FISDAP Cardiac Emergencies 2 — Questions and Answers
Question 1: A patient in ventricular fibrillation receives a defibrillation shock. What is the FIRST action after shock delivery?
- Check for a pulse immediately
- Resume CPR immediately (Correct answer)
- Administer epinephrine 1 mg IV
- Recheck the rhythm on the monitor
Correct answer: Resume CPR immediately
After defibrillation, CPR should be resumed immediately for 2 minutes before pausing to recheck rhythm, as perfusion may not be restored instantly.
Question 2: Which ECG finding is most consistent with a left bundle branch block (LBBB)?
- Broad S wave in lead I and tall R wave in V1
- Broad notched R wave in lead I and V5-V6 with no septal Q waves (Correct answer)
- Delta wave and short PR interval
- Peaked T waves and widened QRS with ST depression
Correct answer: Broad notched R wave in lead I and V5-V6 with no septal Q waves
LBBB produces a broad, notched R wave in lateral leads (I, V5-V6) with absent septal Q waves due to abnormal left ventricular depolarization.
Question 3: A 58-year-old male presents with crushing chest pain and diaphoresis. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior wall STEMI, most commonly caused by occlusion of the right coronary artery.
Question 4: Dopamine is ordered for a patient in cardiogenic shock. At which dose range does dopamine primarily exert beta-1 adrenergic effects to increase cardiac output?
- 1-3 mcg/kg/min
- 5-10 mcg/kg/min (Correct answer)
- 10-20 mcg/kg/min
- Greater than 20 mcg/kg/min
Correct answer: 5-10 mcg/kg/min
At 5-10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing heart rate and myocardial contractility to improve cardiac output.
Question 5: A patient develops pulseless electrical activity (PEA). Which of the following is a reversible cause represented by the 'H's and T's?
- Hyperglycemia
- Hypovolemia (Correct answer)
- Hypercalcemia
- Hypothyroidism
Correct answer: Hypovolemia
Hypovolemia is one of the classic 'H' reversible causes of PEA and should be treated with aggressive IV fluid resuscitation.
Question 6: A patient presents with regular narrow-complex tachycardia at a rate of 180 bpm. Vagal maneuvers fail. What is the drug of choice for terminating this rhythm?
- Amiodarone 150 mg IV
- Adenosine 6 mg rapid IV push (Correct answer)
- Lidocaine 1-1.5 mg/kg IV
- Metoprolol 5 mg IV
Correct answer: Adenosine 6 mg rapid IV push
Adenosine 6 mg given as a rapid IV push is the first-line pharmacological treatment for stable SVT unresponsive to vagal maneuvers.
Question 7: When performing synchronized cardioversion on a patient with unstable atrial flutter, where should the sync marker ideally fall on the ECG waveform?
- On the T wave
- On the P wave
- On the R wave (QRS complex) (Correct answer)
- On the U wave
Correct answer: On the R wave (QRS complex)
Synchronized cardioversion delivers the shock on the R wave of the QRS complex to avoid the vulnerable T-wave period, which could precipitate ventricular fibrillation.
FISDAP Cardiac Emergencies 2
A patient in ventricular fibrillation receives a defibrillation shock.
What is the FIRST action after shock delivery?