EM2 M4 Flashcards
(156 cards)
1
Q
guideline ETT tube depth at lip line adult male vs female
A
22-24cm adult male
21-23cm adult female
2
Q
asthma epidemiology
prevalence in 1980’s vs 1990’s
male vs female
white vs black
A
asthma epidemiology
inc prevalence in 1980’s vs dip in 1990’s
more male peds vs more female adults
more black than white
3
Q
inhaled vs IV steroids for acute asthma exacerbation?
A
IV because may have difficulty with inhaled/oral in acute asthma exacerbation
otherwise equally efficacious routes
4
Q
which is most beneficial in an acute COPD exacerbation, steroids or beta agonist?
A
beta agonist is most beneficial in an acute COPD exacerbation
5
Q
TF
in CAP, co-infection with multiple bacteria such as chlamydia and strep pneumo commonly occurs
A
T
in CAP, co-infection with multiple bacteria such as chlamydia and strep pneumo commonly occurs
6
Q
TF
cigarrette smoke is a risk for strep pneumo pneumonia
A
F
^65, alcoholism, dm, cardiovascular disease, splenectomy, scd, malignancy, immunosuppresion are risks for strep pneumo cap
not smoking
7
Q
TF
Varicell Zoster virus infection can present as pneumonia, more commonly in kids than adults
A
T
Varicell Zoster virus infection can present as pneumonia, more commonly in kids than adults
8
Q
TF
CMV does not usually cause pneumonia in immunocompetent adults
A
T
CMV does not usually cause pneumonia in immunocompetent adults
9
Q
TB facts
- rank on deadlist bugs list
- % world pop infected with TB
- % US pop infected with TB
- incidence trend in US
- incidence trend of MDR TB
A
TB facts
- # 1 rank on deadlist bugs list
- 33% world pop infected with TB
- 4-6% US pop infected with TB
- incidence trend in US v in 1950s from public health advancements, ^ since 1980s espec in low SES
- incidence trend of MDR TB ^ espec in AIDS pts
10
Q
why can klebsiella pna cause currant-jelly sputum
A
klebsiella pna can cause severe necrotizing hemorrhagic pna which causes the currant-jelly sputum, especially in elderly or debilitated… also often complicated by abscess, empyema, bacteremia, and high mortality
11
Q
5 most common pathogens causing cavitary lung lesion
A
TB anaerobic bacteria (aspiration pna) aerobic gnrs staph aureus fungal disease
12
Q
strongest consideration for whether to admit pt for pneumonia… age? comorbidities? vitals?
A
comorbidities vs Elderly
clinical decision…
13
Q
which part of the right lung is most likely to become atelectatic after food aspiration
A
right middle lobe most likely to become atelectatic from aspiration – lobar bronchus to right middle lobehas acute takeoff and poor collateral ventilation
14
Q
What does Heliox do
A
Heliox (mixed helium and oxygen) decreases turbulence of air flow to facilitate air movement into the airways
15
Q
- Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in __%
- Up to ___ of patients with PE have no symptoms of DVT. PE is also found in about ___ of patients who have DVT but who do not have symptoms of PE. Thus, the presence or absence of DVT or symptoms of DVT does or does not? correlate well with the finding of PE.
A
- Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33%
- Up to 2/3s of patients with PE have no symptoms of DVT. PE is also found in about 1/2 of patients who have DVT but who do not have symptoms of PE. Thus, the presence or absence of DVT or symptoms of DVT does or does not? correlate well with the finding of PE.
16
Q
__% of PE patients without identifiable risk factors are diagnosed with cancer within __ years
So…
A
25% of PE patients without identifiable risk factors are diagnosed with cancer within 2 years
So development of PE without any identifiable risk factors warrants a search for an underlying malignancy.
17
Q
High vs low risk cancers for PE
A
esophageal and laryngeal cancer, as well as leukemia and lymphoma have a low incidence of PE, whereas those with ovarian or colon cancers are at higher risk for developing PE
18
Q
TF
Hematologic cancers such as leukemia have higher risk of PE
A
F
esophageal and laryngeal cancer, as well as leukemia and lymphoma have a low incidence of PE, whereas those with ovarian or colon cancers are at higher risk for developing PE
19
Q
development of PE without any identifiable risk factors warrants a search for…
A
Development of PE without any identifiable risk factors warrants a search for an underlying malignancy
Because 25% of PE patients without identifiable risk factors are diagnosed with cancer within 2 years
20
Q
EKG changes with PE
A
Tachycardia and non-specific ST-segment and T-wave abnormalities are the most common findings on EKG of patients with PE; however up to 25% will have EKGs unchanged from their baselines. An S1-Q3-T3 pattern is suggestive but not diagnostic of PE. Right bundle branch block may also be seen in PE, but does not indicate pulmonary infarction or severity of PE. Diffuse PR depression is typically seen in pericarditis
21
Q
____ is a common cause of pneumonia in young adults. It is classically associated with bullous myringitis
A
Mycoplasma pneumoniae is a common cause of pneumonia in young adults. It is classically associated with bullous myringitis
22
Q
____ is the most common cause of community- acquired pneumonia. ____ is the second most common cause.
A
Streptococcus pneumoniae is the most common cause of community- acquired pneumonia. Viral is the second most common cause.
23
Q
____ is not a common cause of community-acquired pneumonia. It generally occurs in the elderly, smokers, alcoholics, and those with other co-morbidities. It is classically associated with a bulging fissure on chest X-ray and …
A
Klebsiella is not a common cause of community-acquired pneumonia. It generally occurs in the elderly, smokers, alcoholics, and those with other co-morbidities. It is classically associated with a bulging fissure on chest X-ray and currant jelly sputum.
24
Q
_____ is an atypical pathogen commonly causing pneumonia. It is often found in the elderly or others with co-morbid illnesses. It is classically associated with GI symptoms and relative bradycardia
A
Legionella is an atypical pathogen commonly causing pneumonia. It is often found in the elderly or others with co-morbid illnesses. It is classically associated with GI symptoms and relative bradycardia
25
Treat torsades
Mag
Then cardioversion if persisting
(Unlikely to respond to cardioversion without adjunctive therapy like mag)
26
In PEA, in addition to providing effective cardiopulmonary resuscitation, what management step is most likely to result in survival?
Identification and treatment of a reversible underlying etiology (H’s and T’s)
27
Unstable VT is treated by...
Unstable VT is treated by a series of three stacked shocks, before medications. Early defibrillation is the key to successful resuscitation
28
Many resuscitation drugs can be given via endotracheal tube. When this method is used, what (if any) change in dosing is recommended?
