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Medicine > Cardio > Flashcards

Cardio Flashcards

1
Q

T/F

PACs/ APBs (premature atrial contract = atrial premature beat) is a benign arrhythmia

A 
T
usually asymptomatic
can cause palpitations
occasionally  --) afib
tx when distress or svt
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2
Q

when to treat PAC/APB

A

(prem at comp / atr prem beat)
when cause distress or svt
(usually asymptomatic, benign)

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3
Q

what does cardiac echo eval for

A 
function (ef)
valvular abnorm
structural abnorm (wall thick/thin/motion)
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4
Q

how to manage pt w persistent asymptomatic PACs (prem atr contr)

A

B blockers (rate control)

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5
Q

cold mottled limb with minimal swelling and absent distal pulses w recent hx of mi think…

A

acute limb ischemia - from heart thrombus embolization (LV thrombus, la thrombus from a fib) or aortic ischemia
-dx test is echo to eval for wall thrombus

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6
Q

next dx test when acute limb ischemia suspected in pt w recent MI

A

echo
for wall thrombus that may have embolized
also immediate aticoagulation and sx eval

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7
Q

how long after therapy initiation to HIT

A

5-10 days usually

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8
Q

HIT makes prone to what kind of thrombus, V or A

A

venous thrombus

-warmth erythema tenderness swelling

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9
Q

which is warm and which is cold A vs V thrombus

A

arterial thrombus - acute limb ischemia, cold

venous thrombus - warm erythematous tedner swollen

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10
Q

chest sympx of PE

A

tachypnea
pleuritic chest pain
+ s & s of DVT

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11
Q

mgmt of acute limb ischemia after mi

A

immediate anticoag
sx eval
TTE (transthoracic echocardiogram)

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12
Q

when does variant/prinzmental angina typically occur

A

at night (midnight - 8am)

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13
Q

tx variant prinzmental angina

A

CCB (diltiazem)

or nitrates

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14
Q

transient STEs on EKG suggest

A

variant/prinzmental angina

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15
Q

T/F

can use BBlockers for variant/prinzmental angina

A

F

CI - can worsen vasospasm

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16
Q

T/F

can use ASA for variant/prinzmental angina

A

F

–| prostacyclin, can promote coronary vasospasm

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17
Q

T/F variant angina mgmt usually includes cholesterol lowering meds

A

F

variant/prinzmental angina often lacks cv risk factors (can manage cholesterol if coincidental elevation)

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18
Q

2 common uses of digoxin

A

inc contractility in CHF

rate control in afib or aflutter

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19
Q

T/F

heparin to treat uncomplicated variant angina (prinzmental

A

F

vasospasm not coagulability, no need for hep

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20
Q

immediate mgmt of STEMI

A

restore blood flow w PCI or fibrinolysis w/in 90 min of contact (or w/in 120 min if transport to capable hosp needed) – PCI better results

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21
Q

best tx for long term mortality in STEMI

A

restore blood flow w PCI or fibrinolysis w/in 90 min of contact (or w/in 120 min if transport to capable hosp needed) – PCI better results

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22
Q

T/F

in acute MI goal is reduce cardiac afterload

A

F
restore blood flow (PCI#1, fibriolysis) – nitrates reduce pain but no evidence of long term outcome improvement… BBs can reduce O2 demand but not recommended or proven good before PCI/fibrinolysis… can consider after if not brady already…. no goodness of prophylactic antiarrhythmics after MI…

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23
Q

secondary prevention in pt w known CAD

5

A
  • DAPT: ASA + P2y12 blocker (clopidogrel, prasugrel, ticagrelor)
  • BB
  • ACEI/ARB
  • statin
  • Aldo antag (spironoloactone, eplerenon) if HFrEF +- DM
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24
Q

clopidogrel
prasugrel
ticagrelor
=

A

p2y12 inhibitors

antiplatelet

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25
Q

typical uses of apixaban

A

nonvalvular afib
VTE
(direct factor Xa inhibitor, anticoag)

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26
Q

isosorbide mononitrate long or short acting nitrate?

