10 free AEMT practice questions: Cardiac Monitoring and Rhythm Recognition

Check the carotid pulse for up to 10 seconds before doing anything else: A pulse check is how you find out whether a rhythm is making a pulse. A heart that just started beating again usually needs a period of blood flow before it makes a pulse you can feel. Checking now is likely to find nothing, and the pause costs you the pressure you built. The scheduled check in two minutes answers the same question.

Reposition the pads and run a second analysis before touching the patient: Moving the pads is worth a look when the device acts like it is not working right. Here the device worked fine and gave you a result, which was no shock. A second analysis doubles the pause and puts off compressions even longer.

Deliver 30 seconds of ventilations, then resume chest compressions: A patient in cardiac arrest does need oxygen, and ventilations matter. Breathing for a patient whose blood is not moving does not get that oxygen anywhere. Compressions come first, and ventilations fit into the cycle around them.

V3 is optional on a field tracing and is added once the first five are clean: Field tracings do get shortened in some settings, so an optional lead sounds possible. A 12-lead needs all twelve leads to be a 12-lead. V3 covers an area of the heart the other leads do not. Leaving V3 off changes what the receiving physician can see.

V3 sits over the sternum, so it is placed last to avoid shifting the others: Placing an electrode last to avoid shifting the others would make sense for a crowded spot on the sternum. V3 is not on the sternum. V1 and V2 are the electrodes beside the sternum, and V3 sits out between V2 and V4, off the bone. The order comes from measuring the midpoint.

V3 shares a cable with the left arm electrode and follows the limb leads: Cable colors and groupings do get memorized in skills training, so a wiring reason can seem likely. Each precordial electrode has its own lead wire. None of them shares a cable with a limb electrode. The sequence comes from where V3 sits on the chest.

Apply the AED pads and let the device analyze before moving the patient: An AED belongs on a patient who is unresponsive, apneic, and pulseless. The device reads the rhythm and nothing else, so the AED cannot tell that this patient has a pulse. On a fast wide-complex rhythm, an AED can advise a shock, and that shock is unsynchronized. An unsynchronized shock on a patient with a pulse can push the heart into a worse rhythm.

Give aspirin and sublingual nitroglycerin en route for the chest tightness: Aspirin and nitroglycerin are for acute coronary syndrome, and chest tightness in a pale, diaphoretic patient can look like acute coronary syndrome. Here the chest tightness is coming from a heart rate too fast to let the ventricles fill. Nitroglycerin lowers preload, and with a systolic pressure of 78 this patient has almost no preload left. Treating the chest tightness does nothing about the fast rate causing it.

Give a 20 mL/kg crystalloid bolus en route to raise the blood pressure: A fluid bolus helps when low blood pressure comes from low volume. This patient's volume is not the problem. At 190 beats per minute, the ventricles do not have time to fill between beats. More fluid going into a heart that cannot fill does not raise how much the heart pumps out.

Place the pad directly over the patch to avoid delay: Placing the pad over the patch saves a few seconds, and time matters in an arrest. The patch blocks the current from reaching the skin, and it can burn the skin under the pad. Taking the patch off only takes a couple of seconds.

Place the pad two inches below the patch and analyze: Moving the pad below the patch keeps the patch out of the way without taking time. Two inches lower puts the pad off its landmark. Where the pad sits decides the path the current takes through the chest. Keep the pad on the landmark and take the patch off.

Peel the patch off with a bare hand and place the pad right away: Taking the patch off is the right move. Doing it with a bare hand puts the nitroglycerin on your own skin, where it soaks in. Placing the pad right away also skips the wipe, so the residue stays where the pad has to stick. Use a gloved hand and wipe the skin dry first.

On the chest and abdomen, where the torso holds them still: A modified torso placement is used for continuous monitoring on a long transport, because the torso does cut down on motion artifact. Moving the limb electrodes onto the chest and abdomen changes the 12-lead tracing itself. The receiving physician is comparing your tracing against a standard placement.

On the wrists and ankles, directly over the bone so they lie flat: The wrists and ankles are the classic diagram positions, and a flat spot over bone looks like a stable place for an electrode. An electrode sitting directly over bone makes poor skin contact. Poor contact is one of the most common causes of a noisy tracing.

On the upper arms and upper thighs, over the largest muscle bellies available: The upper arms and thighs are fleshy, and a bigger muscle sounds like it would give a stronger signal. Large muscle groups are what create motion artifact. This patient is moving, so the largest muscle bellies are the noisiest spot you could pick.