2-2.5x the IV dose when given endotracheally
29
Epi dose in ACLS
1 milligram IV or IO of a 1:10,000 solution every 3 to 5 minutes. Doses >1 milligram are not recommended and may be harmful.”
30
Treat asystole
The treatment of choice for asystole is
epinephrine or vasopressin and atropine
It is important to check that the monitor is working and to check
a second lead to rule out very fine ventricular fibrillation.
31
Treat complete av block type III
Permanent pacing usually
| Brady ventricular rate
32
TF
| The chin-lift maneuver risks spinal injury due to its employment of neck extension.
T
In many patients in the Emergency Department, the inability to rule-out cervical spine injury negates the option to use the chin-lift maneuver, since this method of airway opening can exacerbate C-spine injury.
33
blood Ph, bicarb level in DKA vs HHNC?
patients with DKA typically have profound metabolic acidosis with serum bicarbonate < 10mEq,
acidosis is typically absent in patients with HHNC and serum bicarbonate is usually > 15 mEq
34
ketones glucose BUN levels in DKA vs HHNC?
Serum ketones are present in patients with DKA but not usually in patients with HHNC.
Patients with HHNC typically have blood glucose > 700 mg/dL, whereas patients with DKA have blood glucose > 350 mg/dL.
BUN is elevated more in patients with HHNC (>50 mg/dL) than in patients with DKA (25-50 mg/dL).
35
Hydration status and Na K Mag Phos status of pt in DKA
Patients with DKA are typically severely dehydrated with a total body water deficit of approximately 70-80 mL/kg, in addition to being total body depleted of potassium, magnesium, and phosphorous despite initially normal serum levels of these electrolytes.
Correct sodium about +2 for every 100 glucose over 100
36
____ is contraindicated in patients with HHNC as it may impair endogenous insulin release and is often ineffective in the management of seizures associated with HHNC
Phenytoin (Dilantin) is contraindicated in patients with HHNC as it may impair endogenous insulin release and is often ineffective in the management of seizures associated with HHNC
37
Phenytoin (Dilantin) is contraindicated in patients with HHNC as it may impair endogenous ____ release and is often ineffective in the management of ____ associated with HHNC
Phenytoin (Dilantin) is contraindicated in patients with HHNC as it may impair endogenous insulin release and is often ineffective in the management of seizures associated with HHNC
38
In HHNC managment:
____ is contraindicated as it may impair endogenous insulin release and is often ineffective in the management of seizures associated with HHNC. ____ of the fluid deficit should be replaced over the first __ hours, and the remainder over the ensuing __ hours. ____ must be tightly monitored as fluid resuscitation alone may normalize serum ____ or precipitate ____ in aggressive fluid resuscitation. Too-rapid correction of hyperosmolality may result in development of ____, especially in ____. ____ should be considered in patients with severe dehydration due to increased risk of thrombosis from ____ and ____
Phenytoin (Dilantin) is contraindicated in patients with HHNC as it may impair endogenous insulin release and is often ineffective in the management of seizures associated with HHNC. Half of the fluid deficit should be replaced over the first 8 hours, and the remainder over the ensuing 24 hours. Glucose must be tightly monitored as fluid resuscitation alone may normalize serum glucose or precipitate hypoglycemia in aggressive fluid resuscitation. Too-rapid correction of hyperosmolarity may result in development of cerebral edema, especially in children. Subcutaneous heparin should be considered in patients with severe dehydration due to increased risk of thrombosis from hypovolemia and hyperviscosity
39
Regarding the development of cerebral edema in patients being treated for DKA:
Patients with serum glucose below __ mg/dL still being treated with ____ are most likely to develop clinically evident cerebral edema. Cerebral edema typically occurs __ hours following onset of treatment. ____ have a higher incidence of cerebral edema. Mortality of patients developing cerebral edema is __%. ____ __ mg/kg should be administered upon any change in mental status of ____ being treated for DKA as they are at high risk for developing ____ especially when being treated with ____ and serum ____ is below __ mg/dL.... steroids for cerebral edema?
Regarding the development of cerebral edema in patients being treated for DKA:
Patients with serum glucose below 250 mg/dL still being treated with insulin are most likely to develop clinically evident cerebral edema. Cerebral edema typically occurs 6-10 hours following onset of treatment. Children have a higher incidence of cerebral edema. Mortality of patients developing cerebral edema is 90%. Mannitol .25-.5 mg/kg should be administered upon any change in mental status of children being treated for DKA as they are at high risk for developing cerebral edema especially when being treated with insulin and serum glucose is below 250 mg/dL.... Steroids are not indicated for treatment of cerebral edema and may actually worsen DKA
40
Hyperkalemia with EKG changes is treated with ____ in order to ____. It works quickly and is relatively safe unless patients are ____. Other treatments for acute hyperkalemia include ____ and ____.
Hyperkalemia with EKG changes is treated with calcium to stabilize cardiac membranes. Calcium works quickly and is relatively safe unless patients are digitalized. Other treatments for acute hyperkalemia include sodium bicarbonate and insulin/glucose.
41
An EKG showing signs of hyperkalemia is characterized by ____. Other EKG changes include ____ and ____. The heart rate may be ____, with ____ and ____ as the terminal events. Acute myocardial ischemia can be represented by ____ as well, but in these cases...
An EKG showing signs of hyperkalemia is characterized by diffuse peaked T waves. Other EKG changes include widening of the QRS complex and biphasic QRS-T segments. The heart rate may be slow, with ventricular fibrillation and cardiac arrest as the terminal events. Acute myocardial ischemia can be represented by hyperacute T waves as well, but in these cases the T wave changes are more likely to be focal (i.e. in an anatomical distribution corresponding to the area of threatened myocardium).
42
In managing hypoglycemia:
Glucagon is ineffective in patients .... , as would be expected in ____. Further, glucagon can precipitate ____ in patients with ____ diseases and therefore should not be used in ____ with hypoglycemia of unknown etiology. Typical symptoms of hypoglycemia include ..... . Symptoms should not be attributed to hypoglycemia unless the level falls below __ mg/dL. Type 1 diabetics practicing strict control of serum glucose are at high risk for hypoglycemic episodes precipitated by ____, or by ____ or ____ . Due to the ____ of the oral hypoglycemic agents, hospitalization and __ hours observation (at minimum) are the typical management for overdose of these agents.
