AEMCA Cardiovascular Emergencies 4 — Questions and Answers
Question 1: Which drug is the FIRST-LINE antiarrhythmic for stable wide-complex tachycardia of unknown origin?
- Adenosine 6 mg IV
- Lidocaine 1.5 mg/kg IV
- Amiodarone 150 mg IV over 10 minutes (Correct answer)
- Procainamide 20–50 mg/min IV
Correct answer: Amiodarone 150 mg IV over 10 minutes
Amiodarone 150 mg IV over 10 minutes is the preferred antiarrhythmic for stable wide-complex tachycardia of uncertain origin per ACLS guidelines.
Question 2: A 72-year-old is in cardiogenic shock after a large MI. Which hemodynamic pattern is expected?
- Low BP, high CO, low SVR
- Low BP, low CO, high SVR (Correct answer)
- High BP, high CO, low SVR
- High BP, low CO, low SVR
Correct answer: Low BP, low CO, high SVR
Cardiogenic shock is characterized by low cardiac output from pump failure and compensatory peripheral vasoconstriction (high SVR) causing low blood pressure.
Question 3: Nitroglycerin is CONTRAINDICATED in a patient with suspected MI if the patient has taken which medication within the past 24–48 hours?
- Aspirin 325 mg
- Sildenafil (Viagra) (Correct answer)
- Metoprolol 25 mg
- Atorvastatin 40 mg
Correct answer: Sildenafil (Viagra)
Phosphodiesterase-5 inhibitors like sildenafil potentiate nitrate-induced vasodilation, which can cause severe, refractory hypotension.
Question 4: A patient develops a wide-complex tachycardia at 220 bpm with a pulse and is becoming confused and hypotensive. What is the correct intervention?
- Adenosine 12 mg rapid IV push
- Synchronized cardioversion starting at 100 J (Correct answer)
- Unsynchronized defibrillation at 200 J
- Amiodarone 150 mg IV over 10 minutes
Correct answer: Synchronized cardioversion starting at 100 J
Unstable wide-complex tachycardia with a pulse requires immediate synchronized cardioversion; the synchronized mode prevents shock delivery during the vulnerable T-wave period.
Question 5: Epinephrine 1 mg IV/IO is administered during cardiac arrest. How frequently should this dose be repeated?
- Every 2 minutes
- Every 3–5 minutes (Correct answer)
- Every 5–10 minutes
- Only once during the arrest
Correct answer: Every 3–5 minutes
AHA ACLS guidelines recommend 1 mg epinephrine IV/IO every 3–5 minutes during cardiac arrest.
Question 6: Which condition causes pulsus paradoxus — an exaggerated drop in systolic BP >10 mmHg during inspiration?
- Aortic stenosis
- Cardiac tamponade (Correct answer)
- Mitral valve prolapse
- Hypertrophic cardiomyopathy
Correct answer: Cardiac tamponade
Cardiac tamponade causes pulsus paradoxus because pericardial fluid restricts ventricular filling, and inspiration-related changes in intrathoracic pressure exaggerate this effect.
Question 7: A patient in asystole undergoes CPR. Which medications are indicated per ACLS protocol? (Select the correct combination)
- Atropine 1 mg + epinephrine 1 mg
- Epinephrine 1 mg only (Correct answer)
- Amiodarone 300 mg + epinephrine 1 mg
- Vasopressin 40 units + lidocaine 1.5 mg/kg
Correct answer: Epinephrine 1 mg only
Current ACLS guidelines removed atropine from the asystole/PEA algorithm; only epinephrine 1 mg IV every 3–5 minutes is recommended.
AEMCA Cardiovascular Emergencies 4
Which drug is the FIRST-LINE antiarrhythmic for stable wide-complex tachycardia of unknown origin?