Resuscitation and Cardiovascular Emergencies
This domain tests cardiac arrest management, acute coronary syndromes, tachyarrhythmias, bradyarrhythmias, shock, and immediately life-threatening vascular emergencies. The exam expects protocol-level decisions and recognition of time-critical diagnoses.
Core rules
- Start high-quality chest compressions immediately: rate 100–120/min, depth 5–6 cm, full recoil, minimal interruptions.
- Defibrillate shockable rhythms promptly; give epinephrine after the second shock in refractory VF/pVT, and treat reversible causes.
- For STEMI, activate reperfusion early; primary PCI is preferred when available within time targets. Give aspirin and anticoagulation unless contraindicated.
- In inferior STEMI with hypotension or suspected right ventricular infarction, avoid nitrates and give cautious fluid.
- For unstable tachyarrhythmia, synchronized cardioversion; for unstable bradycardia, atropine first, then pacing or catecholamine support.
Worked example
A 58-year-old with crushing chest pain has ST elevation in II, III, and aVF, BP 82/50, and clear lungs. The rhythm is sinus. Inferior STEMI with right ventricular involvement is likely. Give aspirin, prepare urgent reperfusion, and give a small fluid bolus while avoiding nitroglycerin, which can worsen preload-dependent hypotension.
Traps
- Do not miss posterior MI: anterior ST depression with tall R waves needs posterior leads.
- Do not delay defibrillation for intubation or IV access.
- Do not use nitrates in suspected right ventricular infarction or severe aortic stenosis.
- Post-ROSC care includes targeted temperature management, avoiding hypotension and hypoxia, and treating the cause.