NREMT Paramedic – Cardiology/Resuscitation — Quick Review

An ECG rhythm strip shows an irregularly irregular rhythm with no discernible P waves and a ventricular rate of 130 bpm. Which rhythm is this most consistent with?

Atrial fibrillation with rapid ventricular response

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Atrial flutter with variable block

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Multifocal atrial tachycardia

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Sinus arrhythmia with premature atrial complexes

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A patient presents with dizziness, a heart rate of 34 bpm, and a blood pressure of 78/50 mmHg. The ECG shows P waves and QRS complexes occurring independently of each other, with a regular P-P interval and a regular R-R interval. What rhythm is present?

Third-degree (complete) AV block

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Second-degree type I (Wenckebach) AV block

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Second-degree type II (Mobitz) AV block

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Sinus bradycardia with first-degree AV block

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A cardiac monitor shows a regular, narrow-complex tachycardia at a rate of 180 bpm with no visible P waves. The patient is stable with a blood pressure of 120/80 mmHg. What is the most likely rhythm?

Supraventricular tachycardia (SVT)

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Ventricular tachycardia

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Sinus tachycardia

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Atrial flutter with 1:1 conduction

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Which AV block is characterized by a progressive lengthening of the PR interval until a P wave fails to conduct, followed by a return to a shorter PR interval?

Second-degree type I (Wenckebach) AV block

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First-degree AV block

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Second-degree type II (Mobitz) AV block

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Third-degree (complete) AV block

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A 12-lead ECG shows ST elevation in leads V1 through V4 with reciprocal ST depression in leads II, III, and aVF. Which type of myocardial infarction is indicated?

Anterior wall STEMI, most likely from left anterior descending artery occlusion

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Inferior wall STEMI from right coronary artery occlusion

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Lateral wall STEMI from left circumflex artery occlusion

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Posterior wall STEMI from posterior descending artery occlusion

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On a standard 12-lead ECG, which leads view the lateral wall of the left ventricle?

Leads I, aVL, V5, and V6

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Leads II, III, and aVF

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Leads V1, V2, V3, and V4

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Leads aVR, V1, and V2

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A patient’s 12-lead ECG shows ST depression in leads V1 through V3. The paramedic suspects a posterior MI. Which additional action would confirm this suspicion?

Obtain posterior leads (V7, V8, V9) looking for ST elevation

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Obtain right-sided leads (V3R, V4R) looking for ST elevation

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Repeat the standard 12-lead ECG in 15 minutes to confirm the findings

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Administer nitroglycerin and reassess the ECG for changes

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Which ECG finding is most characteristic of hyperkalemia?

Tall, peaked, narrow-based T waves

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ST elevation with concave morphology in all leads

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Prolonged QT interval with flattened T waves

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Delta waves with a shortened PR interval

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During a cardiac arrest resuscitation, the patient is in pulseless ventricular tachycardia. Two defibrillation attempts and epinephrine have been administered. What antiarrhythmic should be considered next?

Amiodarone 300 mg IV/IO bolus

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Atropine 1 mg IV push

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Adenosine 6 mg rapid IV push

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Diltiazem 20 mg slow IV push

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Which mnemonic identifies the reversible causes of cardiac arrest that should be systematically evaluated during a resuscitation?

The Hs and Ts

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The ABCDEs of primary survey

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The SAMPLE history mnemonic

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The OPQRST pain assessment

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During high-performance CPR, what is the recommended compression fraction goal, and why is it important?

At least 80%, to maintain coronary and cerebral perfusion

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At least 60%, as this allows adequate time for rhythm analysis

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At least 90%, to maximize continuous blood flow to the brain

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At least 50%, as frequent ventilation pauses are equally important

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A patient in cardiac arrest has been receiving high-quality CPR with an ETCO2 of 18 mmHg. During the next rhythm check, the ETCO2 suddenly rises to 52 mmHg. What is the most likely explanation?

Return of spontaneous circulation (ROSC)

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The endotracheal tube has become dislodged from the trachea

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The patient has developed a tension pneumothorax

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The capnography equipment is malfunctioning

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Following ROSC in a cardiac arrest patient, the 12-lead ECG shows ST elevation in leads V1 through V4. The patient remains comatose. What is the most appropriate transport destination and why?

A hospital with both PCI capability and targeted temperature management, because the patient needs emergent catheterization and neuroprotective cooling

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The closest emergency department regardless of capabilities for immediate stabilization

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A hospital with a neurology department for brain injury evaluation only

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A cardiac rehabilitation center for post-arrest recovery planning

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In post-cardiac arrest care, why should hyperoxia be avoided in the patient who has achieved ROSC?

Excessive oxygen administration after ROSC can increase free radical production and worsen reperfusion injury to the brain and myocardium

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High-flow oxygen causes bronchospasm in all post-arrest patients

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Supplemental oxygen interferes with the effectiveness of vasopressor medications

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Hyperoxia causes the pulse oximeter to malfunction and give falsely low readings

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A patient achieves ROSC after a prolonged cardiac arrest. The blood pressure is 82/50 mmHg despite a 500 mL normal saline bolus. What vasopressor is most appropriate to maintain hemodynamic stability?

Initiate a vasopressor infusion (such as norepinephrine or dopamine) per local protocol

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Administer another 1 mg epinephrine IV push per the cardiac arrest protocol

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Start a low-dose dopamine infusion at 2 mcg/kg/min for renal protection

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Administer a 1-liter crystalloid bolus and reassess blood pressure

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A patient presents with a regular, narrow-complex tachycardia at 190 bpm. The patient is stable with a blood pressure of 118/76 mmHg. Vagal maneuvers have been attempted without success. What is the next recommended treatment per ACLS guidelines?

Adenosine 6 mg rapid IV push followed by a 20 mL saline flush, administered at the most proximal IV site available

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Immediate synchronized cardioversion at 50 joules

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Amiodarone 150 mg IV over 10 minutes

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Diltiazem 0.25 mg/kg slow IV push over 2 minutes

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According to the ACLS bradycardia algorithm, what is the first-line medication for symptomatic bradycardia?

Atropine 1 mg IV, repeated every 3 to 5 minutes to a maximum of 3 mg

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Epinephrine 1 mg IV push, repeated every 3 to 5 minutes

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Amiodarone 300 mg IV bolus

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Lidocaine 1 to 1.5 mg/kg IV push

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A patient presents with a wide-complex tachycardia at 160 bpm. The patient is diaphoretic, confused, and has a blood pressure of 74/40 mmHg. What is the most appropriate immediate intervention?

Immediate synchronized cardioversion, with sedation if the patient's condition permits a brief delay

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Adenosine 6 mg rapid IV push to differentiate SVT with aberrancy from VT

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Amiodarone 150 mg IV over 10 minutes while continuing to monitor

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Vagal maneuvers followed by procainamide infusion if unsuccessful

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What is the mechanism of action of adenosine when used to treat supraventricular tachycardia?

It transiently blocks conduction through the AV node, interrupting the reentrant circuit

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It directly stimulates the vagus nerve to slow the heart rate

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It blocks calcium channels in the sinoatrial node to reduce automaticity

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It inhibits sodium channels to slow ventricular conduction velocity

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A paramedic is managing a patient with an anterior STEMI and a blood pressure of 160/100 mmHg. After aspirin has been administered, which medication should be given next, assuming no contraindications?

Nitroglycerin 0.4 mg sublingual to reduce preload and relieve chest pain

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Metoprolol 5 mg IV to immediately reduce heart rate and myocardial oxygen demand

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Morphine 4 mg IV as the first-line analgesic for acute MI pain

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Amiodarone 150 mg IV prophylactically to prevent ventricular arrhythmias

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What is the standard dose and route of epinephrine administered during adult cardiac arrest?

1 mg of the 1:10,000 (0.1 mg/mL) concentration IV/IO every 3 to 5 minutes

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0.3 mg of the 1:1,000 (1 mg/mL) concentration intramuscularly every 15 minutes

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0.5 mg of the 1:10,000 (0.1 mg/mL) concentration subcutaneously every 5 minutes

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2 mg of the 1:1,000 (1 mg/mL) concentration IV push every 10 minutes

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A patient with atrial fibrillation and rapid ventricular response has a heart rate of 170 bpm, blood pressure of 80/50 mmHg, and altered mental status. The paramedic prepares for synchronized cardioversion. What is the recommended initial energy setting for a biphasic defibrillator?

120 to 200 joules biphasic (or follow the manufacturer's recommendation)

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50 joules biphasic for all supraventricular rhythms

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360 joules biphasic as the standard first energy setting

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10 joules biphasic starting at the lowest available setting

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Why must the defibrillator be placed in ‘sync’ mode before performing cardioversion on a patient with an organized tachyarrhythmia?

Sync mode times the shock to the R wave to avoid delivering energy during the vulnerable period of the cardiac cycle, which could induce ventricular fibrillation

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Sync mode reduces the energy output by half to protect the myocardium from damage

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Sync mode ensures the shock is delivered during the T wave for maximum effectiveness

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Sync mode pauses the shock delivery for 10 seconds to allow for patient sedation

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A paramedic prepares to cardiovert a conscious patient with unstable SVT. What should be administered before delivering the shock?

Procedural sedation with a medication such as midazolam or etomidate to reduce pain and anxiety

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Adenosine 12 mg IV push as a final pharmacological attempt before electricity

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Aspirin 324 mg chewed as a cardioprotective measure before the shock

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Atropine 0.5 mg IV to prevent the heart rate from dropping too low after cardioversion

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A patient with symptomatic third-degree heart block is unresponsive to atropine. The paramedic initiates transcutaneous pacing at a rate of 70 bpm. The milliamp output is gradually increased from 0 mA. At 65 mA, pacer spikes appear on the monitor with corresponding wide QRS complexes, but the patient has no palpable pulse. What should the paramedic do?

Continue increasing the milliamp output because electrical capture has occurred but mechanical capture has not yet been achieved

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Stop pacing because the presence of QRS complexes confirms adequate cardiac output

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Decrease the pacing rate to 40 bpm to allow the heart's native rhythm to take over

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Discontinue pacing and begin CPR because pulseless electrical activity is present

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Which of the following is an indication for transcutaneous pacing in the prehospital setting?

Symptomatic bradycardia unresponsive to atropine

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Stable sinus bradycardia at 55 bpm in an asymptomatic athlete

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Atrial fibrillation with rapid ventricular response and hypotension

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Ventricular fibrillation refractory to defibrillation and epinephrine

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A 3-year-old child is in cardiac arrest with a shockable rhythm (ventricular fibrillation). What is the correct initial defibrillation energy dose?

2 joules per kilogram of body weight

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4 joules per kilogram of body weight

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50 joules regardless of weight

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120 joules as the standard biphasic dose

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What is the most common initial rhythm in pediatric cardiac arrest?

Asystole or pulseless electrical activity (non-shockable rhythms)

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Ventricular fibrillation

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Pulseless ventricular tachycardia

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Supraventricular tachycardia with loss of pulses

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During the resuscitation of a 5-year-old child, peripheral IV access cannot be obtained after two attempts. What is the most appropriate next step for vascular access?

Establish intraosseous (IO) access in the proximal tibia

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Attempt a central venous catheter in the internal jugular vein

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Continue peripheral IV attempts in the upper extremity for up to 10 minutes

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Administer all medications via the endotracheal tube route

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What is the recommended compression-to-ventilation ratio for two-rescuer CPR in an infant?

15 compressions to 2 ventilations

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30 compressions to 2 ventilations

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5 compressions to 1 ventilation

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Continuous compressions with asynchronous ventilations

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On a 12-lead ECG, ST segment elevation in leads V1 through V4 is most consistent with which finding?

Anterior wall STEMI

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Inferior wall STEMI

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Lateral wall STEMI

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Right ventricular MI

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A 52-year-old male presents with crushing chest pain. His 12-lead ECG shows ST elevation in leads II, III, and aVF with ST depression in leads I and aVL. What do the ST changes in leads I and aVL represent?

Reciprocal changes confirming an acute inferior STEMI

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A concurrent lateral wall infarction

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Artifact from poor lead placement

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Evidence of a prior anterior MI

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Which 12-lead ECG finding meets the standard criteria for STEMI activation in a patient with chest pain?

