EMT Exam: Noting When Cardiovascular Findings Aren’t Normal

By Arthur Hsieh

You will need to know when cardiovascular findings are not normal for the EMT exam. Problems can arise within the cardiovascular system itself, and problems found elsewhere in the body can cause the cardiovascular system to compensate for the issue, sometimes responding so severely that it injures itself.

When the body senses that perfusion is or may be compromised, several things happen. Heart rate increases, and the skin turns cool, pale, and clammy. Breathing speeds up too, trying to add more oxygen to the bloodstream and take out excess carbon dioxide. Combine all of these changes and the blood pressure remains as close to normal as possible, even higher than normal sometimes.

If the problem isn’t repaired, at some point the cardiovascular system can no longer compensate and begins to fail. Blood pressure falls. The heart slows. The brain, suffering from worsening hypoxia, loses its ability to maintain an alert state; the patient moves from being anxious to being confused and finds it harder to stay awake. As the condition worsens further, the patient becomes unconscious and unresponsive to a painful stimulus.

A 73-year-old female complains of chest tightness and difficulty catching her breath. Her blood pressure is 82/60 mm Hg, her pulse rate is 50, and her respiratory rate is 24 breaths per minute. Her skin is pale, cool, and dry, and her oxygen saturation level is 90 percent. Which of the following actions is appropriate?

  • (A)Have her sit in a chair.

  • (B)Administer the patient’s prescribed nitroglycerin, if available.

  • (C)Administer high-flow oxygen with a nonrebreather mask.

  • (D)Ventilate her with a bag-valve mask.

The correct answer is Choice (C). This patient’s vital signs are well outside the ordinary range. She is having difficulty breathing, and her oxygen saturation level is low, making Choice (C) necessary. Her blood pressure isn’t high enough to support sitting in a chair, Choice (A), or the administration of nitroglycerin, Choice (B). She is still breathing adequately, so manual ventilation, Choice (D), isn’t indicated.