ED and Cards Flashcards
(183 cards)
1
Q
What are the most common complications of HOCM?
A
arrhythmias
myocardial ischemia
sudden death
2
Q
What is bicarb in metabolic acidosis?
A
low bicarb
can check if appropriately compensating with Winter’s formula
pCO2 = 1.5(HCO3) + 8
* body will never OVER compensate, must be a respiratory component
3
Q
How to tx unstable angina or non-St elevation Mi inpt?
A
Admit to ICU/CCU, telemetry
repeat EKG, CPK-MB, troponin at 6 hr intervals
Enoxaparin (though use unfractionated heparin until after procedure if they are going to have one), IV metoprolol, statin oral
4
Q
What is 3rd degree AV block?
A
no correlation between the p and qrs waves
5
Q
How to work up pt with burns from fire?
A
- check carboxyhemoglobin level *carbon monoxide poisoning
- CXR
- CBC, electrolytes
6
Q
What are EKG findings of V tach?
A
- wide QRS
- A-V dissociation
- ischemia findings
- can progress to V fib
- HR usually 100-180
7
Q
How do you convert an unstable pt with v tach?
A
start synchronized cardioversion at 100J, then 200J, then 360J, then 360J, if continues - use meds also to stabilize (lidocaine, amiodarone)
8
Q
What is the work up for a pt with a high fever on CCS of unkown origin?
A
blood cultures, chest xray, urinalysis
9
Q
How to read an EKG?
A
rate (300-150-100-75-60)
rhythm
intervals (PR, QRS (<3 boxes), QT)
T waves
elevations/delta waves
10
Q
How give stress ulcer prophylaxis?
A
For all criticall ill pts (ICU)
PPIs, H2 blockers, or sucralfate
11
Q
What is long term management of hypertensive emergency?
A
- transfer to floor when symptoms resolve
- start oral meds - labetalol or enalapril
*may beed 2-3 meds (should include diuretic)
12
Q
How to work up claudication/peripheral vascular dz?
A
ankle/brachial pressure index (ABI) - do it with a duplex in lower extremities - if <1 = peripheral vascular dz
13
Q
How do you manage CHF with systolic dysfunction after the pt is stabilized?
A
- ACE inhibitor
- once stable add beta blockers
- if can’t do ACE inhibitor use hydralazine plus isosorbide dinitrate
- if a fib - start with digoxin
- Spironolactone (if dyspnea at rest or minimum exertion)
14
Q
How do you differentiate between unstable angina and acute MI?
A
need troponins and CK-MB
15
Q
How to treat unstable a fib?
A
emergency cardioversion for pt with hypotension, AMS, or angina
16
Q
What rhythm control meds can not be used in QT rolongation because they also prolong QT intervals and can lead to Torsades?
A
Sotalol, ibutilide, dofetilide
17
Q
What options can you use for tx for pts with a fib from a rate control perspective?
A
- Calcium channel Blockers:
Diltiazem just as rapid as verapamil with less side effects
Verapamil (constipation), rapid effect, do not use in pts with low EF bc decr contractility
- Beta-blockes (metoprolol and esmolol) *safe in well controlled asthma and COPD
- Digoxin for rate control in pts with poor EF
18
Q
what are the indications for thrombolytics in acute MI?
A
- w/in 12 hours of onset and no access to cath lab for angioplasty
- >1-2 mm ST elevation
- new left bundle branch block (must have an old EKG to compare)
19
Q
What are the side effects of statins?
A
myositis and increase in CPK levels
20
Q
Why are beta blockers contraindicated in anaphylaxis?
A
they block the action of epinephrine (which is one beta receptors)
21
Q
What type of antibiotics are given in burn patients?
A
topical - silver sulfadiazine
22
Q
How do you treat alcoholic hepatitis (incr. AST/ALT, PT, and bili)?
A
Steroids (but not if SBP/infection present)
pentoxyphyline - reduces heptorenal syndrome
23
Q
What is schistocytes a sign of?
A
microangiopathic hemolytic anemia (red blood cells being ripped apart in small vessels)
24
Q
Who gets cardioversion in vtach?
A
hypotension, mental status chages, CHF, chest pain
25
When shoudl you intubate a burn pt?
airway compromise (stridor)
severely altered mental status
26
What is the next step in a fib tx if rate and rhythm control don't work?
ablation
\*50% effective
\*if 2+ CHAD2S score - anticoagulation is on anticoagulation forever
27
How do you manage HOCM once stable/dx?