ST elevation of 1 mm or greater in two or more contiguous leads

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ST elevation in any single lead regardless of amplitude

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ST depression of 2 mm or greater in leads V1 through V3

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T-wave inversion in three or more noncontiguous leads

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A 64-year-old male with chest pain has a 12-lead ECG showing ST elevation in leads II, III, and aVF. You suspect right ventricular involvement. Which additional lead placement should you obtain to confirm this suspicion?

Right-sided V4R lead

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Posterior leads V7 through V9

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Repeat standard 12-lead with limb leads repositioned

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Lewis lead configuration

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A 59-year-old female presents with chest pain and nausea. Her standard 12-lead ECG shows ST depression in leads V1 through V3 with tall R waves in V1 and V2. You suspect a posterior MI. Which additional leads should be placed to evaluate this?

Leads V7, V8, and V9 placed on the posterior chest wall

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Right-sided leads V3R through V6R

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High lateral leads placed one intercostal space above V1 and V2

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Lewis lead placed at the right sternal border

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Which ECG finding is characteristic of a left bundle branch block (LBBB)?

Wide QRS complex greater than 120 ms with a broad, notched R wave in leads I and V6

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Narrow QRS complex with a short PR interval and delta wave

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Wide QRS complex with an RSR' pattern in lead V1

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Normal QRS width with ST elevation in leads V1 through V4

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On a 12-lead ECG, T-wave inversions in the precordial leads of a patient with recent chest pain are most suggestive of which condition?

Myocardial ischemia

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Acute pericarditis

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Hyperkalemia

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Digitalis toxicity

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A 48-year-old male presents with palpitations and lightheadedness. His ECG shows a short PR interval, a slurred upstroke at the beginning of the QRS complex, and a widened QRS. Which condition does this ECG pattern represent?

Wolff-Parkinson-White (WPW) syndrome

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Left bundle branch block

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First-degree AV block

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Brugada syndrome

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A 32-year-old male with no cardiac history presents after a syncopal episode. His ECG shows a coved ST segment elevation in leads V1 through V3 with T-wave inversion, and normal QRS duration. He is currently asymptomatic with normal vital signs. Which condition should the paramedic suspect?

Brugada syndrome

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Anterior STEMI

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Right bundle branch block

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Early repolarization

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A 28-year-old female presents with palpitations after drinking multiple energy drinks. Her ECG shows a normal sinus rhythm with a QTc interval of 540 ms. She has a family history of sudden cardiac death. Which risk does this ECG finding primarily indicate?

Increased risk of torsades de pointes and ventricular fibrillation

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Increased risk of atrial fibrillation with rapid ventricular response

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Increased risk of complete heart block

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Increased risk of aortic dissection

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A 72-year-old male with end-stage renal disease presents with generalized weakness. His ECG shows tall, peaked, narrow-based T waves, a widened QRS complex, and a flattened P wave. His potassium level from a recent lab draw is reported as 7.2 mEq/L. Which ECG change indicates the most imminent risk of cardiac arrest?

The widened QRS complex, which can progress to a sine wave pattern and cardiac arrest

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The peaked T waves, which are a benign early finding that rarely progresses

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The flattened P waves, which indicate atrial standstill without ventricular risk

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The elevated potassium level alone, since ECG changes do not correlate with arrhythmia risk

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A 24-year-old male presents with sharp chest pain that worsens with deep breathing and lying flat but improves when leaning forward. His ECG shows diffuse ST elevation in multiple lead groups that do not follow a single coronary artery distribution, along with PR segment depression in lead II. Which diagnosis is most consistent with these findings?

Acute pericarditis

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Multivessel STEMI

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Aortic dissection with coronary involvement

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Takotsubo cardiomyopathy

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On a 12-lead ECG, what does J-point elevation refer to?

Elevation of the junction between the end of the QRS complex and the beginning of the ST segment

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Elevation of the peak of the T wave above the baseline

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Elevation of the PR segment above the isoelectric line

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Elevation of the P wave amplitude above normal limits

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A 22-year-old athletic male presents for an unrelated complaint. His 12-lead ECG shows J-point elevation with concave upward ST segments in the precordial leads, no reciprocal changes, and a normal heart rate. He is completely asymptomatic. Which interpretation is most likely?

Early repolarization, a benign normal variant commonly seen in young adults

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Acute anterior STEMI requiring emergent catheterization lab activation

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Acute pericarditis requiring anti-inflammatory therapy

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Brugada pattern requiring immediate defibrillator evaluation

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Which ECG finding is most consistent with left ventricular hypertrophy?

Tall R waves in the left-sided leads (V5, V6) and deep S waves in the right-sided leads (V1, V2) meeting voltage criteria

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Tall, peaked P waves in lead II exceeding 2.5 mm

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RSR' pattern in lead V1 with a widened QRS

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Low voltage QRS complexes across all leads

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On a 12-lead ECG, P-wave amplitude greater than 2.5 mm in lead II or a biphasic P wave with a prominent initial positive deflection in V1 is most consistent with which finding?

Right atrial enlargement

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Left atrial enlargement

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First-degree AV block

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Junctional rhythm

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A 66-year-old female presents with chest pressure lasting 3 hours. Her 12-lead ECG shows ST depression in leads V1 through V4 and T-wave inversions in leads I and aVL, without any ST elevation. She has ongoing pain and a troponin level reported from the sending facility as elevated. How should the paramedic differentiate this presentation from a STEMI?

This presentation is consistent with NSTEMI (ischemia without ST elevation), which does not meet criteria for emergent catheterization lab activation but still requires urgent transport and treatment

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ST depression is equivalent to ST elevation, so this should be treated identically as a STEMI

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The absence of ST elevation rules out any form of acute coronary syndrome

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T-wave inversions with ST depression always indicate a chronic, stable condition that is not time-sensitive

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On a 12-lead ECG, which set of leads are considered contiguous leads representing the inferior wall of the heart?

Leads II, III, and aVF

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Leads I, aVL, and V6

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Leads V1, V2, and V3

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Leads V4, V5, and V6

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Left axis deviation on a 12-lead ECG is defined as a QRS axis between which values?

Negative 30 degrees to negative 90 degrees

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0 degrees to positive 90 degrees

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Positive 90 degrees to positive 180 degrees

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Negative 90 degrees to negative 180 degrees

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A 55-year-old male with a history of COPD and cor pulmonale has a 12-lead ECG showing right axis deviation with a dominant R wave in V1 and a deep S wave in V6. Which underlying condition is most likely responsible for these findings?

Right ventricular hypertrophy secondary to chronic pulmonary disease

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Left ventricular hypertrophy from chronic hypertension

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Wolff-Parkinson-White syndrome with right-sided accessory pathway

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Anterior septal MI with Q waves in V1

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A 60-year-old female presents with acute chest pain. Her 12-lead ECG shows ST elevation in leads V3 and V4, with ST depression in leads II, III, and aVF. A colleague suggests the ST depression is simply a baseline artifact. How should you interpret the ST depression?

The ST depression represents reciprocal changes that support the diagnosis of an acute anterior STEMI

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The ST depression is a normal finding unrelated to the anterior ST elevation

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The ST depression indicates a concurrent inferior NSTEMI requiring additional treatment

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The ST depression is caused by lead misplacement and the ECG should be repeated before any interpretation

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You are transporting a patient with a known new LBBB and acute chest pain. The standard 12-lead ECG shows ST elevation in leads with a predominantly positive QRS complex (V5, V6, I, aVL). Per the Sgarbossa criteria, when is ST elevation in the setting of LBBB most suggestive of an acute MI?

When there is concordant ST elevation of 1 mm or greater (ST elevation in the same direction as the QRS complex)

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When there is discordant ST elevation of any amount in leads with a negative QRS

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When the ST segment is isoelectric in all precordial leads

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When the T waves are upright in leads with a predominantly negative QRS

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What is the recommended compression depth for an infant during CPR?

Approximately 1.5 inches (4 cm)

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Approximately 1 inch (2.5 cm)

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Approximately 2 inches (5 cm)

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Approximately 2.5 inches (6 cm)

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What is the correct compression-to-ventilation ratio for two-rescuer infant CPR performed by healthcare providers?

15:2

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30:2

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5:1

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10:2

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A 4-year-old child is found unresponsive and pulseless. You and your partner initiate CPR. At what rate should you deliver chest compressions?

100 to 120 compressions per minute

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80 to 100 compressions per minute

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At least 120 compressions per minute

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60 to 80 compressions per minute

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A 6-year-old child weighing 20 kg is in cardiac arrest with pulseless ventricular tachycardia. What is the correct initial dose of epinephrine for this patient?

0.2 mg (0.01 mg/kg) of 1:10,000 concentration IV/IO

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1.0 mg of 1:10,000 concentration IV/IO

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0.2 mg (0.01 mg/kg) of 1:1,000 concentration IV/IO

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0.02 mg (0.001 mg/kg) of 1:10,000 concentration IV/IO

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A newborn is delivered at 39 weeks gestation. The infant is not breathing, has a heart rate of 50 beats per minute, and appears cyanotic. Initial steps of warming, drying, and stimulation have been performed without improvement. After 30 seconds of effective positive pressure ventilation, the heart rate remains at 50 bpm. What is the most appropriate next intervention?

Begin chest compressions coordinated with ventilations at a 3:1 ratio

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Administer epinephrine 0.01 mg/kg via umbilical vein catheter

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Perform endotracheal intubation before any other intervention

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Increase the ventilation rate to 60 breaths per minute

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A newborn delivered in the field has thick meconium-stained amniotic fluid. The baby is limp and not crying. After initial warming and positioning, what is the recommended approach?

Begin positive pressure ventilation if the infant is not breathing effectively

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Perform immediate endotracheal intubation and suction the trachea before any ventilation

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Suction the oropharynx and nasopharynx aggressively before stimulating the infant

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Withhold ventilation until the airway is cleared by direct laryngoscopy

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A 2-year-old child presents with a heart rate of 40 beats per minute, poor perfusion, altered mental status, and hypotension. The cardiac monitor shows a narrow QRS bradycardia. Bag-valve-mask ventilation with supplemental oxygen has been provided for 2 minutes without improvement. What is the most appropriate next step?

Initiate CPR and prepare epinephrine 0.01 mg/kg IV/IO

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Administer atropine 0.02 mg/kg IV/IO

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Perform immediate transcutaneous pacing

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Administer adenosine 0.1 mg/kg rapid IV push

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A 9-month-old infant presents with a heart rate of 260 beats per minute on the cardiac monitor. The QRS complex is narrow, and P waves are not identifiable. The infant is irritable but has adequate perfusion and a blood pressure of 78/50 mmHg. What is the first pharmacologic intervention?

Adenosine 0.1 mg/kg rapid IV push followed by a saline flush

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Amiodarone 5 mg/kg IV over 20 minutes

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Synchronized cardioversion at 0.5 J/kg

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Verapamil 0.1 mg/kg slow IV push

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You are managing a 5-year-old child in cardiac arrest. The estimated weight is 18 kg. After two rounds of CPR and defibrillation for ventricular fibrillation, epinephrine has been administered. The rhythm remains ventricular fibrillation. Which antiarrhythmic medication and dose should be administered next?

Amiodarone 90 mg (5 mg/kg) IV/IO bolus

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Lidocaine 18 mg (1 mg/kg) IV/IO bolus

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Amiodarone 270 mg (15 mg/kg) IV over 10 minutes

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Magnesium sulfate 450 mg (25 mg/kg) IV/IO

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When using a length-based resuscitation tape to estimate the weight of a pediatric patient, which body landmark determines the correct measurement zone?

The tape is measured from the top of the head to the heel with the child lying supine

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The tape is measured from the chin to the navel with the child lying supine

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The tape is wrapped around the child's mid-upper arm circumference

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The tape is measured from the shoulder to the fingertip with the arm extended

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A 3-year-old child is in cardiac arrest. You are unable to establish IV access after two attempts. What is the preferred alternative route for epinephrine administration?

Intraosseous (IO) access in the proximal tibia

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Endotracheal tube administration at 10 times the IV dose

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Intramuscular injection in the vastus lateralis

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Subcutaneous injection in the deltoid region

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A 7-year-old child weighing 25 kg presents with a wide-complex tachycardia at a rate of 200 bpm. The child is conscious but has weak peripheral pulses, capillary refill of 5 seconds, and a blood pressure of 70/40 mmHg. What is the most appropriate immediate intervention?

