My Heart Hurts
What lead(s) are associated with a right ventricular infarct?
Inferior leads (II, III, avF) and on right sided ECG, V4R (some sources say V3R-V6R)
Are children small adults?
No!
Most common bacteria causing pneumonia and its treatment
Strep Pneumo
Amox 1 g po tid
Within how many hours is a CT non con effective to rule out SAH?
6-12 hours depending on the source
How useful is urinalysis for ruling out nephrolithiasis!
Not very! ~25% have normal UA
What is the definition of an ST elevation (be specific per lead)
1. More than 2 contiguous leads
2. a) > 2.5mm in V2-V3 (M, < 40y.o)
2. b) > 2 mm V2-V3 (M, > 40 y.o)
2. c) > 1.5mm in V2-V3 (F)
2. d) > 1mm otherwise
What size tube do you use for pediatric intubation? size and length
Tube size = (age / 4) + 3.5
Length = size x 3
What bug might you classically suspect with dyspnea in addition to GI symptoms
Legionella
How do you reverse apixaban if a patient has a confirmed intracranial bleed?
PCC (aka octoplex!)
What is the only ED pharma treatment shown to reduce mortality in upper GI bleed
Ceftriaxone to reduce subsequent infection
What are three STEMI equivalents (bonus points for a fourth that used to be considered, now is not)
de Winters (up sloping STE, hyperacute T)
STE aVR and V1
Sgarbossa Criteria
New LBBB (used to be considered, now not so)
What dose of atropine do you use prior to RSI and why is it more used in kids?
Atropine = 0.02 mg/kg
Higher vagal tone in kids = higher risk of bradycardia
Where do you perform a needle thoracostomy?
1. Second Intercostal Space above Rib in Mid Clav Line
2. Fourth Intercostal Space above rib in Anterior Ax line
sBP 220
dBP 120
MAP 130
What is a dieulafoy lesion?
Arteries protrude into the GI tract, cause massive intermittent bleeding. Can get irritated by NSAIDs, higher risk in liver disease.
Name 10 contraindications to thrombolysis
Absolute: Active Bleeding Disorder, surgery within last two/three months, ever had hemorrhagic stroke, ischemic stroke within 3 months, closed head injury within 3 months, intrcranial malignancy ever, AVM in brain, uncontrolled BP
Relative: long list. Inc pregnancy, anticoagulation user, Hx of prolonged CPR, known bleeding disorder
What are the five parameters of a pediatric TBI (things to avoid)
hypoxia, hypotension, hypothermia, hypoglycemia, raised ICP
Spot Diagnosis:
acute onset dyspnea, Hypertension, known CHF history
SCAPE
What are the decrease in MAP goals for hypertensive encephalopathy?
Reduce by 20-25% within 1-2 hours
MAP of 125 over next 2-6 hours
First line pain meds for biliary colic
NSAIDS (opioids often used unnecessarily)
Name 10 diagnoses on DDx for STEMI
ACS, Myocarditis, pericarditis, hyperkalemia, brugada, PE, LBBB, TCA Toxicity, Benign early repol, Hypothermia (osborn waves), Post electroversion (stunning), Acute cerebral hemorrhage, global ischemia (e.g. GI bleed/trauma), Hypercalcemia
What is the Swischuk line?
Line through posterior arch of the cervical vertebrae, used to differentiate pseudosubluxation from true subluxation. We accept < 1.5 mm displacement
Name 10 non-infectious sources of pulmonary infiltrates
•Allergic bronchopulmonary aspergillosis
• Acute eosinophillic lung disease
• Hypersensitivity pneumonitis
• Organizing pneumonia (BOOP)
• ANCA Associated vasculitides (GPA, Churg Strauss)
• Acute interstitial Pneumonia (idiopathic, chemical agents, high mortality)
• Sarcoidosis (granulomatous disease)
• Anti-GBM disease
• Drug induced pneumonitis (chemo, herbal, antimicrobial)
• Chemical pneumonitis (barium, petroleum, pesticides)
• Radiation pneumonitis
• Bronchioloalveolar carcinoma (adenocarcinoma)
• Leukemic infiltrates
• Fat embolism (after trauma, long bone fracture)
• Alveolar hemorrhage (chemo for leukemia)
• ARDS (seps/trauma/surgery/transfusions)
--> often all treated with methylpred
What are exclusion criteria for TPA in stroke?
Age > 80
NHSS Severity Score > 5 (bad stroke)
On anticoagulation
Hx of diabetes and prior ischemic stroke
What is the pathophys of a gallstone ileus (lol)
gallstones transit to small bowel via a gallbladder-intestinal fistula and cause obstruction.