Medical Emergencies: Respiratory and Cardiac Complaints
Help Questions
NREMT: EMT Level › Medical Emergencies: Respiratory and Cardiac Complaints
What is the primary reason for continuous monitoring during transport of a patient with chest pain?
To gather additional assessment data for research and quality improvement
To detect deterioration and adjust treatment accordingly during transport
To document improvement for medical liability protection purposes
To satisfy insurance requirements for ambulance transport reimbursement
Explanation
The correct answer is B. Continuous monitoring allows EMTs to detect changes in patient condition and adjust treatment (oxygen, positioning, transport priority) as needed. A is incorrect because monitoring is for patient care, not liability protection. C is incorrect because insurance requirements don't drive clinical monitoring decisions. D is incorrect because patient care, not research purposes, drives monitoring requirements during emergency transport.
A 45-year-old patient complains of crushing chest pain that radiates to the left arm and jaw. The patient is diaphoretic and nauseous. What is the EMT's primary treatment priority?
Nitroglycerin administration followed by aspirin therapy within protocols
High-flow oxygen therapy and immediate transport to cardiac facility
Pain medication administration and comfort positioning only
IV access establishment and cardiac monitoring during transport
Explanation
The correct answer is A. For suspected myocardial infarction, the EMT's primary treatment is oxygen therapy (if indicated by SpO2 <94%) and rapid transport to a facility capable of cardiac intervention. B is incorrect because while EMTs can assist with prescribed nitroglycerin and administer aspirin per protocol, transport is the primary priority. C is incorrect as IV access and cardiac monitoring are ALS interventions beyond EMT scope. D is incorrect because pain medication administration is not within basic EMT scope of practice.
A patient experiencing chest pain asks about taking their prescribed nitroglycerin. Which contraindication would prevent the EMT from assisting with this medication?
Patient's blood pressure is elevated at 160/90 mmHg
Patient reports the chest pain started during physical exertion
Patient has taken erectile dysfunction medication within 24 hours
Patient has a history of previous myocardial infarction
Explanation
The correct answer is A. Erectile dysfunction medications (like sildenafil) interact dangerously with nitroglycerin, causing severe hypotension. This is an absolute contraindication. B is incorrect because elevated blood pressure is not a contraindication for nitroglycerin. C is incorrect because exertional chest pain may actually indicate a need for nitroglycerin. D is incorrect because previous MI history doesn't contraindicate nitroglycerin use.
During transport of a cardiac patient, when should the EMT perform reassessment of vital signs?
Every 15 minutes for stable patients, every 5 minutes for unstable
Continuously monitor but document vitals only upon hospital arrival
Only if the patient's condition appears to deteriorate significantly
Every 5 minutes for stable patients, every 15 minutes for unstable
Explanation
The correct answer is B. Standard practice requires reassessment every 15 minutes for stable patients and every 5 minutes for unstable patients to monitor for changes and treatment effectiveness. A is incorrect because regular reassessment helps detect subtle changes before obvious deterioration. C is incorrect because it reverses the appropriate intervals - unstable patients need more frequent monitoring. D is incorrect because regular documentation of trends is essential for continuity of care.
A patient complains of chest pain and has a prescribed nitroglycerin spray. What is the correct technique for assisting with this medication?
Spray into the cheek area and have patient swish before swallowing
Spray directly onto the tongue while patient holds their breath
Spray under the tongue without having patient inhale the medication
Spray onto a sugar cube and have patient dissolve it slowly
Explanation
The correct answer is B. Sublingual nitroglycerin spray should be administered under the tongue for rapid absorption through mucous membranes, and the patient should not inhale during spraying. A is incorrect because spraying on the tongue reduces absorption and inhaling the spray isn't recommended. C is incorrect because buccal administration and swallowing reduce the medication's effectiveness. D is incorrect because this method isn't appropriate for nitroglycerin spray administration.
A patient with chronic bronchitis is experiencing an exacerbation with increased sputum production and dyspnea. What color sputum would most concern the EMT?
Yellow or green sputum suggesting possible bacterial infection
Clear or white sputum indicating viral inflammation only
Brown sputum consistent with old blood from previous episodes
Pink, frothy sputum indicating pulmonary edema development
Explanation
The correct answer is D. Pink, frothy sputum indicates pulmonary edema, which is life-threatening and requires immediate intervention. A is incorrect because clear/white sputum, while concerning for exacerbation, isn't immediately life-threatening. B is incorrect because yellow/green sputum suggests infection but isn't as immediately dangerous as pulmonary edema. C is incorrect because brown sputum from old blood, while concerning, isn't as acutely life-threatening as active pulmonary edema.
When assisting a patient with their prescribed albuterol inhaler, how many puffs should the EMT typically help administer?
Two puffs as prescribed, then transport to hospital
Four puffs maximum to ensure adequate bronchodilation
Continue puffs every two minutes until wheezing resolves
One puff initially, then reassess before additional doses
Explanation
The correct answer is B. Standard protocol typically allows for two puffs of albuterol as prescribed by the patient's physician, then transport for further evaluation and treatment. A is incorrect because most prescriptions call for two puffs, not single puff dosing. C is incorrect because four puffs exceed typical prescribed doses and EMT scope. D is incorrect because continuous administration until symptom resolution exceeds EMT scope and could cause medication overdose.
A patient with respiratory distress has accessory muscle use and pursed-lip breathing. What does this indicate?
Medication side effects from recent bronchodilator inhaler usage
Normal compensation mechanism that requires no immediate intervention
Patient anxiety causing hyperventilation and breathing pattern changes
Increased work of breathing indicating significant respiratory compromise
Explanation
The correct answer is B. Accessory muscle use and pursed-lip breathing indicate increased work of breathing and significant respiratory distress requiring immediate attention. A is incorrect because while these are compensation mechanisms, they indicate serious respiratory compromise needing intervention. C is incorrect because anxiety alone doesn't typically cause accessory muscle use. D is incorrect because bronchodilators should improve, not worsen, breathing patterns.
When should an EMT consider requesting ALS intercept for a respiratory emergency?
Patients requesting advanced pain management for chest discomfort
Patient with severe distress not responding to basic interventions
Any patient requiring oxygen therapy or inhaler assistance
All asthma patients regardless of severity or response to treatment
Explanation
The correct answer is B. ALS intercept should be considered when patients have severe respiratory distress that doesn't improve with basic EMT interventions (oxygen, positioning, inhaler assistance). A is incorrect because many patients needing oxygen or inhaler assistance can be managed at the BLS level. C is incorrect because not all asthma patients require ALS intervention. D is incorrect because pain management alone isn't typically an indication for ALS intercept in respiratory emergencies.
A patient experiencing an asthma attack reports that their inhaler is empty. What should the EMT do?
Contact medical control to request permission for inhaler substitution
Administer nebulized albuterol using ambulance equipment if available
Provide supportive care and rapid transport without medication assistance
Use another patient's identical albuterol inhaler from previous call
Explanation
The correct answer is B. EMTs can only assist with medications prescribed to that specific patient. Without the patient's own inhaler, provide supportive care (positioning, oxygen) and transport. A is incorrect because EMTs cannot use medications prescribed to other patients. C is incorrect because medical control cannot authorize using another person's prescription. D is incorrect because nebulized treatments require advanced training and equipment beyond basic EMT scope.