CFRN - Certified Flight Registered Nurse Cardiovascular Emergencies Questions and Answers — Questions and Answers
Question 1: A 68-year-old male presents with a sudden onset of severe, tearing chest pain radiating to his back between the scapulae. His blood pressure is 190/110 mmHg in the right arm and 145/80 mmHg in the left arm. He is tachycardic and anxious. What is the flight nurse's immediate priority in managing this suspected acute aortic dissection?
- Administering a large-bore IV fluid bolus to treat potential shock.
- Rapidly lowering systolic blood pressure to 100-120 mmHg and heart rate to 60-80 bpm. (Correct answer)
- Preparing for immediate pericardiocentesis due to the risk of tamponade.
- Administering aspirin and starting a heparin infusion for a suspected ACS.
Correct answer: Rapidly lowering systolic blood pressure to 100-120 mmHg and heart rate to 60-80 bpm.
The primary goal in managing acute aortic dissection is to reduce aortic wall shear stress to prevent propagation of the dissection. This is achieved by aggressively controlling both blood pressure and heart rate. The target systolic blood pressure is typically 100-120 mmHg, and the target heart rate is 60-80 bpm, usually accomplished with IV beta-blockers first (like esmolol or labetalol), followed by vasodilators if needed.
Question 2: A patient in cardiogenic shock is being transported with an intra-aortic balloon pump (IABP). The CFRN understands that the primary physiological goals of IABP counterpulsation are to:
- Increase preload and increase systemic vascular resistance.
- Increase myocardial oxygen demand and increase contractility.
- Decrease cardiac afterload and augment coronary artery perfusion. (Correct answer)
- Decrease heart rate and decrease mean arterial pressure.
Correct answer: Decrease cardiac afterload and augment coronary artery perfusion.
The IABP works on the principle of counterpulsation. It inflates during diastole, which displaces blood and increases pressure in the aortic root, augmenting coronary artery perfusion. It deflates just before systole, creating a vacuum effect that reduces the pressure the left ventricle must overcome (afterload), thereby decreasing myocardial oxygen demand and improving cardiac output.
Question 3: A patient is being transported with an ECG showing an acute inferior wall ST-elevation myocardial infarction (STEMI). The patient suddenly develops a heart rate of 38, becomes hypotensive, and complains of dizziness. Which of the following interventions is MOST appropriate?
- Immediate synchronized cardioversion at 100 joules.
- Administering a 2-liter bolus of normal saline.
- Administering lidocaine 1 mg/kg IV push.
- Administering atropine 0.5 mg IV and preparing for transcutaneous pacing. (Correct answer)
Correct answer: Administering atropine 0.5 mg IV and preparing for transcutaneous pacing.
Symptomatic bradycardia is a common complication of inferior wall MI due to ischemia of the SA or AV nodes, which are often supplied by the right coronary artery. The first-line treatment for symptomatic bradycardia according to ACLS guidelines is atropine. If atropine is ineffective, transcutaneous pacing is the next step.
Question 4: During the primary survey of a patient with a stab wound to the left chest, the flight nurse notes hypotension, jugular venous distention (JVD), and muffled heart sounds. These findings are collectively known as:
- Cushing's Triad
- Virchow's Triad
- The Lethal Triad of Trauma
- Beck's Triad (Correct answer)
Correct answer: Beck's Triad
Beck's Triad consists of hypotension, jugular venous distention, and muffled heart sounds. It is the classic, though not always present, set of signs for acute cardiac tamponade, an obstructive shock state caused by fluid accumulation in the pericardial sac compressing the heart.
Question 5: A 55-year-old is being transported for a hypertensive emergency with a blood pressure of 230/140 mmHg and signs of acute renal failure. According to current guidelines, what is the most appropriate initial goal for blood pressure reduction?
- Lower mean arterial pressure (MAP) by no more than 20-25% in the first hour. (Correct answer)
- Rapidly decrease systolic blood pressure to less than 120 mmHg within 30 minutes.
- Maintain the current blood pressure to ensure adequate cerebral perfusion.
- Administer oral nifedipine to lower blood pressure by 50% over two hours.
Correct answer: Lower mean arterial pressure (MAP) by no more than 20-25% in the first hour.
In a hypertensive emergency (except for specific conditions like aortic dissection or stroke), the goal is not to normalize blood pressure rapidly, as this can cause hypoperfusion and ischemic injury to vital organs. The recommended approach is a controlled reduction of the mean arterial pressure (MAP) by about 20-25% within the first hour.
Question 6: A patient who achieved Return of Spontaneous Circulation (ROSC) after a witnessed out-of-hospital cardiac arrest remains comatose. The flight crew initiates Targeted Temperature Management (TTM) during transport. What is the recommended target temperature range to be maintained for at least 24 hours?
- 28°C to 30°C
- 30°C to 32°C
- 32°C to 36°C (Correct answer)
- 37.5°C to 38.5°C
Correct answer: 32°C to 36°C
Current AHA and ILCOR guidelines recommend Targeted Temperature Management for comatose adult patients after cardiac arrest. The goal is to select and maintain a constant temperature between 32°C and 36°C for at least 24 hours to improve neurological outcomes. Actively preventing fever is a key component of this strategy.
CFRN - Certified Flight Registered Nurse Cardiovascular Emergencies Questions and Answers
A 68-year-old male presents with a sudden onset of severe, tearing chest pain radiating to his back between the scapulae.
His blood pressure is 190/110 mmHg in the right arm and 145/80 mmHg in the left arm.
He is tachycardic and anxious.
What is the flight nurse's immediate priority in managing this suspected acute aortic dissection?