Fisdap Cardiology Review (Paramedic)
3 signs of Becks triad - ANS-Elevated pulse pressure, muffled heart tones, and hypotension
3rd trimester bright red and painless vaginal bleeding - ANS-Placenta previa
3rd trimester dark red vaginal bleeding with severe pain - ANS-Abruptio placenta
A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You
have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are
using a microdrip administration set (60 gtts/mL), how many drops per minute should you
deliver to achieve the required dose?
A: 42
B: 36
C: 48
D: 30 - ANS-*B: 36*
Reason:
First, convert the patient's weight from pounds to kilograms: 145 ÷ 2.2 = 66 kg. Next,
determine the desired dose: 15 µg/kg/min × 66 kg = 990 µg/min. The next step is to
determine the concentration of dopamine on hand: 800 mg ÷ 500 mL = 1.6 mg/mL (1,600
µg/mL [1.6 × 1,000 = 1,600]). Now, you must determine the number of mL to be delivered
per minute: 990 µg/min [desired dose] ÷ 1,600 µg/mL [concentration on hand] = 0.6 mL/min.
The final step is to determine the number of drops per minute that you must set your IV flow
rate at: 0.6 mL/min × 60 gtts/mL (drop factor of the microdrip) ÷ 1 (total infusion time in
minutes) = 36 gtts/min.
A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You
have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are
using a microdrip administration set (60 gtts/mL), how many drops per minute should you
deliver to achieve the required dose?
A: 48
B: 42
C: 30
D: 36 - ANS-*D: 36*
A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You
have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are
using a microdrip administration set (60 gtts/mL), how many drops per minute should you
deliver to achieve the required dose? - ANS-36.
First, convert the patient's weight from pounds to kilograms: 145 ÷ 2.2 = 66 kg. Next,
determine the desired dose: 15 µg/kg/min × 66 kg = 990 µg/min. The next step is to
determine the concentration of dopamine on hand: 800 mg ÷ 500 mL = 1.6 mg/mL (1,600
µg/mL [1.6 × 1,000 = 1,600]). Now, you must determine the number of mL to be delivered
per minute: 990 µg/min [desired dose] ÷ 1,600 µg/mL [concentration on hand] = 0.6 mL/min.
The final step is to determine the number of drops per minute that you must set your IV flow
,rate at: 0.6 mL/min × 60 gtts/mL (drop factor of the microdrip) ÷ 1 (total infusion time in
minutes) = 36 gtts/min.
A 27-year-old female complains of palpitations. The cardiac monitor reveals a
narrow-complex tachycardia at 180/min. She denies any other symptoms, and states that
this has happened to her before, but it typically resolves on its own. Her blood pressure is
126/66 mm Hg, pulse is 180 beats/min, and respirations are 16 breaths/min. After attempting
vagal maneuvers and giving two doses of adenosine, her cardiac rhythm and vital signs
remain unchanged. You should:
A: infuse 150 mg of amiodarone over 10 minutes, reassess her, and repeat the amiodarone
if needed.
B: transport at once, reassess her frequently, and perform synchronized cardioversion if
necessary.
C: administer 5 mg of midazolam and perform synchronized cardioversion starting with 50
joules.
D: administer 0.35 mg/kg of diltiazem over 2 minutes and then reassess her hemodynamic
status. - ANS-*B: transport at once, reassess her frequently, and perform synchronized
cardioversion if necessary.*
Reason:
Although the patient is in supraventricular tachycardia (SVT), she remains stable following
your initial efforts to slow her heart rate with vagal maneuvers and adenosine. Her failure to
respond to initial treatment does not automatically make her unstable. Simply transport her,
closely monitor her en route, and be prepared to cardiovert her if she does become unstable
(ie, hypotension, altered mental status, chest pain). Unless specified in your local protocols,
pharmacologic therapy beyond adenosine (ie, calcium channel blockers, amiodarone) is
typically not indicated in the field for stable patients with SVT, although these medications
may be given in the emergency department. However, if your protocols or medical control
call for the administration of diltiazem (Cardizem), the initial dose is 0.25 mg/kg.
A 27-year-old female complains of palpitations. The cardiac monitor reveals a
narrow-complex tachycardia at 180/min. She denies any other symptoms, and states that
this has happened to her before, but it typically resolves on its own. Her blood pressure is
126/66 mm Hg, pulse is 180 beats/min, and respirations are 16 breaths/min. After attempting
vagal maneuvers and giving two doses of adenosine, her cardiac rhythm and vital signs
remain unchanged. You should: - ANS-Transport at once, reassess her frequently, and
perform synchronized cardioversion if necessary.
Although the patient is in supraventricular tachycardia (SVT), she remains stable following
your initial efforts to slow her heart rate with vagal maneuvers and adenosine. Her failure to
respond to initial treatment does not automatically make her unstable. Simply transport her,
closely monitor her en route, and be prepared to cardiovert her if she does become unstable
(ie, hypotension, altered mental status, chest pain). Unless specified in your local protocols,
pharmacologic therapy beyond adenosine (ie, calcium channel blockers, amiodarone) is
typically not indicated in the field for stable patients with SVT, although these medications
may be given in the emergency department. However, if your protocols or medical control
call for the administration of diltiazem (Cardizem), the initial dose is 0.25 mg/kg.
A 30-year-old man complains of nausea and one episode of vomiting. He is conscious and
alert and states that he has a slight headache. He denies chest pain or shortness of breath,
and his skin is pink, warm, and dry. His BP is 136/88 mm Hg, pulse is 44 beats/min and
,strong, and respirations are 14 breaths/min and unlabored. The cardiac monitor reveals
sinus bradycardia. Treatment for this patient should include:
A: supportive care and transport to the hospital.
