Cardiology and Resuscitation accounts for 20–24% of the NREMT cognitive exam. The category tests two related skill sets: recognizing acute coronary syndrome (ACS) early in the call, and managing cardiac arrest competently — CPR mechanics, AED use, ventilation strategy, and post-resuscitation care.
This guide covers the topics most likely to appear on your exam, the numbers and doses you need to know cold, and several NREMT-style sample questions with full rationales.
What's tested in this category
- Recognition of acute coronary syndrome — typical and atypical presentations.
- EMT-level interventions for ACS: oxygen, aspirin, assisting with prescribed nitroglycerin.
- Cardiac arrest management: high-quality CPR, AED application, team dynamics.
- Compression rate, depth, and ratio — for adults, children, and infants.
- Recognition of basic dysrhythmias as relevant at the EMT scope (e.g., shockable vs non-shockable rhythms).
- Post-resuscitation care including ventilation rate after ROSC.
- Special populations: pediatric arrest, pregnancy, hypothermia.
Numbers worth memorizing cold
- Adult compression rate: 100–120 per minute, depth 2–2.4 inches.
- Pediatric compression depth: at least 1/3 the AP diameter of the chest (about 2 inches in children, 1.5 inches in infants).
- CPR ratio without advanced airway: 30:2 single rescuer adult; 30:2 single rescuer pediatric; 15:2 two-rescuer pediatric.
- With advanced airway: continuous compressions with 1 breath every 6 seconds (10/min).
- Aspirin for ACS: 162–325 mg chewable (typically four 81 mg baby aspirin).
- Nitroglycerin: 0.4 mg sublingual, may repeat every 5 minutes up to 3 doses if SBP > 100.
- Post-ROSC ventilation: 10 breaths per minute (1 every 6 seconds), avoid hyperventilation.
Not sure how much of this you actually know? Ten questions gives you a readiness score in about three minutes.
Take the free quizRecognizing atypical ACS presentations
The classic 'crushing substernal chest pain radiating to the left arm' is the easy version. The NREMT writes a lot of questions about atypical presentations because in practice these are the patients who get missed.
- Women — more likely to present with fatigue, nausea, jaw or back pain rather than classic chest pain.
- Diabetics — may have silent or minimal pain due to neuropathy.
- Elderly — confusion, weakness, or syncope may be the only presenting symptom.
- Anyone — diaphoresis, dyspnea, nausea, and 'feeling of impending doom' are red flags even without classic pain.
Sample cardiac arrest question
Your turn — pick an answer
You witness a 65-year-old male collapse in a public space. He is unresponsive, pulseless, and apneic. Your AED arrives. After applying the pads, the AED advises 'shock advised.' Immediately after the shock is delivered, what is your next action?
Rationale
After any shock, current AHA guidelines call for immediate resumption of chest compressions for 2 minutes (5 cycles of 30:2) before reanalyzing or pulse-checking. Pulse checks immediately after a shock waste perfusion time and don't change the next step. The AED will reanalyze automatically after 2 minutes. Energy escalation is not an EMT-level decision — the AED handles dose selection.
Sample ACS question
Your turn — pick an answer
A 58-year-old female complains of dyspnea, nausea, and back pain that has lasted 30 minutes. She has a history of diabetes and hypertension. Vitals: BP 142/88, HR 96, RR 22, SpO₂ 96%. She has nitroglycerin prescribed and her own bottle is in her purse. What is the MOST appropriate next action after applying oxygen?
Rationale
Atypical presentation in a diabetic woman is highly suspicious for ACS. Aspirin has a class I recommendation for early administration in suspected ACS and has the strongest mortality benefit of any EMT-level intervention. Nitroglycerin is reasonable but secondary to aspirin; some protocols also require a 12-lead before nitro. Supine positioning isn't indicated. Waiting for ALS to perform a 12-lead delays a time-critical intervention you can perform now.
Common cardiology exam mistakes
- Giving nitroglycerin to a hypotensive patient (SBP < 100) — risks worsening hypotension.
- Giving nitroglycerin within 24–48 hours of erectile dysfunction medication (sildenafil, tadalafil) — can cause profound hypotension.
- Pausing compressions for too long during AED rhythm analysis or pulse checks.
- Hyperventilating after ROSC — increases intrathoracic pressure and reduces preload.
- Skipping aspirin because the patient 'looks too well' — aspirin is the highest-impact ACS intervention.
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