1. beta blocker or calcium channel blocker (Verapamil)
2. may need implantable defibrillator (based on septum size)
3. avoid extreme exertional activity
4. surgical fixes: can infuse alcohol to reduce thickness of septum, surgical myomectomy
28
What is 1st degree AV block?
increased PR interval
29
How do you surgically tx mitral stenosis?
balloon valvuloplasty or valvular replacement
30
How do you w/u and manage sudden, symptomatic bradycardia?
1. EKG
2. Atropine
3. IV fluids
stop beta blockers, nitrates, calcium channel blockers when hypotensive
31
What is the long term management of dyslipidemia?
1. statin (high intensity - rosuvastatin, atorvastatin, bring down by 50%, mod intensity reduces by 30-50%)
2. limit fats in diet
3. exercise (don't start intense exercise at same time as statin/stagger it)
4. LFTs (AST, ALT, bilirubin) q3-6 months
5. repeat LDL, Triglycerides, cholesterol levels in 6 wks, then f/u with levels q6-12 months
32
How do you tx aspirin (salicylate) overdose?
1. always give activated charcoal (on CCS for toxicology)
2. supportive care (IV hydration)
3. IV bicarbonate to alkalinize the urine to increase drug excretion (check urine pH and give until urine pH is \> 7.5)
4. psych consult
33
What is f/u management for acute exacerbation of CHF?
1. transfer to floor when MI excluded and hypoxia improved
2. ECHO when sent to floor
3. dobutamine if symptomatic after use of nitrates/furosemide)
4. add beta-blockers after stable
5. add spironolactone if pt is symptomatic at rest/min exertion
6. if still symptomatic after all of this - digoxin
34
How to manage V tach?
DC cardioversion (unstable), lidocaine or amiodarone (stable), check electrolytes and correct
35
What is the different between epidural and subdural hematoma?
epidural (convex) - breif period of being well
subdural (lenticular)
36
What electrolytes can cause QT prolongation?
HypoK
HyopMag
HypoCa
37
How do you manage CHF with diastolic dysfunction after the pt is stabilized?
1. Beta blockers
38
What is the most common arrythmia?
atrial fibrillation
39
What type of hypersensitivity reaction is anaphylaxis?
Type 1
Anaphylaxis and atopic
IgE cross linking and immediate release of histamine and bradykinin - increase permeability of capillaries, vasodilation, and bronchoconstriction
delayed response due to production of leukotrienes
40
What risk factor makes you more likely to get acetaminophen toxicity?
chronic alcohol use (due to increase in P450 acitvation (increase toxic metabolite production) and poor nutrition (decreased glutathione production)
\*only 4g per day can lead to acetaminophen toxicity (vs 10-15g/day for other people)
41
How to control pain in burn patients?
IV morphine drip or PCA pump, or hydromorphone
\*if renal failure - use fentanyl
42
What blood pressure medicine should be used in hypertensive emergency?
1. Labetalol
\*oral and IV, very safe even in pregnancy
2. Nitroprusside (only in ICU)
\*cyanide poisoning
43
What is type 3 hypersensitivity?
Immune complex mediated
complexes activate complement which attract neutrophils releasing lysosomal enzymes
ex: SLE, polyarteritis nodosa, post-strep glomerulonephritis
44
What are thrombolytics used in acute MI?
tPA
streptokinase
45
What are the 3 things that can give you AST/ALT in the 1000s?
1. medications (acetaminophen, methotrexate, RIPE, amiodarone)
2. Viral hepatitis (A, B, very rarely C)
3. Ischemic liver (after event like v fib/MI)
46
What genetic syndrome is associated with aortic stenosis?
Turner Syndrome
47
Labs to check for alcoholics
Electrolytes, blood alchol level, serum magnesium, ABG, AU, blood cultures, LP (if altered mental status)
48
What usually causes myocardial ST segment elevation vs depression?
ST seg elevation - infarction
ST seg depression - ischemia, or posterior wall MI
49
What are EKG findings of R ventricular hypertrophy?
R in V1 \> 7 mm
50
Who gets started on a statin?
1. anyone with clinical CV disease
2. LDL \> 190
3. person 40-75 yo w/ DM and LDL 70-189 w/o clinical CV disease
4. people with/o clinical CV disease or DM who are 40-75 yo with LDL 70-189 w/ a 10 y CV dz risk \>7.4% (framingham risk score)
51
How to work up a pt with a symptomatic tachycardia?