Synchronized cardioversion starting at 0.5 J/kg (12.5 J)

Correct Incorrect Correct answer

Amiodarone 5 mg/kg IV over 20 minutes

Correct Incorrect Correct answer

Unsynchronized defibrillation at 2 J/kg (50 J)

Correct Incorrect Correct answer

Vagal maneuvers followed by adenosine 0.1 mg/kg rapid IV push

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During neonatal resuscitation, a full-term newborn has a heart rate of 80 bpm and irregular respiratory effort after initial steps. You are providing positive pressure ventilation with a bag-mask device. What ventilation rate should be delivered?

40 to 60 breaths per minute

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12 to 20 breaths per minute

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20 to 30 breaths per minute

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60 to 80 breaths per minute

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What is the initial defibrillation energy dose for a pediatric patient in ventricular fibrillation?

2 J/kg

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1 J/kg

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4 J/kg

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0.5 J/kg

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You are resuscitating a newborn who remains apneic and bradycardic at 45 bpm despite 60 seconds of coordinated chest compressions and ventilation through an endotracheal tube. IV access has not been established. What is the most appropriate next action?

Obtain emergency umbilical venous catheter access and administer epinephrine 0.01 to 0.03 mg/kg IV

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Administer epinephrine 0.1 mg/kg via the endotracheal tube

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Increase the compression rate to 150 per minute

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Administer atropine 0.02 mg/kg via the endotracheal tube

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A 68-year-old male presents with a regular wide-complex tachycardia at a rate of 160 bpm. His blood pressure is 102/68 mmHg and he is alert but complains of chest discomfort. After confirming monomorphic ventricular tachycardia on the monitor, which medication is most appropriate as first-line treatment?

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Lidocaine 0.5 mg/kg IV bolus

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Atropine 0.5 mg IV push

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What is the correct initial IV dose and indication for atropine sulfate in the prehospital setting?

0.5 mg IV for symptomatic bradycardia

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1.0 mg IV for asystole as a first-line agent

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0.25 mg IV for second-degree AV block Type I

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0.5 mg IV for narrow-complex tachycardia

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A 54-year-old female presents with a narrow-complex tachycardia at 188 bpm. Vagal maneuvers have failed. Adenosine 6 mg was given without effect, followed by adenosine 12 mg with no conversion. The patient remains hemodynamically stable. Which medication should the paramedic consider next?

Diltiazem 0.25 mg/kg IV over 2 minutes

Correct Incorrect Correct answer

Adenosine 18 mg rapid IV push

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Lidocaine 1.5 mg/kg IV bolus

Correct Incorrect Correct answer

Epinephrine 1 mg IV push

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A paramedic is treating a 72-year-old male with atrial fibrillation and a rapid ventricular response at 156 bpm. His blood pressure is 88/54 mmHg and he is confused with cool, diaphoretic skin. Why is verapamil contraindicated in this patient?

Verapamil causes vasodilation and myocardial depression that will worsen the existing hypotension

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Verapamil has no effect on atrial fibrillation with rapid ventricular response

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Verapamil is only available in oral form and cannot be given intravenously

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Verapamil converts atrial fibrillation to ventricular fibrillation

Correct Incorrect Correct answer

A 42-year-old male involved in a motor vehicle collision is complaining of severe chest wall pain rated 9 out of 10. His vital signs are: BP 138/82 mmHg, HR 104 bpm, RR 22, SpO2 97%. He has no signs of head injury and is alert and oriented. Which analgesic is most appropriate for prehospital pain management?

Fentanyl 1 mcg/kg IV

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Morphine 4 mg IV push

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Ketorolac 30 mg IV

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Aspirin 325 mg orally

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A paramedic is managing a patient in cardiogenic shock with a blood pressure of 78/50 mmHg and bilateral rales. The patient has IV access established. Which vasopressor is most appropriate for this presentation?

Norepinephrine infusion at 0.1 to 0.5 mcg/kg/min

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Dopamine infusion at 2 to 5 mcg/kg/min

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Epinephrine 1 mg IV push every 3 to 5 minutes

Correct Incorrect Correct answer

Phenylephrine 100 mcg IV bolus

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At what infusion rate does dopamine primarily stimulate beta-1 adrenergic receptors to produce increased cardiac contractility and heart rate?

5 to 10 mcg/kg/min

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1 to 2 mcg/kg/min

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10 to 20 mcg/kg/min

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20 to 30 mcg/kg/min

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Prior to the 2015 ACLS guideline update, vasopressin could be used during cardiac arrest as an alternative to which medication?

Epinephrine

Correct Incorrect Correct answer

Amiodarone

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Atropine

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Lidocaine

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A 58-year-old female with a history of heart failure presents with worsening dyspnea, bilateral crackles, and a blood pressure of 110/72 mmHg. The monitor shows sinus tachycardia at 118 bpm. She has an IV established and the paramedic is considering inotropic support. Why is dobutamine preferred over dopamine in this patient?

Dobutamine increases cardiac contractility with less vasoconstriction and tachycardia than dopamine

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Dobutamine raises blood pressure more effectively through peripheral vasoconstriction

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Dobutamine has a longer half-life that provides more sustained hemodynamic support

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Dobutamine stimulates dopaminergic receptors to improve renal perfusion

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A patient in cardiac arrest has been in refractory ventricular fibrillation despite three defibrillation attempts, epinephrine, and amiodarone. The paramedic suspects hyperkalemia based on the patient’s dialysis history and peaked T waves noted before arrest. Which medication should be administered?

Sodium bicarbonate 1 mEq/kg IV

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Lidocaine 1.5 mg/kg IV

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Magnesium sulfate 2 g IV

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Procainamide 20 mg/min IV infusion

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A patient with a known calcium channel blocker overdose presents with severe bradycardia at 36 bpm and a blood pressure of 62/40 mmHg. The paramedic has administered atropine without effect. Which medication directly counteracts the mechanism of calcium channel blocker toxicity?

Calcium chloride 1 g IV administered slowly

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Naloxone 2 mg IV push

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Flumazenil 0.2 mg IV push

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Amiodarone 150 mg IV over 10 minutes

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A paramedic is treating a patient with torsades de pointes who has a palpable pulse and a blood pressure of 94/58 mmHg. Which medication is the specific pharmacological treatment for this rhythm?

Magnesium sulfate 2 g IV over 5 to 10 minutes

Correct Incorrect Correct answer

Amiodarone 300 mg IV push

Correct Incorrect Correct answer

Procainamide 20 mg/min IV infusion

Correct Incorrect Correct answer

Lidocaine 1 mg/kg IV push

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A paramedic is treating a patient with stable monomorphic ventricular tachycardia who has not responded to amiodarone. The medical direction physician orders procainamide. What is the most important adverse effect to monitor for during procainamide administration?

Hypotension due to vasodilation and negative inotropic effects

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Bronchospasm due to histamine release from mast cells

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Hyperglycemia due to stimulation of hepatic glucose production

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Seizures due to central nervous system excitation

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Which cardiac medication acts by inhibiting thrombin and preventing the conversion of fibrinogen to fibrin?

Heparin

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Aspirin

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Clopidogrel

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Nitroglycerin

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A paramedic administers amiodarone to a patient with ventricular tachycardia. Twenty minutes later, the patient develops a heart rate of 44 bpm. Which property of amiodarone most likely contributed to this adverse effect?

Beta-adrenergic blocking activity that suppresses sinus and AV node conduction

Correct Incorrect Correct answer

Alpha-adrenergic stimulation that increases vagal tone reflexively

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Dopaminergic receptor blockade that reduces chronotropic drive

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Muscarinic receptor activation that mimics parasympathetic stimulation

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A patient on a beta-blocker for hypertension develops symptomatic bradycardia at 38 bpm with hypotension. Atropine 0.5 mg IV has been given twice without improvement. The paramedic suspects the bradycardia is refractory due to the beta-blocker. Which medication addresses this specific drug interaction by bypassing beta-receptor blockade?

Glucagon 3 to 5 mg IV

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Epinephrine 0.3 mg IM

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Naloxone 2 mg IV

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Calcium chloride 1 g IV

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A 72-year-old male presents with dizziness, a heart rate of 34, and a blood pressure of 78/50 mmHg. The monitor shows a complete AV dissociation with no relationship between P waves and QRS complexes. Atropine has been administered without improvement. What is the most appropriate next intervention?

Initiate transcutaneous pacing

Correct Incorrect Correct answer

Perform synchronized cardioversion at 100 joules

Correct Incorrect Correct answer

Administer a second dose of atropine 1 mg IV

Correct Incorrect Correct answer

Start a dopamine infusion at 2 mcg/kg/min

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When initiating transcutaneous pacing on a conscious patient with symptomatic bradycardia, what should the paramedic do to manage patient discomfort?

Administer sedation or analgesia such as midazolam or fentanyl prior to or during pacing

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Apply the pacing pads over thick clothing to reduce skin stimulation

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Start pacing at the maximum output and gradually decrease to threshold

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Instruct the patient to hold their breath during each pacing impulse

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A paramedic has initiated transcutaneous pacing at a rate of 70 bpm on a patient with third-degree heart block. The monitor shows pacing spikes followed by wide QRS complexes. However, the patient remains pulseless. What is the most appropriate action?

Increase the milliampere output until mechanical capture is confirmed by a palpable pulse

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Increase the pacing rate to 120 bpm to improve cardiac output

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Accept the current settings since electrical capture has been achieved

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Discontinue pacing and begin CPR with standard cardiac arrest protocols

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What is the typical starting milliampere (mA) output when initiating transcutaneous pacing for symptomatic bradycardia?

Start at the minimum output and increase until electrical capture is achieved

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Set the output to 200 mA and maintain that level throughout transport

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Begin at 100 mA and decrease until the patient reports reduced discomfort

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Set the output at 50 mA regardless of whether capture is observed

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Which pacing mode delivers electrical impulses only when the patient’s intrinsic heart rate falls below the set rate?

Demand mode

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Fixed (asynchronous) mode

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Overdrive mode

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Capture mode

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A paramedic is transporting a 68-year-old patient with a stable second-degree type II AV block at a rate of 52 beats per minute. The blood pressure is 118/74 mmHg and the patient is asymptomatic. Medical control advises standby pacing. What does this directive mean?

Apply pacing pads and have the pacer ready but do not initiate pacing unless the patient becomes symptomatic or hemodynamically unstable

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Initiate pacing at 60 beats per minute and titrate to maintain a systolic blood pressure above 100 mmHg

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Apply pacing pads and begin pacing at the lowest mA output to maintain demand sensing

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Place the pacing pads but set the device to fixed mode at 80 beats per minute in case of sudden deterioration

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A paramedic initiates transcutaneous pacing on a patient in complete heart block. The monitor shows pacing spikes at 70 per minute, but no QRS complex follows the spikes. The mA output is set at 40 mA. What should the paramedic do?

Increase the milliampere output until consistent electrical capture is achieved

Correct Incorrect Correct answer

Increase the pacing rate to 90 beats per minute

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Switch from demand mode to fixed mode

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Reposition the pads and decrease the milliampere output

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When using fixed (asynchronous) mode transcutaneous pacing, what is the primary risk that differentiates it from demand mode?

A pacing impulse may land on the T wave of an intrinsic beat, potentially causing ventricular fibrillation

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The pacer will not deliver impulses if the patient has any intrinsic rhythm

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Fixed mode requires significantly higher milliampere settings to achieve capture

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The pacing electrodes are more likely to cause skin burns in fixed mode

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A 58-year-old male achieves return of spontaneous circulation (ROSC) after 12 minutes of CPR for ventricular fibrillation. His blood pressure is 92/64 mmHg, heart rate is 110 bpm, and SpO2 is 99% on 100% oxygen via BVM. What is the most appropriate next intervention regarding oxygenation?

Titrate the FiO2 down to maintain SpO2 between 92% and 98%

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Continue 100% oxygen to maximize cerebral perfusion

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Switch to a nasal cannula at 2 L/min immediately

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Discontinue supplemental oxygen since SpO2 is above 94%

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A dental assistant is cleaning up after a procedure and notices that extracted teeth with amalgam restorations have been placed in the regular trash. What should the assistant do?

