CFRN Cardiovascular Emergencies 3 — Questions and Answers
Question 1: A patient transported post-cardiac arrest has return of spontaneous circulation (ROSC). Which targeted temperature management (TTM) goal is currently recommended?
- Strict hypothermia at 33°C for 24 hours
- Normothermia (36–37.5°C) with strict prevention of fever (Correct answer)
- Hyperthermia induction at 38.5°C to promote perfusion
- Temperature is not clinically significant post-ROSC
Correct answer: Normothermia (36–37.5°C) with strict prevention of fever
Current evidence supports targeted normothermia (36–37.5°C) with strict fever prevention rather than mandatory hypothermia at 33°C.
Question 2: A patient presents with cardiogenic shock following anterior STEMI. Which hemodynamic profile best characterizes cardiogenic shock?
- Low PCWP, low SVR, high CO
- High PCWP, high SVR, low CO (Correct answer)
- High PCWP, low SVR, high CO
- Low PCWP, high SVR, low CO
Correct answer: High PCWP, high SVR, low CO
Cardiogenic shock is characterized by high pulmonary capillary wedge pressure (pulmonary congestion), high systemic vascular resistance (compensatory), and low cardiac output.
Question 3: While transporting a pediatric patient with suspected SVT, the flight nurse performs vagal maneuvers without success. What is the correct first-line pharmacologic treatment?
- Amiodarone 5 mg/kg IV
- Adenosine 0.1 mg/kg rapid IV push (max 6 mg) (Correct answer)
- Verapamil 0.1 mg/kg IV
- Digoxin 10 mcg/kg IV
Correct answer: Adenosine 0.1 mg/kg rapid IV push (max 6 mg)
Adenosine 0.1 mg/kg (max 6 mg first dose) given as a rapid IV push is the first-line drug for pediatric SVT after failed vagal maneuvers.
Question 4: During air transport, a patient with an anterior STEMI develops a new right bundle branch block (RBBB) and left anterior fascicular block. What does this finding indicate?
- Benign conduction variant requiring no intervention
- Bifascicular block suggesting high risk for complete heart block (Correct answer)
- Left ventricular hypertrophy pattern
- Posterior wall infarction with mirror changes
Correct answer: Bifascicular block suggesting high risk for complete heart block
New RBBB plus left anterior fascicular block (bifascicular block) in the context of STEMI indicates high risk of progression to complete (third-degree) AV block.
Question 5: A patient receiving IV heparin infusion for ACS develops a platelet count drop from 280,000 to 60,000 over 8 days with new arterial thrombus. What condition should the flight nurse suspect?
- Dilutional thrombocytopenia from fluid resuscitation
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Disseminated intravascular coagulation (DIC)
- Immune thrombocytopenic purpura (ITP)
Correct answer: Heparin-induced thrombocytopenia (HIT)
A 50%+ platelet drop 5–10 days after heparin initiation with new thrombosis is the hallmark presentation of heparin-induced thrombocytopenia (HIT).
Question 6: A flight nurse assesses a patient with a permanent pacemaker during transport and notes pacemaker spikes without subsequent P waves or QRS complexes. This finding indicates which malfunction?
- Oversensing
- Failure to capture (Correct answer)
- Failure to sense (undersensing)
- Normal inhibited pacing
Correct answer: Failure to capture
Pacemaker spikes not followed by a P wave or QRS complex indicate failure to capture, meaning the electrical stimulus is not producing myocardial depolarization.
Question 7: Which electrolyte abnormality is most associated with Torsades de Pointes (TdP) in a critically ill transport patient?
- Hypernatremia
- Hypomagnesemia (Correct answer)
- Hyperkalemia
- Hypercalcemia
Correct answer: Hypomagnesemia
Hypomagnesemia is the primary electrolyte abnormality associated with Torsades de Pointes, and IV magnesium sulfate is the treatment of choice.
CFRN Cardiovascular Emergencies 3
A patient transported post-cardiac arrest has return of spontaneous circulation (ROSC).
Which targeted temperature management (TTM) goal is currently recommended?