Glucagon is ineffective in patients without adequate glycogen stores, as would be expected in alcoholics. Further, glucagon can precipitate a severe lactic acidosis in patients with glycogen storage diseases and therefore should not be used in children with hypoglycemia of unknown etiology. Typical symptoms of hypoglycemia include sweating, tachycardia, nervousness, hunger, and neurologic symptoms (virtually any neurologic deficit). Symptoms should not be attributed to hypoglycemia unless the level falls below 40-50 mg/dL. Type 1 diabetics practicing strict control of serum glucose are at high risk for hypoglycemic episodes precipitated by skipping a meal, or by increasing energy output or insulin dose. Due to the extended half-lives of the oral hypoglycemic agents, hospitalization and 24-hour observation (at minimum) are the typical management for overdose of these agents.
43
TF
| Hypoglycemia can present with virtually any neurological deficit
T
| Hypoglycemia can present with virtually any neurological deficit
44
Temperature range, mental status, shivers, heart rate, respiratory rate in patient with moderate hypothermia
Moderate hypothermia is associated with temperatures of 28-32 C. Shivering ceases at about 32 degrees Celsius. Moderate hypothermia is associated with altered mental status, absence of shivering, bradycardia, and bradypnea.
45
Manage frostbitten extremity
| expected symptoms
Immersion of the affected extremity is the mainstay of treatment for patients with frostbite. Numbness of the affected area is the most common initial symptom and severe pain is frequently encountered after rewarming. Tetanus prophylaxis and debridement is indicated , but is not the most appropriate initial step in the management of patients with frostbite
46
TF Free T4 and TSH levels are typically low in secondary and tertiary hypothyroidism
TF Free thyroxine (T4) is always depressed in hypothyroid states.
TF Serum thyroid-stimulating hormone (TSH) is the most sensitive test to diagnose primary hypothyroidism
TF T3 level may be normal in hypothyroid states.
TF Total thyroxine levels may be normal due to elevated thyroxine-binding globulin (TBG) levels.
T Free T4 and TSH levels are typically low in secondary and tertiary hypothyroidism.
F Free thyroxine (T4) is NOT always depressed in hypothyroid states... Free T4 may be normal in early stages of hypothyroidism due to physiologic compensation from elevated TSH levels.
T Serum thyroid-stimulating hormone (TSH) is the most sensitive test to diagnose primary hypothyroidism
T T3 level may be normal in hypothyroid states.
T Total thyroxine levels may be normal due to elevated thyroxine-binding globulin (TBG) levels.
47
How does hypothyroidism affect glucose sodium cholesterol blood count acid/base status?
Hyperglycemia is not typically associated with hypothyroidism. Hypoglycemia may be present, but is unusual, and may suggest hypothalamic-pituitary involvement. Hyponatremia is common and corrects with thyroid replacement. Hypercholesterolemia to over 250 mg/dL is typical. A mild normochromic, normocytic anemia may be present, in addition to respiratory acidosis from hypoventilation.
48
Azotemia is...
Azotemia is an elevation of blood urea nitrogen (BUN) and serum creatinine levels. The reference range for BUN is 8-20 mg/dL, and the normal range for serum creatinine is 0.7-1.4 mg/dL.
49
How does adrenal insufficiency affect K Na glucose calcium bun Cr hematocrit?
Hyperkalemia is seen in approximately 64% of patients with adrenal failure. Typically this is because of aldosterone production failure that normally enhances potassium excretion. Even more common is hyponatremia, present in 88% of patients. Hypoglycemia is present in two-thirds of patients and is a significant cause of morbidity and mortality associated with adrenal failure. Hypercalcemia is seen in 6 to 33% for unclear reasons; azotemia (elevated BUN and Cr) and increased hematocrit from hypovolemia may also be present.
50
Manage suspected adrenal insufficiency
Dexamthasone is the treatment of choice in suspected but not confirmed adrenal insufficiency. It will not affect the serum cortisol level; therefore, it will not interfere with the diagnosis of adrenal insufficiency using the ACTH stimulation test. Administering cosyntropin, a synthetic form of ACTH, and measuring the serum cortisol levels typically perform the ACTH stimulation test. In confirmed adrenal insufficiency, hydrocortisone IV or cortisone IM are the treatments of choice.
51
How does secondary adrenal insufficiency affect... weight strength appetite skin pigmentation
Weight loss, weakness, anorexia and nausea and vomiting, normal skin pigmentation:
Hyperpigmentation is seen in greater than 90% of Primary adrenal insufficiency. It is a result of compensatory adrenocorticotropic hormone (ACTH) and melanocyte-stimulating hormone (MSH) secretion. The secretion is a feedback mechanism that is not activated in secondary adrenal insufficiency, for example, adrenal insufficiency from pituitary infarction or hypothalamic insufficiency.
52
Hyperpigmentation is seen in greater than 90% of ____ adrenal insufficiency. It is a result of compensatory ____ and ____ secretion
Hyperpigmentation is seen in greater than 90% of Primary adrenal insufficiency. It is a result of compensatory adrenocorticotropic hormone (ACTH) and melanocyte-stimulating hormone (MSH) secretion
53
4 contraindications to hyperbaric oxygen therapy
Untreated pneumothorax is an absolute contraindication to HBO therapy. The reason is concern that it can progress to tension pneumothorax, especially during the decompression phase of therapy..... The COPD patient with a large bleb represents a relative contraindication for similar reasons..... Treatment with doxorubicin, and many other drugs -- such as cisplatin (Cisplatinum®), bleomycin (Blenoxane®), disulfiram (Antabuse®), and mafenide acetate (Sulfamylon®) -- contraindicates HBO therapy because of potentially toxic effects when combined with HBO..... URI illnesses such as otitis media are relative contraindications, due to the potential for tympanic membrane rupture secondary to inability of the ears to equalize pressure during therapy. This can be addressed through myringotomy with placement of tubes (in cases where multiple HBO treatments are anticipated).
54
TF
| Pregnancy contraindicates hyperbaric oxygen therapy
F
In pregnant patients, HBO therapy has been shown to be safe for the fetus when given at appropriate levels and “doses” (durations). In fact, pregnancy lowers the threshold for HBO treatment of carbon monoxide-exposed pregnant patients. This is due to the high affinity of fetal hemoglobin for CO.
55
6 indications for hyperbaric oxygen therapy... necrotizing enterocolitis?
```
carbon monoxide poisoning
decompression sickness
air or gas embolism
crush injury
compartment syndrome
necrotizing fasciitis NEC FAC
```
Not necrotizing enterocolitis
56
advise/manage a novice mountain climber suffering from mild but worsening headache and nausea. Can he go on climbing with some medications?
