10 free AEMT practice questions: Acute Coronary Syndrome Recognition and Treatment

One 81 mg tablet, swallowed whole with a sip of water: One 81 mg tablet is the daily dose for prevention. A single tablet is only a quarter of the target dose. Swallowing the tablet whole slows the aspirin down even more.

Two 81 mg tablets, swallowed whole with a sip of water: Two tablets is 162 mg, and some protocol ranges start at 162 mg. Swallowing the tablets whole slows the aspirin down. Even if your protocol starts at 162 mg, the tablets still get chewed.

Six 81 mg tablets, chewed rather than swallowed whole: Six tablets is 486 mg, which is past the target. More aspirin past 324 mg does not block more platelets in the time that matters. The extra tablets only raise the bleeding risk.

Give a full 324 mg on top of the tablet the patient took this morning: A full 324 mg is the right dose for a patient who has not taken any aspirin. This patient already took 81 mg this morning. A full dose on top of the morning tablet goes past the target and adds no platelet effect. The goal is to reach 324 mg total, not to give 324 mg again.

Withhold aspirin, since a dose was already taken in the last 24 hours: Holding aspirin makes sense when the patient already took a full dose. This patient took one daily 81 mg tablet. A morning dose is the reason to top up, not the reason to stop. Holding aspirin leaves this patient at a quarter of the dose that lowers the risk of dying.

Withhold aspirin until the receiving facility confirms the morning dose: Aspirin for chest pressure is time critical, and the dose does not wait for a phone call to the hospital. You already know the patient took one 81 mg tablet this morning. That history is enough to figure out the rest of the dose on scene.

Give the full 324 mg, since the mortality benefit outweighs the bleeding: Aspirin does lower the death rate in acute coronary syndrome, and that is why it is standard care. That benefit assumes a patient who is not bleeding. The black stools tell you this bleed has not stopped. Giving aspirin here would make the bleeding worse.

Give a single 81 mg tablet, since a low dose is safe with a bleeding ulcer: Dropping to one 81 mg tablet sounds safer. One tablet still blocks platelets. The active bleed makes any dose of aspirin wrong, not only the full 324 mg.

Withhold aspirin, since a patient over 80 carries too much bleeding risk: Age alone is not on the aspirin contraindication list. Plenty of patients in their eighties get aspirin for chest pain without a problem. What stops aspirin for this patient is the active bleed, not the age of 87.

Within 30 minutes of first contact with the patient: A 12-lead at 30 minutes is still a tracing, just a slow one. Waiting that long uses up time a patient with a real ST elevation does not have. The patient may even reach the hospital before the hospital ever sees the tracing.

After the patient has been loaded into the ambulance: You will load the patient, but loading first costs scene minutes this patient cannot afford. The tracing then gets done in a moving, vibrating ambulance instead of on a still scene.

After both aspirin and nitroglycerin have been given: Aspirin and nitroglycerin both belong on this call. Nitroglycerin can blunt the ST changes the 12-lead is meant to catch. Giving the medications first can hide the exact finding the tracing exists to record.

V5 at the anterior axillary line and V6 at the midaxillary line, in the sixth space: The anterior axillary line and the midaxillary line are right for V5 and V6. The sixth space is wrong. V4 already set the level at the fifth space. Dropping V5 and V6 lower pulls the lateral leads off that level and changes what they see.

V5 and V6 both at the midaxillary line, one in the fifth and one in the sixth space: The midaxillary line is right for V6. Putting V5 there too leaves the anterior axillary line empty. You get two views of nearly the same spot instead of a full sweep of the lateral wall.

V5 at the midclavicular line and V6 at the anterior axillary line, both level with V4: The anterior axillary line is where V5 belongs, not V6. V4 already sits on the midclavicular line, so putting V5 there doubles up that view. The whole lateral set ends up one position too far toward the middle of the chest.

