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

One 81 mg tablet, swallowed whole with a sip of water: One tablet is 81 mg, a quarter of the target. That is a daily preventive dose, not a treatment dose for an acute event, and swallowing it whole slows it down further.

Two 81 mg tablets, swallowed whole with a sip of water: Two tablets gets you to 162 mg, which is inside some protocol ranges, but swallowing them whole throws away the speed you were buying. If your protocol range starts at 162 mg, you still chew them.

Six 81 mg tablets, chewed rather than swallowed whole: Six tablets is 486 mg. More aspirin past the target does not block more platelets in the time frame that matters, and it raises the bleeding risk for nothing.

Give a full 324 mg on top of the tablet the patient took this morning: Stacking a full second dose on top of the morning tablet takes the patient past the target for no added platelet effect. The rule is to reach 324 mg, not to give 324 mg again.

Withhold aspirin, since a dose was already taken in the last 24 hours: A morning dose is the reason to top up, not the reason to stop. Withholding here leaves the patient at a quarter of the dose that carries the mortality benefit.

Withhold aspirin until the receiving facility confirms the morning dose: A dose this time critical does not wait for a phone call. The history you already have is enough to do the arithmetic at the bedside.

Give the full 324 mg, since the mortality benefit outweighs the bleeding: The mortality benefit is real, but it is not a reason to push an antiplatelet drug into a patient who is bleeding right now. The contraindication list is not a suggestion.

Give a single 81 mg tablet, since a low dose is safe with a bleeding ulcer: A smaller dose of an antiplatelet drug still blocks platelets in a patient whose ulcer is already bleeding. There is no safe fraction here.

Withhold aspirin, since a patient over 80 carries too much bleeding risk: Age by itself is not on the withhold list. Plenty of patients in their eighties and nineties get aspirin for this, and it is the bleeding that stops this one.

Within 30 minutes of first contact with the patient: Thirty minutes is long enough that many patients are already at the hospital door, which defeats the purpose of a prehospital tracing entirely.

After the patient has been loaded into the ambulance: Waiting for the ambulance wastes the scene minutes that the standard is built around, and a moving vehicle is a worse place to get a clean tracing than a still one.

After both aspirin and nitroglycerin have been given: Tying the tracing to the medications gets the order backward. Nitroglycerin can ease the very changes the receiving physician needs to see, so the tracing goes first.

V5 at the anterior axillary line and V6 at the midaxillary line, in the sixth space: Dropping to the sixth space moves both lateral electrodes off the plane V4 established, which changes what the lateral leads see.

V5 and V6 both at the midaxillary line, one in the fifth and one in the sixth space: Stacking two electrodes on one vertical line gives you two views of nearly the same spot and leaves the anterior axillary line empty.

V5 at the midclavicular line and V6 at the anterior axillary line, both level with V4: V4 is already at the midclavicular line. Putting V5 there too doubles up a view and slides the whole lateral set one position inward.

The community hospital, since the closest appropriate facility rule governs: Closest appropriate is not the same as closest. A hospital that cannot perform the procedure this patient needs is not the appropriate one, however near it is.

The community hospital, since the transfer can be arranged while care starts: A transfer is not a background task. It means a second bed, a second crew, a second set of paperwork, and a second ride, and the clock runs through all of it.

The catheterization hospital, unless the drive would run past 20 minutes: A fixed drive time ceiling is not how this decision is made. The comparison is between going once and going twice, and a longer first ride is usually the faster route to the catheterization table.

Give high flow oxygen by non-rebreather and leave it at 15 L per minute: High flow is a starting point for a patient in real distress, but leaving it wide open pushes the saturation far past where it needs to be, and that extra oxygen narrows coronary vessels.

Withhold oxygen, since the saturation is still above 90 percent: Ninety is not the threshold. The number that decides oxygen in a suspected coronary event is 94 percent, and this patient is under it with a respiratory rate to match.

Give oxygen by nasal cannula and stop once the breathing feels easier: Feeling easier is not the endpoint. Comfort can arrive while the saturation is still sitting under 94 percent, and it can arrive from sitting the patient up rather than from the oxygen. The number is what tells you when you have given enough.

It confirms the patient has already reached decompensated shock: Shock is a perfusion diagnosis built on more than skin. This patient has a blood pressure, a mental status, and a pulse quality you have not weighed yet.

It rules out a musculoskeletal source for the discomfort entirely: Nothing in a field assessment rules a cause out entirely. A finding can raise concern for one cause without closing the door on another.

It indicates the discomfort has been present for over an hour: Skin findings do not keep time. Diaphoresis can show up in the first minutes or not at all.

It lets the AEMT begin a treatment that protocol otherwise withholds: Aspirin, oxygen, access, and nitroglycerin all run off your protocol and the patient in front of you. None of them wait on a transmitted tracing.

It shortens the ride by clearing a bed in the emergency department: Bed assignment is not what the tracing buys. The catheterization team is the resource that takes time to assemble, and that is what gets started.

It replaces the radio report the crew would otherwise have to give: Transmission and the radio report do different jobs. The notification still goes out, and it is half of what starts the hospital moving.

Withhold oxygen, since raising it in this disease removes the drive to breathe: Withholding oxygen from a hypoxic patient is never the answer. The drive idea is not how this works, and a saturation of 84 percent is starving both the brain and the muscle you are worried about.

Give oxygen by nasal cannula at 2 L and leave it there regardless of the reading: A fixed setting is not titration. Two liters may land this patient anywhere from 84 to 95 percent, and choosing a flow rate instead of a target means you find out where it landed by accident.

Give oxygen only until the chest pressure itself begins to ease: Chest pressure is not the endpoint for oxygen. The saturation is, and tying the two together leaves you titrating to the wrong number.