Cardiac and Respiratory Medical Emergencies - NREMT: Paramedic Level
Card 1 of 25
What ECG finding most specifically indicates hypokalemia in a symptomatic patient?
What ECG finding most specifically indicates hypokalemia in a symptomatic patient?
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Prominent U waves. Low potassium disrupts repolarization, leading to visible U waves following the T wave on ECG.
Prominent U waves. Low potassium disrupts repolarization, leading to visible U waves following the T wave on ECG.
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Which rhythm requires defibrillation rather than synchronized cardioversion when pulseless?
Which rhythm requires defibrillation rather than synchronized cardioversion when pulseless?
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Ventricular fibrillation. As a chaotic rhythm without organized QRS complexes, it necessitates unsynchronized high-energy shocks to restore sinus rhythm.
Ventricular fibrillation. As a chaotic rhythm without organized QRS complexes, it necessitates unsynchronized high-energy shocks to restore sinus rhythm.
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What is the first-line antiarrhythmic for stable narrow-complex SVT after vagal maneuvers?
What is the first-line antiarrhythmic for stable narrow-complex SVT after vagal maneuvers?
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Adenosine. It transiently blocks AV node conduction, interrupting reentry circuits in supraventricular tachycardias.
Adenosine. It transiently blocks AV node conduction, interrupting reentry circuits in supraventricular tachycardias.
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What is the initial adult adenosine dose for regular narrow-complex SVT per ACLS?
What is the initial adult adenosine dose for regular narrow-complex SVT per ACLS?
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$6\ \text{mg rapid IV push, then flush}$. Rapid administration maximizes AV node blockade to terminate reentrant SVT while minimizing side effects.
$6\ \text{mg rapid IV push, then flush}$. Rapid administration maximizes AV node blockade to terminate reentrant SVT while minimizing side effects.
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What is the second adult adenosine dose if SVT persists after the first dose per ACLS?
What is the second adult adenosine dose if SVT persists after the first dose per ACLS?
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$12\ \text{mg rapid IV push, then flush}$. Escalated dosing enhances AV node suppression if the initial amount fails to break the tachycardia circuit.
$12\ \text{mg rapid IV push, then flush}$. Escalated dosing enhances AV node suppression if the initial amount fails to break the tachycardia circuit.
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Which AV block shows progressive PR prolongation followed by a dropped QRS complex?
Which AV block shows progressive PR prolongation followed by a dropped QRS complex?
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Second-degree AV block Type I (Wenckebach). Progressive AV node fatigue lengthens conduction until failure, creating a pattern of grouped beating.
Second-degree AV block Type I (Wenckebach). Progressive AV node fatigue lengthens conduction until failure, creating a pattern of grouped beating.
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What is the most appropriate initial ventilation strategy for apnea with a pulse?
What is the most appropriate initial ventilation strategy for apnea with a pulse?
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BVM ventilation with oxygen. It provides positive pressure to maintain oxygenation and ventilation until advanced airway management.
BVM ventilation with oxygen. It provides positive pressure to maintain oxygenation and ventilation until advanced airway management.
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What ECG finding most specifically indicates hyperkalemia in a symptomatic patient?
What ECG finding most specifically indicates hyperkalemia in a symptomatic patient?
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Tall, peaked T waves. Elevated potassium levels impair cardiac repolarization, causing characteristic T-wave changes as an early ECG indicator.
Tall, peaked T waves. Elevated potassium levels impair cardiac repolarization, causing characteristic T-wave changes as an early ECG indicator.
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Which ECG interval is prolonged in first-degree AV block?
Which ECG interval is prolonged in first-degree AV block?
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PR interval $>0.20\ \text{s}$. Delayed AV node conduction prolongs atrial-to-ventricular impulse time, though every P wave conducts to a QRS.
PR interval $>0.20\ \text{s}$. Delayed AV node conduction prolongs atrial-to-ventricular impulse time, though every P wave conducts to a QRS.
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Which condition classically presents with sudden dyspnea, pleuritic chest pain, and tachycardia?
Which condition classically presents with sudden dyspnea, pleuritic chest pain, and tachycardia?
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Pulmonary embolism. Thrombus occlusion of pulmonary arteries causes ventilation-perfusion mismatch and right heart strain.
Pulmonary embolism. Thrombus occlusion of pulmonary arteries causes ventilation-perfusion mismatch and right heart strain.
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Which AV block shows constant PR intervals with intermittent dropped QRS complexes?
Which AV block shows constant PR intervals with intermittent dropped QRS complexes?
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Second-degree AV block Type II (Mobitz II). Fixed conduction block below the AV node causes unpredictable QRS drops without PR changes.
Second-degree AV block Type II (Mobitz II). Fixed conduction block below the AV node causes unpredictable QRS drops without PR changes.
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Which medication is contraindicated in suspected right ventricular infarction with hypotension?
Which medication is contraindicated in suspected right ventricular infarction with hypotension?
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Nitroglycerin. It reduces preload, worsening hypotension in preload-dependent right ventricular failure.
Nitroglycerin. It reduces preload, worsening hypotension in preload-dependent right ventricular failure.
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What ECG feature defines complete (third-degree) AV block?
What ECG feature defines complete (third-degree) AV block?
