Cardiology and Resuscitation
What this domain tests
This domain covers acute coronary syndromes, dysrhythmia recognition, stroke, and cardiac arrest. The exam rewards high-quality CPR mechanics, early defibrillation, and safe medication decisions over memorized algorithms.
Core rules
- Compressions 100–120/min, depth 5–6 cm (2–2.4 in) in an adult, full recoil, interruptions under 10 seconds.
- 30:2 before an advanced airway; after one is placed, continuous compressions with one breath every 6 seconds.
- Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia. Defibrillate as early as possible; do not delay shocks to start an IV.
- Epinephrine 1 mg IV/IO every 3–5 minutes; amiodarone 300 mg after the third shock for refractory VF/pVT.
- Reversible causes: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis.
- ACS: chew aspirin 324 mg if not allergic; nitroglycerin 0.4 mg sublingual every 5 minutes up to three doses only if systolic pressure is adequate and no recent PDE5 inhibitor.
- Stroke: document last known well, check glucose, use a stroke screen, and transport to a stroke center; thrombolysis generally extends to 4.5 hours.
Worked example
A 58-year-old with crushing chest pressure and diaphoresis has a systolic pressure of 132 mmHg. You give aspirin, apply the monitor, obtain a 12-lead, and give nitroglycerin while watching for hypotension. If pressure fell below about 100 mmHg, nitroglycerin would be withheld.
Traps
Pulse checks longer than 10 seconds, leaning on the chest, shocking asystole, and giving nitroglycerin to a hypotensive patient are classic mark-losers.