B: high-flow oxygen and 0.5 mg atropine IV push.
C: high-flow oxygen and a 20 mL/kg fluid bolus.
D: 2 to 10 µg/min of epinephrine via IV infusion. - ANS-*A: supportive care and transport to
the hospital*
Reason:
Although the patient's heart rate is slow, he is hemodyamically stable; therefore,
pharmacological or electrical intervention aimed at increasing his heart rate is not indicated
at this point. Provide supportive care (ie, oxygen as needed, IV set to a KVO/TKO rate) and
transport him to the hospital. Consider administering an antiemetic drug, such as
ondansetron (Zofran) or promethazine (Phenergan). If his clinical status deteriorates (ie,
chest pain, dyspnea, altered mental status, hypotension), atropine sulfate (0.5 mg) or
transcutaneous cardiac pacing (TCP) will be necessary. IV fluid boluses are not indicated at
this point because there is no evidence of hypovolemia.
A 30-year-old man complains of nausea and one episode of vomiting. He is conscious and
alert and states that he has a slight headache. He denies chest pain or shortness of breath,
and his skin is pink, warm, and dry. His BP is 136/88 mm Hg, pulse is 44 beats/min and
strong, and respirations are 14 breaths/min and unlabored. The cardiac monitor reveals
sinus bradycardia. Treatment for this patient should include: - ANS-Supportive care and
transport to the hospital.
Although the patient's heart rate is slow, he is hemodyamically stable; therefore,
pharmacological or electrical intervention aimed at increasing his heart rate is not indicated
at this point. Provide supportive care (ie, oxygen as needed, IV set to a KVO/TKO rate) and
transport him to the hospital. Consider administering an antiemetic drug, such as
ondansetron (Zofran) or promethazine (Phenergan). If his clinical status deteriorates (ie,
chest pain, dyspnea, altered mental status, hypotension), atropine sulfate (0.5 mg) or
transcutaneous cardiac pacing (TCP) will be necessary. IV fluid boluses are not indicated at
this point because there is no evidence of hypovolemia.
A 35-year-old female experienced a syncopal episode shortly after complaining of
palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival,
she is conscious and alert, denies any injuries, and states that she feels fine. She further
denies any significant medical history. Her vital signs are stable and the cardiac monitor
reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this
information, what MOST likely caused her syncopal episode?
A: A sudden increase in cardiac output
B: Paroxysmal supraventricular tachycardia
C: Aberrant conduction through the ventricles
D: A brief episode of ventricular tachycardia - ANS-*B: Paroxysmal supraventricular
tachycardia*
Reason:
, Syncope (fainting) of cardiac origin is caused by a sudden decrease in cerebral perfusion
secondary to a decrease in cardiac output. This is usually the result of an acute
bradydysrhythmia or tachydysrhythmia. In this particular patient, the presence of frequent
premature atrial complexes (PACs), which indicates atrial irritability, suggests paroxysmal
supraventricular tachycardia (PSVT) as the underlying dysrhythmia that caused her syncopal
episode. In PSVT, the heart is beating so fast that ventricular filling and cardiac output
decrease, which results in a transient decrease in cerebral perfusion. Not all patients with
PSVT experience syncope. Many experience an acute onset of palpitations and/or
lightheadedness that spontaneously resolves.
A 35-year-old female experienced a syncopal episode shortly after complaining of
palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival,
she is conscious and alert, denies any injuries, and states that she feels fine. She further
denies any significant medical history. Her vital signs are stable and the cardiac monitor
reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this
information, what MOST likely caused her syncopal episode?
A: A brief episode of ventricular tachycardia
B: A sudden increase in cardiac output
C: Aberrant conduction through the ventricles
D: Paroxysmal supraventricular tachycardia - ANS-*D: Paroxysmal supraventricular
tachycardia*
Reason:
Syncope (fainting) of cardiac origin is caused by a sudden decrease in cerebral perfusion
secondary to a decrease in cardiac output. This is usually the result of an acute
bradydysrhythmia or tachydysrhythmia. In this particular patient, the presence of frequent
premature atrial complexes (PACs), which indicates atrial irritability, suggests paroxysmal
supraventricular tachycardia (PSVT) as the underlying dysrhythmia that caused her syncopal
episode. In PSVT, the heart is beating so fast that ventricular filling and cardiac output
decrease, which results in a transient decrease in cerebral perfusion. Not all patients with
PSVT experience syncope. Many experience an acute onset of palpitations and/or
lightheadedness that spontaneously resolves.
A 35-year-old female experienced a syncopal episode shortly after complaining of
palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival,
she is conscious and alert, denies any injuries, and states that she feels fine. She further
denies any significant medical history. Her vital signs are stable and the cardiac monitor
reveals a sinus rhythm with frequent premature atrial complexes. On the basis of this
information, what MOST likely caused her syncopal episode?
A: A brief episode of ventricular tachycardia
B: Aberrant conduction through the ventricles
C: Paroxysmal supraventricular tachycardia
D: A sudden increase in cardiac output - ANS-*C: Paroxysmal supraventricular tachycardia*
Reason:
Syncope (fainting) of cardiac origin is caused by a sudden decrease in cerebral perfusion
secondary to a decrease in cardiac output. This is usually the result of an acute
bradydysrhythmia or tachydysrhythmia. In this particular patient, the presence of frequent
premature atrial complexes (PACs), which indicates atrial irritability, suggests paroxysmal
supraventricular tachycardia (PSVT) as the underlying dysrhythmia that caused her syncopal
episode. In PSVT, the heart is beating so fast that ventricular filling and cardiac output
decrease, which results in a transient decrease in cerebral perfusion. Not all patients with
