blood and guts
bellows
cranium
drugs
pump house
100
How does dabigatran work?
Dabigatran (pradaxa) is an active direct thrombin inhibitor that inhibits clot-bound and circulating thrombin
100
Immediately following intubation, the end tidal CO2 reading is 1 mmHg. Where is the endotracheal tube?
Esophagus
100
To reduce intracranial pressure where should the head of the bed be positioned?
~30 degrees
100
Which one of the following agents is an inotrope?
a. Epinephrine
b. Metoprolol
c. Diltiazem
Epinephrine.
Epinephrine stimulates beta inotropic receptors to increase contractility
100
. Six hours following an MVA a patient has a 10 fold increase in his CK and myoglobin. What is your first/primary intervention?
Increased IVF for rhabdomyolysis.
200
When presenting with a GI bleed these patients should be started on prophylaxtic antibiotics.
Patients with Cirrhosis.
200
A chest tube is placed for a large pneumothorax. There is no bubbling of the water seal. What are you concerned about?
Incorrect placement. A chest tube that is successfully placed to resolve a pneumothorax should fluctuate/bubble.
200
Which pair of cranial nerves is being evaluated when a corneal reflex test is performed?
CN V and VII.
Touching the cornea stimulates the V1 branch of CN V (trigeminal nerve). This causes a reflex stimulation of CN VII which causes the left eye to blink
200
Medication for the treatment of malignant hyperthemia.
Dantrolene.
It disrupts the sustained muscle contractions, which cause the hyperkalemia, fever and tetany.
200
. Ms. Lo is admitted with oliguric renal failure. She suddenly develops hypotension with the following rhythm. What is the treatment?
IV calcium, glucose, insulin. K lowering therapies.
300
What ratio should be used for pRBC, platelets and plasma (ffp) in a massive tranfusion?
For most a ratio of 1:1:1.
Labs to follow are PT, aPTT, CBC and fibrinogen. If fibrinogen dropping add cryoprecipitate.
300
What is the formula for minute volume?
Tidal volume X respiratory rate
Minute volume is the total amount of air exhaled in one minute and is calculated as the tidal volume X respiratory rate.
300
Following a severe traumatic brain injury, Jamie’s urine output increases to 300 ml/hr, BP decreases to 90/60 and HR increases to 144. His serum sodium is 155 mmol/L. What are you worried this might be and how do you treat it?
Diabetes insipidus.
Desmopression/DDAVP
300
Mr. Kieffer is admitted following an overdose of beta blockers with bradycardia and hypotension. After IV fluids, what medication should be given?
IV atropine 1mg. May repeat up to 3 x.
_______
IV crystalloid (for hypotension, as above), IV atropine, IV glucagon, IV calcium salt, vasopressor, IV high dose insulin and dextrose, and IV lipid emulsion therapy
300
Martha is admitted following a motor vehicle collision. Her past medical history includes daily prednisone for the treatment of systemic lupus. Despite fluid replacement therapy and initiation of levophed, her blood pressure remains low. What should be added in this situation?
Hydrocortisone.
For adrenal insufficiency.
400
Christine is a 19 year old who suffers from anorexia . She is admitted with failure to thrive, weighing 40 kg. What is she at risk for, and what labs need monitoring?
Refeeding syndrome.
Mag, phos and K- replete as neeeded.
400
Mrs. Bennedict has a large anterior-lateral wall ST segment elevation myocardial infarction. She develops severe shortness of breath, orthopnea, pink frothy sputum and jugular venous distention. BP 160/95 HR 135 and RR 32. What is your pharmacologic treatment?
lasix. This is acute pulmonary edema.
400
Head trauma, on the most recent neuro check the left pupil is now fixed and dilated. What has happened? What nerve?
Mass effect with herniation. CN3 (sits at the top of the brain stem and is the first to be compressed).
400
What drug is used to prevent cerebral vasospasm after a subarachnoid hemorrhage?
Nimodipine (CCB).
400
Following a CABG a patient has the following EKG changes: new 2-3 mm ST segment elevation in Leads I, II, III, aVF, aVL and V5-V6. What is this?
Pericarditis. Common post procedure as the pericardium is dissected during surgery.
500
A patient is admitted with a Type B aortic dissection, distal to the left subclavian. How should this be managed?
Primarily medically with BP lowering agents.
500
What is the treatment for carbon monoxide poisoning?
high flow 100% oxygen. (to expedite displacement of the CO from hemoglobin)
500
Ms. Oliviera is admitted in coma of unknown etiology. She has a BP of 158/75 HR 52 (NSR) and requires intubation for level of consciousness and pulmonary edema. Her temperature is 34C.
What can cause this clinical picture?
Hypothyroid
Mild hypertension, bradycardia, respiratory depression, coma and hypothermia are all consistent with hypothyroidism.
Hypothyroid coma is almost always precipitated by an event such as sepsis; investigation of the underlying cause for the hypothyroid coma should occur
500
Which one of the following pharmacological agents should be administered with levothyroxine for the treatment of myxedema coma?
Steroids
Until the possibility of coexisting adrenal insufficiency has been excluded, the patient must be treated with glucocorticoids in stress doses
500
Mrs. Andios is a Type II diabetic with a history of TIA and congestive heart failure. She is admitted to the critical care unit for monitoring following a Hartmann’s procedure for colon cancer. Two hours post operatively, she develops atrial fibrillation w RVR with hypotension and altered mental status. What is the best treatment?
Urgent cardioversion