The syndrome of high altitude illness ranges from mild AMS (Acute Mountain Sickness) to life threatening conditions of HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema). This patient is experiencing mild AMS. After the symptoms of altitude illness occur, further ascent to a higher sleeping altitude is contraindicated. Halting ascent or activity to allow further acclimatization may reverse symptoms..... Acetazolamide is a carbonic anhhydrase inhibitor that induces a renal bicarbonate diuresis, causing a metabolic acidosis and thereby increasing ventilation and arterial oxygenation..... Supplemental oxygen addresses the hypoxic insult of high altitude exposure..... Ibuprofen is useful for the treatment of his headache..... Dexamethasone can help with the symptoms of AMS, but does not play a role in acclimatization.
57
Which endocrine abnormality is the most likely cause of a-fib
How to treat a-fib... pace?
Hyperthyroidism can cause a-fib
AF’s many treatment options include calcium channel blockers, beta blockers, amiodarone, quinidine, and cardioversion. Pacing is not a treatment option.
58
Thyroid storm... straightforward dx? Can it be diagnosed in the absence of tered mental status? When to start treatment? How to screen?
diagnosis of thyroid storm in the emergency department may be challenging due to the relatively infrequent occurrence of the disease and its typically nonspecific signs and symptoms.... may be mistaken for psychiatric illness, heat stroke, sympathomimetic toxidromes, hypoglycemia and withdrawal syndromes, among others..... Altered mental status, though frequently present, is not a prerequisite for diagnosis..... Treatment should be initiated in a timely fashion in any patient suspected of having thyroid storm due to the potential lethality of this disease...... Immediate laboratory testing is typically not available to confirm clinically suspected cases, although thyroxine (T4) radioimmunoassay and free T4 index are good screening tests for hyperthyroidism.
59
Symptoms of thyrotoxicosis
Fever, nervousness, weight loss, thyrotoxic stare, thyromegaly, palpitations, tachycardia, congestive heart failure, wide pulse pressure, tremor
60
How to give iodine for thyroid storm
Iodine inhibits preformed thyroid hormone release and should be administered at least one hour after treatment with PTU to prevent organification of iodine. A typical dose is potassium iodide (SSKI) 5 drops every 6 hours PO or NG, or sodium iodide 1 gm slow IV drip every 8 to 12 hours. Iodine should not be administered to patients with known iodine allergy.
61
Common components of supportive treatment of thyroid storm... amiodarone for afib? aspirin for antipyrexia?
```
oxygen
corticosteriods
acetaminophen to manage hyperpyrexia
diuretics to treat congestive heart failure
propanolol
```
Not amiodarone... amiodarone is an iodine-rich antidysrhythmic with poorly-defined effects on thyroid function that has been associated with both hyperthyroidism and hypothyroidism. It should therefore be avoided in the management of thyroid disease. Propranolol is standard therapy in thyroid storm and, in addition to its effects of adrenergic blockade, also may reduce dysrhythmias..... Of note, aspirin should be avoided in the treatment of hyperpyrexia as it may increase the level of active thyroid hormone by displacing thyroid hormone from thyroglobulin.
62
Symptoms of Scorpion envenomnation... who is most affected... treatment...prognosis...
Most scorpion envenomations are mild, limited to pain and paresthesias at the site of envenomation. Children are affected more severely than adults: restlessness, jerking movements of the limbs, roving eye movements, and drooling are seen in severe cases. Anaphylaxis can also occur..... Intubation is required rarely..... Most envenomations require analgesics only; ..... antivenom is indicated for severe reactions and anaphylaxis. Antivenom treatment is not without complications – serum sickness, and immediate and delayed hypersensitivity reactions occur..... Without antivenom treatment, symptoms usually last for 1-2 days.
63
```
Scorpion sting
Symptoms
Systemic toxicity?
Puncture wound?
Treatment mainstay, antivenom?
```
Although there are many toxic species of scorpions in the world, and all can sting humans, only a few cause serious toxicity. In the United States, only Centruroides exilicauda is capable of causing systemic toxicity. The sting is followed immediately by localized pain and paresthesias, and these can progress to involve the entire extremity or body. Systemic symptoms are unusual in adults, but more common and severe in children. Evidence of a sting, such as a puncture wound is almost never seen on exam. The mainstay of treatment is analgesia. Although antivenom is very effective in alleviating symptoms, both immediate and delayed allergic reactions occur with its use. Routine use of antivenom is not indicated, as most symptoms usually resolve in 1-2 days.
64
Treat snakebite
Observe 8 hours, antivenom if symptoms arise...
patient is unlikely to suffer envenomation if he does not have any local or systemic symptoms in 8 hours. The dosage of antivenom is dependent on the degree of symptoms and children receive a proportionately higher dose compared to adults. Prophylactic antibiotics are not recommended
65
Define heat stroke
Symptoms
Treatment
Complications
Heat stroke is a life-threatening illness defined clinically as a core body temperature that rises above 40.5 degrees Celsius and is usually accompanied by hot, dry skin (though in some cases sweating may be present) and central nervous system abnormalities such as delirium, convulsions, and coma. Treatment goals include lowering the core temperature to < 39.4 degrees Celsius by promoting cooling through conduction and evaporation and treating the complications that might arise with heat stroke, including seizures, respiratory failure, hypotension, rhabdomyolysis, and multi-organ dysfunction syndrome
66
Treat severe hypothermia with afib amd diminished mental capacity
Atrial dysrhythmias are common below 32 C and are associated with a slow ventricular response. It usually Converts Spontaneously with ReWarming.... active rewarming techniques (active external – Bair Hugger, AVA rewarming, immersion, active core – peritoneal lavage), the best answer for someone with severe hypothermia with mental status change and cardiac dysrhythmias is probably active core rewarming. This technique minimizes rewarming collapse in patients with temperatures below 32o C..... The patient will likely need IntuBation as ileus, bronchorrhea, and depressed protective airway reflexes are common with hypothermia.
67
```
Lightning strike, expect....
Asystole?
Respiratory arrest?
GCS of 3?
Extensive burns?
```
Lightning often causes “short-circuiting” of electrical systems such as heart, respiratory centers, and central and autonomic nervous systems, in addition to arterial and muscular spasm. However, significant skin burns and deep tissue destruction seldom occur.
68
Causes of false positive and false negative guaoac tests
Red fruits or meats, methylene blue, chlorophyll, iodide, cupric sulfate and bromide preparations can cause a false positive guaiac test. A false negative guaiac test can be caused by bile or ingestion of magnesium-containing antacids or ascorbic acid. Red Jell-O, tomato sauce, wine, iron therapy and Pepto-Bismol may cause the stool to look bloody when it is not.
