Cardiac Arrest, Diabetes, Shock, ACS/STEMI, Stroke

Question 1

Why such emphasis on cardiac arrest

Answer 1

System stress test
Foundation for creation of EMS

Question 2

Rate of OHCA

Answer 2

0.5-1 events for every 1,000 people per year

Question 3

Most important factors determining outcome from OCHA

Answer 3

Systems of community care

Question 4

What did the PAD trial show

Answer 4

Survival in OHCA doubles at sites with AEDs

Question 5

Decrease in survival for vfib every minute without shock

Answer 5

7-10% for each minute that passes

Question 6

Who runs cardiac arrest in pit crew model?

Answer 6

Compressor, group works around compressor to optimize flow time

Question 7

Shock first or compressions first?

Answer 7

No clinical significant difference between the two
If VF short duration, i.e witnessed, shock first preferred

Question 8

AIRWAYS trial said

Answer 8

No difference in survival b/w Igel vs ETT

Question 9

PART Trial

Answer 9

King LT vs ETI - favored King airway overall but very low intubation success rate

Question 10

ALPS trial

Answer 10

No difference between all 3 all comers
5% improvement in witnessed arrests

Question 11

PARAMEDIC 2 Trial

Answer 11

Eli higher rate of ROSC and 30 day survival but no favorable neurologic outcome

Question 12

IM glutton time to correct sugar

Answer 12

8-21 minutes
vs 8 minutes for IV sugar

Question 13

BP formula

Answer 13

CO x PVR

Question 14

CO formula

Answer 14

SV x HR

Question 15

Marker of perfusion in a fixed ventilatory rate

Answer 15

Waveform capnography

Question 16

Challenges to prehospital vasopressor use

Answer 16

Lack of reliable weight based dosing
Pumps vs drips

Question 17

Pediatric shock differences

Answer 17

Low cardiac output and high SVR (cold shock)
Higher fluid volumes (60 cc/kg)
Epi first line to counter low CO
Up to 40% of CO in beds due to work of breathing

Question 18

Maximum ASA survival benefit

Answer 18

Within 4 hours of MI

Question 19

Who is less likely to get ASA

Answer 19

Women (2.8 fewer women than men)
(45% of eligible patients get ASA)

Question 20

LAPSS

Answer 20

Cincy +
Age greater than 45
No hx of seizures
Symptoms less than 24 hours
Baseline function not bedridden or wheelchair
Blood glucose 60-400

Question 21

Order in seizure mgmt

Answer 21

1. Immediate supportive care
2. Give bentos (even if sugar low)
3. Treat easily reversible causes
4. Evaluate for suspected underlying causes

Question 22

Order of hyper K changes in EKGs

Answer 22

1. Peaked T waves
2. QR interval lengthening
3. Widening QRS