Remove the teeth from the regular trash and place them in a designated amalgam waste container

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Leave the teeth in the regular trash since they are considered general waste

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Place the teeth in the sharps container along with used needles

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Rinse the teeth with water and then discard them in the biohazard bag

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A dental office has three categories of employees: dentists, dental assistants, and front desk staff. Which employees must be included in the exposure determination section of the Exposure Control Plan?

Dentists and dental assistants, because both have reasonably anticipated occupational exposure to blood or other potentially infectious materials

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All three categories, because everyone in a dental office is equally at risk for bloodborne pathogen exposure

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Only the dental assistants, because they perform instrument processing and cleanup duties

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Only the dentists, because they perform invasive procedures on patients

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How should used dental x-ray developer solution be disposed of in a dental office?

Pour it into the sanitary sewer system according to local regulations, as it is generally considered nonhazardous

Correct Incorrect Correct answer

Collect it for silver recovery along with the fixer solution

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Place it in a red biohazard bag for regulated waste pickup

Correct Incorrect Correct answer

Store it in a sharps container until a hazardous waste company retrieves it

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A dental assistant is stuck by a contaminated needle while recapping an anesthetic syringe. According to the Exposure Control Plan, what should the assistant do immediately after the injury?

Wash the wound with soap and water, then report the incident to the employer for documentation and medical follow-up

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Apply hydrogen peroxide to the wound and continue working until the end of the day before reporting

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Squeeze the wound to force bleeding, then apply a bandage and resume patient care

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Document the incident in the patient chart and notify the patient's physician

Correct Incorrect Correct answer

A dental assistant accidentally spills a chemical disinfectant on the operatory floor. What is the first step the assistant should take?

Refer to the Safety Data Sheet for the product to determine proper cleanup procedures

Correct Incorrect Correct answer

Immediately mop the spill with water and paper towels

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Evacuate the entire office and call 911

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Cover the spill with gauze and continue treating the patient

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A dental assistant is evaluating the radiography infection control protocol for a new practice. The protocol states that barriers are placed on sensors but does not address disinfection of sensors after barrier removal. Is this protocol adequate?

No, because barriers can leak or tear undetected, so sensors should also be disinfected after barrier removal as a second line of defense

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Yes, because barriers provide complete protection and disinfection is unnecessary when barriers are used

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No, because sensors must be sterilized by autoclaving after each use regardless of barrier use

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Yes, because the manufacturer warranty does not cover damage from chemical disinfectants

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Which federal agency establishes regulations for the disposal of pharmaceutical waste generated in dental offices?

The Environmental Protection Agency (EPA)

Correct Incorrect Correct answer

The Occupational Safety and Health Administration (OSHA)

Correct Incorrect Correct answer

The Food and Drug Administration (FDA)

Correct Incorrect Correct answer

The Centers for Disease Control and Prevention (CDC)

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A dental office recently transitioned from conventional film to digital sensors. The dental assistant notices that the infection control protocol for radiography has not been updated. Which infection control risk is unique to digital sensors compared to conventional film?

Digital sensors are reused between patients and cannot be heat sterilized, requiring consistent barrier use and surface disinfection

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Digital sensors produce more scatter radiation, increasing the risk of airborne contamination

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Digital sensors require longer exposure times, increasing the risk of patient movement and retakes

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Digital sensors store patient data that could be transmitted to the wrong patient file

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Which ECG characteristics define a normal sinus rhythm?

Regular rhythm with a rate of 60 to 100 bpm, upright P waves before each QRS, and a consistent PR interval of 0.12 to 0.20 seconds

Correct Incorrect Correct answer

Regular rhythm with a rate of 40 to 60 bpm, upright P waves, and a PR interval greater than 0.20 seconds

Correct Incorrect Correct answer

Irregular rhythm with a rate of 60 to 100 bpm, variable P wave morphology, and narrow QRS complexes

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Regular rhythm with a rate of 100 to 150 bpm, absent P waves, and a QRS duration greater than 0.12 seconds

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A paramedic applies the cardiac monitor to a pulseless, apneic patient and observes a chaotic, irregular waveform with no identifiable P waves, QRS complexes, or T waves. The amplitude of the waveform varies continuously. What rhythm is displayed?

Ventricular fibrillation

Correct Incorrect Correct answer

Ventricular tachycardia

Correct Incorrect Correct answer

Atrial fibrillation with rapid ventricular response

Correct Incorrect Correct answer

Torsades de pointes

Correct Incorrect Correct answer

A paramedic is managing a cardiac arrest patient. The monitor shows an organized rhythm with narrow QRS complexes at a rate of 72 bpm, but the patient has no palpable pulse. What is this rhythm called, and what is the appropriate treatment?

Pulseless electrical activity (PEA); continue CPR, administer epinephrine, and identify reversible causes

Correct Incorrect Correct answer

Sinus rhythm with pulse; reassess the patient and prepare for transport

Correct Incorrect Correct answer

Asystole; administer epinephrine and continue CPR

Correct Incorrect Correct answer

Ventricular fibrillation; deliver immediate defibrillation

Correct Incorrect Correct answer

A patient in cardiac arrest has an organized rhythm on the monitor at 84 bpm with narrow QRS complexes. The paramedic confirms no pulse. After two rounds of epinephrine and CPR, the rhythm remains unchanged but the patient remains pulseless. Which reversible cause should the paramedic consider if the patient has distended neck veins, muffled heart tones, and hypotension prior to the arrest?

Cardiac tamponade

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Hypovolemia

Correct Incorrect Correct answer

Hyperkalemia

Correct Incorrect Correct answer

Which ECG rhythm is characterized by the complete absence of electrical activity, appearing as a flat line on the monitor?

Asystole

Correct Incorrect Correct answer

Ventricular fibrillation

Correct Incorrect Correct answer

Pulseless electrical activity

Correct Incorrect Correct answer

Fine atrial fibrillation

Correct Incorrect Correct answer

A 72-year-old patient presents with syncope and a heart rate of 34 beats per minute. The ECG shows regular P waves and regular QRS complexes, but the P waves and QRS complexes have no consistent relationship to each other. Which rhythm is most likely?

Third-degree (complete) heart block

Correct Incorrect Correct answer

Second-degree type I (Wenckebach)

Correct Incorrect Correct answer

Second-degree type II

Correct Incorrect Correct answer

Sinus bradycardia

Correct Incorrect Correct answer

What is the typical intrinsic rate of a junctional escape rhythm?

40 to 60 beats per minute

Correct Incorrect Correct answer

20 to 40 beats per minute

Correct Incorrect Correct answer

60 to 80 beats per minute

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80 to 100 beats per minute

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A 58-year-old patient on a cardiac monitor displays a regular rhythm at 32 beats per minute with wide QRS complexes (>0.12 seconds) and no identifiable P waves. Which rhythm does this represent?

Idioventricular rhythm

Correct Incorrect Correct answer

Junctional bradycardia

Correct Incorrect Correct answer

Sinus bradycardia

Correct Incorrect Correct answer

Second-degree AV block type II

Correct Incorrect Correct answer

A patient with a history of heart failure presents with palpitations. The ECG shows an underlying sinus rhythm at 78 beats per minute with intermittent wide, bizarre QRS complexes that occur early and are followed by a compensatory pause. These complexes appear in a pattern of every other beat. Which finding is present?

PVCs in a bigeminal pattern

Correct Incorrect Correct answer

Multifocal PVCs

Correct Incorrect Correct answer

Ventricular tachycardia

Correct Incorrect Correct answer

Bundle branch block

Correct Incorrect Correct answer

A 45-year-old patient presents with chest pain and a heart rate of 188 beats per minute. The ECG reveals a regular rhythm with wide QRS complexes. The patient is diaphoretic with a blood pressure of 82/50 mmHg. What is the most appropriate initial intervention?

Synchronized cardioversion

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Vagal maneuvers

Correct Incorrect Correct answer

A 30-year-old patient reports sudden onset of palpitations while at rest. The ECG shows a regular, narrow complex tachycardia at 170 beats per minute with no visible P waves. Blood pressure is 118/72 mmHg. After applying a vagal maneuver, the rhythm abruptly converts to normal sinus rhythm. Which rhythm was most likely present?

Supraventricular tachycardia (SVT)

Correct Incorrect Correct answer

Atrial flutter with 2:1 conduction

Correct Incorrect Correct answer

Sinus tachycardia

Correct Incorrect Correct answer

Atrial fibrillation with rapid ventricular response

Correct Incorrect Correct answer

In the context of ECG interpretation, what does the term “EKG artifact” most commonly refer to?

Interference on the tracing caused by external factors such as patient movement or loose electrodes

Correct Incorrect Correct answer

An abnormal P wave morphology indicating atrial enlargement

Correct Incorrect Correct answer

A pathological Q wave suggesting prior myocardial infarction

Correct Incorrect Correct answer

ST segment depression indicating myocardial ischemia

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A patient in cardiac arrest has an initial rhythm that appears to be asystole on the monitor. Before confirming asystole, which action should the paramedic perform?

Check the ECG in a second lead and confirm that leads are properly connected

Correct Incorrect Correct answer

Immediately defibrillate at 200 joules

Correct Incorrect Correct answer

Administer atropine 1 mg IV push

Correct Incorrect Correct answer

Perform synchronized cardioversion at 100 joules

Correct Incorrect Correct answer

A 58-year-old male is found unresponsive and apneic. Your cardiac monitor shows ventricular fibrillation. CPR is in progress and an IV has been established. Following the first defibrillation attempt, what is the next medication in the cardiac arrest algorithm?

Epinephrine 1 mg IV

Correct Incorrect Correct answer

Amiodarone 300 mg IV

Correct Incorrect Correct answer

Atropine 1 mg IV

Correct Incorrect Correct answer

Vasopressin 40 units IV

Correct Incorrect Correct answer

A 72-year-old female presents with a heart rate of 186 bpm, blood pressure of 78/50 mmHg, diaphoresis, and altered mental status. The monitor shows a narrow-complex tachycardia with no discernible P waves. Which intervention should the paramedic perform first?

Synchronized cardioversion

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Vagal maneuvers

Correct Incorrect Correct answer

Which of the following findings indicates that a tachycardic patient is hemodynamically stable and may be treated with pharmacological interventions rather than immediate cardioversion?

Alert and oriented with a blood pressure of 118/76 mmHg

Correct Incorrect Correct answer

Altered mental status with cool, diaphoretic skin

Correct Incorrect Correct answer

Chest pain with a blood pressure of 72/48 mmHg

Correct Incorrect Correct answer

Acute pulmonary edema with oxygen saturation of 84%

Correct Incorrect Correct answer

A 64-year-old male with a history of heart failure presents with a stable wide-complex tachycardia at a rate of 150 bpm. His blood pressure is 110/70 mmHg and he is alert. Which medication is most appropriate for this patient?

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Metoprolol 5 mg IV

Correct Incorrect Correct answer

Diltiazem 20 mg IV over 2 minutes

Correct Incorrect Correct answer

A paramedic is treating a stable patient with a regular narrow-complex tachycardia at 170 bpm. Vagal maneuvers have failed. An IV is established. What is the correct initial dose of adenosine?

6 mg rapid IV push followed by a 20 mL saline flush

Correct Incorrect Correct answer

12 mg rapid IV push followed by a 20 mL saline flush

Correct Incorrect Correct answer

6 mg slow IV push over 2 minutes

Correct Incorrect Correct answer

3 mg rapid IV push followed by a 10 mL saline flush

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In the ACLS tachycardia algorithm, which calcium channel blocker can be used to control the ventricular rate in stable atrial fibrillation with rapid ventricular response?

Diltiazem

Correct Incorrect Correct answer

Nifedipine

Correct Incorrect Correct answer

Amlodipine

Correct Incorrect Correct answer

Verapamil administered intramuscularly

Correct Incorrect Correct answer

A patient in cardiac arrest has received three defibrillation attempts and one dose of epinephrine. The monitor continues to show ventricular fibrillation. According to the ACLS algorithm, what medication and dose should be administered next?