69
Thumbprinting sign on abdominal xr suggests
Thumbprinting represents local areas of swelling in the bowel mucosa caused by submucosal edema and hemorrhage and suggests ischemic colitis.
Aka Thumbprinting is a radiographic sign of large bowel wall thickening, usually caused by oedema, related to an infective or inflammatory process (colitis). The normal haustra become thickened at regular intervals appearing like thumbprints projecting into the aerated lumen.
70
Most common cause of intrinsic lower gi bleed in adult is...
In how many adults is no cause found
Diverticulosis and angiodysplasia account for 80% of lower GI bleeds. In approximately 10% of all patients with GI bleeding, no source of bleeding will be found.
71
Define angiodysplasia and it’s clinical significance
angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently involve the cecum or ascending colon, although they can occur at other places.
72
6 most common causes of upper gib in adults
The most common causes of upper GI bleeding are (in descending order of frequency): PUD, gastric erosions, varices, Mallory-Weiss tears, esophagitis, and duodenitis.
73
Mortality of upper gib vs lower gib
Most common cause of upper gib in adults vs kids
Bleed once, next bleed usually from same spot?
In general, however, the mortality of upper gastrointestinal bleeding is higher than lower gastrointestinal bleeding.... In adults, the most common cause of upper gastrointestinal bleeding is peptic ulcer disease. In children, it is esophagitis. Unfortunately..... it can be difficult to diagnose the source of gastrointestinal bleeding as the bleeding may often stop and start spontaneously or from different sites
74
TF
| Majority of bleeding from diverticula cones from the right colon
T
| Majority of bleeding from diverticula cones from the right colon
75
Manage gi bleed with unstable pulse and heart rate
Urgent first steps in management include placement of two intravenous lines that are larger-bore than 22-gauge (18 gauge or larger size preferred) to enable rapid volume resuscitation, in addition to the oxygen, monitoring, intravenous fluids and preparation of blood products. Patients with an upper GI bleed who remain hemodynamically unstable require urgent consultation with gastroenterology.
76
Most common cause of lowet gi bleed
Diverticulosis is the most common cause of lower GI bleeding. Angiodysplasia is the more common in young people
77
Difference in history for common causes of lower gi bleed fissure hemorrhoid cancer
Sudden sharp pain after defecation along with blood on toilet tissue characterizes anal fissures. A thrombosed external hemorrhoid causes painful bleeding on defecation. Usually there is a history of external hemorrhoids and associated itching, swelling, and mucoid drainage. Internal hemorrhoids usually exhibit painless bleeding that may drip into the toilet after defecation. Rectal cancers also have painless bleeding but usually are associated with a change in bowel movement character and other signs and symptoms of malignancy.
78
```
Which of the following bacteria does NOT produce bloody diarrhea?
Clostridium perfringens
Campylobacter enteritis
Yersinia enterocolitica
Escherichia coli 0157
```
Clostridium perfringens is the most common cause of food poisoning in the United States. Patients ingest heat-resistant spores of C. pergringens which produce an enterotoxin in the GI tract. Campylobacter, E. coli 0157, Salmonella and Yersinia are all invasive bacteria that can cause bloody enteritis.
79
Define and manage acute myocardial infarction
AMI is defined when two of the following three findings are present: clinical history of chest pain of at least 20 minutes duration, EKG changes and/or positive myocardial enzyme testing.....This patient needs immediate thrombolytic therapy or cardiac catheterization; if percutaneous coronary intervention (PCI) can be achieved within 90-120 minutes of emergency department arrival, the literature supports its selection over thrombolytic therapy as primary intervention. In preparation for either thrombolytic therapy or PCI, you need to control her pain, maximize O2 delivery, decrease work of the heart and inhibit platelet function. O2, nitroglycerin and morphine will increase O2 delivery to the heart. A beta blocker, which should also be administered to AMI patients who lack contraindications, will decrease the work of the heart, and aspirin will inhibit platelets. A glycoprotein IIb/IIIa-inhibitor should also be administered – selections will depend on the exact treatment course chosen for the patient. Anticoagulation with low molecular weight heparin or unfractionated heparin (dose being dependent on exact treatment course for patient) should be started if there are no patient historical or chest X-ray findings suggestive of aortic dissection.
80
Indications for fibrinolytic therapy for acute myocardial infarction
Fibrinolytic therapy is indicated for patients with STEMI (as a reperfusion option) if time to treatment is <6 to 12 hours from symptom onset, and the ECG has at least 1-mm ST-segment elevation in two or more contiguous leads
81
When is nitroglycerin contraindicated for acute myocardial infarction, how to confirm
—Nitrate-induced hypotension is also suggestive of right ventricular infarction, and of tamponade. Initial therapy for both would include volume loading and avoidance of vasodilators or other agents that may lower the blood pressure.”
—
82
Manage angina symptoms with preexisting preexisting or new bi or trifascicular bundle branch block
In the face of an AMI, the risks of complete heart block are much greater when new or preexisting bi- or trifascicular conduction blocks are present. In this setting, prophylactic placement of a ventricular demand Pacemaker is indicated
83
Localize STEMI
The LAD supplies the anterior wall of the myocardium. The left circumflex artery, the LAD, or a branch of the RCA supplies the lateral wall of the left ventricle. Proximal occlusion of the LAD will give ST elevation in leads V1-6, aVL and I (an anterolateral MI). Occlusion of a branch of the RCA will result in an inferolateral MI (ST elevation in leads II, III, aVF and I, aVL, V5 and V6). The RCA supplies the inferior wall and SA node. Occlusion in leads II, III and aVF causes an inferior MI. The right ventricle is usually supplied by the RCA or, less commonly, a dominant left circumflex. ST elevation in leads V4 and V5 of a right-side leads EKG suggests infarction of the right ventricle. A posterior MI (ST depression in V1-V3) results from occlusion of the RCA, its posterior descending branch, or a dominant left circumflex.
84
CT or aortogram to confirm suspected aortic dissection
CT of the chest is the test most often used to confirm the diagnosis of aortic dissection. CT is readily available in most Emergency Departments, and has a sensitivity of 83-98% and specificity of 87-100% for aortic dissection (highest accuracy with helical scans). Other benefits associated with the use of CT include the ability to identify intramural thrombus, pericardial effusion, and potentially reveal another etiology for the patient's pain. The major disadvantage of CT is the need for iodinated contrast, which requires normal renal function.
85
Once aortic dissection is suspected the physician should plan for early cardiothoracic surgery consultation; additionally, which of the following is the best next step?
Start IV beta blocker to decrease shearing forces on the aorta and IV sodium nitroprusside to lower blood pressure.
