Large Group -Seng

Question 1

Can you have a normal EKG with an MI?

Answer 1

Yes. NSTEMI

50% of MI’s

Question 2

How quickly does a STEMI need to get to a cath lab for treatment?

Answer 2

90 minutes

Question 3

What is the treatment for an MI? Are all steps always appropriate?

Answer 3

MONA (Morphine, O2, nitrates, ASA)

NO!

• Do NOT give nitrates for right sided MI’s
• ASA is bad for a dissection

Question 4

What is the protocol for treatment of V fib arrests that you get a normal sinus pulse back?

Answer 4

Therapeutic hypothermia
(cool to 33 degrees Celsius)

decrease temp by 1 degree/ hour

better neurological outcomes

Question 5

What does a chest x-ray that shows a widened mediastinum suggest?

Answer 5

AAA

Question 6

If you suspect a PE, what test should you order?

Answer 6

D-Dimer (nonspecific)

if comes back + can order a CT angiogram w/contrast (caution in renal failure)

Question 7

What is the main treatment for acute decompensated CHF?

Answer 7

Positive pressure ventilation (intubate or CPAP or BIPAP) to increase the P and get the fluid off of the lungs

(keep pCO2 between 25-45)

Question 8

What test should ALWAYS be ordered in a female of child bearing age with abdominal pain? What are you trying to rule out?

Answer 8

Urine pregnancy test

rate limiting step

want to rule out ectopic pregnancy

Question 9

What tests should be ordered in a suspected ruptured ectopic pregnancy?

Answer 9

• urine preg
• type and screen
• NPO (not a test but obviously)
• ultrasound to look for free fluid (in Morison’s Pouch)*

Question 10

What are the indications for tPA?

Answer 10

• ischemic stroke
• onset less than 4.5 hours ago
• NIHSS 5-22
• Age > 18

Question 11

What are the contraindications for tPA?

Answer 11

• Head trauma or previous stroke last 3 months
• Previous intracranial hemorrhage
• BP > 185/110 mmHg
• Active bleeding
• INR > 7, Platelets < 100K
• Seizure
• Rapidly improving symptoms
• Major surgery in the last 14 days

Question 12

What do we want to maintain systolic blood pressure at for a hemorrhagic stroke?

Answer 12

< 140 mmHg

these pts require frequent re-evaluation because we can’t really do anything

Question 13

What types of things can mimic strokes?

Answer 13

• hypoglycemia
• Traumatic brain injury
• Overdose of antiocoagulants
• Brain tumor
• Todd’s Paralysis (post-seizure motor deficit)
• Conversion disorder
• Malingering

Question 14

What are some common PE findings in DKA?

Answer 14

• Tachypnia (Kussmaul breathing)
• Dry mucous membranes
• Fruity ketone breath
• Confused Neuro status

Question 15

What exam should you always do on an altered patient?

Answer 15

full skin exam

Question 16

What 3 things need to be present to get a diagnosis of DKA?

Answer 16

• Diabetic=high blood glucose
• Ketones are high (serum or urine)
• Acidosis

Question 17

What are the causes of anion gap metabolic acidosis?

Answer 17

Methanol 
Uremia 
DKA 
Paraldehyde 
Infection
Lactic acid
Ethylene glycol 
Salicylates 
(MUDPILES)

Question 18

How do you calculate an anion gap?

Answer 18

sodium - (bicarb + chloride)

Question 19

What is the treatment for DKA?

Answer 19

• 6-7 liters of IV fluids**
• Insulin drip
• Potassium replacement
• IV Abx (big guns until get cultures) for infections
• Counseling on non-compliance
• Intubate if you must but beware (hard to match ventilation to the rapid breathing)
• ICU admission

Question 20

What is the #1 cause of DKA?

Answer 20

pts not being compliant with their medications (or cannot afford them)