Because V3 sits over the sternum and the other electrodes must be clear of it: V1 and V2 do sit right beside the sternum, and crowding at the sternal border is a real placement problem. V3 does not sit over the sternum at all. V3 sits out on the chest wall between V2 and V4, and the sternum has nothing to do with the placement order.

Because V3 is optional on a standard tracing and is added only when time allows: A rushed crew sometimes skips a lead, and tracings do come in with a lead missing. All six precordial leads are part of a standard 12-lead. A tracing without V3 is an incomplete tracing, not a faster one.

Because V3 must sit one space lower than V4 to capture the inferior wall: The numbering puts V3 before V4, so it seems like the electrodes should walk down the chest in number order. V3 sits between V2 and V4, not one space lower than V4. The inferior wall is seen by the limb leads, not by a precordial electrode.

Resume compressions and repeat the AED analysis in one minute rather than two: Rechecking sooner sounds careful after a rhythm change. An early analysis adds another pause in compressions. Perfusion pressure builds up over the whole cycle and drops the moment compressions stop.

Hold compressions and recheck the carotid pulse for another ten seconds: A slow, organized rhythm makes you want to be sure you did not miss a weak pulse. The carotid check already took the full ten seconds, and ten seconds is the limit. If you are not sure of a pulse within ten seconds, you compress.

Resume compressions and prepare to shock at the next analysis, since the rhythm is organized: A shock is the treatment for chaotic electrical activity. Whether a rhythm is shockable depends on the type of rhythm, not on how neat the rhythm looks. An organized rhythm with no pulse is pulseless electrical activity, and pulseless electrical activity is not shockable.

Detailed identification of ST-segment elevation and infarct localization: Finding which wall of the heart has the infarct, like inferior, anterior, or lateral, takes a 12-lead. A 12-lead compares many angles, and a 3-lead or 4-lead setup cannot do that. Reading an infarct pattern is also above AEMT scope.

Definitive differentiation between all types of supraventricular tachycardia: Telling one narrow complex tachycardia from another, like AVNRT versus atrial flutter with fine flutter waves, takes a 12-lead. Often the hospital also needs more monitoring to tell them apart. One continuous view only shows you the rhythm is narrow, fast, and regular. Narrow, fast, and regular helps you pick your next step as an AEMT. One view does not tell you which supraventricular rhythm is present.

Precise axis determination for cardiac diagnosis: Axis is the overall direction the electrical current travels through the heart. Finding the axis means comparing several limb lead angles on a 12-lead. A 3-lead or 4-lead setup gives only one angle, so there is no second view to compare.

Transmit the tracing and note the placement used: Noting a nonstandard placement is right when standard placement truly cannot be done, like when a burn, a dressing, or a wound covers the spot. The note then tells the physician how to read the tracing. Nothing here stops you from placing the electrodes correctly. A note does not put back the information the wrong placement lost.

Move V1 and V2 to the midclavicular line: The midclavicular line is a real landmark, but for other leads. V4 goes in the fifth intercostal space at the left midclavicular line, and V5 and V6 continue out to the side from there. Putting V1 and V2 at the midclavicular line loses the view of the septum and crowds them into the space of the lateral leads.

Read the tracing before deciding whether to repeat it: Reading the tracing first is how a provider who interprets 12-leads decides if an error matters. Interpretation is outside AEMT scope. Even a provider who can interpret cannot trust a tracing once an electrode is known to be misplaced. A bad tracing cannot tell you whether the misplacement mattered. Move the electrodes and get a new tracing instead.

Check the carotid pulse for up to 10 seconds: Checking for a pulse sounds like the way to find out if the shock worked. A heart that was just shocked rarely makes a pulse you can feel right away, so the check tells you nothing. Searching for a pulse also costs the blood flow that compressions were building. After a delivered shock, the next two minutes are compressions.

Reanalyze the rhythm with the defibrillator: The AED reanalyzes the rhythm after the two minutes of compressions. Running a second analysis right after the shock makes the pause longer, and no blood is moving during that pause.

Deliver two ventilations, then reassess: Airway and breathing before circulation is the order every provider learns. After a shock, CPR restarts with compressions, not breaths. This patient's compressions already stopped twice, once for the analysis and once for the shock. Blood flow is what this patient needs right now, and the breaths come in their normal place within the compression cycles.