86
Management of aortic dissection
Principles
Pharm... nitroglycerin? Aspirin? Morphine?
Imaging... MRI?
When a patient has an aortic dissection, it is important to decrease further dissection (i.e. extension of the vascular tear) by reducing shearing forces on the aorta using negative inotropes (beta blockers) and to control hypertension. Sodium nitroprusside is often used for blood pressure control in dissections as it is an easily titratable antihypertensive. Because sodium nitroprusside increases heart rate and may increase shearing forces, a beta blocker should be started before (or concurrently with) it. The effects of nitroglycerin are not easily titratable, making it a less desirable drug for blood pressure control. Aspirin should be avoided, as it may increase bleeding complications. Morphine may be used for pain control and to decrease sympathetic tone. Imaging decisions surrounding aortic dissection are complex bit think cxr and CT unless contraindicated..?, incorporating such factors as patient safety (e.g. transport to imaging areas, administration of dye loads) and need for assessment of nonaortic structures (e.g. pericardial space) and functional anatomy (e.g. valvular regurgitation). As a general rule, MRI is not emergently available and lacks sufficient monitoring capabilities for a patient with suspected acute aortic dissection (MRI is useful for long-term, outpatient monitoring of dissection in most centers).
87
Dressler’s syndrome
5 criteria
Etiology
Treatment
Dressler’s syndrome is fever, pleuritis, leukocytosis, pericardial friction rub, and evidence of pericarditis or pleural effusion occurring several weeks after MI. It is thought to be autoimmune in nature and is treated with NSAIDs
88
Pheochromocytoma is treated with...
Phentolamine
| a1 blocker
89
Diurese pregnant patient with hypertension?
Patients with pregnancy induced hypertension have a decreased intravascular volume, despite the edema
90
Hypertensive emergency aka
malignant hypertension (also known as hypertensive emergency or hypertensive crisis)
91
Why not diagnose new-onset htn based on ed measurements
The "white-coat" syndrome, in which patients' blood pressures are elevated only in the clinical setting and not at home, has been shown to account for as many as a fifth of all cases of newly diagnosed "hypertension." Understanding of this phenomenom is important for emergency physicians, since its frequency explains why patients should not be given a diagnosis of new-onset hypertension based on E.D. measurements.
92
Best medication to treat cocaine induced angina with STE’s... beta block? Lidocaine? Nitroglycerin?
Lorazepam
In a patient with suspected myocardial ischemia secondary to cocaine abuse, beta blockade is probably contraindicated as it may lead to uncontrolled alpha-agonism and could cause worsening hypertension (this notion continues to be debated). Lidocaine is contraindicated and the use of nitroglycerin is controversial.
93
5 causes of pneumomediastinum
Hamman sign
Westermark sign
Pneumomediastinum and pneumopericardium result from Valsalva maneuvers, barotrauma, inhalation from positive pressure devices, asthma, and cocaine. On physical exam there may be a Hamman’s sign or mediastinal crunch heard over the precordium. Westermark’s sign is dilation of pulmonary vessels proximal to a pulmonary embolism resulting in a cut-off appearance of the vessel on CXR.
94
CV Neuro GI and MSK sequela of cocaine intoxication
Cocaine toxicity can cause a variety of cardiovascular sequelae including: cardiac dysrhythmias, coronary artery vasospasm, myocardial
ischemia/infarction, and aortic dissection. The central nervous system is also
commonly involved with seizures, intracranial hemorrhages/infarctions and
hypertensive encephalopathy being common. Mesenteric ischemia can occur as well
as rhabdomyolysis.
95
3 ways to confirm diagnosis of PE in patient with convincing history
First step lower extremity ultrasound?
The diagnosis is made: (1) if DVT is demonstrated by duplex US, venography, CT, MRI or some other technique; (2) if V/Q scan is convincingly positive; or (3) if pulmonary angiography, spiral CT, or another convincing test is positive
Straight to Chest CT if history convincing skip LE doppler
96
TIA history is a risk (__%/year) for ____ stroke, the result of ____
Consequently, consider ____ to reduce risk
TIAs are associated with increased risk for thrombotic strokes, the result of ulceration of cerebral artery plaque. Patients with TIA have a 5 to 6% percent chance per year of having a stroke. Antiplatelet therapy reduces risk of stroke in these patients.
97
Suspicion for subarachnoid hemorrhage is high but noncon head CT is negative, next step?
Sensitivity of noncon head ct for subarachnoid hemorrhage?
Sudden onset headache with nausea, vomiting, photophobia, or neck stiffness should raise the concern for spontaneous subarachnoid hemorrhage. Sensitivity of a non-contrast CT scan varies with respect to many factors (e.g. time since bleed) but is generally in the range of 90%; therefore, if the clinical suspicion is high, a lumbar puncture should be performed and a cell count for red blood cells done.
98
Epidural hematoma:
- Present in __% of severe head injury patients
- Most often a result of a ____ that traverses a ____
- ____blood collection between the ____ and ____
- Immediate ____ is indicated
- Classically associated with a ____ interval prior to ____
Epidural hematoma:
- Present in only about 1% of severe head injury patients
- Most often a result of a skull fracture that traverses a middle meningeal artery
- Biconvex blood collection between the skull and dura
- Immediate surgical evacuation is indicated
- Classically associated with a “lucid” interval prior to coma
99
Epidural hematomas are least likely in what age group, why
Epidural hematoma (EDH) is less likely in children and elderly because of the close attachment of the dura to the periostium of the skull. This is especially true of children less than 2 years because of the added elasticity of the skull.
100
Hemotympanum refers to....
It is often the result of...
Hemotympanum, or hematotympanum, refers to the presence of blood in the tympanic cavity of the middle ear. Hemotympanum is often the result of basilar skull fracture.
101
```
epidural hematomas:
Severe headache?
Neurologic deficits?
Nausea?
Sleepiness?
Hemotympanum?
```
```
epidural hematomas:
Severe headache? Yep
Neurologic deficits? Yep
Nausea? Yep
Sleepiness? Yep
Hemotympanum? Nope - basilar skill fracture not epidural hematoma so much... but possible...
```
102
Which of the following are potential complications of bacterial meningitis?Seizure disorder
Focal paralysis or sensory loss
Intellectual impairment
Sensorineural hearing loss
Which of the following are potential complications of bacterial meningitis?Seizure disorder
Focal paralysis or sensory loss
Intellectual impairment
Sensorineural hearing loss
All of them
103
LP:
- In the adult and older pediatric population, lumbar punctures may be performed as high as the ____ interspace and as low as the ____ interspace.
- Positioning consists of.... neck flexion?