Amiodarone 300 mg IV bolus

Correct Incorrect Correct answer

Lidocaine 0.5 mg/kg IV bolus

Correct Incorrect Correct answer

Amiodarone 150 mg IV bolus

Correct Incorrect Correct answer

Magnesium sulfate 2 g IV

Correct Incorrect Correct answer

A patient achieves return of spontaneous circulation (ROSC) after 12 minutes of CPR for ventricular fibrillation. The patient remains unresponsive with a blood pressure of 92/60 mmHg, heart rate of 104 bpm, and SpO2 of 96% on BVM ventilation. Which post-arrest care intervention should the paramedic prioritize during transport?

Titrate oxygen to maintain SpO2 between 94% and 99% and avoid hyperventilation

Correct Incorrect Correct answer

Administer high-flow oxygen at 15 L/min via non-rebreather mask

Correct Incorrect Correct answer

Begin transcutaneous pacing at a rate of 80 bpm

Correct Incorrect Correct answer

Administer a 2 L normal saline bolus to increase blood pressure above 120 systolic

Correct Incorrect Correct answer

In pit crew CPR, what is the recommended interval for rotating chest compressors to maintain high-quality compressions?

Every 2 minutes

Correct Incorrect Correct answer

Every 1 minute

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Every 5 minutes

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Only when the compressor reports fatigue

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What is the recommended depth of chest compressions for an adult patient in cardiac arrest?

At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)

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At least 1.5 inches (4 cm) but no more than 2 inches (5 cm)

Correct Incorrect Correct answer

At least 2.5 inches (6.5 cm) but no more than 3 inches (7.5 cm)

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At least 1 inch (2.5 cm) but no more than 1.5 inches (4 cm)

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During a cardiac arrest resuscitation, the paramedic pauses CPR to analyze the rhythm. The pause lasts 15 seconds. Which statement best describes the impact of this pause on resuscitation quality?

The pause is too long; interruptions in chest compressions should be limited to less than 10 seconds

Correct Incorrect Correct answer

The 15-second pause is acceptable for rhythm analysis

Correct Incorrect Correct answer

Pauses up to 30 seconds are acceptable if the patient is intubated

Correct Incorrect Correct answer

Pauses for rhythm analysis do not affect coronary perfusion pressure

Correct Incorrect Correct answer

What is the recommended energy setting for the initial defibrillation attempt using a biphasic defibrillator?

120 to 200 joules, per manufacturer recommendation

Correct Incorrect Correct answer

360 joules for all biphasic defibrillators

Correct Incorrect Correct answer

50 joules as the universal starting dose

Correct Incorrect Correct answer

200 joules using a monophasic waveform

Correct Incorrect Correct answer

A 50-year-old male is in cardiac arrest. The monitor shows a flat line in Lead II. The paramedic confirms asystole in a second lead. CPR is in progress and an IV is established. What medications are indicated for this rhythm?

Epinephrine 1 mg IV every 3 to 5 minutes

Correct Incorrect Correct answer

Atropine 1 mg IV every 3 to 5 minutes

Correct Incorrect Correct answer

Amiodarone 300 mg IV followed by defibrillation

Correct Incorrect Correct answer

Epinephrine 1 mg IV alternating with vasopressin 40 units IV

Correct Incorrect Correct answer

A 62-year-old female is in PEA cardiac arrest. CPR is in progress, an advanced airway is placed, and epinephrine has been administered. The monitor shows a sinus rhythm at 72 bpm but there is no palpable pulse. Which of the following reversible causes should be investigated first based on the organized rhythm?

Hypovolemia, as it is the most common reversible cause of PEA

Correct Incorrect Correct answer

Hyperkalemia, because it always presents with an organized rhythm

Correct Incorrect Correct answer

Hydrogen ion (acidosis), which requires immediate sodium bicarbonate

Correct Incorrect Correct answer

Hypothermia, which is the most likely cause in all PEA patients

Correct Incorrect Correct answer

During a cardiac arrest resuscitation, the paramedic notes peaked T waves, widened QRS complexes, and a sine wave pattern on the monitor prior to the arrest. Which electrolyte abnormality is the most likely cause, and what is the appropriate treatment?

Hyperkalemia; administer calcium chloride IV

Correct Incorrect Correct answer

Hypokalemia; administer potassium chloride IV

Correct Incorrect Correct answer

Hypercalcemia; administer normal saline bolus

Correct Incorrect Correct answer

Hypomagnesemia; administer magnesium sulfate IV

Correct Incorrect Correct answer

Which of the following is a shockable cardiac arrest rhythm?

Pulseless ventricular tachycardia

Correct Incorrect Correct answer

Pulseless electrical activity

Correct Incorrect Correct answer

Asystole

Correct Incorrect Correct answer

Sinus bradycardia with a pulse

Correct Incorrect Correct answer

A patient in cardiac arrest has a rhythm that shows no electrical activity in Lead II. The paramedic switches to Leads I and III and finds the same flat line. What action should the paramedic take?

Continue high-quality CPR, establish vascular access, and administer epinephrine

Correct Incorrect Correct answer

Defibrillate at 200 joules and reassess the rhythm

Correct Incorrect Correct answer

Confirm fine ventricular fibrillation and defibrillate at 120 joules

Correct Incorrect Correct answer

Apply transcutaneous pacing at 80 bpm

Correct Incorrect Correct answer

A 38-year-old female in cardiac arrest from a suspected opioid overdose has PEA on the monitor. In addition to standard ACLS care, which intervention specifically addresses the likely cause of this arrest?

Administer naloxone 2 mg IV

Correct Incorrect Correct answer

Administer sodium bicarbonate 1 mEq/kg IV

Correct Incorrect Correct answer

Administer calcium chloride 1 g IV

Correct Incorrect Correct answer

Perform bilateral needle decompression

Correct Incorrect Correct answer

A 70-year-old male collapses while receiving dialysis. He is pulseless and the monitor shows a wide, bizarre rhythm consistent with VF. Given his medical history, which reversible cause from the Hs and Ts should the paramedic prioritize investigating?

Hyperkalemia

Correct Incorrect Correct answer

Hypothermia

Correct Incorrect Correct answer

Cardiac tamponade

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

During a resuscitation, the paramedic notices the end-tidal CO2 (EtCO2) reading has been consistently below 10 mmHg despite 20 minutes of CPR. What does this finding indicate?

The low EtCO2 suggests poor prognosis and may support a decision to consider termination of efforts

Correct Incorrect Correct answer

The EtCO2 reading confirms adequate chest compression quality

Correct Incorrect Correct answer

The endotracheal tube is likely in the esophagus and should be repositioned

Correct Incorrect Correct answer

A vasopressor infusion should be started to increase the EtCO2

Correct Incorrect Correct answer

Which of the following is included in the “Ts” of the Hs and Ts mnemonic for reversible causes of cardiac arrest?

Tension pneumothorax

Correct Incorrect Correct answer

Tachycardia

Correct Incorrect Correct answer

Tracheal obstruction

Correct Incorrect Correct answer

Transient ischemic attack

Correct Incorrect Correct answer

A 58-year-old male presents with palpitations, chest pain, and dizziness. The cardiac monitor shows a regular, narrow-complex tachycardia at 186 beats per minute. BP is 82/54 and the patient appears diaphoretic and pale. Vagal maneuvers and adenosine have been attempted without success. What is the most appropriate next intervention?

Perform synchronized cardioversion starting at 50 to 100 joules

Correct Incorrect Correct answer

Administer a second dose of adenosine at 12 mg rapid IV push

Correct Incorrect Correct answer

Administer amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Perform unsynchronized defibrillation at 200 joules biphasic

Correct Incorrect Correct answer

A 50-year-old female presents with palpitations and lightheadedness. The cardiac monitor shows a regular, wide-complex tachycardia at 170 beats per minute. The patient has a palpable pulse. BP is 76/48 and she is becoming increasingly confused. What is the appropriate intervention and initial energy setting?

Synchronized cardioversion at 100 joules

Correct Incorrect Correct answer

Unsynchronized defibrillation at 200 joules

Correct Incorrect Correct answer

Synchronized cardioversion at 50 joules

Correct Incorrect Correct answer

Administer lidocaine 1 to 1.5 mg/kg IV push

Correct Incorrect Correct answer

When performing synchronized cardioversion, the defibrillator delivers the shock at which point in the cardiac cycle?

On the R wave of the QRS complex

Correct Incorrect Correct answer

On the T wave of the cardiac cycle

Correct Incorrect Correct answer

On the P wave at the start of atrial depolarization

Correct Incorrect Correct answer

At a random point during the cardiac cycle

Correct Incorrect Correct answer

You are preparing to cardiovert a patient with unstable atrial fibrillation with rapid ventricular response. The patient weighs approximately 120 kg. Where should the defibrillation pads be placed for optimal energy delivery?

One pad on the right upper chest below the clavicle and the other on the left lateral chest at the midaxillary line

Correct Incorrect Correct answer

Both pads on the anterior chest, one on each side of the sternum

Correct Incorrect Correct answer

One pad on the left upper chest and one on the right lateral chest

Correct Incorrect Correct answer

One pad on the upper abdomen and one on the left chest

Correct Incorrect Correct answer

A paramedic is preparing to perform synchronized cardioversion on a patient with unstable ventricular tachycardia with a pulse. After sedation, the paramedic charges the defibrillator and presses the shock button. Which safety step is most critical immediately before energy delivery?

Verbally and visually confirm that no one is in contact with the patient or the stretcher

Correct Incorrect Correct answer

Verify that the patient's oxygen saturation is above 94% before delivering the shock

Correct Incorrect Correct answer

Remove the cardiac monitor electrodes to prevent interference with the shock

Correct Incorrect Correct answer

Turn off the oxygen source to prevent combustion during the electrical discharge

Correct Incorrect Correct answer

A patient with unstable atrial flutter is being prepared for synchronized cardioversion. The paramedic has applied pads in the anterolateral position but is having difficulty obtaining consistent R-wave sensing due to artifact. Which alternative pad placement may improve synchronization sensing and energy delivery?

Anterior-posterior placement with one pad on the sternum and one on the back between the scapulae

Correct Incorrect Correct answer

Move both pads closer together on the anterior chest

Correct Incorrect Correct answer

Place one pad on the patient's right thigh and one on the left chest

Correct Incorrect Correct answer

Remove the pads and use hand-held paddles instead for better control

Correct Incorrect Correct answer

A 64-year-old male achieves return of spontaneous circulation (ROSC) after 12 minutes of CPR for ventricular fibrillation cardiac arrest. He remains unresponsive. Vital signs post-ROSC are HR 88, BP 108/72, RR 14 (ventilated via endotracheal tube), and SpO2 100% on 100% FiO2. What ventilation adjustment should be made?

Titrate the FiO2 down to maintain an SpO2 of 92% to 96%

Correct Incorrect Correct answer

Continue 100% FiO2 to ensure maximum oxygen delivery to the brain

Correct Incorrect Correct answer

Reduce the FiO2 to room air (21%) immediately

Correct Incorrect Correct answer

Increase the ventilation rate to 20 breaths per minute to maximize CO2 washout

Correct Incorrect Correct answer

Targeted temperature management (therapeutic hypothermia) is recommended for which post-cardiac arrest patient population?

Unresponsive adult patients with ROSC after cardiac arrest, regardless of the initial rhythm

Correct Incorrect Correct answer

Only patients who had ventricular fibrillation as the initial arrest rhythm

Correct Incorrect Correct answer

All patients who achieve ROSC, including those who are alert and following commands

Correct Incorrect Correct answer

Only patients under 50 years of age who achieve ROSC after cardiac arrest

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After achieving return of spontaneous circulation (ROSC) in a cardiac arrest patient, the paramedic notes the ETCO2 has risen to 42 mmHg and the ventilatory rate is set at 20 breaths per minute. What is the most appropriate ventilation adjustment?

Decrease the ventilation rate to 10 breaths per minute to avoid hypocapnia

Correct Incorrect Correct answer

Increase the ventilation rate to 24 breaths per minute to optimize oxygenation

Correct Incorrect Correct answer

Maintain the current rate since ETCO2 is within normal range

Correct Incorrect Correct answer

Remove the advanced airway and switch to bag-valve mask ventilation

Correct Incorrect Correct answer

A 58-year-old male achieves ROSC after ventricular fibrillation cardiac arrest. His blood pressure is 94/62 mmHg on a norepinephrine infusion, heart rate is 88 bpm, and the 12-lead ECG shows 3 mm ST elevation in leads II, III, and aVF. What is the most appropriate next step?