EKG, pulse ox, fluids if hypotensive
52
How do you initially manage hypertensive emergency?
1. EKG
2. BUN/Cr, CBC
3. IV labetolol, nutroprusside, or enalaprilat
4. oxygen and pulse ox
53
What is the differential for MI?
unstable angina
Acute MI
dissecting aortic aneurysm
pericarditis
esophageal spasms
PE
musculoskeletal pain
pancreatitis
pneumothorax
54
Who should receive hyperbaric oxygen for pts with carbon monoxide poisoning?
1. carboxyhemoglobin \>25%
2. altered mental status
3. angina
4. pregnancy with carboxyhemoglobin \> 15%
55
What non-cardiac drugs also block Ca channels and can cause QT prolongation?
macrolides, fluoroquinolones, antipsychotics (haloperidol), methadone
56
What cardiac drugs should not be used in HOCM?
digoxin
nitrates \*causes decr venous return and increased obstruction
vasodilators
ACE inhibitors \*incr peripheral resistance
57
How to manage emergent atrial fibrillation?
IV diltiazem (or verapamil) (CCB)
admit to telemetry unit
58
What is the difference between action potentials in your heart nodal cells vs the non-nodal cells?
In non-nodal cells, the depolarization is mediated by Na channels (rapid) (then Ca and K come in)
In nodal cells (SA and AV), the depolarization is mediated by Ca channels (slow until meets the threshold, then faster Ca channels open).
59
What are the most common post MI complications?
arrhythmia (most common in first 3 days)
valvular dysfunction/rupture (3-5 days)
cardiogenic shock
aneurysm formation (delayed)
mural thrombus (at anytime)
myocardial rupture (3-5 days)
conduction defects
60
How to work up dyspnea with exertion and abnormal cardiac exam in outpt office?
1. pulse ox, oxygen
2. EKG, CXR, ECHO
61
How to long can it take for respiratory failure to develop in a burn victim?
6-24 hours
62
How to work up unstable angina (transient chest pain at rest or worsening pain with exercise)?
aspirin, nitroglycerin, morphine
EKG
CXR
CK-MB and troponin to differentiate bewteen MI and unstable angina
63
Pre-surgery labs
CBC, PT, Type and Cross
64
How do you cardiovert a pt who has been in a fib for less than 48hrs?
Usually will cardiovert on their own. But if they don't, start heparin drip and cardiovert. then go on anticoagulation for weeks.
65
What is the long term management after acute MI?
beta-blockeres and statins
ACE inhibitors if EF is low (\<40%) or sig. anterior wall MI (V1-V4)
Clopidogrel, prasugrel, or ticagrelor for severeal months if a stent is placed
66
What makes the heart beat faster (mechanism) and slower?
Epi/NE activate B receptors than incr cAMP, which causes repolarization to happen faster in the nodal cells and that incr HR
Actylcholine decreased cAMP and slows repolarization to decr HR (parasympathetic)
67
What is this rhythm?
V fib
68
How to work up possible acute MI?
1. aspirin
2. nitroglycerin (unless contraindicated - hypotensive, murmur, or Hypertrophic obstructive cardiomyopathy)
3. morphine (relax the pt)
4. EKG - st elevation
5. CK-MB (takes 4 hrs to elevate after MI and peaks at 12-18 hrs and lasts 2-3 days)
6. troponin (any elevation = damage, stays elevated for 1-2 wks)
7. CXR
8. pulse ox
69
When do you see Kerley B lines on CXR?
pulmonary edema
70
Initial labs in a pt with A fib?
Thyroid function tests (look for thyrotoxicosis)
Cardiac enxymes
ECHO
ABG
71
What is Type 2 hypersensitivity?
Cytotoxic IgM, IgG bind to fixed antigen
complement mediated lysis - NK cells
ex: autoimmune hemolytic anemia, rheumatic fever, goodpasture's syndrome, bullous pemphigoid, ITP
72
What are the common causes of death in the initial period after a 2nd or 3rd degree burn?
hypovolemic shock, infection, airway injury
73
S4 gallup
"a STIFF heart"
74
How do you tx peripheral vascular dz/claudication?
