Resus Pearls, part 1

Question 1

Most common cardiovascular cause of sudden cardiac death in young athletes

Answer 1

Hypertrophic cardiomyopathy, accounting for 1/3 of such events

its presence disqualifies affected individuals from competitive sports

Question 2

ECG of this condition typically shows T-wave inversion in the right precordial leads (V1-V3)

Answer 2

Arrhythmogenic right ventricular cardiomyopathy

Question 3

Most frequent coronary artery anomaly associated with sudden cardiac death

Answer 3

Anomalous origin of the Left Coronary Artery from the Pulmonary Artery
which results in the LCA tranversing betwen the aorta and main pulmonary artery.

Question 4

Greatest risk of sudden cardiac death in children and adults with congenital heart disease exists in those with?

Answer 4

left heart obstructive lesion
e.g., aortic stenosis, aortic coarctation
and cyanotic defects
e.g., Ebstein’s anomaly, TGA, ToF

Question 5

Typical finding in hemodynamically significant aortic stenosis

Answer 5

A harsh, late-ppeaking systolic murmur at the upper right sternal border with radiation to the neck

Question 6

Remarks on sick sinus syndrome

Answer 6

affects the heart’s primary pacemaker and can cause intermittent lightheadedness, syncope, or sudden cardiac death
a diffuse degenrative disease of the heart’s electrical generation and conduction system

Question 7

Remarks on Brugada syndrome

Answer 7

rominent J-wave with a characteristic downsloping ST-segment elevation in V1-V3
Most commonly affects men

Question 8

Best opportunity for prevention of sudden cardiac death

Answer 8

The best opportunity for prevention of SCD is to recognize s/s of the syndromes that place a patient at higher risk of SCD and to admit or refer such patients for proper evaluation and prophylaxis

Question 9

To ensure that ventricular fibrillation is not masquerading as asystole, rescuers can

Answer 9

switch to another lead whenever a “flat line” is recorded on the ECG during resuscitation or use US if available

Question 10

Remarks on shock

Answer 10

1. Blood pressure may not drop if there is an increase in peripheral vascular resistance in the presence of decreased CO with tissue hypoperfusion.
2. For this reason, blood pressure is an insensitive marker for global tissue hypoperfusion.
3. Shock may occur with a normal BP, and hypotension may occur without shock.

Question 11

The ABCDE tenets of shock resuscitation are

Answer 11

Airway establishment
Breathing, control of work of breathing
Circulation optimization
Delivery of adequate oxygen
Endponints of resus achievement

Question 12

Fluids that should be avoided in sepsis

Answer 12

hydroxyethyl starch

Question 13

Remarks on classification of hemorrhage severity

Answer 13

Classification of hemorrhage severity as a percentage of blood volume loss estimated based on SBP, HR, GCS is NOT reliable and should NOT be used to guide ED resuscitation.

Question 14

Remarks on hypotensive resuscitation

Answer 14

1. It limits initial fluid resuscitaiton to an acceptable SBP goal until surgical control of the bleeding is obtained, usually in the operating room.
2. The acceptable value has sometimes been defined as 90 mm Hg
3. Hypotensive resuscitation should not be used in patients with myocardial disease, cerebral ischemia, or traumatic brain injury.

Question 15

Remarks on balanced crystalloids

Answer 15

Solutions containing lactate or acetate are considered balanced crystalloids because they are buffered and have a lower chloride concentration compared to normal saline.
Balanced crystalloids yield better clinical outcomes compared to normal slaine in both critically ill and non-critically ill patients from all causes, although the effect is small.**

Question 16

One half of anaphylactic fatalities occur when?

Answer 16

within the first hour

Question 17

First priority in severe anaphylaxis

Answer 17

Securing the airway

Question 18

Remarks on gastric lavage in anaphylaxis

Answer 18

Gastric lavage is NOT recommended for foodborn allergens and may be assoc’d with complications (i.e., aspriration) and delays in the adminsitration of more effective treatments (e.g., epinephrine)

Question 19

Treatment of choice in anaphylaxis

Answer 19

Epinephrine
Repeat every 5-10 mins according to response or if relapse occurs.
Injections in the thigh are more effective at achieving peak blood levels than injections into the deltoid area.

Question 20

Drug most commonly implicated in eliciting true allergic reactions

Answer 20

Penicillin.

Question 21

75% of fatal anaphylactic drug reactions are from

Answer 21

Penicillin

Question 22

Remarks on cross-reactivity of penicillin

Answer 22

The cross-reactivity of penicillin allergy with cephalosporins is about 10%, so patients with a previous life-threatening or anaphylactic reaction to penicillin should NOT be given cephalosporins