Notify the receiving facility to activate the cardiac catheterization lab

Correct Incorrect Correct answer

Administer aspirin and nitroglycerin and transport to the closest emergency department

Correct Incorrect Correct answer

Perform synchronized cardioversion at 100 joules for presumed STEMI equivalent rhythm

Correct Incorrect Correct answer

Withhold cardiac catheterization lab activation until the patient regains consciousness

Correct Incorrect Correct answer

Which facility destination is most appropriate for a patient who achieves ROSC after out-of-hospital cardiac arrest with ST elevation on the 12-lead ECG?

A facility with cardiac catheterization capability

Correct Incorrect Correct answer

The closest community hospital emergency department

Correct Incorrect Correct answer

A facility with a burn center

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A trauma center with neurosurgical capability

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Transcutaneous pacing (TCP) is most clearly indicated for which cardiac rhythm?

Symptomatic third-degree (complete) heart block

Correct Incorrect Correct answer

Atrial fibrillation with a rapid ventricular response

Correct Incorrect Correct answer

Normal sinus rhythm with occasional premature ventricular complexes

Correct Incorrect Correct answer

Ventricular fibrillation

Correct Incorrect Correct answer

A paramedic initiates transcutaneous pacing on a patient with symptomatic second-degree type II heart block. The pacing rate is set at 70 bpm and the milliampere (mA) output is being slowly increased. At what point has electrical capture been achieved?

When each pacing spike is followed by a wide QRS complex and a palpable pulse is confirmed

Correct Incorrect Correct answer

When the pacing spikes are visible on the monitor regardless of QRS response

Correct Incorrect Correct answer

When the patient stops complaining of chest discomfort from the pacing pads

Correct Incorrect Correct answer

When the milliampere output reaches the maximum setting on the device

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A 72-year-old female presents with dizziness and a heart rate of 32 bpm. The monitor shows a third-degree heart block. Atropine 1 mg IV has been administered without effect. The paramedic prepares to initiate transcutaneous pacing. What is the recommended initial pacing rate?

60 to 80 beats per minute

Correct Incorrect Correct answer

30 to 40 beats per minute to match the intrinsic rate

Correct Incorrect Correct answer

100 to 120 beats per minute to maximize cardiac output

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40 to 50 beats per minute as a conservative starting point

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A paramedic has achieved electrical capture with transcutaneous pacing at 70 mA in a patient with complete heart block. The patient is alert and complaining of significant pain from the pacing stimulus. Blood pressure has improved to 108/72 mmHg. What is the most appropriate action to address the patient’s discomfort?

Administer sedation or analgesia per protocol while maintaining the pacing settings

Correct Incorrect Correct answer

Discontinue pacing since the blood pressure has normalized

Correct Incorrect Correct answer

Reduce the milliampere output below the capture threshold to decrease discomfort

Correct Incorrect Correct answer

Switch from demand mode to fixed mode to reduce the frequency of pacing stimuli

Correct Incorrect Correct answer

At what compression-to-ventilation ratio should a single paramedic perform CPR on an infant in cardiac arrest?

30:2

Correct Incorrect Correct answer

15:2

Correct Incorrect Correct answer

5:1

Correct Incorrect Correct answer

30:1

Correct Incorrect Correct answer

What is the correct dose of epinephrine for pediatric cardiac arrest?

0.01 mg/kg of 1:10,000 concentration IV/IO

Correct Incorrect Correct answer

0.1 mg/kg of 1:1,000 concentration IV/IO

Correct Incorrect Correct answer

0.01 mg/kg of 1:1,000 concentration IV/IO

Correct Incorrect Correct answer

1 mg regardless of weight IV/IO

Correct Incorrect Correct answer

A 6-year-old child presents with a heart rate of 220 bpm, irritability, and pallor. The cardiac monitor shows a narrow complex tachycardia with no discernible P waves. Blood pressure is 78/50 mmHg. The paramedic attempts vagal maneuvers without success. What is the next most appropriate intervention?

Adenosine 0.1 mg/kg rapid IV push followed by a rapid saline flush

Correct Incorrect Correct answer

Synchronized cardioversion at 0.5 joules per kg

Correct Incorrect Correct answer

Amiodarone 5 mg/kg IV over 20 minutes

Correct Incorrect Correct answer

Verapamil 0.1 mg/kg slow IV push

Correct Incorrect Correct answer

A 3-year-old child in SVT with a heart rate of 240 bpm is now unresponsive with a blood pressure of 54/30 mmHg. Two doses of adenosine have failed to convert the rhythm. What is the most appropriate next intervention?

Synchronized cardioversion starting at 0.5 to 1 joule per kg

Correct Incorrect Correct answer

A third dose of adenosine at 0.2 mg/kg rapid IV push

Correct Incorrect Correct answer

Unsynchronized defibrillation at 2 joules per kg

Correct Incorrect Correct answer

Amiodarone 5 mg/kg IV push over 1 minute

Correct Incorrect Correct answer

A paramedic is preparing to administer medications to a 4-year-old child in cardiac arrest. The child’s weight is unknown, and no parent is available. Using a length-based resuscitation tape, the estimated weight is 18 kg. What is the correct epinephrine dose for this patient?

0.18 mg (1.8 mL of 1:10,000 concentration)

Correct Incorrect Correct answer

0.018 mg (0.18 mL of 1:10,000 concentration)

Correct Incorrect Correct answer

1.8 mg (18 mL of 1:10,000 concentration)

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1 mg (10 mL of 1:10,000 concentration)

Correct Incorrect Correct answer

Which ECG leads are classified as augmented leads?

aVR, aVL, and aVF are the three augmented leads that view the heart from the frontal plane

Correct Incorrect Correct answer

V1, V2, and V3, which are the precordial leads viewing the anterior heart

Correct Incorrect Correct answer

Leads I, II, and III, which are the standard limb leads

Correct Incorrect Correct answer

V4, V5, and V6, which view the lateral wall of the heart

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A paramedic obtains a 12-lead ECG on a patient with chest pain and notes T wave inversion in leads V1 through V4. What does this finding suggest?

T wave inversion in leads V1 through V4 suggests anterior wall ischemia and warrants evaluation for acute coronary syndrome

Correct Incorrect Correct answer

This is a normal variant that requires no further action or evaluation

Correct Incorrect Correct answer

T wave inversion in precordial leads is diagnostic for pericarditis

Correct Incorrect Correct answer

This finding indicates a left bundle branch block requiring transcutaneous pacing

Correct Incorrect Correct answer

A 12-lead ECG shows ST elevation in leads I, aVL, V5, and V6 with reciprocal depression in leads II, III, and aVF. Which type of myocardial infarction does this pattern indicate?

Lateral MI, based on ST elevation in the leads that view the lateral wall of the left ventricle

Correct Incorrect Correct answer

Inferior MI, based on ST changes in leads II, III, and aVF

Correct Incorrect Correct answer

Anterior MI, based on ST elevation in the precordial leads

Correct Incorrect Correct answer

Right ventricular MI, which requires right-sided leads for confirmation

Correct Incorrect Correct answer

According to current ACLS guidelines, what is the recommended compression depth for adult cardiac arrest?

At least 2 inches (5 cm) but no more than 2.4 inches (6 cm) for adult patients

Correct Incorrect Correct answer

At least 1.5 inches (4 cm) to avoid rib fractures in adult patients

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At least 3 inches (7.5 cm) to ensure adequate cardiac output

Correct Incorrect Correct answer

Compression depth varies based on the patient's body weight and chest wall compliance

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What is the recommended compression rate for high-quality CPR in adult cardiac arrest?

100 to 120 compressions per minute

Correct Incorrect Correct answer

60 to 80 compressions per minute to allow adequate ventricular filling

Correct Incorrect Correct answer

At least 140 compressions per minute for maximum cardiac output

Correct Incorrect Correct answer

80 to 100 compressions per minute as recommended by current guidelines

Correct Incorrect Correct answer

During a cardiac arrest resuscitation, a paramedic notices that compressions are being paused for more than 15 seconds during rhythm checks. Why is it critical to minimize interruptions in chest compressions?

Pauses in compressions cause coronary perfusion pressure to drop rapidly, reducing the likelihood of return of spontaneous circulation

Correct Incorrect Correct answer

Brief pauses in compressions have no effect on patient outcomes during resuscitation

Correct Incorrect Correct answer

Long pauses are beneficial because they allow the heart to refill completely

Correct Incorrect Correct answer

Interruptions only matter during the first 2 minutes of CPR and are acceptable afterward

Correct Incorrect Correct answer

A paramedic is managing a cardiac arrest and the team has performed 20 minutes of high-quality CPR without return of spontaneous circulation. When reviewing the H and T causes, which reversible etiologies should be systematically evaluated?

Hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (pulmonary and coronary)

Correct Incorrect Correct answer

Only hypoxia and hypovolemia, since these are the only treatable causes in the field

Correct Incorrect Correct answer

Heart failure, tachycardia, and trauma, which are the standard H and T causes

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Hyperglycemia, hyperthermia, and hypertension, which are the primary reversible causes

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A 3-year-old child is found unresponsive and apneic with no pulse. Pediatric CPR is initiated by a two-rescuer team. What is the correct compression-to-ventilation ratio for this patient?

15 compressions to 2 ventilations

Correct Incorrect Correct answer

30 compressions to 2 ventilations

Correct Incorrect Correct answer

5 compressions to 1 ventilation

Correct Incorrect Correct answer

15 compressions to 1 ventilation

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A 6-month-old infant presents with a heart rate of 280 bpm, poor perfusion, and mottled skin. The cardiac monitor reveals a narrow complex tachycardia consistent with SVT pediatric presentation. The infant is showing signs of cardiovascular compromise. What is the most appropriate initial intervention?

Attempt vagal maneuvers by applying a bag of ice water to the infant's face for 15 to 20 seconds

Correct Incorrect Correct answer

Administer adenosine 0.1 mg/kg rapid IV push as the first-line treatment

Correct Incorrect Correct answer

Perform synchronized cardioversion at 0.5 J/kg immediately

Correct Incorrect Correct answer

Administer amiodarone 5 mg/kg IV over 20 minutes

Correct Incorrect Correct answer

A paramedic needs to calculate medication doses for a 4-year-old child. Using weight-based dosing, which method is most commonly used in the prehospital setting to estimate a pediatric patient’s weight when actual weight is unknown?

A length-based resuscitation tape such as the Broselow tape

Correct Incorrect Correct answer

The formula: weight in kg equals age in years times 3 plus 10

Correct Incorrect Correct answer

Visual estimation by the paramedic based on experience

Correct Incorrect Correct answer

Asking the parents to estimate the child's weight in pounds and dividing by 2.2

Correct Incorrect Correct answer

Before delivering a synchronized cardioversion shock, the paramedic must ensure patient and crew safety. What is the critical safety process that must occur before energy delivery?

A systematic verbal and visual clearing process to confirm no personnel are touching the patient, bed, or any connected equipment

Correct Incorrect Correct answer

Ensuring the patient has been sedated before proceeding with the shock

Correct Incorrect Correct answer

Verifying that the oxygen source has been moved at least 10 feet from the patient

Correct Incorrect Correct answer

Confirming the rhythm has not changed by performing a 12-lead ECG immediately before the shock

Correct Incorrect Correct answer

A paramedic is treating a patient with renal failure who presents with weakness and a heart rate of 40 bpm. The ECG shows peaked T waves, a prolonged PR interval, and a widened QRS complex. These findings are most consistent with which condition?

Hyperkalemia ECG changes due to elevated serum potassium levels

Correct Incorrect Correct answer

Acute anterior wall myocardial infarction

Correct Incorrect Correct answer

Digitalis toxicity with AV block

Correct Incorrect Correct answer

Hypothermia with Osborn waves

Correct Incorrect Correct answer

A 72-year-old patient presents with syncope, a heart rate of 30 bpm, and blood pressure of 70/40 mmHg. The cardiac monitor shows external pacing is indicated due to a complete heart block. The paramedic applies the pacing pads and sets the rate to 60 bpm. At what initial milliamps should the output be set?

