Respiratory and Cardiac Medical Emergencies - NREMT AEMT Level

1. Which medication is used for chest pain suspected to be ischemic when systolic BP is adequate and no contraindications exist?

   Nitroglycerin per protocol. Causes vasodilation to reduce myocardial oxygen demand and improve coronary perfusion.

2. What breath sound is most consistent with fluid in the alveoli, such as in CHF or pulmonary edema?

   Crackles (rales). Reflects fine, discontinuous sounds from air moving through fluid-filled alveoli, typical in congestive conditions.

3. What is the most reliable field indicator of ventilation and airway patency during assisted breathing?

   Waveform capnography (EtCO$2$) if available. Monitors end-tidal CO2 levels to confirm tube placement and assess ventilation adequacy in real time.

4. What oxygen flow rate is typically used for an adult nasal cannula in prehospital care?

   Nasal cannula: $1$–$6$ L/min. Provides low-flow oxygen delivery suitable for patients with mild hypoxia, delivering approximately 24-44% FiO2 depending on the rate.

5. Which rhythm is treated with immediate defibrillation in an unresponsive, pulseless adult?

   Ventricular fibrillation or pulseless ventricular tachycardia. These shockable rhythms respond to electrical cardioversion to restore organized cardiac activity.

6. What is the recommended compression-to-ventilation ratio for $2$-rescuer adult CPR without an advanced airway?

   Ratio: $30:2$. Balances circulation and ventilation in basic life support to minimize interruptions.

7. Which medication is indicated for suspected anaphylaxis with respiratory compromise or hypotension?

   Epinephrine IM per protocol. Counteracts severe allergic reactions by causing vasoconstriction and bronchodilation to stabilize vital signs.

8. What is the typical oxygen flow rate for a nebulizer driven by oxygen?

   Nebulizer: $6$–$8$ L/min. Ensures adequate aerosolization of medication without excessive flow that could reduce drug delivery efficiency.

9. Which rhythm requires immediate high-quality CPR and epinephrine rather than defibrillation?

   Asystole or pulseless electrical activity (PEA). Non-shockable rhythms require circulation support and vasopressors to address underlying causes.

10. What is the typical target EtCO$2$ range for a ventilated adult with adequate perfusion?

    EtCO$2$: $35$–$45$ mmHg. Represents normal range for eucapnia, guiding ventilation to avoid hypo- or hyperventilation complications.

11. What is the recommended adult chest compression rate during CPR?

    Compression rate: $100$–$120$/min. Optimizes cardiac output by balancing speed and quality, per AHA resuscitation guidelines.

12. What is the key treatment priority for acute pulmonary edema with severe dyspnea and hypertension?

    CPAP if not contraindicated, plus oxygenation/ventilation support. Applies positive pressure to reduce preload and afterload, improving oxygenation in cardiogenic pulmonary edema.

13. What is the recommended adult chest compression depth during CPR?

    Depth: $2$–$2.4$ inches ($5$–$6$ cm). Ensures adequate cardiac output by compressing the heart sufficiently against the spine.

14. What is the standard adult rate for bag-valve-mask ventilation without an advanced airway?

    Ventilate $1$ breath every $5$–$6$ seconds. Prevents hyperventilation in respiratory arrest, providing 10-12 breaths per minute to maintain normal CO2 levels.

15. Which medication is commonly given for suspected cardiac chest pain if not contraindicated?

    Aspirin per protocol (if no allergy or active bleeding). Inhibits platelet aggregation to reduce thrombus formation in acute coronary syndromes.

16. Which assessment finding best indicates inadequate ventilation requiring assisted ventilations?

    Altered mental status with poor tidal volume or slow rate. Signals hypoventilation leading to hypercapnia and acidosis, requiring intervention to ensure gas exchange.

17. What is the preferred initial medication for bronchospasm in asthma or COPD with wheezing?

    Inhaled beta-$2$ agonist (albuterol) per protocol. Relaxes bronchial smooth muscle to alleviate wheezing and improve airflow in reactive airway diseases.

18. What is the most reliable field indicator of oxygenation when a good waveform is present?

    Pulse oximetry (SpO$2$) with reliable pleth waveform. Measures hemoglobin oxygen saturation noninvasively, with waveform confirming accuracy in perfusion assessment.

19. What is the standard adult rate for bag-valve-mask ventilation with an advanced airway in place?

    Ventilate $1$ breath every $6$ seconds ($10$/min). Maintains adequate ventilation during CPR without causing hyperventilation, aligning with AHA guidelines for advanced airways.

20. What is the first-line prehospital treatment for suspected opioid-induced respiratory depression?

    Ventilate with BVM; give naloxone per protocol. Reverses opioid-induced hypoventilation by antagonizing mu-receptors while supporting airway and breathing.

21. What clinical finding most strongly suggests upper airway obstruction rather than lower airway disease?

    Stridor. Indicates high-pitched sound from turbulent airflow in narrowed upper airways, distinguishing it from wheezing in lower airways.

22. What oxygen flow rate is typically used for an adult nonrebreather mask (NRB)?

    NRB: $10$–$15$ L/min. Delivers high-flow oxygen up to 90-100% FiO2 when the reservoir bag is inflated, ideal for severe hypoxia.

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