interval prolongation
Correct answer: Peaked, tall T waves in the affected leads
Hyperacute T waves—tall, peaked, and asymmetric—are the earliest ECG sign of myocardial ischemia, appearing before ST elevation.
Question 3: A patient has a pulseless rhythm that appears as a rapid, completely disorganized waveform on the monitor. What is the immediate treatment?
- Begin CPR and administer epinephrine 1 mg IV
- Deliver unsynchronized defibrillation immediately (Correct answer)
- Initiate transcutaneous pacing
- Administer amiodarone 300 mg IV push
Correct answer: Deliver unsynchronized defibrillation immediately
Ventricular fibrillation is treated with immediate unsynchronized defibrillation, as there is no organized rhythm to synchronize with.
Question 4: In the management of suspected cardiac tamponade in a pulseless patient, which intervention is definitive?
- Fluid resuscitation with 1-2 L NS
- Pericardiocentesis (Correct answer)
- Needle decompression of the chest
- Administration of epinephrine 1 mg IV
Correct answer: Pericardiocentesis
Pericardiocentesis, the needle drainage of blood from the pericardial sac, is the definitive treatment for cardiac tamponade.
Question 5: When performing two-rescuer adult CPR, at what rate should chest compressions be delivered?
- 60-80 compressions per minute
- 80-100 compressions per minute
- 100-120 compressions per minute (Correct answer)
- 120-140 compressions per minute
Correct answer: 100-120 compressions per minute
Current AHA guidelines recommend chest compressions at a rate of 100-120 per minute for optimal coronary and cerebral perfusion during CPR.
Question 6: A patient presents with symptomatic bradycardia at 38 bpm unresponsive to atropine. What is the next intervention?
- Administer a second dose of atropine 1 mg IV
- Initiate transcutaneous pacing (Correct answer)
- Administer adenosine 6 mg IV
- Synchronized cardioversion at 50 J
Correct answer: Initiate transcutaneous pacing
When atropine fails to treat symptomatic bradycardia, transcutaneous pacing is the next step while preparing for transvenous pacing.
Question 7: A 12-lead ECG shows ST elevation in leads V1-V4 with a new left bundle branch block in a patient with chest pain. How should this be managed?
- Treat as a non-STEMI and admit for observation
- Activate the cardiac catheterization lab for emergent PCI (Correct answer)
- Administer aspirin only and repeat the ECG in 30 minutes
- Consult cardiology before any intervention
Correct answer: Activate the cardiac catheterization lab for emergent PCI
New LBBB with chest pain is a STEMI equivalent requiring emergent activation of the cath lab for percutaneous coronary intervention.
Paramedics Exam Cardiology and Resuscitation 4
A patient with atrial fibrillation has a ventricular rate of 140 bpm and a BP of 88/60 mmHg with altered mental status.
What is the most appropriate intervention?