Start at the lowest output and increase until electrical capture is achieved, typically between 50 and 100 milliamps

Correct Incorrect Correct answer

Set the output at the maximum of 200 milliamps and decrease until capture is lost

Correct Incorrect Correct answer

Begin at exactly 80 milliamps because this captures in most patients

Correct Incorrect Correct answer

Start at 20 milliamps and increase by 2 milliamps every 30 seconds

Correct Incorrect Correct answer

Which ECG leads are the augmented limb leads?

aVR, aVL, and aVF

Correct Incorrect Correct answer

I, II, and III

Correct Incorrect Correct answer

V1, V2, and V3

Correct Incorrect Correct answer

V4, V5, and V6

Correct Incorrect Correct answer

A 58-year-old male presents with crushing substernal chest pain radiating to the jaw. The 12-lead ECG shows deep, symmetrical T wave inversions in leads V1 through V4. ST segments are isoelectric. What does this finding most likely represent?

Wellens syndrome, indicating critical LAD stenosis

Correct Incorrect Correct answer

Acute anterior STEMI

Correct Incorrect Correct answer

Pericarditis

Correct Incorrect Correct answer

Right ventricular hypertrophy

Correct Incorrect Correct answer

A 62-year-old female presents with chest pain and diaphoresis. The 12-lead ECG shows ST elevation in leads I, aVL, V5, and V6 with reciprocal ST depression in leads III and aVF. Which coronary artery territory is most likely involved?

Left circumflex artery (lateral wall)

Correct Incorrect Correct answer

Right coronary artery (inferior wall)

Correct Incorrect Correct answer

Left anterior descending artery (anterior wall)

Correct Incorrect Correct answer

Posterior descending artery (posterior wall)

Correct Incorrect Correct answer

A patient presents with weakness and muscle cramps. A 12-lead ECG reveals tall, peaked, narrow T waves, widened QRS complexes, and flattened P waves. Which electrolyte abnormality is most consistent with these findings?

Hyperkalemia

Correct Incorrect Correct answer

Hypokalemia

Correct Incorrect Correct answer

Hypercalcemia

Correct Incorrect Correct answer

Hypomagnesemia

Correct Incorrect Correct answer

On a 12-lead ECG, a right bundle branch block (RBBB) is characterized by which classic finding?

An RSR' pattern ('rabbit ears') in lead V1 with a wide QRS greater than 120 ms

Correct Incorrect Correct answer

Deep S waves in V1 and tall R waves in V6

Correct Incorrect Correct answer

ST elevation in all precordial leads with PR depression

Correct Incorrect Correct answer

Shortened QT interval with delta waves

Correct Incorrect Correct answer

Following return of spontaneous circulation (ROSC) in a 60-year-old cardiac arrest patient, the monitor shows SpO2 of 100% on a BVM with 15 L/min oxygen. ETCO2 is 42 mmHg and blood pressure is 94/60. What adjustment to ventilation should you make?

Titrate oxygen down to maintain SpO2 of 94% to avoid hyperoxia

Correct Incorrect Correct answer

Continue high-flow oxygen at 15 L/min to maximize tissue oxygenation

Correct Incorrect Correct answer

Switch to a nasal cannula at 2 L/min immediately

Correct Incorrect Correct answer

Increase the ventilation rate to lower the ETCO2 below 35 mmHg

Correct Incorrect Correct answer

A patient achieves ROSC after 20 minutes of CPR for ventricular fibrillation. The 12-lead ECG obtained post-ROSC shows ST elevation in leads V1 through V4. The patient remains unresponsive. What transport destination decision should the paramedic make?

Transport to a cardiac catheterization capable facility for emergent percutaneous coronary intervention

Correct Incorrect Correct answer

Transport to the nearest emergency department regardless of catheterization capability

Correct Incorrect Correct answer

Transport to the nearest trauma center for neurologic evaluation

Correct Incorrect Correct answer

Remain on scene and wait for air medical transport to a tertiary center

Correct Incorrect Correct answer

Which of the following is a key component of targeted temperature management (TTM) in post-cardiac arrest care?

Maintaining a target core temperature between 32 C and 36 C for at least 24 hours

Correct Incorrect Correct answer

Actively rewarming the patient to 38 C as quickly as possible

Correct Incorrect Correct answer

Applying ice packs only to the groin and axillae for 6 hours

Correct Incorrect Correct answer

Cooling the patient only if they regain consciousness within 30 minutes of ROSC

Correct Incorrect Correct answer

A 50-year-old male presents with palpitations and lightheadedness. His heart rate is 186 and the monitor shows a regular, narrow complex tachycardia. Blood pressure is 78/50 and he is diaphoretic. Vagal maneuvers and adenosine have been unsuccessful. What is the next appropriate intervention?

Synchronized cardioversion starting at 50 to 100 joules

Correct Incorrect Correct answer

Unsynchronized defibrillation at 200 joules

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

A second dose of adenosine 12 mg rapid IV push

Correct Incorrect Correct answer

A 48-year-old female presents with chest pain and shortness of breath. The cardiac monitor shows a wide complex tachycardia at 180 bpm. She has a weak, rapid pulse and blood pressure of 82/54. What is the appropriate energy setting for initial synchronized cardioversion of monomorphic ventricular tachycardia with a pulse?

100 joules biphasic

Correct Incorrect Correct answer

50 joules biphasic

Correct Incorrect Correct answer

200 joules biphasic unsynchronized

Correct Incorrect Correct answer

360 joules monophasic

Correct Incorrect Correct answer

Why is it critical to use the synchronization function when cardioverting a patient with an organized tachyarrhythmia who has a pulse?

Synchronization times the shock to the R wave, avoiding the vulnerable T wave period that could cause ventricular fibrillation

Correct Incorrect Correct answer

Synchronization reduces the energy required to convert the rhythm by half

Correct Incorrect Correct answer

Synchronization prevents the defibrillator from delivering a shock if the rhythm is normal sinus

Correct Incorrect Correct answer

Synchronization allows for multiple sequential shocks to be delivered automatically

Correct Incorrect Correct answer

A patient presents with a heart rate of 42 bpm, blood pressure of 78/50, and complaints of dizziness and near-syncope. The cardiac monitor shows a sinus bradycardia. The patient’s skin is cool and diaphoretic. According to the ACLS bradycardia algorithm, this patient is classified as which type?

Unstable bradycardia, because the patient has signs and symptoms caused by the slow rate

Correct Incorrect Correct answer

Stable bradycardia requiring only monitoring and reassessment

Correct Incorrect Correct answer

Sick sinus syndrome requiring permanent pacemaker placement in the field

Correct Incorrect Correct answer

Relative bradycardia that is compensatory and should not be treated

Correct Incorrect Correct answer

During a cardiac arrest resuscitation, you identify ventricular fibrillation on the monitor. After the third defibrillation attempt and continued high-quality CPR, what medication sequence should be administered according to the VF/pulseless VT algorithm?

Epinephrine 1 mg IV/IO, followed by amiodarone 300 mg IV/IO after the next rhythm check if VF persists

Correct Incorrect Correct answer

Amiodarone 300 mg IV/IO first, followed by epinephrine after the next cycle

Correct Incorrect Correct answer

Vasopressin 40 units IV/IO as the first-line vasopressor

Correct Incorrect Correct answer

Lidocaine 100 mg IV/IO followed by a continuous lidocaine infusion

Correct Incorrect Correct answer

A 4-year-old child weighing 18 kg is in cardiac arrest with pulseless ventricular tachycardia. What is the correct dose of epinephrine for this pediatric patient?

0.18 mg (0.01 mg/kg) of 1:10,000 concentration IV/IO

Correct Incorrect Correct answer

1.0 mg (standard adult dose) of 1:10,000 IV/IO

Correct Incorrect Correct answer

0.18 mg of 1:1,000 concentration IV/IO

Correct Incorrect Correct answer

0.018 mg (0.001 mg/kg) of 1:10,000 IV/IO

Correct Incorrect Correct answer

A 6-year-old child presents with a heart rate of 220 bpm, irritability, and poor perfusion (capillary refill 5 seconds). The cardiac monitor shows a narrow complex tachycardia with no visible P waves. The child has good IV access. What is the first pharmacologic intervention?

Adenosine 0.1 mg/kg rapid IV push with immediate saline flush

Correct Incorrect Correct answer

Amiodarone 5 mg/kg IV over 20 minutes

Correct Incorrect Correct answer

Synchronized cardioversion at 0.5 J/kg

Correct Incorrect Correct answer

Verapamil 0.1 mg/kg slow IV push

Correct Incorrect Correct answer

A patient with symptomatic third-degree AV block has not responded to atropine. You initiate transcutaneous pacing at a rate of 70 bpm. The monitor shows pacing spikes followed by wide QRS complexes, but the patient remains hypotensive and unresponsive. What should you assess next?

Palpate for a pulse to confirm mechanical capture, as electrical capture does not guarantee effective cardiac output

Correct Incorrect Correct answer

Increase the pacing rate to 120 bpm to overcome the block

Correct Incorrect Correct answer

Decrease the pacing output since the QRS complexes indicate the current is too high

Correct Incorrect Correct answer

Discontinue pacing since the presence of QRS complexes confirms adequate perfusion

Correct Incorrect Correct answer

A 74-year-old female presents with syncope. The cardiac monitor shows regular P waves at a rate of 80 per minute and a regular ventricular rate of 32 per minute. There is no consistent relationship between the P waves and QRS complexes. What rhythm is present?

Third-degree (complete) AV block

Correct Incorrect Correct answer

Second-degree AV block Type I (Wenckebach)

Correct Incorrect Correct answer

Second-degree AV block Type II

Correct Incorrect Correct answer

Sinus bradycardia with first-degree AV block

Correct Incorrect Correct answer

A patient on a dopamine infusion at 5 mcg/kg/min for cardiogenic shock shows improvement in blood pressure from 78/50 to 92/62. However, the patient develops new onset of nausea and tachycardia at 128 bpm. The medical director advises increasing the rate to 10 mcg/kg/min. At this higher dose range, what additional pharmacologic effect of dopamine becomes predominant?

Beta-1 adrenergic stimulation causing increased cardiac contractility and heart rate

Correct Incorrect Correct answer

Dopaminergic receptor stimulation causing renal vasodilation

Correct Incorrect Correct answer

Alpha-1 adrenergic stimulation causing peripheral vasoconstriction

Correct Incorrect Correct answer

Muscarinic cholinergic stimulation causing bronchodilation

Correct Incorrect Correct answer

During a cardiac arrest, your team has been performing high-quality CPR for 25 minutes with 5 defibrillation attempts for refractory ventricular fibrillation. Epinephrine and amiodarone have been administered per protocol. The ETCO2 has remained below 10 mmHg throughout the resuscitation despite confirmed tracheal tube placement and good compression quality. What does the persistently low ETCO2 suggest about prognosis?

An ETCO2 persistently below 10 mmHg after 20 minutes of CPR is associated with poor likelihood of achieving ROSC

Correct Incorrect Correct answer

The low ETCO2 confirms the tube is in the esophagus and must be replaced

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The ETCO2 reading is unreliable during cardiac arrest and should be ignored

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The low ETCO2 indicates that CPR quality needs to improve significantly

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A 65-year-old male presents with chest pain and shortness of breath. The 12-lead ECG shows ST elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. You obtain a right-sided 12-lead ECG, and V4R shows 1 mm ST elevation. This additional finding indicates what associated condition that affects your treatment decisions?

Right ventricular infarction, requiring IV fluid boluses and avoidance of nitroglycerin and morphine

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Left ventricular hypertrophy, which requires no change in treatment

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Pericarditis, requiring administration of aspirin and positioning changes

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Posterior wall extension, requiring emergent pericardiocentesis

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During a cardiac arrest in an adult patient, your team is performing high-quality CPR. The ETCO2 waveform has been consistently showing values of 18 to 22 mmHg. A new compressor takes over and the ETCO2 drops to 8 mmHg. All other factors remain unchanged. What is the most likely explanation for the ETCO2 decrease?

The new compressor is providing inadequate compression depth or rate, reducing cardiac output

Correct Incorrect Correct answer

The patient has developed a tension pneumothorax requiring decompression

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The endotracheal tube has migrated into the esophagus

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The patient's underlying rhythm has changed to asystole from VF

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A 50-year-old male presents after a syncopal episode. He is now alert and asymptomatic. The cardiac monitor shows a regular rhythm at 72 bpm with a PR interval that is constant at 0.28 seconds. Each P wave is followed by a QRS complex. What rhythm is this?

