CFRN Cardiovascular Emergencies 2 — Questions and Answers
Question 1: A flight nurse is transporting a patient with suspected cardiac tamponade. Which hemodynamic triad (Beck's Triad) is classically associated with this condition?
- Hypertension, bradycardia, and widened pulse pressure
- Hypotension, muffled heart sounds, and jugular venous distension (Correct answer)
- Tachycardia, hypertension, and pulmonary edema
- Pulsus paradoxus, fever, and pleural friction rub
Correct answer: Hypotension, muffled heart sounds, and jugular venous distension
Beck's Triad for cardiac tamponade consists of hypotension, muffled heart sounds, and jugular venous distension (JVD).
Question 2: During air transport, a patient develops a wide-complex tachycardia at 180 bpm with a pulse. The patient is hemodynamically stable. What is the most appropriate initial intervention?
- Immediate synchronized cardioversion at 200 J
- Adenosine 6 mg rapid IV push
- Amiodarone 150 mg IV over 10 minutes (Correct answer)
- Defibrillation at 360 J
Correct answer: Amiodarone 150 mg IV over 10 minutes
For stable wide-complex tachycardia of unknown origin, amiodarone 150 mg IV over 10 minutes is the preferred pharmacologic treatment.
Question 3: A patient in the flight environment has a systolic BP of 70 mmHg, HR 120 bpm, and shows signs of right heart failure. Which vasopressor is preferred to avoid increasing pulmonary vascular resistance?
- Norepinephrine (Correct answer)
- Phenylephrine
- Vasopressin
- Dopamine
Correct answer: Norepinephrine
Norepinephrine is preferred in right ventricular failure as it improves systemic vascular resistance while having less effect on pulmonary vascular resistance than vasopressin or high-dose dopamine.
Question 4: A CFRN is caring for a patient with an IABP (intra-aortic balloon pump) during transport. The balloon should inflate and deflate in relation to the cardiac cycle in which way?
- Inflate during systole, deflate during diastole
- Inflate during diastole, deflate just before systole (Correct answer)
- Inflate continuously at a fixed rate
- Inflate during diastole, deflate during mid-systole
Correct answer: Inflate during diastole, deflate just before systole
The IABP inflates during diastole to augment coronary perfusion and deflates just before systole to reduce afterload.
Question 5: Which ECG finding is most consistent with hyperkalemia in a patient being transported after a crushing injury?
- ST segment depression and U waves
- Peaked T waves and widened QRS complex (Correct answer)
- Prolonged QT interval and delta waves
- Shortened PR interval and tall P waves
Correct answer: Peaked T waves and widened QRS complex
Hyperkalemia classically causes peaked (tall, narrow) T waves and progressive QRS widening, which can degrade into a sine-wave pattern.
Question 6: During a rotor transport at high altitude, a patient with STEMI receives fibrinolytic therapy. Which finding represents a sign of successful reperfusion?
- Persistent ST elevation and absence of chest pain
- Development of accelerated idioventricular rhythm (AIVR) and decreasing ST elevation (Correct answer)
- New-onset complete heart block
- Increase in serum troponin levels
Correct answer: Development of accelerated idioventricular rhythm (AIVR) and decreasing ST elevation
Reperfusion after fibrinolysis is suggested by accelerated idioventricular rhythm, resolution of ST elevation, and relief of chest pain.
Question 7: A flight nurse is managing a patient with Type A aortic dissection during transport. Which medication class is the priority to initiate first for blood pressure and heart rate control?
- Calcium channel blockers
- ACE inhibitors
- Beta-blockers (Correct answer)
- Nitrates alone
Correct answer: Beta-blockers
Beta-blockers are initiated first in aortic dissection to reduce heart rate and dp/dt (rate of pressure rise) before adding vasodilators to avoid reflex tachycardia.
CFRN Cardiovascular Emergencies 2
A flight nurse is transporting a patient with suspected cardiac tamponade.
Which hemodynamic triad (Beck's Triad) is classically associated with this condition?