Cardiology & Resuscitation
Cardiology is the second-largest content area on the NREMT and the most common source of preventable deaths in EMS. This is where good candidates separate from great ones.
EMT · AEMT · Paramedic
Acute Coronary Syndrome (ACS)
Chest pain, jaw/arm/back radiation, diaphoresis, and dyspnea are the classic presentation — but women, elderly, and diabetic patients often present atypically. Treat aggressively when the history fits, even if the ECG doesn't.
- Position of comfort, O₂ titrated to SpO₂ ≥ 94%
- Aspirin 162–324 mg chewed if no true allergy
- Nitro 0.4 mg SL if SBP > 100 and no PDE-5 inhibitor
- Rapid transport to a PCI-capable center
Cardiac arrest
Minimize interruptions in compressions. Rate 100–120, depth 2–2.4 inches for adults, and full chest recoil. Every pulse check should be under 10 seconds.
12-lead ECG (paramedic)
Group leads (inferior, lateral, septal, anterior), look for STE in two contiguous leads with reciprocal depression, and always get a V4R on inferior STEMIs to rule in right ventricular involvement.
Frequently asked
- How much aspirin do I give for suspected ACS?
- 162–324 mg chewed. It must be non–enteric coated if possible, and it must be chewed, not swallowed whole.
- When is nitroglycerin contraindicated?
- SBP < 100, right ventricular infarct, and use of a PDE-5 inhibitor (sildenafil, tadalafil, vardenafil) within the previous 24–48 hours.
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