The community hospital, since the closest appropriate facility rule governs: The closest appropriate facility rule is real. Appropriate means the hospital can do the procedure this patient needs. The community hospital is 7 minutes away and has no catheterization laboratory, so it cannot open the artery.

The community hospital, since the transfer can be arranged while care starts: Transfers are a real part of EMS. A transfer does not run in the background while care starts. A transfer needs a second ambulance, a second crew, and a second handoff, and the heart muscle keeps dying through all of it. The shorter first ride ends in a longer total time to opening the artery.

The catheterization hospital, unless the drive would run past 20 minutes: No fixed drive time limit decides this, at 20 minutes or any other number. What matters is the total time to opening the artery, one trip versus two. A 24 minute direct drive still beats a 7 minute drive followed by a transfer.

Give high flow oxygen by NRB and leave it at 15 L per minute: High flow by NRB is a starting point for a patient in real distress. Leaving it at 15 L per minute pushes the saturation far past where it needs to be. Extra oxygen can narrow the coronary vessels.

Withhold oxygen, since the saturation is still above 90 percent: A saturation above 90 percent can look good enough. In a suspected coronary event, the number that decides oxygen is 94 percent. This patient is at 93% with a respiratory rate of 24.

Give oxygen by nasal cannula and stop once the breathing feels easier: Easier breathing is a good sign, but easier breathing is not the end point for oxygen. The patient can feel better while the saturation is still under 94 percent. Sitting the patient up can also ease the breathing, apart from anything the oxygen did. The saturation number tells you when you have given enough.

It confirms the patient has already reached decompensated shock: Cool, clammy skin can be part of shock, but decompensated shock takes more than the skin. You would weigh a falling blood pressure, an altered mental status, and a weak or absent peripheral pulse along with the skin. None of those are given here.

It rules out a musculoskeletal source for the discomfort entirely: A field finding can raise your suspicion for one cause without ruling out another. Musculoskeletal pain can still cause sweating through the body's stress response. Cool, clammy skin never fully rules out a muscle or bone source.

It indicates the discomfort has been present for over an hour: The skin does not tell you how long the discomfort has lasted. Sweating can start in the first minutes of an event or show up late. The hour of discomfort comes from what the patient told you.

It lets the AEMT begin a treatment that protocol otherwise withholds: Aspirin, oxygen, IV access, and nitroglycerin all come from your own protocol. You give them based on the patient in front of you. None of them waits on the hospital reading a transmitted tracing. Nothing in this call ties a treatment to the transmission going through.

It shortens the ride by clearing a bed in the emergency department: Clearing a bed can follow a good early notification, but the bed is a side effect. A free bed does not make the drive any shorter. The part that takes time to put together is the catheterization team. The early tracing gets that team moving.

It replaces the radio report the crew would otherwise have to give: The radio report and the transmitted 12-lead do different jobs. You still give the radio report. The hospital's response starts when someone there sees the tracing or hears the notification. The tracing goes along with the report and does not replace it.

Withhold oxygen, since raising it in this disease removes the drive to breathe: Withholding oxygen comes from the old teaching that oxygen takes away a COPD patient's drive to breathe. The hypoxic drive is not real. Chronic lung disease is never a reason to withhold oxygen from a hypoxic patient. A saturation of 84% is not giving enough oxygen to the heart muscle you are already worried about.

Give oxygen by nasal cannula at 2 L and leave it there regardless of the reading: Two liters by nasal cannula is a reasonable place to start. Setting a fixed flow and walking away skips the titration this patient needs. Two liters could land this patient anywhere from the 80s to the mid 90s. Watch the saturation on the monitor and adjust the flow to reach the target.

Give oxygen only until the chest pressure itself begins to ease: The chest pressure and the oxygen level are separate problems. You titrate oxygen to the saturation reading, not to whether the pain has eased. Stopping when the pressure eases could stop the oxygen too soon. You could also miss that the saturation already reached the target or went past it.