Paramedics Exam Cardiology and Resuscitation 5 — Questions and Answers
Question 1: A patient has received three defibrillation attempts and two doses of epinephrine for refractory VF. What antiarrhythmic drug should be administered next?
- Lidocaine 1.5 mg/kg IV
- Amiodarone 300 mg IV push (Correct answer)
- Magnesium sulfate 2 g IV
- Procainamide 20 mg/min IV infusion
Correct answer: Amiodarone 300 mg IV push
Amiodarone 300 mg IV push is the first-line antiarrhythmic for shock-refractory VF or pulseless VT per ACLS guidelines.
Question 2: During resuscitation for Torsades de Pointes, which medication is specifically indicated?
- Amiodarone 300 mg IV push
- Lidocaine 1 mg/kg IV push
- Magnesium sulfate 1-2 g IV over 5-20 minutes (Correct answer)
- Adenosine 6 mg rapid IV push
Correct answer: Magnesium sulfate 1-2 g IV over 5-20 minutes
Magnesium sulfate is the treatment of choice for Torsades de Pointes because it stabilizes the cardiac membrane and shortens the QT interval.
Question 3: A patient experiences cardiac arrest and the monitor shows asystole. After confirming asystole in two leads, what is the appropriate action?
- Defibrillate immediately at 200 J biphasic
- Begin CPR and administer epinephrine; do not defibrillate (Correct answer)
- Initiate transcutaneous pacing immediately
- Administer atropine 3 mg IV and reassess
Correct answer: Begin CPR and administer epinephrine; do not defibrillate
Asystole is a non-shockable rhythm managed with CPR, epinephrine every 3-5 minutes, and treatment of reversible causes; defibrillation is contraindicated.
Question 4: What is the maximum depth at which chest compressions should be performed in an adult during CPR?
- At least 2 inches (5 cm) with a maximum of 2.4 inches (6 cm) (Correct answer)
- At least 2.5 inches (6.5 cm) with no maximum
- Exactly 2 inches (5 cm)
- As deep as possible to maximize output
Correct answer: At least 2 inches (5 cm) with a maximum of 2.4 inches (6 cm)
AHA guidelines specify compression depth of at least 2 inches but no more than 2.4 inches to optimize perfusion while avoiding injury.
Question 5: A patient presents with chest pain, diaphoresis, and the following 12-lead findings: ST elevation in V1-V2 with a right bundle branch block pattern. Which territory is most likely affected?
- Inferior wall (RCA territory)
- Anteroseptal wall (proximal LAD territory) (Correct answer)
- Lateral wall (LCx territory)
- Posterior wall (RCA or LCx territory)
Correct answer: Anteroseptal wall (proximal LAD territory)
ST elevation in V1-V2 with a new RBBB pattern suggests a proximal LAD occlusion affecting the anteroseptal wall and the right bundle branch.
Question 6: After ROSC is achieved, targeted temperature management (TTM) is indicated. What is the recommended target temperature range?
- 32-34°C for all post-cardiac arrest patients
- 32-36°C, selected and maintained for at least 24 hours (Correct answer)
- 36-38°C to prevent fever only
- Below 32°C for patients with VF arrest
Correct answer: 32-36°C, selected and maintained for at least 24 hours
Current guidelines recommend maintaining a target temperature between 32-36°C for at least 24 hours after ROSC to minimize neurologic injury.
Question 7: A patient in cardiac arrest has an IO line established in the proximal tibia. Which of the following is true regarding IO drug delivery during resuscitation?
- IO drug dosing must be doubled compared to IV doses
- IO access provides equivalent drug delivery to central venous access and uses identical dosing (Correct answer)
- IO should only be used for fluid resuscitation, not medication delivery
- IO drug delivery is slower than peripheral IV and requires dose adjustment
Correct answer: IO access provides equivalent drug delivery to central venous access and uses identical dosing
IO access provides rapid, reliable vascular access equivalent to central venous access with identical drug dosing to IV administration.
Paramedics Exam Cardiology and Resuscitation 5
A patient has received three defibrillation attempts and two doses of epinephrine for refractory VF.
What antiarrhythmic drug should be administered next?