A

long acting

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27
Q

when to use colchicine in context of MI

A

when postinfarction pericarditis (rub, chest pain)

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28
Q

uses of DAPT

A

dual antiplatelet theray (ASA + P2Y12 inhib [clopidogrel, prasugrel, ticagrelor])

  • nstemi - reduces recurrent MI
  • anti stent thrombosis (give for 12 mos)
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29
Q

how long DAPT for prevention of coronary stent thrombosis

A

at least 12 mos

recommended in all drug-eluting stent pts

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30
Q 
severe or resistent HTN
HTN onset v age 35
sudden ^ BP
^ Cr .5-1 after ACEI or ARB wo BP reduction
systolic epigastric bruit

50 yo F w any of above should be screened for __

A

fibromuscular dysplasia
-abnormal cell dev in arterial wall
(noninflammatory, nonatherosclerotic)

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31
Q

50 yo F w any 1 of these 5 characteristics should be screened for fibromuscular dysplasia

A 
severe or resistent HTN
HTN onset v age 35
sudden ^ BP
^ Cr .5-1 after ACEI or ARB wo BP reduction
systolic epigastric bruit
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32
Q

fibromuscular dysplasia

pathogenesis & presentation

A

abnormal cell dev in arterial wall
(noninflammatory, nonatherosclerotic)

  • resistant HTN (renal a stenosis)
  • amaurosis fugax [fleeting darkness - painless transient vision loss uni or bi], horner’s, TIA, stroke (brain ischemia - carotid or vertebral a)
  • non-specific HA, pulsatitle tinnitus, dizziness (also carotid or vertebral a)
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33
Q

amaurosis fugax =

A

fleeting darkness - painless transient vision loss uni or bi - e.g. from embolus, fibromuscular dysplasia

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34
Q

which arteries does FMD fibromuscular dysplasia usually affect

A

renal
carotid
vertebral

but can affect any

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35
Q

dx FMD

A

fibromuscular dysplasia

  • CTA
  • Duplex US
  • cath-based digital subtraction arteriography if above noninvasive not diagnostic
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36
Q

aldo/renin activity ratio in FMD

A 
~10 (v20)
fibromuscular dysplasia (secondary hyperaldosteronism)
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37
Q

aldo/renin activity ratio in primary hyperaldosteronism

A

> 20
because primary aldo suppresses renin
e.g. adrenal hyperplasia, adenoma

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38
Q

how to diff between adrenal hyperplasia vs adenoma as cause of primary hyperaldosteronism

A

adrenal vein sampling

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39
Q

cushingoid findings

A 
central obesity
purple striae
proximal muscle wasting
glucose intolerance
hypertension
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40
Q

1st test for GCA giant cell arteritis

A

ESR elevated

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41
Q

fever fatigue HA transient monocular vision loss jaw claudication =

A

presentation of GCA

giant cell arteritis

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42
Q

elevated plasma free metanephrines in this secondary cause of hypertension

A

pheochromocytoma

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43
Q

classic triad of
episodic headache, sweating, palpitations
w tachycardia =

A

presentation of pheochromocytoma

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44
Q

FMD fibromuscular dysplasia

classically presents in what demo

A

F age `15-50

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45
Q

low PCWP + high MvO2 =

A

septic shock

  • low pulm cap wedge press (peripheral vasodilation
  • high mixed venous O2 (less systemic vascular resistance, faster flows, inc cardiac output adds to effect, tissues pull out smaller proportion of O2)
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46
Q

go-to lab for differentiating CHF from other causes of dyspnea

A

proBNP

sns 90, sp 76, ppv 83

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47
Q

dressler syndrome

A

post MI pericarditis… usually 1-6 wks post MI

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48
Q

uremic pericarditis

A

pleuritic CP
pericardial friction rub
uremia

from ARF w uremia ^60
tx = dialysis

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49
Q

how to treat uremic pericarditis

A

dialysis

rapidly resolves chest pain and reduces size of pericardial effusion

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50
Q

how long after MI for dressler’s

A

1-6 wks

post-MI pericarditis

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51
Q

indications for pericardiocentesis

A

s&s of cardiac tamponade
-hypot, JVD, pulsus paradoxus

or diagnostic if pericardial effusion etiology unclear

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52
Q

ekg findings in uremic pericarditis

A

NOT classic pericarditis diffuse STEs

normal EKG i think…

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53
Q

this tx rapidly improves chest pain and decreases size of pericardial effusion in uremic pericarditis

