ABEM ACCM Practice Questions - ABEM Anesthesiology Critical Care Medicine Subspecialty Certification (ACCM) Exam

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A 64-year-old man develops cardiogenic shock 6 hours after anterior STEMI with successful PCI. He has SBP 75 mmHg on norepinephrine and dobutamine, lactate 6.5, and pulmonary edema. Echo shows EF 15% with akinetic anterior wall. What is the most appropriate next intervention?

Initiate mechanical circulatory support (Impella or VA-ECMO) Add vasopressin only and continue current therapy Start nitroprusside infusion to reduce afterload Administer 2 L crystalloid bolus

Correct Answer:

Initiate mechanical circulatory support (Impella or VA-ECMO)

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