1. stop smoking
2. aspirin and other antiplatelet drugs such as clopidogrel for severe dz
2. graded exercise program
3. meticulous foot care
4. Cilostazol (antiplatelet and vasodilator)
5. statins if LDL \>100
6. possible revascularization with angioplasty/surgery
6. 5. ACI inhibitors for HTN
7. follow at 1 month intervals to coach on exercise/lifestyle and ABIs q3-6 months
75
Why do we do an unsynchronized shock in v fib?
bc a synchronized shock is coordinated with ventricular contraction, but there is no ventricular contraction in v fib - so it has to be unsynchronized
76
Triad of opiod intoxication
respiratory depression, miosis (pinpoint pupils), depressed mental status
77
How to treat stable a fib?
rate control with AV nodal blocking agent (diltiazem or verapamil)
78
What is a common side effect of amiodarone?
pulmonary fibrosis, thyroid disorders, and corneal deposits (all long term use)
79
When a pt with syncope has a murmur, what are the top 3 diagnoses to think of?
aortic stenosis
HOCM
mitral stenosis
80
How do manage hypertensive emergency after intial stabilization?
1. head CT
2. CXR
3. conitnue IV antihypertensive (labetolol, nitroprusside, enalaprilat)
4. transfer to ICU
5. reduce BP by 1/3 but not \<95 mm Hg Diastolic
81
How do you treat cardiac tamponade?
needle decompression (50-100 ml)
82
What are next steps management of an acute MI after the initial w/u?
clopidogrel oral (antiplatelet)
metoprolol, statin, ace inhibitor (lisinopril) if EF is decreased
angioplasty
repeat CK-MB and troponin (4 hrs), EKG in 15-30 mins
83
How does digoxin work for afib?
Increases contractilty by increasing amount of Ca in the cell for depolarization of the nodal cells, but then it also stimulates the vagus nerce to increase parasympathetic drive and decreases RESTING heart rate only
84
How do you use the CHADS2 score?
To determine anticoagulation in non-valvular a-fib...(valvular a fib all need anticoagulation)
C - CHF (1pt)
H - HTN (1pt)
A is for age \>75 (1pt)
D is for DM (1 pt)
S is for stroke or TIA (2pt)
score of 0-1 aspirin
score of 2+ anticoagulant (Warfarin, dabigatran, rivaroxaban, abixaban) and will need to stay on it forever
85
What is the treatment for Torsades?
GIve Magnesium!
Can also try lidocaine, then unsynchronized cardioversion
86
How to follow pts with acetaminophen toxciity?
repeat acetaminophen levels after 4 hours - more accurate.
\*follow LFTs and coags: if increase in PT and signs of hepatic encephalopathy - need liver transplant
87
What is the best drug to treat hypertension in a diabetic?
ACE inhibitors
88
What condition most commonly leads to a fib?
chronic HTN
\*but mitral regurg/stenosis can cause it, so can MI, drugs (cocaine)
89
3 principles to manage a fib?
1. rate control HR \<110 at rest \*this is better than rhythm control in general
2. anticoagulation
3. rhythm control (DC cardioversion, chemical cardioversion - amiodarone, sotalol, flecainide)
90
What are some considerations when deciding to convert someone out of a fib?
rate vs rythmm control
rate - usually better, will need to be on long term maintenance drug
long term success of maintaining rnormal sinus rhythm is less if the arrhythmia has been there a long time or if left atria is enlarged
91
How do you tx patients with a fib if you choose to do rhythm control?
**Amiodarone!**
\*best option for maintaining rhythm after conversion when there is systolic dysfunction
Only one other option in pts with low EF - dofetilide
92
How do you treat carbon monoxide poisoning?
100% oxygen
93
How do you tx delirium tremens?
benzodiazepines (life saving!)
- chlordiazepoxide 50-100 mg q4-6 hrs, diazepam, lorazepam, or phenobarbital
IV thiamine and folic acid
Fluids
replete Mg
94
What is type 4 hypersensitivity?
Delayed (T-cell mediated)
sensitized T lymphocytes encounter antigen which leads to macrophage activation
\*only type of hypersensitivity rxn that doesn't involve antibodies
es: multiple sclerosis, Giullain-Barre, graft-vs-host, PPD, contact dermatitis
95
What is a common side effect of lidocaine?
confusion, esp in elderly
96
How to treat supraventricular tachycardia?
carotid sinus massage
adenosine
97
What EKG signs would be expected in aortic stenosis?
left ventricular hypertrophy
98
How do you treat cyanide toxicity from nitroprusside use?
sodium thiosulfate and stop nutroprusside
99
How do you cardiovert a stable pt who has been in a fib for more than 48 hours.
