EKG
How is a posterior myocardial infarction confirmed on EKG?
Posterior infarction is confirmed by the presence of ST elevation and Q waves in the posterior leads (V7-9).
Name the components of the HEART score
History, EKG, age, risk factors, initial troponin
Name the H’s and T’s (10 combined) to consider in cardiac arrest.
Hypovolemia, Hypoxia, Hydrogen Ion, Hypo/hyperkalemia, hypothermia, tension pneumothorax, Tamponade, Toxins, Thrombosis.
This probe type is most commonly used for focused cardiac ultrasound in the ED.
Phased array probe
What is the initial dose of Amio in cardiac arrest for adults? What is the subsequent dose?
300 mg, 150 mg
Name five concerning EKG findings in the setting of syncope.
1. WPW
2. HOCM
3. Ischemia
4. Prolonged QT
5. Brugada
6. AV Block
7. RV Dysplasia (Epsilon Wave)
What is the STEMI diagnosis-to-balloon time at a PCI facility and what is the STEMI diagnosis-to-balloon time at a non-PCI facility?
At a PCI facility, it should not exceed 60 minutes and at a non-PCI facility. It should not exceed 90 minutes.
What is the importance to ETCO2 monitoring in cardiac arrest?
In addition to confirming a patent airway, quantitative waveform capnography can guide minute ventilation and chest compression parameters to sustain normal or near-normal values (≥20 mm Hg) and offers ancillary evidence of return of spontaneous circulation if an abrupt increase is noted.
Describe the US findings of McConnell’s sign
Akinesis or hypokinesis of the mid-free wall of the right ventricle (RV) with preserved or hyperkinetic motion of the RV apex, most commonly visualized in the apical four-chamber view.
What is the initial weight based bolus dose for Diltiazem?
0.25 mg/kg over 2 minutes
What are the classic findings in Wellens Syndrome and what is Wellens syndrome highly specific for?
Biphasic or deeply inverted T waves in V2-3, plus a history of recent chest pain now resolved. It is highly specific for critical stenosis of the left anterior descending artery (LAD)
What criteria is used to diagnose an occlusive myocardial infarction in a patient with a left bundle branch block? Describe the criteria.
Modified Scarbossa Criteria
1. Concordance at least 1 mm.
2.Discordance at least 25% of the proceeding S-wave.
What is the pediatric dose of Epi during a code?
0.01mg/kg
What does EPSS stand for, what does it estimate, and what is a normal value?
E-point septal separation, estimates LVEF, and normal is <7mm
This vasopressor has strong alpha-1 and beta-1 effects and is the recommended first-line agent in undifferentiated shock. However, excessive dosing may lead to increased myocardial oxygen demand and arrhythmias.
Norepinephrine (Levophed)
Describe the findings of Type 1 Brugada syndrome
Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.
A young male presents with pleuritic chest pain and diffuse ST elevations. What findings can help distinguish pericarditis from STEMI?
PR segment depression, lack of reciprocal changes, global versus localized changes, absence of wall motion abnormalities
What may a patient benefit from if they are in refractory VFib?
Double (or dual) sequential defibrillation with pads both anterior-posterior and base-apex position
This finding on cardiac ultrasound during PEA arrest distinguishes pseudo-PEA from true electromechanical dissociation.
Organized cardiac motion on ultrasound (pseudo-PEA)
This beta blocker is both cardioselective and ultra-short acting, making it ideal for rate control in critically ill patients with unstable hemodynamics.
Esmolol
What EKG abnormalities (name two of three) can be seen in patient with raised intracranial pressure?
1. Widespread giant T wave inversions (“ cerebral tea waves)
2. QT prolongation
3. Bradycardia
Name the absolute contraindications to thrombolytics in acute myocardial infarction (8 in total).
1. Any prior intracranial hemorrhage.
2. Known structural cerebral vascular lesion or malignant neoplasm (ex. Arterial, venous, malformation, primary or metastatic.)
3. Suspected aortic dissection.
4. Ischemic stroke within three months.
5. Active bleeding or bleeding diathesis (excludes menses).
6. Significant close head or facial trauma within three months.
7. Intracranial or spinal surgery with him three months.
8. Severe uncontrolled hypertension (unresponsive to emergency therapy)
During cardiac arrest, this physiologic derangement caused by excessive ventilation can reduce coronary perfusion pressure and worsen outcomes.
Decreased venous return due to increased intrathoracic pressure (hyperventilation)
What are sensitive and specific findings of cardiac tamponade on point-of-care ultrasound?
Sensitive findings: Systolic right atrial (RA) collapse and a plethoric, non-collapsible inferior vena cava (IVC) are highly sensitive for tamponade physiology.
Specific findings: Diastolic right ventricular (RV) free wall collapse is highly specific for tamponade
This cardiac medication overdose can cause bidirectional ventricular tachycardia.
Digoxin