Cardiovascular Emergencies and Cardiac Arrest Management
Exam items focus on rapid recognition of time-critical cardiovascular conditions, correct arrest sequence, and safe medication use.
Core rules
- ACS: chest pressure, radiation, diaphoresis, nausea; obtain a 12-lead early. Give aspirin 300 mg chewed unless allergic; nitroglycerin only if SBP >90 mmHg and no recent PDE5 inhibitor.
- Cardiac arrest: start high-quality CPR immediately-rate 100–120/min, depth 5–6 cm, full recoil, minimal interruptions. Attach AED/defibrillator as soon as available.
- Shockable rhythms: defibrillate, then CPR; epinephrine 1 mg IV/IO every 3–5 minutes; amiodarone 300 mg after the third shock.
- Search for Hs and Ts: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis, trauma.
- Post-ROSC: titrate oxygen to 94–98%, support BP, obtain 12-lead, and transport to a facility capable of post-arrest care.
Worked example
A witness collapses in a clinic. You confirm unresponsiveness and absent breathing, start CPR, and apply the AED, which advises a shock. After the shock you resume compressions immediately, establish IV access, and give epinephrine 1 mg after the second shock. The rhythm remains VF; after the third shock you give amiodarone 300 mg.
Traps
Prolonged pulse checks; interrupting compressions to intubate; giving nitroglycerin in hypotension; delaying defibrillation; and failing to consider reversible causes.