\*TEE is looking for clots, if you find one - don't cardiovert, go on heparin and anticoagulaiton
100
How to work up acetaminophen toxicity (pt with N/V, RUQ tenderness)?
CBC, lytes, LFTs, PT, amylase, lipase, abdominal U/S
tox labs - aspirin level, acetaminophen level
101
What are common causes of V tach?
1. electrolyte abnormalities
- hypoMg, HypoCa, Hyper/hypoK
2. TCA overdose
102
What are the side effects of amiodarone?
causes QT prolongation - but doesn't lead to torsades
ataxia, nausea, thyroid effects, hepatitis, cirrhosis, corneal deposits, cough, constipation, momry and sleep disturbance
103
What is the murmur of aortic stenosis?
systolic murmur on URSB, radiates to carotids and is worse with leg raise/squatting (increasing venous return) and better with valsalva (decreasing venous return)
104
What is an EKG sign of cardiac tamponade?
varying size of QRS wave - means heart is freely moving in the chest wall
105
What is the most common presenting symptom of HOCM?
dyspnea
106
How do you give furosemide in pulmonary edema due to CHF?
give furosemide every 20 minutes until pt is making enough urine
107
What kind of CT do you get for head trauma (looking for blood)?
Non contrast head CT
108
How does dobutamine work?
positive inotrope - increases contractility and this helps empty the lungs by improving heart function
109
What does adenosine do?
slows conduction through the AV node and can help figure out what is happening in SVT
110
What are reasons a pt might get pushed into congestive heart failure?
1. not taking meds
2. ischemia
3. arrythmia (afib, doesn't get extra help from atrium anymore)
111
When does hepatotxocity occur in acetaminophen toxicity?
peak injury 72-96 hrs after ingestion
\*watch them!
112
S3 gallup
"I'M re-laxed"
113
What is 2nd degree AV block?
\*only heart block that causes arrythmias
1. wenkebach - increasing PR interval until a beat is dropped
2. all PR intervals are the same, but they are increased and lead to dropped beats?
114
Who needs hemodialysis in salicylate overdose?
1. persistent acidosis with pH \<7.1
2. initial salicylate levels \>160 mg/dL or \> 130 mg/dL after 6 hrs
3. coma/seizuers
4. renal failure
5. congestive heart failure
115
What can cause complete heart block?
Meds (B-blockers, CCB, digoxin)
Myocarditis (viral or lyme dz)
MI (especially inferior wall)
aging and fibrosis of the conduction system (Most common)
116
What are good options for smoking cessation?
varenicline, bupropion (if also have depression)
117
How to evaluate for cardiac tamponade?
CXR - shows dark halo around the heart
assess pulsus paradoxicus (drop in BP with inhalation \>10 mm Hg)
ECHO
118
Why is it important to give beta blockers in CHF?
1. reduces oxygen consumption of the heart
2. anti-arrythmic and anti-ischemic (which is MCC death in CHF)
119
Do we shock patients in asystole?
no!
CPR and epinephrine
120
How do you tx cocaine-induced hypertensive crisis?
(alpha blocker) phentolamine
\*DO NOT USE beta blocker
121
Who requires a Head CT before an LP?
altered mental status, papiledema, sz, immunocompromised
122
What are cannon "a waves?"
When there is a wave in the jugular veins bc the tricuspid valve is close when the atrium is contracting
123
What type of heart dysfunction is HOCM?
diastolic - issue is that heart chambers are small and can't fill up
\*use beta blockers!
124
What is the most important side effect when using nitroprusside to lower blood pressure (vaso dilator)
acute cyanide toxicity (esp in setting of renal failure)
125
How do you initially treat syncope with abnormal cardiac exam?
1. EKG, Tele bed in hospital
2. ECHO, troponin
126
What is Wernicke Syndrome?
thiamine deficiency (seen in alcholics)
confusion, ataxia, mand ophthalmoplegia (weakness or paralysis of one or more extraocular muscles)
reversible with thiamine treatment
127
Who gets pleuritic chest pain?
