Pharmacology/Toxicology
Ventilators/Airway
Neurology
Pregnancy
Potpourri
100
Severe lactic acidosis with a normal SpO2 is a characteristic finding of this poisoning. Is that bitter
almonds I smell?
What is cyanide toxicity?
100
In the classic ARDSNet study from 2000; these two interventions were found to reduce mortality in patients with ARDS.
What are TV 6-8cc/kg and plateau pressure <30cmH2O?
100
These are two serious complications of subarachnoid hemorrhage.
What are rebleeding and vasospasm?
100
A woman at 12 weeks of gestation present with abdominal pain and bleeding. On pelvic exam her cervical os is open; she reports not having had any passage of fetal parts. She is classified as having this type of abortion.
What is inevitable?
100
This pathognomonic sign occurs due to electrons showering over the skin and leads to extravasation of RBCs; it usually disappears in 24 hours.
What is a Lichtenberg figure?
200
This is the main toxic metabolite responsible for the retinal, ophthalmic, and neurotoxicity seen in methanol ingestion.
What is formic acid?
200
A patient with the following x-ray is intubated and placed on standard ventilator settings. You note a plateau pressure of 45cm H2O. What ventilator adjustment should be made for this patient?
What is lowering the tidal volume? (this patient has stiff lungs and a low compliance based on the high plateau; higher TV is likely to cause barotrauma)
200
The AHA/ASA recommends this systolic blood pressure goal in ICH.
What is between 130-150mmHg?
200
This is the dose and route of Rhogam that should be administered if <15mL of fetal blood exposure is expected in an Rh- mother with vaginal bleeding in the second or third trimesters.
What is 300mcg intramuscular?
200
This medication has been shown to confer a survival benefit in cirrhotics with upper GI bleed when variceal bleeding is suspected.
What is ceftriaxone?
-Infection associated with 25-65% of upper GI bleeds from varices (UTI, SBP, pneumonia). Ceftriaxone 1 g IV or cefotaxime 2 g IV associated with NNT of 22 to prevent death and NNT of 4 to prevent infection. Bacterial infection is commonly associated with variceal hemorrhage and appears to be an independent risk factor for failure to control bleeding [31] and predicts both early rebleeding and death. A Cochrane meta-analysis of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding involving 12 trials with 1241 patients evaluated antibiotic prophylaxis compared with placebo or no antibiotic prophylaxis. Antibiotic prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality
-Albumin also useful in patients meeting certain criteria (Cr 1.5, BUN > 30, bilirubin > 4).
-A variceal bleed is a venous bleed, so over-resuscitation can dramatically increase the driving pressure of the bleed (roughly equal to the central venous pressure). Consider a cautious resuscitation strategy with tolerance of soft blood pressures (noting that patients with cirrhosis often live at a low blood pressure).
-Octreotide: vasoactive agent; acts on somatostatin receptors causing inhibition of the release of chemicals that cause vasodilation of the portal venous system, thereby decreasing blood flow to the varices.
-Erythromycin to empty stomach
-DDVAP if uremic or on ASA
-PPI helps with endoscopy and stigmata of re-bleeding
-Transfusion
-GI/TIPS
300
In addition to the risk of arrhythmia, dobutamine and milrinone may have this untoward effect when initiated
What is hypotension? (both cause vasodilation and may lead to unexpected drops in BP due to the B2 effect!)
300
These three problems may cause elevated peak pressures but low plateau pressures in a ventilated patient.
What are bronchoconstriction, mucous plugging, biting on the tube? (all of which cause increased resistance to flow)
300
The risk of osmotic demyelination syndrome in the setting of overly rapid correction of chronic hyponatremia can be mitigated with this strategy.
What is desmopressin? (reintroduces hyponatremia)
300
A woman who is at 34-weeks of pregnancy presents with persistently elevated blood pressures of 160mmHg systolic. This is the amount of protein in her urine that would classify her as having pre-eclampsia.
What is >300mg in 24/hrs, spot protein/creatinine ratio >0.3, or 1+ on dipstick?
300
These are five criteria for burn center referral.
What are partial thickness burns >10% TBSA; burns involving the face, hands, feet, genitals, perineum, major joints; third degree burns, electrical, chemical burns; inhalation injury, burns with concomitant trauma or serious comorbidities.
400
This treatment is used to treat severe refractory cases of hydrogen fluoride burns.
What is intra-arterial calcium gluconate infusion?
400
Troubleshooting the ventilator is an important intervention in patients who develop hypoxia postintubation. If hypoxia remains undetected, it can be rapidly fatal without early intervention. A structured approach to concurrently identify and treat the underlying cause is imminent. This is what the helpful mnemonic "DOPES” stands.
What is...
S - Stacked breaths. Remove the patient from the vent and squeeze the anterior chest wall for 10 seconds
400
These are the medications you can consider for reversal of bleeding after administration of tPA.
What are cyroprecipitate (high fibrinogen content) or TXA/aminocaproic acid (anti-fibrinolytic)?
400
A woman arrives in your ED after delivering en route to the hospital. The baby appears well and EMS delivered the placenta and clamped the cord. You notice copious bleeding that you suspect is greater than 1L, she is normotensive. Her uterus feels boggy on exam and there is no deep vaginal tear. These are the next therapies you should attempt.
What are bimanual massage, manual removal of products of conception, oxytocin drip, and TXA?
400
This type of GI bleed is associated with a sentinel/herald bleed.
What is aortoenteric fistula?
500
This beta blocker causes blockage of potassium efflux, which leads to QTc prolongation and puts a patient at risk for Torsades in an overdose.
What is Sotalol?
500
A patient with a Type II Hypercapneic Respiratory Failure has a PCO2 of 72 and pH of 7.28 on arterial blood gas. NIV is initiated. After one hour of being on BiPap, repeat arterial blood gas reveals a PCO2 of 82 and pH of 7.21. Before committing to endotracheal intubation and mechanical ventilation, a further trial of BiPap should be performed, however this should be adjusted on the BiPap machine.
What is the IPAP to EPAP ratio?
500
The ESETT Trial demonstrated that in benzodiazepine-refractory convulsive status epilepticus, the anticonvulsant drugs levetiracetam (60mg/kg), valproate (40mg/kg) and fosphenytoin (20mg/kg phenytoin equivalent) each led to seizure cessation and improved alertness by 60 minutes in approximately half the patients, and the three drugs were associated with similar incidence of adverse events. These are the feared complications of using fosphenytoin over the other agents.
What are sodium channel blockade, hypotension, bradycardia, and arrhythmias?
500
A woman at 38 weeks gestation presents to the ED for evaluation of chest pain and dyspnea. These are the components of the decision making algorithm you should use to evaluate for her risk of PE.
What is modified YEARS Algorithm and its components, pregnant, presence of clinical signs of DVT, Hemoptysis, PE #1 diagnosis.
500
SIRS is 88% sensitive in the detection of sepsis. This other screening tool for sepsis has a poorer sensitivity of 60% but better prognostic value for detecting sicker patients who have a higher associated mortality.
What is qSOFA?
Important to recognize associated with much higher mortality, as high, between 30-50%.
Based on SEPSIS-3 the definition of shock. 2016.
Sepsis 1 - 1991, Sepsis-induced, with hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities
Sepsis 2 - 2001, SBP < despite adequate fluid resus, (lactate >4)
Sepsis 3 - Hypotension, persistent
Requiring vasopressors for MAP ≥ 65
Lacate >2.0 despite IV fluid resus