NREMT Paramedic: Cardiology
You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision. As you are assessing him, he
... [Show More] tells you that he has congestive heart failure and atrial fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely responsible for this patient's clinical presentation? Answer- Digoxin.
This patient has classic signs of digitalis toxicity. Digoxin is commonly prescribed to patients with congestive heart failure and atrial fibrillation (A-Fib) or atrial flutter (A-Flutter). Its positive inotropic effects increase cardiac contractility and maintain cardiac output, while its negative chronotropic effects control the ventricular rate of the A-Fib or A-Flutter. Digitalis preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic index—that is, there is a fine line between a therapeutic and toxic dose. You should suspect digitalis toxicity in any patient who takes Digoxin or Lanoxin and presents with complaints such as nausea, vomiting, abdominal pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac dysrhythmia can be caused by the toxic effects of digitalis. Treatment involves the administration of Digibind, which is given at the hospital.
Which of the following is an absolute contraindication for fibrinolytic therapy? Answer- Subdural hematoma 3 years ago.
According to current emergency cardiac care (ECC) guidelines, absolute contraindications for fibrinolytic therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural, intracerebral hematoma); known structural cerebrovascular lesion (ie, arteriovenous malformation); known malignant intracranial tumor (primary or metastatic); ischemic stroke within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours; suspected aortic dissection; active bleeding or bleeding disorders (except menses); and significant closed head trauma or facial trauma within the past 3 months. Relative contraindications (eg, the physician may deem fibrinolytic therapy appropriate under certain circumstances) include, a history of chronic, severe, poorly-controlled hypertension; severe uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago; dementia; traumatic or prolonged (> 10 minutes) CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding; noncompressible vascular punctures; pregnancy; prior exposure (> 5 days ago) or prior allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of anticoagulants (ie, Coumadin).
A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you should: Answer- Administer up to 325 mg of aspirin.
Since oxygen has already been administered to this patient and your partner is attaching the ECG leads, you should administer aspirin (160 to 325 mg, non-enteric-coated). Early administration of aspirin has clearly been shown to reduce mortality and morbidity in patients experiencing an [Show Less]