- The subarachnoid space extends to the __ vertebral level.
- In locating the puncture site, a line connecting the posterior superior iliac crests will intersect the midline at approximately __.
LP:
- In the adult and older pediatric population, lumbar punctures may be performed as high as the L2/L3 interspace and as low as the L5/S1 interspace.
- Positioning consists of.... lateral recumbent position but an LP may be performed in the upright seated position.... Flexion of the neck does not facilitate the LP to any great extent and may add to a patient’s discomfort as well as compromise the unconscious patient’s airway.
- The subarachnoid space extends to the S2 vertebral level.
- Patients are positioned in lateral recumbent position with their lower back arched toward the physician.
- In locating the puncture site, a line connecting the posterior superior iliac crests will intersect the midline at approximately L4.
104
pure loss of unilateral motor function without disturbances in other neurological modalities (e.g. no other cortical findings such as aphasia, agnosia, or hemianopsia) suggests what type of stoke where...
...what are risk factors
lacunar infarct in the internal capsule
suggested by pure loss of unilateral motor function without disturbances in other neurological modalities (e.g. no other cortical findings such as aphasia, agnosia, or hemianopsia)
risk factors include dm htn and afam
105
agnosia means
agnosia means inability to interpret sensory information
106
manage college student presenting with very likely meningitis
centriaxone IV (maybe with vanc depending on resistance profile of region and likely etiologic agents)
early abx is important, don't delay for diagnostic tests (CT, LP)
107
regarding Bell's palsy:
inability to wrinkle the forehead indicates a ___ lesion of the facial nerve, making ___ much less likely. __ of bell's palsy patients present with ___ pain around the time of onset. ___ is a well-known cause of facial nerve palsy and should be worked up if they live/visited in an endemic region. moss neurologists recommend a short course of ___ as part of treatment. There is evidence that ___ is involved as a causative agent and ___ is recommended.
inability to wrinkle the forehead indicates a Peripheral lesion of the facial nerve, making Stroke much less likely. Half of bell's palsy patients present with Retroauricular pain around the time of onset. Lyme Disease is a well-known cause of facial nerve palsy and should be worked up if they live/visited in an endemic region. moss neurologists recommend a short course of Prednisone as part of treatment. There is evidence that HSV is involved as a causative agent and Acyclovir is recommended.
108
Central vertigo, such as that from MS or stroke, is or is not? associated with acute hearing loss... why
Central vertigo, such as that from MS or stroke, is Not associated with acute hearing loss because of the Distributed nature of the CN VIII nuclei
109
vestibular neuronitis vs labyrinthitis -- associated with sensorineural hearing loss? Vertigo?
vestibular neuronitis is Not associated with hearing loss even though it involves inflammation of CN VIII
labyrinthitis Can result in sensorineural hearing loss (inflammation of inner ear structures)
Both can cause Vertigo...
110
TF
| some horizontal nystagmus on extreme lateral gaze can be a normal finding
T
| some horizontal nystagmus on extreme lateral gaze can be a normal finding
111
which is more suggestive of central rather than peripheral vertigo -- sudden onset or diplopia?
Diplopia is more suggestive of central vertigo -- any cranial nerve deficit should raise suspicion for a central process as an etiology of vertigo
112
BPPV is caused by ___, usually from ___, and can be treated wth ___ because.... or ___ because...
BPPV is caused by Vestibular Stimulation, usually from loose Debris in the Semicircular Canals, and can be treated wth Benzodiazepines (Diazepam) because of their Sedative effects on the Limbic system, Thalamus, and Hypothalamus or Anticholinergics (Meclizine, Diphenhydramine, Promethazine) because Vestibular Neurons are edited by Acetylcholine
113
4 big risk factors for spinal epidural abscess
| what bugs should abx cover
4 big risk factors for spinal epidural abscess
-IVDU DM CKD immunosuppresion
abx should cover staph aureus (most common), GNRs, anaerobes
114
outcomes for spinal epidural abscess depend on...
outcomes for spinal epidural abscess depend on Speed of diagnosis and Surgical decompression -- it is a neurosurgical emergency requiring URGENT neurosurgical evaluation
115
diagnosis of myasthenia gravis is made with the ___, where ___ is given and symptoms are observed to ___
Cooling ___ symptoms and heat ___ them
diagnosis of myasthenia gravis is made with the Tension Test, where Edrophonium is given and symptoms are observed to Transiently Improve
cooling Improves mg symptoms and heat Exacerbates them
116
speed of onset of action of nitroprusside
what complication can long term nitroprusside treatment lead to, especially in which patients... why might it be a risk in patient with history of long-term cyclosporine treatment
nitroprusside has Extremely Rapid onset of action
long term nitroprusside can lead to Cyanide toxicity (an intermediate metabolite), especially in Renal Failure patients... Cyclosporine can cause renal insufficiency...
117
define hypertensive urgency and emergency
| what is the goal of therapy
^210/140 is urgency
with end organ symptoms is emergency
goal is reduce MAP by 10-25% in first hour, alleviating symptoms while not compromising cerebral perfusion
118
other than hypoxia hypoglycemia toxic ingestion and head trauma, what are 3 less common Medical cases of seizure/status epileptics
SCD SLE leukemia
| sickle cell disease lupus leukemia
119
what happens to pulse pressure in early shock
narrow pulse pressure in early shock, from increased sympathetic tone raising the diastolic.
120
which is first priority in shock, supplemental O2 or IVF
supplemental O2 first priority in shock, all patients in shock should get it first thing
121
how is epidemiology different in shock in children
how is reliability of signs and symptoms different
how is ability to maintain blood pressure different in kids
shock in children usually caused by trauma and infections
signs and symptoms less reliable so physical exam less reliable
kids can maintain blood pressure better than adults in shock
122
4 classes of hypovolemic shock
| in general, blood pressure does not drop until approximately __% of blood volume is lost
```
I 0-15% blood loss
II 15-30%
III 30-40%
IV ^40%
in general, blood pressure does not drop until approximately 30% of blood volume is lost
```
123
best IV access for volume resuscitation in hypovolemic patient is:
triple lumen internal jugular? PICC?
14g to 16g antecubital catheter (large and short catheter in a large or central vein)
triple lumens and PICCs are long and thin with more resistance to flow
124
why is D5W a poor choice for volume resuscitation
D5W is hypotonic, isotonic fluids are preferred for volume resuscitation (NS LR albumin blood)
125
As a general rule, when is blood transfusion indicated in the treatment of hypovolemic shock resulting from acute hemorrhage?
after 1L crystalloid bolus?