PE, pneumothorax, pneumonia, pericarditis
| (pain that is worse with inspiration)
128
How to monitor patients with anaphylaxis after initial treatment?
montior for 6-8 hours due to possibilty of late second reaction
129
What type of cardiac exam is typical of hypertrophic cardiomyopathy?
prominent apical impoulse, S4 gallup, 2/6 harsh systolic ejection murmur at LLSB that is worse with valsalva (decr venous return) and improves with squatting (incr venous return and relieves outflow tract obstruction from HOCM)
130
How to work up "fluttering" or "palpitations?"
EKG
\*if EKG is normal - do a Holter monitor
131
What 3 meds should any pt with acute altered mental status of unclear etiology receive?
Naloxone
thiamine
dextrose
132
What premeds do you use with cardioversion?
diazepam or midazolam if you have time
133
How do you stress test in a pt who can not do an exercise stress test?
use dipyridamole thallium test
134
What is long term management for pts with unstable angina/non ST elevation MI?
aspirin + second anti-platelet (clopidogrel) if underwent angioplasty or had MI
statin, beta-blockers, and ace inhibitors
\*can stop ACE inhibitor at 6 wks if f/u ECHO shows EF \> 40%
135
What arrythmia can occur with low magnesium (alcholics)?
Torsades
136
Ddx for a pt with fever, altered mental status, tremor?
delirium tremens, alcholic hallucinosis, acute intoxication, acute schizophrenia, bacterial meningitis, subdural hematoma
137
Why do pts with aortic stenosis get angina?
bc the coraonaries aren't being filled enough and that causes the ischemia
138
If pt has scleroderma and malignant hypertension how do you treat this pt?
ACE inihbitors
139
What drugs can be used for anticoagulation?
Warafin (goal INR 2-3)
Dabigatran: oral direct thrombin inhibitor
Rivaroxaban, abixaban: oral factor Xa inhibitor
140
What type of murmur is heard with mitral stenosis?
diastolic murmur at LLSB , worse with squatting/leg raising (increased venous return) and better with valsalva (less venous return)
\*most common valvular issue after rheumatic fever
141
How to w/u CHF with shortness of breath?
sit pt upright, EKG, Oxygen and pulse ox, furosemide IV, nitroglycerin IV (relieve pulmonary congestion with vasodilation), ECHO, CXR, ABG, CK-MB, Troponins, BNP, go ICU
142
How do you tx claudication that is worsening?
arteriography if considering surgical revascularization
143
What are the 2 types of heart failure?
systolic (EF \< 45%)
diastolic (EF \>45%)
144
What labs do you see in alcoholic hepatitis?
AST: ALT 2:1
AST will never be over 500, usually 100-200
145
What are goal urine outputs for kids and adults?
adults - 0.5 cc/hr
children - 1 cc/hr
146
How to manage mitral valave stenosis?
1. left heart catheterization (to characterize the stenosis)
2. salt restriction (trying to decrease fluid to improve the heart function)
3. diuretics (trying to decrease fluid to improve the heart function)
4. surgical repair when valve is \<1 cm wide
147
What is the most common cause of death in burns victims?
carbon monoxide poisoning
148
What is the follow up and management after you cardiovert and stabilize a pt?
stay in ICU, CCU
continue amiodarone
do stress test once the pt is stable
consult cardiology, ECHO (r/u structural causes)
consider automatic implanatble cardioverter defirbillator placement
metoprolol
149
How to manage aortic stenosis?
```
ECHO to eval valve diameter
if symptomatic (chest pain, fainting), transcatheter aortic valve repair or open valve replacement if undergoing heart surgery for other reasons (CABG)
```
150
Who should have a pacemaker placed?
1. symptomatic bradycardia
2. type 2 or 3rd degree AV block
151
What is the better ECHO for evaluating mitral stenosis?
TEE rather than TTE
152
What is the concern in Mitral stenosis when the atria gets dilated? (EKG notched P wave or biphasic p wave)
a fib - may need anticoagulation (warfarin) and digoxin if they are experience with a fib
153
How to you anticoagulant after a stent placement?
aspirin and a second anti-platelet drug like clopidogrel, prasugrel, or ticagrelor for 1 year
154
What does multifocal atrial tachycardia look like on EKG?
multiple p wave morphologies (originating from different places in the atrium)
155
tx of intracranial hemorrhage?
intubation and hyperventilation (pCO2 of 25-30 mmHg)
IV mannitol
neurosurg consult for surgical evacuation of hematoma
maintain systolic BP \> 100 mmHg
156
How to treat acetaminophen toxicity?
