Do They Qualify?
A 45-year-old patient presents with central chest pain. They are alert, able to chew and swallow, and have no history of allergy. There are no signs of active bleeding.
What is a patient who qualifies for ASA administration under the Cardiac Ischemia Medical Directive?
A patient presents with chest pain and requests their nitroglycerin. They are alert with a blood pressure of 118/76 but report taking sildenafil earlier that morning.
What is a contraindication to nitroglycerin due to recent PDE inhibitor use?
A patient presents with chest pain at rest, pale and diaphoretic. Another presents with chest pain only on exertion that resolves with rest. Both have normal vital signs on assessment.
What is unstable angina versus stable angina?
A 58-year-old presents with chest pressure, pale and diaphoretic. They are alert, able to answer questions appropriately, and deny allergy. Vital signs are stable. Pain started 20 minutes ago while at rest.
What is administering ASA?
A patient with suspected cardiac ischemia is eligible for antiplatelet therapy. The medication must be given orally in a single dose that falls within a narrow range used in prehospital care.
What is ASA 160–162 mg PO?
A 60-year-old patient presents with chest pain and a blood pressure of 92/60. They are alert and have a history of angina with a prescribed nitroglycerin spray.
What is a patient who does NOT qualify for nitroglycerin due to hypotension?
A 28-year-old patient presents with musculoskeletal pain and requests pain medication. They report taking ibuprofen two hours prior to your arrival.
What is a contraindication to NSAID administration due to recent use?
Two patients present with shortness of breath. One has wheezing, prolonged expiratory phase, and a history of asthma. The other has crackles, hypertension, and pink frothy sputum.
What is bronchoconstriction versus acute cardiogenic pulmonary edema?
A patient presents with increasing shortness of breath. They are tachypneic with wheezing, speaking in short sentences, and have a known history of asthma. Oxygen is applied but symptoms persist.
What is administering salbutamol?
A 75 kg patient in severe bronchoconstriction requires intramuscular medication after becoming apneic. The dose must be weight-based and not exceed the adult maximum.
What is epinephrine 0.5 mg IM?
A 70-year-old patient presents in moderate respiratory distress with suspected pulmonary edema. Blood pressure is 168/94, heart rate 104, and the patient is alert.
What is a patient who qualifies for nitroglycerin in acute cardiogenic pulmonary edema?
A patient presents with respiratory distress and suspected bronchoconstriction. They are apneic and require BVM ventilation.
What is a patient who requires epinephrine first, making salbutamol inappropriate as the initial intervention?
Two trauma patients present with tachycardia and hypotension. One has a clear mechanism for blood loss with signs of poor perfusion. The other has a confirmed STEMI with clear lung sounds and no evidence of fluid overload.
What is hemorrhagic shock versus cardiogenic shock?
A trauma patient presents with a deep laceration to the thigh. Direct pressure slows but does not stop the bleeding. The patient is becoming tachycardic and pale.
What is applying a tourniquet?
A hypertensive patient with acute cardiogenic pulmonary edema is receiving sublingual medication. Their systolic blood pressure is greater than 140 mmHg, requiring an increased dose within protocol limits.
What is nitroglycerin 0.6–0.8 mg SL?
A 16-year-old patient presents with severe pain from an isolated extremity injury. They are alert, have normal vital signs, and no contraindications are identified.
What is a patient who qualifies for analgesia under the Analgesia Medical Directive?
A patient presents with severe respiratory distress and SpO₂ of 84%. They are anxious, unable to follow instructions, and repeatedly remove the mask when applied.
What is a contraindication to CPAP due to inability to cooperate?
Two patients present with respiratory distress. One is alert, anxious, and able to follow commands. The other is confused, unable to cooperate, and intermittently removes oxygen devices.
What is a patient appropriate for CPAP versus a patient with contraindication to CPAP due to inability to cooperate?
A patient presents with severe respiratory distress. They are hypertensive, tachypneic, with crackles on auscultation and decreasing oxygen saturation despite oxygen therapy. They are alert and able to follow commands.
What is initiating CPAP and administering nitroglycerin?
A 90 kg trauma patient meets criteria for antifibrinolytic therapy. The initial dose is calculated using a fixed weight-based approach but is delivered as a standardized adult dose.
What is TXA 1 gram IV/IM?
A patient presents with severe respiratory distress, accessory muscle use, SpO₂ of 86%, and is able to follow commands and sit upright. There is no suspicion of pneumothorax or trauma.
What is a patient who qualifies for CPAP therapy?
A trauma patient with suspected hemorrhage is hypotensive and meets criteria for TXA. However, the time of injury is unknown and may exceed several hours.
What is a contraindication to TXA due to uncertain or prolonged time since injury?
Two patients present with pain. One has isolated musculoskeletal injury with no medical history. The other has similar pain but reports active GI bleeding and recent NSAID use.
What is a patient appropriate for NSAID analgesia versus a patient with contraindications to NSAIDs?
A patient with confirmed STEMI becomes increasingly hypotensive. Lung sounds are clear and there are no signs of fluid overload. Mental status is beginning to decline.
What is initiating a fluid bolus for cardiogenic shock?
A hypotensive adult patient without signs of fluid overload requires circulatory support. The directive specifies a weight-based bolus with reassessment after incremental volumes and a defined maximum limit.
What is 0.9% NaCl 20 mL/kg IV bolus (max 2000 mL, reassess every 250 mL)?