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AV dissociation (P waves and QRS unrelated). Complete conduction failure separates atrial and ventricular rhythms, with escape pacemakers driving QRS independently.
AV dissociation (P waves and QRS unrelated). Complete conduction failure separates atrial and ventricular rhythms, with escape pacemakers driving QRS independently.
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Which acute coronary syndrome finding most strongly suggests right ventricular infarction?
Which acute coronary syndrome finding most strongly suggests right ventricular infarction?
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ST elevation in V4R. Right-sided leads detect inferior wall extension involving the right ventricle, guiding fluid management.
ST elevation in V4R. Right-sided leads detect inferior wall extension involving the right ventricle, guiding fluid management.
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What is the primary prehospital treatment for suspected opioid-induced respiratory depression?
What is the primary prehospital treatment for suspected opioid-induced respiratory depression?
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Ventilatory support and naloxone. Opioids depress respiratory drive, requiring reversal and mechanical support to restore ventilation.
Ventilatory support and naloxone. Opioids depress respiratory drive, requiring reversal and mechanical support to restore ventilation.
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What is the target adult oxygen saturation range for most acutely ill patients?
What is the target adult oxygen saturation range for most acutely ill patients?
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$94%\text{ to }98%$. This range balances oxygenation needs while preventing hyperoxia-induced vasoconstriction and oxidative stress.
$94%\text{ to }98%$. This range balances oxygenation needs while preventing hyperoxia-induced vasoconstriction and oxidative stress.
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What oxygen saturation target range is commonly used for COPD patients at risk of hypercapnia?
What oxygen saturation target range is commonly used for COPD patients at risk of hypercapnia?
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$88%\text{ to }92%$. Lower targets preserve hypoxic respiratory drive in chronic hypercapnia, avoiding CO2 retention.
$88%\text{ to }92%$. Lower targets preserve hypoxic respiratory drive in chronic hypercapnia, avoiding CO2 retention.
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Which medication is first-line for acute bronchospasm relief in asthma or COPD exacerbation?
Which medication is first-line for acute bronchospasm relief in asthma or COPD exacerbation?
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Inhaled beta-2 agonist (albuterol). It relaxes bronchial smooth muscle via beta-2 receptor stimulation, rapidly improving airflow.
Inhaled beta-2 agonist (albuterol). It relaxes bronchial smooth muscle via beta-2 receptor stimulation, rapidly improving airflow.
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Which clinical finding most strongly indicates immediate needle decompression in trauma?
Which clinical finding most strongly indicates immediate needle decompression in trauma?
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Tension pneumothorax with hemodynamic compromise. Trapped air causes mediastinal shift and shock, necessitating urgent pressure relief to restore venous return.
Tension pneumothorax with hemodynamic compromise. Trapped air causes mediastinal shift and shock, necessitating urgent pressure relief to restore venous return.
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Which lung sound is most consistent with lower airway bronchospasm in acute asthma?
Which lung sound is most consistent with lower airway bronchospasm in acute asthma?
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Wheezing. Bronchoconstriction produces high-pitched expiratory sounds from turbulent airflow in narrowed airways.
Wheezing. Bronchoconstriction produces high-pitched expiratory sounds from turbulent airflow in narrowed airways.
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Which ECG rhythm is defined by an irregularly irregular rhythm with no distinct P waves?
Which ECG rhythm is defined by an irregularly irregular rhythm with no distinct P waves?
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Atrial fibrillation. This rhythm arises from multiple atrial foci firing chaotically, resulting in absent P waves and irregular ventricular response.
Atrial fibrillation. This rhythm arises from multiple atrial foci firing chaotically, resulting in absent P waves and irregular ventricular response.
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What is the first-line medication for symptomatic bradycardia with poor perfusion per ACLS?
What is the first-line medication for symptomatic bradycardia with poor perfusion per ACLS?
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Atropine. As a parasympatholytic, it increases heart rate by blocking vagal tone in bradycardic patients with hemodynamic instability.
Atropine. As a parasympatholytic, it increases heart rate by blocking vagal tone in bradycardic patients with hemodynamic instability.
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What is the initial adult atropine dose for symptomatic bradycardia per ACLS?
What is the initial adult atropine dose for symptomatic bradycardia per ACLS?
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$1\ \text{mg IV/IO bolus}$. This dose effectively blocks vagal stimulation to raise heart rate without exceeding safe limits initially.
$1\ \text{mg IV/IO bolus}$. This dose effectively blocks vagal stimulation to raise heart rate without exceeding safe limits initially.
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What is the maximum total adult atropine dose for symptomatic bradycardia per ACLS?
What is the maximum total adult atropine dose for symptomatic bradycardia per ACLS?
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$3\ \text{mg total}$. Cumulative dosing ensures maximal vagal blockade while minimizing toxicity risks in persistent bradycardia.
$3\ \text{mg total}$. Cumulative dosing ensures maximal vagal blockade while minimizing toxicity risks in persistent bradycardia.
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Which intervention is preferred for unstable tachycardia with a pulse and signs of shock?
Which intervention is preferred for unstable tachycardia with a pulse and signs of shock?
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Synchronized cardioversion. It delivers energy timed to the R wave to convert the rhythm safely without inducing ventricular fibrillation.
Synchronized cardioversion. It delivers energy timed to the R wave to convert the rhythm safely without inducing ventricular fibrillation.
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