Advanced Cardiovascular Life Support (ACLS) Practice Exam

A 48-year-old man with crushing chest pain is pale and has a blood pressure of 58/32 mm Hg. What should be your next intervention?

1. Administer aspirin

2. Synchronized cardioversion

3. Start CPR

4. Provide high-flow oxygen

The correct answer is: Synchronized cardioversion

In this scenario, you are presented with a 48-year-old man experiencing crushing chest pain, pale appearance, and significantly low blood pressure indicative of possible cardiogenic shock or severe myocardial ischemia. The appropriate intervention in such critical conditions often focuses on addressing potential life-threatening arrhythmias or severe hemodynamic instability. Synchronized cardioversion is an appropriate choice in instances of unstable tachyarrhythmias, particularly if the patient is experiencing symptoms such as chest pain, altered mental status, or signs of shock. In this case, the low blood pressure coupled with chest pain suggests that the patient may be suffering from a serious arrhythmia, which needs immediate correction to restore hemodynamic stability. While administering aspirin, providing high-flow oxygen, or performing CPR are important actions in overall management, they do not directly address the urgency of potential arrhythmias leading to the patient's compromised state. Aspirin is vital for myocardial infarction management, oxygen is beneficial for tissue perfusion, and CPR is critical for cardiac arrest situations; however, the situation described indicates the need for immediate intervention to correct a potentially lethal arrhythmia, thus making synchronized cardioversion the most critical next step.