Cardiovascular

Question 1

Refractory hypotension

Answer 1

Continued hypotension after >3 L fluid resuscitation over first hour

Question 2

Rate control for Afib/Aflutter

Answer 2

Metoprolol or esmolol
Verapamil or diltiazem

Also used for other forms of SVT refractory to initial therapy

Question 3

Rhythm control for non-Afib SVT

Answer 3

Vagal maneuvers and/or adenosine

Question 4

Rhythm control for preexcited Afib

Answer 4

Procainamide

Preexcited Afib is wide QRS without regular rhythm, caused by WPW due to accesory pathway bypassing AV node

Question 5

Rhythm control for monomorphic ventricular tachycardia?

Answer 5

Amiodarone

Question 6

Lidocaine

Answer 6

Class IB

Hemodynamically stable ventricular tachycardia

Question 7

Amiodarone

Answer 7

Monomorphic ventricular tachycardia
Long-term rhythm control in persistent Afib

Question 8

Low or high potassium torsades?

Answer 8

Low –> QT prolongation –> Torsades

High –> peaked T waves –> PR and QRS intervals lengthen –> sine wave

Question 9

How do pressures change in abdominal compartment syndrome?

Answer 9

CVP decoupled from cardiac preload
CVP up, preload down, ventricullar filling down

Question 10

How much blood volume can be accompanied in each space?

Answer 10

Chest: 40% on each side
Abdomen, pelvis: entire; pelvic blood loss may be hidden within retroperitoneum
Thigh: 1-2L/thigh

Pelvic fracture –> tearing of thin-walled venous plexus (presacral, lumbar)
Pelvic x-ray typically performed as adjunct to trauma primary survey

Question 11

Afib with aberrancy vs WPW preexcited Afib

Answer 11

Afib with abberancy usually fixed width QRS and less beat-to-beat variation, has LBBB or RBBB

Question 12

Differences between exercise induced collapse

Answer 12

Exercise-associated postural hypotension - remains alert with normal mental status; due to sudden stop of exercise and decreased venous return to heart from muscles contracting around veins

Exertional heat stroke - usually >104 degrees; associated with AMS

Exertional hyponatremia - AMS, swollen hands - due to excessive fluid intake (weight gain)

Question 13

How does management differ between ruptured AAA in those with known history vs unknown and hemodynamically unstable?

Answer 13

Known history does not require FAST and can go straight to surgery (open repair or endovascular)
Unknown history should receive FAST first

CT is only done if hemodynamically stable