Cardiac
Name that arrhythmia:
PRI interval gradually increases until a QRS complex is dropped
2nd Degree Type 1
During compensated shock, the body's main concern is the preservation of BP, specifically MAP to maintain brain, kidney, and coronary artery perfusion. How do you calculate MAP?
MAP = 2(Diastolic Pressure) + Systolic / 3
56 y/o M presents with fatigue, weight loss, jaundice, and hematemesis. He's a severe alcoholic and avoids the doctor. Pt continues vomiting blood. What is your number 1 differential?
Esophageal Varices
Pt is a 22 y/o F that is concerned about bright red vaginal bleeding. It is painless. She is 38 weeks pregnant and has missed her last 3 OB appointments. What is her condition?
Placenta Previa
Normal Respiratory Rate for an Infant
25-50
What are ECG signs of Hyperkalemia? Give at least 2.
Flattened P wave... Widened QRS... Peaked T Wave... Presence of a U wave... Sinusoidal ECG in end-stage.
Pt is a 7 y/o M that has been sick with a fever and productive cough for the past 3 days. Rhonchi is heard over the lower fields with wheezing. His HR is 142, RR 28, BP is 98/56 and he's still currently febrile. Pt is alert but sleepy. What phase of shock is he in?
Compensated Shock at this time.
Pt is a 60 y/o F that has increasing pain in her right upper quadrant. Pt recently went out to eat at a fast food restaurant but recalls nothing else out of the ordinary. Her Murphey's sign is positive. What is this indicative of?
Cholecystitis
Pt is a 30 y/o F that is 36 weeks pregnant. She has been experiencing headaches, swelling in her hands and feet, and she's been seeing spots. Pt has increased anxiety and called 911. Her BP is 150/96. What are you concerned for?
Pre-Eclampsia
Pt is a 3 y/o that is suddenly presenting as lethargic, cyanotic, and drooling. As you sit with the child getting a story, she begins elongating her neck and is unable to swallow. What are you concerned for?
Epiglottitis
Your pt's ECG shows a STEMI. There is ST elevation in V3 and V4. You've correctly identified this as an anterior STEMI. Which coronary artery is infarcted?
LAD
There are 4 main types of Shock. Neurogenic shock falls under which major type of the 4?
Distributive - neurogenic shock is caused by damage to the central nervous system, impairing cardiac function that can loosen blood vessel tone and result in severe hypotension.
Pt is an 18 y/o F. She has hematuria and a positive Grey-Turner's Sign.
What is Grey-Turner's sign and what are you concerned for?
Ecchymosis or discoloration of the flanks.
Ruptured Kidney
You're delivering a term baby in the back of the ambulance. What are at least 3 things to look for with baby presentation?
Prolapsed Cord... Breech Delivery... Limb Presentation... Meconium Staining... Shoulder Dystocia... Multiple Babies... Nuchal Cord
Your pt is a burn victim. She's 2 months old. The bath water was too hot. Pt has circumferential 2nd degree burns to both legs that stops at her upper thighs. Groin and backside are not involved. What is the TBSA % of her burns?
28% - burns stop before groin or backside. 14% for each leg.
Your patient has CHF with the following symptoms: Pitting edema, hypertension, and wheezing. Why should Beta-adrenergic medications (Albuterol) be avoided in this patient?
Albuterol is a beta-2 agonist, or adrenergic bronchodilator. Administering albuterol for this pt can cause flash pulmonary edema, or flash CHF.
Your patient was found to have a stab wound to the chest. He is minimally responsive and his respirations are absent to the right side. He's tachycardia, hypotensive, and has distended neck veins. What type of shock are you concerned for?
Obstructive Shock
Pt is a 16 y/o F having a "panic attack". She is experiencing carpal-pedal spasms, tingling lips and face, and she's dizzy. Pt has a known hx of severe anxiety. What are her symptoms indicative of?
Hint: Think Acid-Base Disturbances
Respiratory Alkalosis
Baby has been successfully delivered 1 minute ago. The infant is presenting with a pink body and blue limbs. His pulse is 80 and is minimally responsive to stimuli. He shows no activity and his respirations are slow and irregular. What is the infants APGAR score?
4
What is the pediatric dose of epinephrine (IV/IO) for cardiac arrest and bradycardia?
0.01 mg/kg IV/IO
Pt is a 38 y/o F that is minimally responsive. Her husband reports she just got home following a heart transplant. Pt is bradycardic, her remaining vitals are stable. Why won't atropine work on this patient?
Because the new heart is not connected to the vagus nerve.
"Burn Shock" is a unique combination of which 2 major types of shock?
Distributive and Hypovolemic
based on intravascular volume depletion, low pulmonary artery occlusion pressure, increased systemic vascular resistance, and depressed cardiac output.
What are the 5 steps in neonatal resuscitation?
1. Stimulate: rewarm, rub the back, dry, flick soles of feet.
2. Ventilate: room air then add O2 as needed.
3. CPR
4. Advanced Airway
5. Medications
A 4 y/o M presents with altered mental status, rapid and deep respirations, and a 3-day history of vomiting and excessive urination. Which of the following are most likely cause for these symptoms?
A. Hypovolemia
B. Hyperglycemia
C. Drug Overdose
D. Respiratory Acidosis
E. Metabolic Alkalosis
B. Hyperglycemia based on the Kussmaul respirations.
Pt is likely hypovolemic as well, but it's not the root problem.
Pt is also in metabolic acidosis