Blood transfusion is indicated for Massive hemorrhage ^30% blood loss or shock that is Not Responsive to significant crystalloid infusion (2L or 30ml/kg).... and Elderly patients or those with Co-morbid illnesses may require blood products earlier than healthy adults
126
TF
| pressors are indicated for hypovolemic shock
F
| pressers are NOT indicated for hypovolemic shock
127
O negative blood is reserved for...
| acute massive hemorrhage without time to wait for a type or cross?
O negative blood is reserved for Women of Childbearing Age
| can give O Positive blood for massive hemorrhage without time to wait for type or cross
128
```
cariogenic shock
goals of therapy
agent of choice
temporizing procedure
pressors?
```
cariogenic shock
- oxygenation, limit ischemia, improve pump, decrease after load are goals of therapy
- Dobutamine is agent of choice
- Intra-Aortic Baloon pump is temporizing procedure
- no pressors, contraindicated, don't want afterload up
129
treat anaphylactic shock in order of priority of agents
epinephrine
steroids
diphenhydramine (antihistamine)
130
when MIGHT epinephrine not be the best initial treatment of anaphylaxis
if coronary artery disease is a Major concern you MIGHT consider avoiding epinephrine for anaphylaxis
131
spine injury leading to vasodilation and hypotension without the expected tachycardic response is called ____, produced by ____, is a type of ____ like ____ and treated with a ___ agent like ___ if severe, otherwise just treat with ___ ___ ___
spine injury leading to vasodilation and hypotension without the expected tachycardic response is called Neurogenic Shock, produced by Autonomic nervous system disruption, is a type of Distributive Shock like Anaphylactic Shock and treated with a Pressor agent like Phenylephrine if severe, otherwise just High Dose Steroids, IVF, Immobilization.
132
define neurogenic shock
common cause
it is a subclassifications of ___ shock
treated with
neurogenic shock is Autonomic nervous system disruption leading to vasodilation and hypotension without the expected tachycardia response
e.g. from Spine injury
a type of Distributive Shock like Anaphylactic Shock and treated with a Pressor agent like Phenylephrine if severe, otherwise just High Dose Steroids, IVF, Immobilization.
133
blood transfusion for neurogenic shock?
blood transfusion generally not indicated for shock, care to avoid fluid overload
neurogenic shock is a type of Distributive Shock like Anaphylactic Shock and treated with a Pressor agent like Phenylephrine if severe, otherwise just High Dose Steroids, IVF, Immobilization.
134
treat cardiac tamponade
treat cardiac tamponade with
| emergent decompression with pericardiocentesis or pericardial window
135
TF
give steroids for septic abortion if patient is in shock because it is a distributive shock like anaphylaxis
TF get labs
basically how to treat septic abortion
F
DON'T give steroids for septic abortion (distributive but SEPTIC not anaphylactic like)... steroids can worsen infection
give broad spectrum abx, IVF, emergent ob/gyn consult and transport to OR,
T get labs - BMP CBC coags DIC panel serum pregnancy test blood cultures
136
college student with mild URTI last week presents now toxic with fever headache and non-blanching purple spotted petechial rash... most likely diagnosis?
meningococcemia
137
what happens to cardiac index in septic shock
PCWP pulmonary capillary wedge pressure?
body temp?
cardiac index decreases in septic shock
(CI is CO/TBSA)
PCWP normal or low
hyper or hypothermia... not usually normothermia
138
what happens to body temperature in septic shock
hyper or hypothermia... not usually normothermia
139
why do SVR systemic vascular resistance and CI cardiac index decrease in septic shock?
because endotoxins
140
TF
| all types of shock states are associated with decreased urine output
T
| shock defined as insufficient organ perfusion
141
4 common bacterial causes of sepsis
e coli
staph aureus
pseudomonas aeruginosa
streptococcus pneumoniae
142
```
TF
PE is a complication of shock
DIC
ARDS
ATN
CHF?
```
F not PE, not a complication of shock
T DIC ARDS ATN CHF all complications of shock
143
body temperature upper limit of normal
100.4 F or 38 C is upper limit of normal body temp
(though some clinicians have told me 99-100.4 is a "low grade fever...")....
144
manage a fever in neonate v30 days old
| v90 days old?
BCx UCx LP then Amp and Gent for any fever (^100.4) in a child less than 30 days old... can be a marker for bacteremia, sepsis, meningitis, and clinical findings are notoriously unreliable
v90 days controversial but some proceed same as above
145
4 ekg findings of classic wolf-parkinson-white syndrome
tachycardia, short P-R v0.12s, QRS ^0.10s, slurred upstroke to QRS (delta wave)... maybe symptoms like syncope
146
3rd degree heart block requires...
pacing
| 3rd degree heart block requires pacing
147
first priority in afib with RVR if patient is stable
pharmacologic rate control
| is first priority in afib with RVR if patient is stable
148
___ is the drug of choice for acute termination of AVNRT av nodal reentrant tachycardia e.g. regular narrow-complex SVT.... how effective is it
Adenosine, a purinergic blocking agent that causes Acute and Transient AV nodal Blockade,
is the drug of choice for acute termination of AVNRT av nodal reentrant tachycardia e.g. regular narrow-complex SVT.... adenosine is nearly 100% effective in terminating AVNRT
149
best treatment for AV block Moritz type II is...
pacing
best treatment for AV block Moritz type II is pacing.
because bradycardic refractory to atropine and easily degrades to complete heart block
150
what is wide complex tachycardia
| how to treat
SVT with aberrancy
or VTach
treat SVT with vagal maneuver or adenosine if stable, cardioversion if unstable
treat as VT if any uncertainty (immediate defibrillation)
151
treat narrow complex tachycardia aka ____
treat narrow complex tachycardia aka SVT
- treat SVT with vagal maneuver or adenosine if stable, cardioversion if unstable
- treat as VT if any uncertainty (immediate defibrillation)
152
ventricular rate in uncomplicated afib
120-180 ventricular rate in uncomplicated afib
153
are AFib waves fine or coarse
either
| AFib waves are either fine or coarse
154
1 physiologic and 3 common pharmacologic causes of 2nd degree AV mobitz II block
increased vagal tone
| dig cab bb
155
frequency of atrial rate in AFlutter
| ventricular rate?
~300 atrial rate in AFlutter
| ventricular rate may be predictable 2:1 or 3:1, than can tell 150 or 100 rate... but may also be variable
156
RBBB is characterized by what 3 EKG findings
RBBB ekg findings
- prolonged QRS
- terminal R wave in V1 (aka MandM sign rabbit ears RSR... anterior/precordial leads)
- slurred S wave in I and V6