A

dialysis

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54
Q

arrhythmia most specific for digitalis tox

A

a tach w AV block

  • inc ectopy in atria or ventricles - a tach
  • inc vagal stim - av block
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55
Q

diff a tach vs a flut

A

a tach 150-250 bpm

a flut 250-350 bpm

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56
Q

which is faster, a tach or a flut

A

a flut

a tach 150-250 bpm
a flut 250-350 bpm

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57
Q

a tach w av block most specific for this drug toxicity

A

digoxin

  • inc ectopy in atria or ventricles - a tach
  • inc vagal stim - av block
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58
Q

digoxin MOA

A 
blocks KKNaNaNa ATPase
in intra Na
dec exchange w Ca++
inc intra Ca++
inc contractility (positive inotropy)

also stim vagus (negative chronotropy)

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59
Q

t/f

digoxin tox causes atrial flutter

A 
false
a tach (ectopy)
av block (vagus stim)
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60
Q

t/f

digoxin tox causes a fib

A 
false
a tach (ectopy)
av block (vagus stim)
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61
Q

t/f

digitalis tox causes mobitz II av block

A

f
path of conduction system below av node does that

digoxin does
a tach (ectopy)
av block (vagus stim)
62
Q

t/f digitalis causes multifocal atrial tachy

A

f
think that implies shifting foci?…

digoxin does
a tach (ectopy... just one?)
av block (vagus stim)
63
Q

common causes of afib

A 
atrial volume delta (chf, diuresis)
adrenergic input (inf, stress, thyrotoxixosis)
pulm process (ra volume delta)
pe (check for dvt in afib)
e- abnorm
thyrotoxixosis/other drugs
64
Q

afib originates

aflut originates

A

fib pulm vein inlet ectopy

flut tricusp annulus reentrant

65
Q

how tx afib if hypotens

A

no bb or ccb (ok if normotense)

– dig, amio
digoxin amiodarone

66
Q

target rate control in afib to prevent…

A

v 110
to prevent tachy cardiomyopathy

anticoagulate to ppx thrombus, not rhythm control (m&m evidence not there)

67
Q

t/f

control rhythm to prevent clot in afib

A

f
anticoagulate
no m&m evidence for rhythm control

control rate v110 to prev tachy cardiomyopathy

68
Q

pt comes in to ED screaming ACS (acute coronary syndrome), what are you going to do

A

nitroglycerin (relieves spasm)
aspirin (stabilizes plaque)
oxygen if needed

trop, 12 lead EKG, call medicine and cards

then BB (reduce short term mortality)
and ACEI (reduce long term mortality if certain it is an MI

then maybe even heparin and clopidogrel

69
Q

CABG is reserved for

A

3-vessel disease or more
or
left main stem equivalent

70
Q

pt has single vessel STEMI, next step

A

angioplasty with drug-eluting stent
(requires one year clopidogrel)

consider bare metal stent (1 month clopidogrel) or angioplasty alone (no clopidogrel) if high risk of non-compliance with clopidogrel

71
Q

old guy with angina, JVD but clear lungs, and STEMI in leads II III aVF

think
act
avoid

A

R sided infarct

give IVMF because right-sided infarcts are preload dependent

avoid ntiroglycerin and morphine because they are venodilators and will make it worse

72
Q

outpatient with functionally impairing exertional angina but normal EKG, next step

A

treadmill ecg stress test

do when exertional angina with no ecg abnorms and can ambulate

73
Q

when to get dobutamine stress echo for outpatient exertional angina

A

if
baseline ecg abnorms, or
any contraindication to ambulation
(cane, amputee, etc.. not positive treadmill ecg stress test)

74
Q

times to get nuclear stress test for outpatient exertional angina

A

bundle branch block
poor view on echo
previous bypass

75
Q

when to get angiography for outpatient exertional angina

A

NSTEMI, STEMI, or positive stress test

76
Q

what test to get for outpatient exertional angina when

  • normal ecg and can walk
  • normal ecg can’t walk
  • bbb poor view on echo, previous bypass
  • angiography
A

normal ecg and can walk
-treadmill ecg stress test

normal ecg can’t walk
-dobutamine echo

bbb poor view on echo, previous bypass
-nuclear stress test

angiography
-NSTEMI, STEMI, positive stress test

77
Q

cardiac enzymes may take up to __ hours to peak so can only be considered negative after at least __ sets separated by __ hours or after __ hours of ongoing chest pain

A

cardiac enzymes may take up to 18 hours to peak so can only be considered negative after at least 2 sets separated by 6 hours or after 18 hours of ongoing chest pain

78
Q

elderly man with significant cardiac history and risk factors comes to ED with angina and ecg is abnormal but consistent with baseline and enzymes are negative, next step?

