Paramedics Exam Cardiology and Resuscitation 2 — Questions and Answers
Question 1: A patient presents with a wide-complex tachycardia at 180 bpm. The patient is hemodynamically unstable with a BP of 70/40 mmHg. What is the most appropriate immediate intervention?
- Administer amiodarone 150 mg IV
- Synchronized cardioversion starting at 100 J (Correct answer)
- Unsynchronized defibrillation at 200 J
- Adenosine 6 mg rapid IV push
Correct answer: Synchronized cardioversion starting at 100 J
Unstable wide-complex tachycardia requires immediate synchronized cardioversion; pharmacologic therapy is reserved for stable patients.
Question 2: During CPR, which finding on capnography most reliably indicates return of spontaneous circulation (ROSC)?
- ETCO2 drops below 10 mmHg
- ETCO2 suddenly rises above 40 mmHg (Correct answer)
- ETCO2 remains stable at 20 mmHg
- ETCO2 rises gradually to 35 mmHg
Correct answer: ETCO2 suddenly rises above 40 mmHg
A sudden abrupt rise in ETCO2 above 40 mmHg during CPR is a reliable indicator of ROSC due to restored cardiac output.
Question 3: A 58-year-old male presents with crushing chest pain radiating to the left arm. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior STEMI, most commonly caused by occlusion of the right coronary artery.
Question 4: Which of the following is the preferred initial energy setting for defibrillation of ventricular fibrillation with a biphasic defibrillator?
- 120-200 J as recommended by the manufacturer (Correct answer)
- 360 J
- 50 J
- 200 J monophasic equivalent
Correct answer: 120-200 J as recommended by the manufacturer
Biphasic defibrillators should be used at the manufacturer-recommended dose (120-200 J); if unknown, use the maximum available.
Question 5: A patient in cardiac arrest has a PEA rhythm. Which of the following H's and T's is the most likely reversible cause if the patient has a history of recent dialysis?
- Hypoxia
- Hyperkalemia (Correct answer)
- Hypothermia
- Tension pneumothorax
Correct answer: Hyperkalemia
Dialysis patients are at high risk for hyperkalemia, which can cause PEA and is a reversible cause of cardiac arrest.
Question 6: What is the correct compression-to-ventilation ratio for two-rescuer adult CPR with an advanced airway in place?
- 30:2 with pauses for ventilation
- 15:2 with pauses for ventilation
- Continuous compressions at 100-120/min with 1 breath every 6 seconds (Correct answer)
- Continuous compressions at 100-120/min with 1 breath every 10 seconds
Correct answer: Continuous compressions at 100-120/min with 1 breath every 6 seconds
Once an advanced airway is secured, CPR transitions to continuous chest compressions with asynchronous ventilations at a rate of one breath every 6 seconds.
Question 7: A patient with known heart failure presents with acute pulmonary edema and a BP of 160/100 mmHg. Which medication is the highest priority?
- Furosemide 40 mg IV
- Nitroglycerin 0.4 mg SL (Correct answer)
- Morphine 2 mg IV
- Metoprolol 5 mg IV
Correct answer: Nitroglycerin 0.4 mg SL
Nitroglycerin rapidly reduces preload and afterload via venodilation, providing immediate symptomatic relief in hypertensive acute pulmonary edema.
Paramedics Exam Cardiology and Resuscitation 2
A patient presents with a wide-complex tachycardia at 180 bpm.
The patient is hemodynamically unstable with a BP of 70/40 mmHg.
What is the most appropriate immediate intervention?