STEMI/No STEMI
What's your differential?
To RSI or not to RSI?
Contraindicated!
Math is Hard...
Neuro or Not?
100
STEMI (Sgarbossa Criteria Met-ST elevation >25%)
100
A 65-year-old male presents with crushing chest pain, diaphoresis, and nausea. Vitals: BP 88/52, HR 46, ECG shows bradycardia with inferior ST elevations.
What is right ventricular STEMI?
100
A 22-year-old male with a GCS of 3 after a high-speed MVC. He's apneic and has visible head trauma.
RSI
100
This medication is contraindicated in patients with active gastrointestinal bleeding due to its antiplatelet and anticoagulant effects.
What is aspirin?
100
You need to give acetaminophen to a 15 kg pediatric patient. The dose is 15 mg/kg. What is the total dose in mg?
What is 225 mg?
100
A 65-year-old male suddenly develops right-sided weakness and slurred speech while watching TV. His blood sugar is 98, BP 180/92, and GCS is 14.
What is neuro? (Likely acute ischemic stroke)
200
No STEMI (Hyperkalemia)
200
A 24-year-old diabetic patient is found confused with fruity breath, dry mucosa, and deep, rapid respirations.
What is diabetic ketoacidosis (DKA)?
200
A 45-year-old alert male is in CHF with severe respiratory distress. He's speaking in one-word sentences but is maintaining a SpO₂ of 94% on CPAP.
Do not RSI
200
This analgesic is contraindicated in patients with head injuries or altered mental status due to the risk of respiratory depression and masking neurologic changes.
What is morphine?
200
You’re administering epinephrine 1:10,000 at 0.01 mg/kg to a child who weighs 20 kg. What volume do you give from a standard 1:10,000 (0.1 mg/mL) prefilled syringe?
What is 2 mL?
200
A 45-year-old female is found confused and combative. She has a history of diabetes, her skin is pale and clammy, and her BGL is 37.
What is NOT neuro? (Hypoglycemia mimicking stroke or seizure)
300
STEMI (Inferior)
300
A 33-year-old female presents with sudden anxiety, shortness of breath, tachycardia, and a sense of doom after a long flight.
What is pulmonary embolism?
300
A 60-year-old stroke patient has a GCS of 7, is moaning, and has poor airway protection with gurgling respirations.
RSI
300
This antiemetic is contraindicated in patients with known prolonged QT syndrome because it can further prolong the QT interval and precipitate torsades de pointes.
What is ondansetron?
300
A 90-pound patient needs a medication dosed in mg/kg. How many kilograms does the patient weigh? (Round to nearest tenth.)
What is 40.9 kg?
300
A 78-year-old male complains of sudden-onset headache described as “the worst of his life.” BP is 210/100, HR 56. He vomited once and is now lethargic.
What is neuro? (Likely subarachnoid hemorrhage)
400
No STEMI (Pericarditis)
400
A 30-year-old male presents with altered mental status, pinpoint pupils, respiratory rate of 6, and bradycardia.
What is opioid overdose?
400
A 35-year-old female in anaphylaxis has facial swelling, audible stridor, and minimal air movement despite epinephrine administration.
RSI
400
This paralytic is contraindicated in patients with suspected hyperkalemia, such as those with end-stage renal disease or crush injuries, due to the risk of fatal arrhythmias.
What is succinylcholine?
400
You are ordered to give ketorolac (Toradol) 0.5 mg/kg to a patient who weighs 72 kg. What is the dose in mg?
What is 36 mg?
400
A 32-year-old female with anxiety presents with rapid breathing, lightheadedness, and perioral tingling. She has a normal neurological exam.
What is NOT neuro? (Likely hyperventilation syndrome or panic attack)
500
STEMI (Lateral Wall)
500
A 70-year-old female presents with syncope. Her ECG shows a wide-complex tachycardia at a rate of 190. She's hypotensive and altered.
What is unstable ventricular tachycardia?
500
A 55-year-old diabetic is unconscious with a BGL of 22 mg/dL. He has snoring respirations but improves after dextrose administration.
Do not RSI
500
This corticosteroid is contraindicated in patients with systemic fungal infections because it suppresses immune response and may worsen the infection.
What is methylprednisolone?
500
You need to administer a dopamine infusion at 10 mcg/kg/min to a 100 kg patient. The bag is mixed as 400 mg in 250 mL. What is the mL/hr rate?
What is 37.5 mL/hr?
500
A 58-year-old male is postictal, non-verbal, and confused after witnessed tonic-clonic seizure activity. Pupils equal and reactive.
What is neuro? (Postictal state following generalized seizure)
600
STEMI (Anteroseptal)
600
A 9-year-old male with fever, sore throat, and drooling sits in tripod position. Breath sounds are diminished.