A

observation and repeat cardiac enzymes at 6 hours

cardiac enzymes may take up to 18 hours to peak so can only be considered negative after at least 2 sets separated by 6 hours or after 18 hours of ongoing chest pain – after ruling out NSTEMI with enzymes, can consider stress tests or reassurance

79
Q

TF

LAD plus LCX disease = L mainstem equialent

A

T

80
Q

what angiography results indicate medical managment for CAD

A

non-occlusive or non-obstructing CAD

81
Q

man in ED with STEMI and nearest PCI center 85 min away

what do you do

A

tPA (streptokinase IV) most critically
also asa bb acei hepariniv

and transfer to PCI center

(magic number is 60 minutes for transport and 90 minutes door-to-baloon)

82
Q

stage I heart failure drug tx
II
III
IV

A

I - bb acei asa statin
II - add furosemide
III - add spironolactone, isosorbide dinitrate / hydralazine (bidil) combo
IV - iv dobutamine and ventricular assist device until transplant

83
Q

symptomatic stages of heart failure

A

I - no limitations
II - comfortable walking
III - comfortable at rest only
IV - uncomfortable at rest

84
Q

when to refer for AICD (automated implantable cardioverter defibrillator) for primary prevention of cardiac arrhythmias in setting of heart failure

A

EF v35% class II or III (comfortable walking comfortable at rest)

or EF v30% class I (unlimited comfort)

not for class IV uncomfortable at rest – dobutamine and ventricular assist device until transplant for these

85
Q

tf

give / change bb dose in setting of heart failure exacerbation

A

f

don’t mess with it, worsens chf exacerbation

86
Q

how does sublingual nitroglycerin work

A

venodilation, reducing preload, makes heart work less

87
Q

What does an ACI do

A

reduces afterload
good for cardiac remodeling
good for BP control

88
Q

tf

st depressions in V1-V4 is an NSTEMI

A

F

STEMI (posterior infarct)

89
Q

interpret BNP

A

v200 is not heart failure

^500 is heart failure

90
Q

when is left heart cath done for heart failure

A

reserved for after heart failure diagnosed

to ascertain if ischemic or non-ischemic (late in workup)

91
Q

difference between heart failure and ARDS

how to assess

A

cardiogenic vs non-cardiogenic pulmonary edema

echo and PCWP (normal in ARDS)
– specifically if PCWP v12 noncardiogenic, if PCWP ^12 cardiogenic

92
Q

treatment for aortic stenosis

A

surgical valve replacement

maybe baloon valvuloplasty as a bridge to surgical replacement IF hyemodynamically unstable or a poor surgical candidate

93
Q

treatment for mitral valve stenosis

A

baloon valvuloplasty

94
Q

when can aortic stenosis be medically managed and reevaluated in 3 months

A

asymptomatic and non-severe (valve area ^.9cm^2 and mean gradient v60mmhg)

95
Q

symptomatic tricuspid valve regurge in setting of past iv drug use - treat

A

valve replacement

96
Q

old lady with asymptomatic 4/6 murmur

next step

A

TTE thrans thoracic echocardiogram

TTE for any murmur ^4/6 or continuous regardless of symptoms

97
Q

when is observation until symptoms arise appropriate for a heart murmur

A

v3/6 and systolic only

98
Q

when to workup a heart murmur in otherwise completely healthy asymptomatic person

A

TE for any murmur ^4/6 or continuous regardless of symptoms

or family history of HOCM, bicuspid aortic valve, or connective tissue disorder - get TTE

99
Q

treatment of choice for constrictive pericarditis, e.g. in setting of lupus

A

pericardiectomy

100
Q

treat pericardial effusion while waiting for pericardocentesis

A

IVMF - increase R heart pressure to get more blood pumping through

101
Q

when is pericardial window the treatment of choice for pericardial effusion

A

after fluid has reaccumulated after pericardiocentesis…

102
Q

diagnose and treat acute pericarditis

A

ecg

ibuprofen, colchicine 2nd line

103
Q

tf

steroids for acute pericardititis

A

f
ibuprofen, colchicine 2nd line

steroids cause bad rebound…

104
Q

aortic stenosis vs mitral insufficiency murmur

A

AS - systolic crescendo decrescendo

MR - holosystolic

105
Q

decrescendo diastolic murmur

A

aortic insufficiency

106
Q

what to do for sudden onset syncope in pt with known CAD or structural heart disease

