Code grey
heart & Co
Worst nightmare
Expect the unexpected
Heart & Pro
100

In septic shock, this vasopressor is the first-line agent when fluid resuscitation fails to restore hemodynamic stability.

What is norepinephrine?

100

This phase of the cardiac action potential is characterized by rapid Na⁺ influx and produces the steep upstroke in ventricular myocytes

What is phase 0: depolarization

100

Your patient develops an unexpected laryngospasm despite adequate anesthetic depth and no obvious airway irritation. This electrolyte disturbance should be on your differential.

what is hypocalcemia

100

During sentinel lymph-node mapping, SpO₂ unexpectedly falls despite an otherwise reassuring respiratory picture. The culprit absorbs light near 660 nm and can produce a falsely low pulse-oximeter reading.

what is patent blue?

100

During anesthesia, a patient suddenly develops a regular narrow-complex tachycardia but remains hemodynamically stable. After vagal maneuvers fail, this drug is the next step to terminate the rhythm + dose.

What is adenosine?

6 mg IV rapid push + 20 mL saline flush → after 1–2 min, 12 mg IV, may repeat 12 mg once

200

A trauma patient arrives with ongoing hemorrhage. To rapidly predict the need for massive transfusion, this four-component bedside score uses penetrating mechanism, positive FAST, SBP <90 mmHg, and HR >120/min. (+score for activation)

What is the Assessment of Blood Consumption (ABC) score> 2? .

200

During induction, a patient's venous return and their LV end-diastolic volume fall. According to this principle, stroke volume will also decrease because ventricular fiber stretch has decreased.

What is the Frank–Starling mechanism?

200

An intubated patient suddenly develops high airway pressures and wheezing. The capnogram takes on this characteristic shape due to prolonged expiration.

What is a “shark-fin” capnogram?

200

During laparoscopy, ETCO₂ initially rises, then begins to fall as the patient becomes hypotensive and tachycardic. The change from rising to falling ETCO₂ suggests progression to this complication.

What is tension pneumothorax?

200

An intraoperative wide-complex tachycardia has a pulse but causes significant hemodynamic deterioration. Unlike its pulseless counterpart, this act should be delivered.

What is synchronized cardioversion?

300

During emergency surgery for source control, a patient in septic shock remains hypotensive despite ongoing volume resuscitation. Rather than relying on CVP to decide whether to give more fluid, these two intraoperative variables can better assess whether stroke volume will respond to additional preload.

What are pulse pressure variation (PPV) and stroke volume variation (SVV)?

300

A patient post-MVA develops marked hypertension followed by reflex bradycardia. If the underlying process continues to affect the medullary centers, what additional clinical finding may appear?

What is irregular breathing? 

Whats is Cheyne-Stokes respiration?

What is cushing triad?

cycles of increasing then decreasing breaths followed by apnea

300

A patient develops complete laryngospasm after extubation. Positive-pressure ventilation and airway maneuvers fail. This drug is the definitive pharmacologic step to break the spasm.

What is succinylcholine?

300

Your mechanically ventilated patient develops unexplained high airway pressures and hypoxemia but remains hemodynamically stable. Without interrupting the anesthetic, this test is your best next diagnostic tool + sign

What is bedside lung ultrasound with No lung sliding

300

During central venous catheter insertion, this rhythm is classically associated with the procedure.

what are PVCs?

400

A patient in cardiogenic shock has a low cardiac index, CVP >15 mmHg, normal-to-low PCWP, and a PAPi <0.9. Which ventricle is primarily failing?

What is the right ventricle / RV-dominant cardiogenic shock?

400

A patient develops severe bradycardia and hypotension shortly after spinal anesthesia, particularly while sitting. This reflex—triggered by noxious ventricular stimuli—produces a classic triad that includes coronary vasodilation.

What is the Bezold–Jarisch reflex? 

cardioinhibitory reflex 

Trigger: Noxious LV stimuli (inf MI, SA, severe hypovolemia, meds) 

Sensor: chemoreceptors & mechanoreceptors in LV wall

TRIAD: Hypotension + Bradycardia + Coronary vasodilation

Afferent: unmyelinated C fibers (LV) → ↑ parasympathetic tone

400

While pre-marking the neck for a potential eFONA, one ultrasound view shows the cricoid and tracheal rings as a “string of pearls,” while the other identifies the thyroid cartilage, air–mucosa interface, and cricoid sequentially. Name the two CTM identification techniques + orientation.

What are the longitudinal “string-of-pearls” technique and the transverse TACA technique?

400

Bonus

Bonus

400

A patient develops polymorphic ventricular tachycardia with a prolonged QT. Giving this used antiarrhythmic could actually worsen the problem rather than treat it.

what is amiodarone?

(torsade de pointes)

500

Positive-pressure ventilation can improve cardiac output in one phenotype of cardiogenic shock yet worsen hemodynamics in another by increasing PVR and reducing preload. Name the phenotype in which PPV may be harmful.

What is RV-dominant cardiogenic shock?

500

This sympathetic cardiac receptor increases both inotropy and lusitropy through the Gs–cAMP–PKA pathway.

What is the β₁-adrenergic receptor?

500

The tube won’t go in, the SAD won’t oxygenate, and your optimized final facemask attempt has failed. The next move is no longer above the vocal cords: name the rescue technique and its sequence.

What is emergency front-of-neck airway: vertical incision → stab + bougie → size 6.0 tube → confirm with waveform capnography?

500

An intraoperative pneumothorax can rapidly progress to tension physiology after initiation of positive-pressure ventilation when the pleural defect develops this characteristic behavior.

What is a one-way valve mechanism?

500

During spinal anesthesia, a COPD patient develops an irregular rhythm at 88 bpm while remaining completely stable. The ECG demonstrates changing P-wave morphologies rather than a single ectopic focus. Name this benign rhythm.

What is wandering atrial pacemaker?