IV acetylcysteine \*helpful up to 24 hours by replacing glutathione stores
charcoal administration
157
Follow up management for cardiac tamponade?
continue IV NS
pericardiocentesis with needle
possible placement of pericardial window
surgical consult
transfer to ICU
158
What are risk factors for coronary artery dz?
DM, peripheral vascular dz, HTN, smoking tobacco, hyperlipidemia, HDL \<40, first degree relative with MI/heart dz (male \<55, women \<65)
159
What do you always check in addition to acetaminophen level when worried about overdose?
aspirin level
160
Should you anticoagulate an elderly person with a fib who has a fall risk?
YES!
Would have to fall daily to increase risk for intracranial bleed on warfarin.
161
How to initially tx burn victims?
1. 100% oxygen if elevated carboxyhemoglobin
2. fluid resuscitation 4ml/kg/% BSA burned (Ringer's lactate, plasmalyte)
3. prevent infection with topical antibiotics
4. enteral nutrition
5. intubation if significant respiratory injury
162
What is the mechanism for increasing contractility in the heart?
protein kinase A leads to increase in both intracellular and extraculular Ca availability which makes depolarization happen faster in nodal cells.
\*this is what CCBs target to slow the heart (why they decr contractility)
163
What are EKG findings of L ventricular hypertrophy?
S in V1 or V2 + R in V5 \> 35 mm
164
What are contraindications to thrombolytics?
1. GI bleed
2. intracranial hemorrhage
3. recent surgery
4. aortic dissection
5. any active internal bleeding
6. relative contraindications: BP \>180/110, active ulcers, recent head trauma, pregnancy
165
What electrolyte can be low in alcoholics?
Magnesium, replete!
166
How to treat a fib with mitral stenosis?
digoxin
may also use a beta blocker to slow heart rate and increase ventricular filling time
167
Which valve can you balloon (aortic or mitral)?
Mitral - caused by fibrosis
\*CANNOT valve aortic bc caused by calcification and will just break apart
168
How does spironolactone work?
inhibits renin-angiotensin system (diuretic) and lowers mortality in syslotic dysfunction
169
When do you use rhythm control in pts with a fib?
If the pt can't tolerate rate control.
170
How to initially manage anaphylaxis?
1. pulse ox, oxygen
stridor = intubate
2. epinephrine
3. IV NS
4. diphenhydramine
5. IV steroids
6. albuterol if wheezing
\*unstable - dyspnea, stridor, hypotension
171
How to treat pts with v fib?
CPR
DC unsynchronized cardioversion (360 J)
CPR (don't check pulse)
check rhythm
repeat defibrillation at 360 J
CPR
IV access - epinephrine or vasopressin q5 mins
check rhythm
Defibrillate
CPR
Amiodarone
check rhythm
Defibrillate
172
who should get glycoprotein 2b/3a?
anyone who is going to go for cardiac catheritization in acute MI
173
What 3 conditions do we use unsynchronized defibrillation?
V fib
Pulseless ventricular tachycardia
Torsades de pointes
174
How to interpret chest xrays?
AP (portable) or PA (in radiology)
rotation
penetration - should see spine all the way down to diaphragm
check diaphragms/pleural effusions/air/even diaphragm
Cardiac silhouette (should be less than 50%)
Bones - rib fx or metastatic dz
Lung parenchyma
175
What is seen here and what is the most likely dz?
hyperinflation, flat diaphragms, darkening of lung fields, elongated heart
COPD
176
What is the dz and what findings do you see?
pneumonia - lobar
177
How to tx lobar pneumonia?
ceftriaxone + azithrmycin
or
flouroquinolone
178
What do we see here and what is on the ddx?
fine lacy appearance, diffuse in all lobes, reticular pattern
atypical pneumonia, viral pneumonia, or interstitial lung dz
179
What chest xray findings are present in CHF?
increased flow in apices "cephalization"
cardiomegaly
pleural effusion
kerley B lines (fluid in interlobular septum)
180
What always must be done after you put in a line or tube in a pt?
xray to check position!
181
What is the correct position of the endotracheal tune?1
1-2 cm above carina
182
What is the correct position for a central line?
tip of the line at the junction of the SVC and the right atrium (at the point where the right main stem bronchus is seen)
\*not in the atrium
183
What type of xray should you get if you are worried about abdominal perforation?
chest xray
(KUBs don't always include the top of the diaphragm)
