Respiratory and Cardiovascular Care
Oxygenation, Airway, and Perfusion
Respiratory and cardiovascular questions test your ability to recognize early deterioration and intervene. Early hypoxia shows restlessness, anxiety, and tachycardia before cyanosis. Know oxygen delivery devices and their approximate FiO2, and know when a patient needs escalation. Asthma care follows a stepwise approach: short-acting bronchodilators for rescue, inhaled corticosteroids for control, and systemic steroids for exacerbations. Know signs of increased work of breathing, silent chest as an ominous sign, and positioning to optimize ventilation. For cardiac care, recognize angina versus infarction, monitor for arrhythmias after infarction, and understand heart failure management with daily weights, fluid limits, and monitoring for pulmonary edema.
Traps to Watch
Questions often pair an intervention with the wrong sequence. In an acute coronary syndrome, aspirin and nitroglycerin come after assessment, and nitroglycerin is avoided with right ventricular infarction or recent phosphodiesterase inhibitor use. Do not give oxygen routinely to every patient; it is titrated to target saturation. Also, a "silent" presentation is common in older adults and people with diabetes.
Rule of Thumb
Treat the patient, not the monitor. A changing mental status in a respiratory patient means check oxygenation and airway first.
Worked Example
A patient with chest pain and ST elevation receives aspirin, is placed on a monitor, and is prepared for reperfusion. Nitroglycerin is held because the patient took a phosphodiesterase inhibitor the previous day, which risks profound hypotension.