Resuscitation and Cardiovascular Emergencies
Core concepts
Candidates must command the universal cardiac arrest algorithm (compression depth 5–6 cm, rate 100–120/min, full recoil, minimal interruptions), rhythm-specific management of shockable versus non-shockable arrest, and reversible-cause thinking (the H's and T's). For acute coronary syndrome, know door-to-balloon targets, when fibrinolysis is acceptable, and the contraindications that examiners love. Understand tachyarrhythmia management: stable versus unstable, narrow versus broad complex, and the role of synchronised cardioversion versus defibrillation. For bradycardia, atropine first-line with pacing for high-grade block. Acute decompensated heart failure, hypertensive emergencies, aortic dissection, and pulmonary embolism complete the domain.
Traps
Questions often blur "unstable" with "symptomatic" - instability means hypotension, altered mentation, ischaemic chest pain, or acute heart failure. Another trap is the pulseless electrical activity patient: the answer is always compressions plus cause-hunting, never a shock. Beware the patient on a rate-control agent where the tachycardia is compensatory. In dissection, the trap is giving thrombolysis for a presumed MI.
Rule of thumb
For any wide-complex tachycardia, treat as ventricular tachycardia until proven otherwise; if unstable, synchronised cardioversion; if pulseless, defibrillate. For suspected PE with haemodynamic instability, thrombolysis or embolectomy - not just anticoagulation.
Worked example
A 58-year-old with crushing chest pain, BP 88/54, clear lungs, and ST elevation on ECG: this is a cardiogenic shock picture - activate the cath lab, avoid nitrates, and consider inotropes; do not give a fluid bolus blindly.