A

admit for 24 hr tele to try to catch the arrhythmia

107
Q

statin reccommendation in known CAD pt

A

high dose statin
atorvastatin 80mg or
rosuvastatin 40mg

108
Q

middle and high potency statin drugs

A

lovastatin pravastatin simvastatin
(middle potency)

atorvastatin rosuvastatin
(high potency)

109
Q

why is 40mg the max dose of simvastatin

A

side effects and black box warning with amlodipine

110
Q

when to start ezetemibe in known CAD pt

A

if already on a statin - combo can decrease MI and strokes but not overall cv disease or mortality

111
Q

when to start niacin in known CAD pt

A

no longer recommended as second agent on top of statin not proven effective, but still used by some in absence of evidence
– just know flushing side-effect, aspirin ppx against flushing, and that it increases HDL

112
Q

old guy 96yo with healthy BP and lipid panel on rosuvastatin, continue or discontinue rosuvastatin?

A

discontinue
-statins improve 10 y mortality risk, not doing anything for this guy anymore – he does not Need it as his lipid panel and cv status is great, so in old folks try to deescalate therapy/polypharmacy as much as you can

113
Q

when to stop a statin

A

low risk patient

or no 10 year mortality benefit (e.g. pt in late 90s)

114
Q

normal lipid panel

A

total cholesterol v200
ldl v100
HDL ^60
triglycerides v150

115
Q

start statin in middle-aged dude screened at health fair and found to have high LDL low HDL prediabetic A1c a little HTN but asymptomatic?

A

No. counsel diet/lifestyle

start statin (atorvastatin or rosuvastatin) for for high risk pt (HAS DISEASE) – CAD or DM stroke PAD etc or TONS of ASCVD risk factors

116
Q

TF

lisinopril and HCTZ both cause hyperkalemia

A

F
ACEIs and ARBS do cause HYPERkalemia

HCTZ causes HYPOkalemia

117
Q

how do thiazide diuretics and loop diuretics affect potassium

A

HYPOkalemia

118
Q

main se of amlodipine

A

peripheral edema

119
Q

main se’s of ACIs and ARBS

A

inc Cr and HYPERkalemia

ACEIs cause angioedema too

120
Q

main se of metoprolol

A

bradycardia

121
Q

TF

thiazide diuretics cause both hyperkalemia and hyponatremia

A

T

los dos

122
Q

TF

beta blocker is first-line for htn

A

Fish

not first line for htn anymore, 2nd line, but first line for known CAD so will often see

123
Q

blood pressure goal in pt age ^60yo withOut DM or CKD

A

v150/90

124
Q

blood pressure goal in pt age 18-59yo or ^60 With DM or CKD

A

v140/90

125
Q

1st line antihypertensives
2nd line
3rd line

A

thiazide diruetic, CCB, ACEI/ARB
(and according to comorbidities – BB if CAD, ACEI if DM)

higher doses of above

BB, hydralazine (vasodilators), aldosterone antagonists, furosemide (other diuretics)

126
Q

blood pressure goal in pt age ^60yo withOut dm or ckd

blood pressure goal in pt age 18-59yo or ^60 With DM or CKD

A

v150/90 goal ^60 no dm or ckd

v140/90 goal v60 or ^60 With DM or CKD

127
Q

when is midodrine added to CV med regimen

moa

A

in setting of adrenal insufficiency to increase blood pressure

alpha1 agonist

128
Q

old lady with orthostatic dizziness and hr 50 and afib, what to do with metoprolol

A

reduce metoprolol (se bradycardia… e.g. symptomatic near-syncope)

129
Q 
1st degree AV block
2nd degree AV block type 1
2nd degree AV block type 2
3rd degree AV block
idioventricular rhythm
A 
1 - PR prolonged but fixed
2 type 1 - PR lengthens till QRS dropped
2 type 2 - PR fixed but randomly dropped QRSs
3 - P QRS dissociation
idiov - no p waves, QRS wide, non-tachy
130
Q

which AV blocks are commonly misread

A

2 type 1 - PR lengthens till QRS dropped
vs
3 - P QRS dissociation

commonly confused

131
Q

manage 3rd degree av block (complete dissoc)

