Resuscitation and Cardiovascular Emergencies
High-quality CPR and the arrest algorithm
The candidate must know current basic and advanced life support sequence: recognition, activation, early compressions, defibrillation for shockable rhythms, and advanced airway and drug administration without interrupting compressions. Key numbers to internalize: compression rate 100–120 per minute, depth at least 5 cm in adults, full recoil, minimal interruptions, and a compression-to-ventilation ratio of 30:2 for one- or two-rescuer adult BLS without an advanced airway. Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; non-shockable are asystole and pulseless electrical activity, where the priority is finding and correcting reversible causes (hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis).
Acute coronary syndrome and dysrhythmias
Distinguish ST-elevation myocardial infarction, which needs reperfusion urgently, from other ACS presentations. Know that a new left bundle branch block and posterior or right ventricular infarction change management. For tachyarrhythmias, unstable patients get synchronized cardioversion; pulseless patients get defibrillation. Bradycardia with a pulse is treated only if symptomatic - atropine first, then pacing or catecholamines per protocol.
Traps in questions
- Defibrillation is unsynchronized; cardioversion is synchronized. Mixing these is a classic distractor.
- Do not delay compressions for intubation or rhythm checks longer than about ten seconds.
- Nitroglycerin is contraindicated in right ventricular infarction and recent phosphodiesterase inhibitor use.
- A "normal" troponin early in presentation does not exclude ACS.
Rule of thumb
Treat the patient, not the monitor. A worked example: a patient with palpitations, heart rate 190, narrow complex, blood pressure 78/40, and altered mentation. Because there are signs of instability, the correct action is immediate synchronized cardioversion, not a sequence of vagal maneuvers and drug trials.
Post-arrest care
Targeted temperature management, avoiding hyperoxia and hypotension, and early coronary evaluation when the arrest was cardiac in origin are examinable.