Paramedics Exam Cardiology & Resuscitation 5 — Questions and Answers
Question 1: A 70-year-old patient is in asystole. After confirming the rhythm in two leads, what is the correct immediate action?
- Defibrillate at 200J
- Begin high-quality CPR and administer epinephrine (Correct answer)
- Administer atropine 3mg IV
- Perform transcutaneous pacing immediately
Correct answer: Begin high-quality CPR and administer epinephrine
Asystole is a non-shockable rhythm; treatment is high-quality CPR with epinephrine every 3–5 minutes and search for reversible causes.
Question 2: Which of the following represents the correct interpretation of a QTc interval greater than 500 ms?
- Normal variant in elderly patients
- Significantly prolonged, associated with risk of Torsades de Pointes (Correct answer)
- Sign of hyperkalemia
- Indicates accelerated idioventricular rhythm
Correct answer: Significantly prolonged, associated with risk of Torsades de Pointes
A QTc >500 ms significantly increases the risk of Torsades de Pointes, a life-threatening polymorphic ventricular tachycardia.
Question 3: The treatment of choice for Torsades de Pointes (TdP) in a hemodynamically stable patient is:
- Amiodarone 150mg IV over 10 minutes
- Magnesium sulfate 1–2g IV over 5–20 minutes (Correct answer)
- Synchronized cardioversion at 100J
- Lidocaine 1.5 mg/kg IV bolus
Correct answer: Magnesium sulfate 1–2g IV over 5–20 minutes
Magnesium sulfate 1–2g IV is the first-line treatment for TdP as it suppresses the triggered activity causing the arrhythmia.
Question 4: Which statement about performing CPR on a pregnant patient in cardiac arrest is correct?
- Perform compressions higher on the sternum to avoid the gravid uterus
- Manually displace the uterus to the left while performing standard CPR (Correct answer)
- Do not perform CPR — go straight to emergency C-section
- Ventilate at a higher rate of 20 breaths/minute due to increased O2 demand
Correct answer: Manually displace the uterus to the left while performing standard CPR
Left uterine displacement (LUD) relieves aortocaval compression and improves venous return during CPR in pregnancy.
Question 5: A patient presents with bradycardia at 38 bpm, hypotension, and diaphoresis. Atropine 0.5mg IV fails to improve the rate. What is the next most appropriate intervention?
- Repeat atropine 0.5mg up to a maximum of 1mg
- Initiate transcutaneous pacing (Correct answer)
- Administer adenosine 6mg IV push
- Give epinephrine 1mg IV push
Correct answer: Initiate transcutaneous pacing
When atropine fails for symptomatic bradycardia, transcutaneous pacing is the next indicated intervention per ACLS guidelines.
Question 6: Which of the following best describes the mechanism of action of amiodarone in ventricular arrhythmias?
- Pure beta-1 receptor blocker that slows AV conduction only
- Multi-channel blocker that prolongs the action potential and refractory period (Correct answer)
- Sodium channel opener that increases automaticity
- Pure calcium channel blocker that decreases myocardial contractility
Correct answer: Multi-channel blocker that prolongs the action potential and refractory period
Amiodarone blocks sodium, potassium, and calcium channels and also has beta-blocking properties, prolonging the action potential duration.
Question 7: In a patient with STEMI, which of the following represents the goal door-to-balloon time for primary PCI at a PCI-capable hospital?
- 30 minutes
- 60 minutes
- 90 minutes (Correct answer)
- 120 minutes
Correct answer: 90 minutes
The AHA/ACC guideline recommends door-to-balloon time of 90 minutes or less for primary PCI in STEMI patients.
Paramedics Exam Cardiology & Resuscitation 5
A 70-year-old patient is in asystole.
After confirming the rhythm in two leads, what is the correct immediate action?