A

pace it

transcutaneous pacing if pt unstable – then fix cause if reversible

tranvenous while in the hospital

implantable pacemaker for long term

132
Q

CHADS2 score

A 
CHF hx 1
HTN hx 1
Age^75 1
DM hx 1
Stroke or TIA hx 2

for cardioembolic stroke risk in AFib

133
Q

treat AFib based on CHADS2 score

A 
0 - aspirin vs reassurance
1 - OAC or asa
2 or more
-NOAC (dabigatran, apixaban, rivaroxaban)
-or Warfarin if NOACs unavailable
134
Q

CHA2DS2 VaSc score

A 
CHF hx 1
HTN hx 1
Age^65 1 ^75 2
DM hx 1
Stroke or TIA hx 2
Vascular dz (MI PAD aortic plaque) 1
Sex F 1

for cardioembolic stroke risk in AFib

0 - aspirin vs reassurance
1 - OAC  or asa
2 or more
-NOAC (dabigatran, apixaban, rivaroxaban)
-or Warfarin if NOACs unavailable
135
Q

AFib with RVR and evidence of CHF exacerbation, pt stable – rate control drug?

avoid?

A

BB, digoxin, or amiodarone
(yes amio can control rate or rhythm)

NOT CCB - avoid in CHF Exacerbation as can decrease EF

136
Q

ACLS stands for

A

advanced cardiac life support

137
Q

code blue on pt found in bed with apparent emesis and probable aspiration

act - first priority, others

A

COMPRESSIONS (CAB)
-moving partially oxygenated blood better than not moving oxygenated blood, Compressions Save Lives

Then airway, breathing, IV access, epi etc

138
Q

unstable bradycardia of any kind gets ____ as first step

A

transcutaneous pacing

unstable bradycardia of any kind gets Transcutaneous Pacing as first step

139
Q

girl took all of Mom’s metoprolol in suicide attempt, in ED with unstable bradycardia needing hemodynamic support, act

A

transcutaneous pacing
-unstable bradycardia of any kind gets Transcutaneous Pacing as first step

Then consider glucagon as antidote to BB, Epi and Dopamine to inc hr, Atropine to temporize hr while infusion gets started

140
Q

medically treat

Afib that is stable

Aflutter that is stable

SVT

wide-complex monomorphic tachycardia that is stable

Vtach/Vfib arrest

torsades

panic attack

A

Metoprolol (and Amiodarone) - afib that is stable

Metoprolol - aflutter that is stable

Adenosine - SVT

Amiodarone - wide-complex monomorphic tachycardia that is stable

DC Cardioversion shock - Epi if shock doesn’t work - Amiodarone after epi - vtach/vfib arrest

Mg - torsades

Lorazepam - panic attack

141
Q

no P waves, resting hr ^150, QRS narrow =

A

SVT

142
Q

describe SVT on ekg

A

no P waves, resting hr ^150, QRS narrow

143
Q

pt with SOB and tachycardia but stable, EKG no P waves, resting hr ^150, QRS narrow

dx
treat

A

SVT

Adenosine IV push 6mg followed by 12mg and 12 mg again if failure to break rhythm

144
Q

get rate control in A-fib/A-flutter

A

Metoprolol

..Amiodarone for rhythm… and rate control in Afib too…

145
Q

when to terminate resuscitory efforts in ACLS

A

after 20-25 minutes or more of cardiac rest in a pulseless electrical activity or asystole

146
Q

when is lidocaine used in ACLS

A

in Vtach or Vfib arrest after 2 doses of amiodarone

147
Q

when is defibrillation used in ACLS

A

in Vtach or Vrib only

148
Q

when is Epi used in ACLS

A

in all forms of cardiac arrest, given q3-5 minutes

149
Q

when are the following used in ACLS

Lidocaine
Defibrillation
Epi

A

Lidocaine - in Vtach or Vfib arrest after 2 doses of amiodarone

Defibrillation - in Vtach or Vrib only

Epi - in all forms of cardiac arrest, given q3-5 minutes

150
Q

92 yo pt found in hospital bed with rigor mortis, dependent pooling of blood, and cold (room temperature) – activate acls?

A

no

call time of death

if pt was found this way buried in snow on a mountain, then maybe attempt resuscitation and don’t declare dead until warm-dead… but he his in a hospital bed in a controlled environment not expose environment

Medicine (13 decks)

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