Cardiovascular Emergencies and Resuscitation
Core concepts
Candidates must recognize acute coronary syndrome, lethal dysrhythmias, cardiogenic shock, pulmonary edema, hypertensive emergencies, and cardiac arrest rhythms. Know high-quality CPR parameters (rate, depth, recoil, compression fraction, minimizing interruptions), defibrillation principles (biphasic energy, pad placement, safety), and the reversible causes framework. Understand ACLS drug sequencing, post-arrest care, and the difference between shockable and non-shockable rhythms. For ACS, know the role of aspirin, nitroglycerin (with contraindications), and 12-lead interpretation basics including ST elevation and reciprocal changes.
Traps in questions
Common traps include giving nitroglycerin to a patient with right ventricular infarction or recent phosphodiesterase inhibitor use, delaying defibrillation for drug administration, and pausing compressions for pulse checks longer than necessary. Watch for questions that confuse bradycardia with hypotension-treat the patient, not the monitor. Also be alert to the distinction between cardioversion and defibrillation, and to synchronized versus unsynchronized energy settings.
Rule of thumb
In cardiac arrest, the priority order is: high-quality CPR, early defibrillation for shockable rhythms, then drugs and advanced airway without interrupting compressions. For ACS with hypotension or suspected right ventricular involvement, withhold nitrates and prioritize fluids and transport.