Week 5

Question 1

Stool Studies

Answer 1

Hemacut
Ova and parasites
Fecal leukocytes
Giardia antigen
C diff
Stool culture
GI PCR

Question 2

Inferior MI leads

Answer 2

Inferior

STD AVL

STE in II,III, AVF
location

Question 3

Septal MI leads

Answer 3

Septal

STD V5 V6

STE V1and V2
Location

Question 4

Lateral MI leads

Answer 4

I, aVL, V5-V6

Question 5

Fever, Anemia, Thrombocytopenia, Renal, Neuro Symptoms

Answer 5

TTP

All features DO NOT need to be present at the same time
Consider diagnosis without the full pentad

Question 6

ACS meds

Answer 6

-aspirin -162-325 mg
-anticoagulant:. Unfractionated heparin
-Consider a P2Y12 inhibitor:
Clopidogrel 600 mg or ticagrelor 180 mg PO
-Consider IV nitroglycerin

• Consider beta blockade:
  For patients with anterior STEMI who present within 6 hours and will go for primary PCI (not thrombolytic therapy) and no contraindications
  Consider metoprolol or esmolol
  BB Contraindications: systolic blood pressure (SBP) <120, heart rate >100, PR interval >240 ms, second- or third-degree atrioventricular (AV) block, or impending shock

Question 7

Crystalloid recommended by ATLS

Answer 7

• LR- 1 L total
• Transfuse blood products in a 1:1:1 ratio of packed red blood cells (PRBCs) : fresh frozen plasma (FFP) : platelets.

Question 8

ATLS ABCs- B

Answer 8

BREATHING
Rapidly treat any suspected or known pneumothorax or hemothoraces.
Place a chest tube (28-32 French per Advanced Trauma Life Support 10 guidelines).

Question 9

ATLS ABCs- C

Answer 9

CIRCULATION
Shock may be Hemorrhagic, neurogenic, cardiogenic, or obstructive.

-Perform a FAST

-Control hemorrhage with pressure dressings or tourniquets

-Consider pelvic binder

-Avoid high-volume crystalloid- 1 L of LR total is recommended (per Advanced Trauma Life Support 10 guidelines).

• Transfuse blood products in a 1:1:1 ratio of packed red blood cells (PRBCs) : fresh frozen plasma (FFP) : platelets.

-Patients with clear evidence of significant hemorrhage who present within the first 3 h after injury should receive TXA

Question 10

ATLS ABCs- D

Answer 10

DISABILITY
-Rapid neurological assessment.
-GCS, neurological exam, brainstem reflexes, and pupillary exam results.
- cervical collar and cervical spine precautions

-If concern for elevated intracranial pressure (ICP):
Elevate head of bed to 30°
-Administer 3% sodium chloride for acute ICP management (500 mL can be bolused).
-If acute decompensation, then give mannitol (1-1.5 g/kg bolus).
-Request neurosurgical consult.

Question 11

TTP CBC findings

Answer 11

Severe thrombocytopenia (<30 × 109/L) and hemolytic anemia, as demonstrated by schistocytes on peripheral smear

PT/INR, PTT, Coombs, and fibrinogen are typically normal (unlike DIC).

Question 12

The foundation of therapy for TTP is based on _____________

Answer 12

the removal of anti-ADAMTS-13 antibodies and replacement of ADAMTS-13 with emergency plasma exchange therapy

Question 13

___________ is the most common dysrhythmia in children.

Answer 13

Paroxysmal SVT

It should be suspected in a child with a heart rate over 180 bpm or an infant with a heart rate over 220 bpm.

Question 14

Mesenteric Ischemia Treatment

Answer 14

-IV fluids
-ABX- Zosyn
-Surgical/ Vascular Consult
-Heparin AFTER consult

Question 15

Anaphylaxis epi dose - peds

Answer 15

IM Epi 0.01 mg/kg

Repeat every 5 minutes as needed.

Question 16

Anaphylaxis epi dose

Answer 16

0.3 mg 1:100 (IM) mid lateral thigh

Repeat every 5 minutes as needed.