What is epiglottitis?
600
A 75-year-old male with a GCS of 14 and severe facial trauma is deteriorating and beginning to slur words. Airway swelling is progressing.
RSI
600
This benzodiazepine is contraindicated in patients with known hypersensitivity to the drug or other benzos, and must be used cautiously in hypotension due to potential for worsening perfusion.
What is midazolam?
600
A 25 kg child requires cefazolin at 25 mg/kg. You have a vial with 1 gram (1000 mg). How much of the vial do you use?
What is 625 mg, or 62.5% of the vial?
600
A 40-year-old dialysis patient presents with confusion and flapping hand tremor when arms are extended. Breath has a urine-like odor.
What is NOT neuro? (Uremic encephalopathy due to missed dialysis)
700
STEMI (Anterolateral)
700
A 62-year-old female has sudden, tearing chest pain radiating to the back, BP 210/110, unequal pulses in both arms.
What is aortic dissection?
700
A 70-year-old male has massive burns to face and chest, hoarse voice, and singed nasal hairs. Airway sounds are currently normal.
RSI
700
This medication is contraindicated in severe bradycardia and second- or third-degree AV blocks without a functioning pacemaker.
What is metoprolol?
700
A patient requires a magnesium sulfate infusion of 40 mg/kg over 20 minutes. They weigh 60 kg. What’s the total dose in grams?
What is 2.4 grams?
700
A 22-year-old college student is found unresponsive in her dorm room. Pupils are pinpoint, RR 6, and no signs of trauma.
What is NOT neuro? (Likely opioid overdose — a tox mimic)
800
No STEMI (Sine Waves)
800
A 58-year-old male presents with nausea, vomiting, vision changes, and yellow-green halos after taking his prescribed digoxin.
What is digoxin toxicity?
800
A 30-year-old trauma patient has a GCS of 5, RR 10, and is hypoxic despite oxygenation. There is no facial trauma.
RSI
800
This medication is contraindicated in patients with suspected myocardial infarction who have taken sildenafil or similar medications within the past 24–48 hours.
What is nitroglycerin?
800
You have 1 mg of epinephrine mixed in 250 mL of NS. You’re ordered to run it at 4 mcg/min. What is the mL/hr rate?
What is 60 mL/hr?
800
A 70-year-old male presents with gradual-onset confusion and left-sided weakness. He fell last week but didn’t seek treatment.
What is neuro? (Likely chronic subdural hematoma)
900
No STEMI (Left Bundle Branch Block)
900
A 22-year-old female has lower abdominal pain, fever, and vaginal discharge. She reports pain with intercourse.
What is pelvic inflammatory disease (PID)?
900
A 40-year-old combative head injury patient has a GCS of 9, is fighting interventions, and will not tolerate immobilization or transport.
RSI
900
This neuromuscular blocker is contraindicated in patients with a history of malignant hyperthermia due to risk of a life-threatening hypermetabolic crisis.
What is succinylcholine?
900
A 45 kg pediatric patient requires TXA 15 mg/kg over 20 minutes. How many mg total do you administer?
What is 675 mg?
900
A 50-year-old female complains of visual disturbances and right-sided facial droop. She has a history of migraines and says “this happens sometimes.” Neuro exam is otherwise normal.
What is NOT neuro? (Likely migraine with aura or complex migraine)
1000
STEMI (Inferior Wall)
1000
A 44-year-old alcoholic is vomiting bright red blood, hypotensive, and tachycardic.
What is esophageal varices rupture?
1000
A 66-year-old female is found sitting upright and speaking in short sentences. She has a history of COPD, CHF, and ESRD. She complains of chest tightness and difficulty breathing that started an hour ago. She is diaphoretic, has mild accessory muscle use, and bilateral crackles in all lung fields. Her vitals are: BP 172/88, HR 112, RR 28, SpO₂ 91% on a non-rebreather. ETCO₂ is 47. GCS is 15. She refuses to lie flat and becomes more dyspneic when supine. You are 25 minutes from the hospital.
Do Not RSI.
1000
This fluid-resuscitation adjunct is contraindicated in patients with known bleeding disorders or active thromboembolic disease due to its pro-coagulant effect.
What is tranexamic acid (TXA)?
1000
You’re setting up a dopamine infusion for a 72 kg patient in cardiogenic shock. The doctor orders 12 mcg/kg/min. Your bag contains 800 mg of dopamine in 500 mL of D5W.
What is 32.4 mL/hr?
1000
A 61-year-old male presents with confusion, ataxia, and nystagmus. He is malnourished and admits to daily alcohol use.
What is neuro? (Likely Wernicke’s encephalopathy — thiamine deficiency)