FISDAP Cardiac Emergencies 3 — Questions and Answers
Question 1: A patient in wide-complex tachycardia is hemodynamically unstable with a BP of 70/40 mmHg. What is the immediate treatment?
- Adenosine 6 mg rapid IV push
- Amiodarone 150 mg IV over 10 minutes
- Immediate synchronized cardioversion (Correct answer)
- Vagal maneuvers followed by cardioversion
Correct answer: Immediate synchronized cardioversion
Hemodynamic instability with wide-complex tachycardia mandates immediate synchronized cardioversion regardless of the underlying rhythm.
Question 2: During a cardiac arrest resuscitation, what is the recommended dose and frequency of epinephrine administration?
- 0.5 mg IV every 5 minutes
- 1 mg IV every 3-5 minutes (Correct answer)
- 2 mg IV every 10 minutes
- 1 mg IV every 2 minutes
Correct answer: 1 mg IV every 3-5 minutes
The standard dose of epinephrine during cardiac arrest is 1 mg IV/IO administered every 3-5 minutes throughout the resuscitation.
Question 3: Which of the following best describes the role of the precordial thump in cardiac arrest management?
- Routinely used for all shockable rhythms
- Only considered for witnessed monitored pulseless VT when a defibrillator is not immediately available (Correct answer)
- Contraindicated in all prehospital settings
- Used after every failed defibrillation attempt
Correct answer: Only considered for witnessed monitored pulseless VT when a defibrillator is not immediately available
The precordial thump may be considered only for witnessed, monitored pulseless VT when defibrillation is not immediately available, as its benefit is uncertain.
Question 4: A 45-year-old patient presents with acute pulmonary edema secondary to CHF. His BP is 160/100 and SpO2 is 82% on room air. Which intervention is the HIGHEST priority?
- Furosemide 40 mg IV
- Nitroglycerin SL followed by IV infusion
- CPAP or BiPAP therapy (Correct answer)
- Dopamine infusion to support perfusion
Correct answer: CPAP or BiPAP therapy
CPAP/BiPAP is the highest-priority intervention as it immediately improves oxygenation by increasing mean airway pressure and reducing pulmonary edema.
Question 5: Atropine is indicated for symptomatic bradycardia. What is the initial adult dose?
- 0.1 mg IV
- 0.5 mg IV (Correct answer)
- 1.0 mg IV
- 2.0 mg IV
Correct answer: 0.5 mg IV
The initial dose of atropine for symptomatic bradycardia is 0.5 mg IV, which may be repeated every 3-5 minutes to a maximum of 3 mg.
Question 6: A patient's ECG shows a P wave for every QRS complex, but the PR interval progressively lengthens until a QRS is dropped, then repeats. This pattern describes which dysrhythmia?
- First-degree AV block
- Second-degree AV block Type I (Wenckebach) (Correct answer)
- Second-degree AV block Type II (Mobitz II)
- Third-degree (complete) AV block
Correct answer: Second-degree AV block Type I (Wenckebach)
Progressive PR interval lengthening followed by a dropped QRS is the hallmark of Wenckebach (Mobitz Type I) second-degree AV block.
Question 7: Which electrolyte abnormality is most commonly associated with the development of Torsades de Pointes?
- Hyperkalemia
- Hypocalcemia
- Hypomagnesemia (Correct answer)
- Hypernatremia
Correct answer: Hypomagnesemia
Hypomagnesemia is the electrolyte abnormality most strongly associated with Torsades de Pointes and is also the treatment of choice (magnesium sulfate 2g IV).
FISDAP Cardiac Emergencies 3
A patient in wide-complex tachycardia is hemodynamically unstable with a BP of 70/40 mmHg.
What is the immediate treatment?