Normal sinus rhythm with first-degree AV block

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Second-degree AV block Type I (Wenckebach)

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Third-degree AV block with a junctional escape rhythm

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Junctional rhythm without AV block

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During high-quality CPR on an adult patient, what is the recommended compression fraction (percentage of time with active chest compressions)?

At least 60%, with a goal of 80% or higher

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At least 30%, since pauses for ventilation are equally important

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Exactly 50%, with equal time for compressions and ventilations

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100%, as compressions should never be paused for any reason

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After achieving ROSC in a 55-year-old male, you are managing the patient during transport. His blood pressure is 74/48 despite a 500 mL normal saline bolus. The cardiac monitor shows sinus tachycardia at 108. ETCO2 is 32 mmHg. What vasopressor should you consider starting for post-ROSC hypotension?

Norepinephrine infusion titrated to a target systolic blood pressure of at least 90 mmHg

Correct Incorrect Correct answer

Epinephrine 1 mg IV push every 3 to 5 minutes as during cardiac arrest

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Atropine 0.5 mg IV for the tachycardia

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Dopamine at 2 mcg/kg/min for renal perfusion dose only

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A cardiac arrest patient has been in pulseless electrical activity (PEA) for 15 minutes despite high-quality CPR and epinephrine every 3 to 5 minutes. You consider the reversible causes. The patient’s medical history includes end-stage renal disease on dialysis. Which of the H’s and T’s is most likely contributing to this PEA arrest?

Hyperkalemia (one of the H's)

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Hypothermia

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Tension pneumothorax

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Cardiac tamponade

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A 2-year-old child is in cardiac arrest with asystole. The child weighs 12 kg. You have established IO access. After administering the first dose of epinephrine, what is the appropriate defibrillation decision for this rhythm?

Do not defibrillate; asystole is a non-shockable rhythm in both pediatric and adult patients

Correct Incorrect Correct answer

Defibrillate at 2 J/kg (24 joules) since all pediatric cardiac arrest rhythms should be defibrillated

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Defibrillate at 4 J/kg (48 joules) as a high-energy initial shock for pediatric asystole

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Attempt synchronized cardioversion at 1 J/kg to convert the asystole to a perfusing rhythm

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What is the purpose of the 2-minute CPR cycle between rhythm checks during cardiac arrest resuscitation?

To build and maintain coronary perfusion pressure, which requires uninterrupted compressions to generate sufficient pressure gradients for cardiac and cerebral blood flow

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To allow medications adequate time to circulate before the next defibrillation attempt

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To give the compressor adequate rest before switching roles

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To provide time for the defibrillator to recharge between shocks

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A patient with symptomatic bradycardia (HR 38, BP 80/50, altered mental status) receives atropine 0.5 mg IV. His heart rate increases to 52 but he remains symptomatic. What is the maximum total dose of atropine for symptomatic bradycardia before moving to the next intervention?

3 mg total (0.5 mg doses every 3 to 5 minutes, up to 6 doses)

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1 mg total (two 0.5 mg doses)

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0.5 mg as a single dose only

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6 mg total (twelve 0.5 mg doses)

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A 45-year-old male presents with palpitations. The cardiac monitor shows an irregularly irregular rhythm with no discernible P waves. The ventricular rate is 142. QRS complexes are narrow. What rhythm is present?

Atrial fibrillation with rapid ventricular response

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Multifocal atrial tachycardia

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Atrial flutter with variable block

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Supraventricular tachycardia (SVT)

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You are preparing to perform synchronized cardioversion on a hemodynamically unstable patient with atrial fibrillation with RVR at 180 bpm. After applying defibrillation pads and selecting the sync mode, you press the shock button but the defibrillator does not deliver a shock. What is the most likely reason?

The synchronization circuit cannot reliably identify R waves in the irregular rhythm, causing the device to delay or fail to discharge

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The battery is dead and the defibrillator needs to be replaced

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The energy setting is too low for the defibrillator to charge

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The patient's skin is too dry for the pads to conduct electricity

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What is the recommended dose and administration method for amiodarone in the treatment of pulseless ventricular tachycardia or ventricular fibrillation?

300 mg IV/IO push as the first dose, with a second dose of 150 mg if the rhythm persists

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150 mg IV/IO push as the first dose, with a second dose of 300 mg

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300 mg slow IV infusion over 30 minutes, repeated once if needed

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450 mg IV/IO push as a single dose with no repeat

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A 50-year-old male with chest pain has a 12-lead ECG showing a shortened PR interval less than 120 ms and a delta wave (slurred upstroke of the QRS complex). The QRS is slightly widened. He is currently in normal sinus rhythm at 78 bpm. What underlying condition do these findings represent?

Wolff-Parkinson-White (WPW) syndrome, indicating a ventricular pre-excitation accessory pathway

Correct Incorrect Correct answer

First-degree AV block with bundle branch block

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Brugada syndrome with risk of sudden death

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Hyperkalemia with early ECG changes

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During a witnessed cardiac arrest in a patient with an implanted cardioverter-defibrillator (ICD), you see the patient’s body twitch, suggesting the ICD is delivering shocks. The patient remains in VF on your monitor. What should you do regarding the ICD?

Continue standard ACLS including external defibrillation; place defibrillation pads at least 1 inch away from the ICD generator and proceed with normal resuscitation

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Wait for the ICD to deliver all of its programmed shocks before attempting external defibrillation

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Do not apply external defibrillation pads to avoid damaging the ICD device

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Turn off the ICD using a magnet before starting CPR

Correct Incorrect Correct answer

During cardiac arrest management, the rhythm check after the second shock reveals persistent ventricular fibrillation. CPR is resumed. According to the ACLS algorithm, what medication should be administered during this cycle?

Epinephrine 1 mg IV/IO

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Amiodarone 300 mg IV/IO

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Atropine 1 mg IV/IO

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Lidocaine 100 mg IV/IO

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In the ACLS pulseless electrical activity (PEA) algorithm, what are the H’s and T’s used to identify?

Reversible causes of cardiac arrest that should be identified and treated during resuscitation

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Criteria for termination of resuscitation efforts in the field

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Indicators that the patient has achieved return of spontaneous circulation

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Contraindications to epinephrine administration during cardiac arrest

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A patient in cardiac arrest has been in refractory ventricular fibrillation despite three shocks, epinephrine, and amiodarone 300 mg. The rhythm remains VF after the fourth shock. What is the next appropriate antiarrhythmic dose?

Amiodarone 150 mg IV/IO as a second dose

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Amiodarone 300 mg IV/IO repeated at the same initial dose

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Magnesium sulfate 2 g IV/IO for all refractory VF cases

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Procainamide 20 mg/min IV infusion during active CPR

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A patient presents with symptomatic bradycardia (heart rate 35 bpm, BP 78/50, altered mental status). Atropine 0.5 mg IV has been given twice without improvement. What is the next intervention per the ACLS bradycardia algorithm?

Initiate transcutaneous pacing or start a dopamine or epinephrine infusion

Correct Incorrect Correct answer

Administer a third dose of atropine 0.5 mg IV and reassess

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Perform synchronized cardioversion at 100 joules

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Administer adenosine 6 mg rapid IV push

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What is the recommended compression-to-ventilation ratio for single-rescuer CPR on an adult patient without an advanced airway in place?

30 compressions to 2 ventilations

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15 compressions to 2 ventilations

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Continuous compressions with no ventilations

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5 compressions to 1 ventilation

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A patient with atrial fibrillation and a ventricular rate of 180 bpm is diaphoretic, has chest pain, and BP of 78/50. The paramedic determines synchronized cardioversion is indicated. What is the recommended initial energy setting for biphasic cardioversion of atrial fibrillation?

120 to 200 joules biphasic (or as recommended by the device manufacturer)

Correct Incorrect Correct answer

50 joules biphasic for all supraventricular tachycardias

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360 joules monophasic as the standard first attempt

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200 joules biphasic, which is the universal starting dose for all arrhythmias

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Why is synchronized cardioversion preferred over unsynchronized defibrillation for treating unstable tachyarrhythmias with a pulse?

Synchronization delivers the shock during the R wave, avoiding the vulnerable T wave period that could induce ventricular fibrillation

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Synchronized shocks use less energy and are therefore safer for the myocardium

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Unsynchronized shocks cannot be used on patients who have a pulse

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Synchronization allows the defibrillator to automatically select the optimal energy level

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A paramedic attempts synchronized cardioversion on a patient with unstable SVT. The defibrillator is in sync mode, but when the shock button is pressed, the device does not fire. What is the most likely cause?

The device cannot detect R waves to synchronize with, possibly due to low amplitude QRS complexes or lead artifact

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The battery is depleted and the device needs to be replaced

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Synchronized cardioversion is contraindicated for SVT and the device has a safety lockout

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The pads are placed in the wrong position, preventing any shock delivery

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Before performing synchronized cardioversion on a conscious patient with unstable monomorphic ventricular tachycardia, what preparation step is essential for patient safety and comfort?

Administer sedation (such as midazolam or fentanyl) if time and hemodynamic status allow, to reduce pain and anxiety from the shock

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Apply topical lidocaine to the chest where the pads will be placed

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Instruct the patient to take a deep breath and hold it during the shock

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Wait for the patient to become unresponsive before delivering the shock to avoid causing pain

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What is the recommended initial energy setting for synchronized cardioversion of unstable monomorphic ventricular tachycardia using a biphasic defibrillator?

100 joules biphasic

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50 joules biphasic

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200 joules biphasic as the universal starting dose

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360 joules monophasic

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After successful cardioversion of unstable atrial fibrillation, the patient’s rhythm converts to normal sinus rhythm at 78 bpm. However, two minutes later the monitor shows the rhythm has deteriorated back to rapid atrial fibrillation at 170 bpm with recurrent symptoms. What is the appropriate action?

Repeat synchronized cardioversion at the same or higher energy, and consider initiating an antiarrhythmic medication to maintain sinus rhythm

Correct Incorrect Correct answer

Accept the recurrence and manage conservatively with IV fluids only

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Defibrillate the patient unsynchronized at maximum energy

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Administer adenosine 12 mg rapid IV push to terminate the atrial fibrillation

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A paramedic initiates transcutaneous pacing on a patient with symptomatic third-degree heart block. The pacing rate is set to 70 bpm and the current is gradually increased. At 80 mA, pacer spikes appear on the monitor but there is no capture. What should the paramedic do?

Continue increasing the milliamperage until electrical capture is confirmed by a wide QRS complex following each pacer spike

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Stop increasing current at 80 mA to avoid skin burns and accept loss of capture

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Decrease the pacing rate to 40 bpm to match the patient's intrinsic rate

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Switch to pharmacological management only and discontinue pacing attempts

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Where should the pacing pads be placed for transcutaneous pacing in the anterior-posterior configuration?

One pad on the anterior chest over the left precordium and one pad on the posterior chest between the scapulae

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Both pads on the anterior chest, one below each clavicle

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One pad on the right anterior chest and one on the left lateral chest wall

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One pad on the patient's neck and one on the left upper abdomen

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Transcutaneous pacing has been initiated on a patient with symptomatic bradycardia. The monitor shows pacer spikes followed by wide QRS complexes at the set rate of 70 bpm. However, the patient’s femoral pulse rate is only 40 bpm. What does this finding indicate?

There is electrical capture but not mechanical capture; the paced beats are not generating effective myocardial contraction

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The pacer is functioning correctly and the femoral pulse is being counted incorrectly

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The patient has developed ventricular fibrillation that is being masked by the pacer spikes

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The pacing rate needs to be decreased to match the patient's intrinsic heart rate

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A conscious patient requiring transcutaneous pacing reports severe chest pain from the pacing stimulus. The pacer is capturing at 90 mA. What can the paramedic do to improve patient comfort?

Administer analgesic or sedative medication such as fentanyl or midazolam while maintaining pacing

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Decrease the milliamperage below the capture threshold to reduce pain

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Discontinue pacing and rely solely on atropine for rate support

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Apply ice packs to the chest around the pacing pads to numb the area

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NREMT Paramedic – Cardiology/Resuscitation — Quick Review

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