Paramedic practice test · 10–14% of the exam
Paramedic Cardiology and Resuscitation
Cardiology and Resuscitation is 10–14% of the paramedic exam, and the National Registry says about 30% of the domain’s items are graphical: an ECG strip or 12-lead you must interpret before you can answer. Our questions describe each tracing in words (rate, regularity, P waves, PR interval, QRS width and ST changes by lead group) so you practice the reasoning without a strip.
150 questions in 3 hours 30 minutes, weighted to the six official domains, with a score report by domain and topic and an explanation for every answer.
Or start with a free domain drillA 77-year-old man has symptomatic bradycardia, and the paramedic asks for atropine. The partner pulls a prefilled syringe from a box that is the same size and color as the atropine box, but it is epinephrine 0.1 mg/mL. Which practice best prevents this look-alike error from reaching the patient?
What the Cardiology and Resuscitation domain tests
The rest of the domain is acute coronary syndromes, heart failure and cardiogenic shock, unstable and stable tachycardias, symptomatic bradycardia, cardiac arrest management, post-ROSC care and pediatric cardiology.
- Rhythm interpretation: sinus rhythms, atrial fibrillation and flutter, SVT, ventricular tachycardia and fibrillation, asystole and PEA, every degree of AV block, junctional and paced rhythms, bundle branch blocks.
- 12-lead interpretation: STEMI localization by lead group with reciprocal changes, right-ventricular infarction, hyperkalemia, pericarditis, WPW.
- Acute coronary syndrome: 12-lead within 10 minutes, aspirin, nitroglycerin and its contraindications, atypical presentations, STEMI destination.
- Cardiac arrest: compression quality, defibrillation energy, epinephrine and antiarrhythmic doses, capnography, reversible causes, team roles.
- Tachycardia and bradycardia algorithms: when to cardiovert, pace, give adenosine, amiodarone, atropine or an infusion.
- Heart failure, cardiogenic shock, hypertensive emergency, aortic dissection and tamponade.
- Pediatric cardiology: bradycardia with poor perfusion, SVT, weight-based doses and energies.
In our 150-question practice exam this domain gets 17 questions, the middle of its official 10–14% range.
Know these cold
- STEMI lead groups: inferior II, III and aVF; septal V1–V2; anterior V3–V4; lateral I, aVL, V5–V6. Reciprocal ST depression supports the diagnosis; ST elevation in V4R means right-ventricular involvement, so hold nitroglycerin.
- No nitroglycerin after sildenafil or vardenafil within 24 hours or tadalafil within 48 hours, with hypotension, or with suspected right-ventricular infarction.
- Arrest drugs: epinephrine 1 mg IV/IO every 3–5 minutes; amiodarone 300 mg then 150 mg, or lidocaine 1–1.5 mg/kg then 0.5–0.75 mg/kg, for VF or pulseless VT that persists after defibrillation.
- Compressions 100–120 per minute, 2 to 2.4 inches deep, full recoil, rhythm check every 2 minutes; with an advanced airway, one breath every 6 seconds. EtCO2 under 10 mmHg means improve compressions.
- Bradycardia: atropine 1 mg, repeated every 3–5 minutes to 3 mg; then pacing, dopamine 5–20 mcg/kg/min or epinephrine 2–10 mcg/min.
- Tachycardia: unstable means synchronized cardioversion (narrow regular 50–100 J, narrow irregular 120–200 J, wide regular 100 J); stable narrow regular gets vagal maneuvers then adenosine 6 mg, then 12 mg; torsades gets magnesium 1–2 g.
- Pediatric: defibrillate at 2 J/kg then 4 J/kg; epinephrine 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL); adenosine 0.1 mg/kg then 0.2 mg/kg; cardiovert at 0.5–1 J/kg then 2 J/kg.
Common questions
How many ECG questions are on the paramedic exam?
The National Registry allots about 30% of the Cardiology and Resuscitation domain to graphical items with ECG rhythm strips. With the domain at 10–14% of the exam, that is roughly 3–4% of your questions, and strips can also appear inside Clinical Judgment scenarios.
Why describe rhythms in words instead of showing strips?
Because the reasoning is what the exam tests: rate, regularity, P waves and their relationship to the QRS, PR interval, QRS width and ST changes. Practicing from a description makes you name those features explicitly, which is exactly what you must do with a strip under time pressure.
Which resuscitation facts do you test, given the 2025 AHA update?
Only facts that are the same in the 2020 and 2025 guidelines: compression rate and depth, ventilation with an advanced airway, drug doses and intervals, defibrillation and cardioversion energies, capnography targets and the reversible causes. We left out epinephrine timing in shockable rhythms, IV versus IO preference, post-arrest temperature targets and double sequential defibrillation, which changed or were newly addressed.
Ready for exam day?
150 questions in 3 hours 30 minutes, weighted to the six official domains, with a score report by domain and topic and an explanation for every answer.
Or start with a free domain drillThe other Paramedic domains
- Airway, Respiration and Ventilation 8–12%
- Trauma 6–10%
- Medical, Obstetrics and Gynecology 24–28%
- EMS Operations 8–12%
- Clinical Judgment 34–38%
Domain weights and knowledge areas from the National Registry Paramedic Examination Specifications (July 2024). National Registry: AEMT and Paramedic Certification Examinations · National Registry Paramedic Examination Specifications (test plan, July 1, 2024).
Original independent practice questions. Not affiliated with or endorsed by the National Registry of Emergency Medical Technicians. Follow your local protocols and medical director in the field.