Wednesday, November 30, 2016
Tuesday, November 29, 2016
Monday, November 28, 2016
01. The answer is: d. The rhythm is irregular. The P waves are upright and uniform but are not paired with a QRS complex. The atria and ventricles are beating independently of one another.
02. The answer is: a. Atropine
03. The answers are: b. Epinephrine is a positive chronotrope and increases the heart rate and d. Epinephrine is an alpha adrenergic agonist and will cause vasoconstriction. It also has positive inotropic activities that increase myocardial contraction
04. The answer is: c. It improves myocardial contractility and increases the sinoatrial node rate
05. The answer is: a. Transcutaneous pacing
Friday, November 25, 2016
01. The answer is: a. There is a 20 mm/hg drop in the systolic blood pressure and a 10 mm/hg drop in the diastolic blood pressure when going from lying to standing. The symptom is caused by blood pooling in the lower extremities upon a change in body position.
02. The answers are: a. The initial dose of dopamine is 0.5 mg, b. Atropine can be administered every 3 – 5 minutes, and d. The maximum cumulative dose of atropine is 3 mg
03. The incorrect answers are: b. Epinephrine is given 1 mg every 3 – 5 minutes and d. Epinephrine is given at 2 – 20 mcg/kg/min. The correct dose of epinephrine is: a. Epinephrine is given at 2 – 10 mcg/min and it should be titrated to the patient’s response
04. The answer is: c. Atropine
05. The answer is: All the above
Thursday, November 24, 2016
01. The answer is: b. Pharyngeal reflex.
02. d. None of the above. There is not a lab marker for Pradaxa (Dagbitran)
03. c, Serum glucose or bedside blood sugar testing must be done to rule out neruological symptoms related to hypoglycemia. According to the manufacturer, Alteplase may be given prior to the results of the PT/INR but the infusion should be stopped if the results exceed the recommended parameters.
04. The answer is: c. 300 mg
05. The answer is: a. Non-contrast enhanced computed tomography (CT)
Wednesday, November 23, 2016
01. The answer is; b. The CT scan results and lab results should be ready within 45 minutes.
02. The answer is: a. 60 minutes. 10 minutes—patient seen by the ED physician for an initial assessment. • 15 minutes—patient seen by the stroke team • 25 minutes—non-contrast CT scan performed • 45 minutes—CT scan results available to the stroke team and decision made for treatment • 60 minutes—initiation of fibrinolytic therapy within 3 hours of stroke symptoms unless contraindicated.
03. The answer is: All of the above.
04. b. Atrial fibrillation. A left atrial clot may develop with atrial fibrillation
05. The answer is: b. 185 and 110 mm Hg
Tuesday, November 22, 2016
01. The incorrect answer is: d. The anticoagulant effects of aspirin help to reduce the size of the clot. Aspirin has antiplatelet activities and helps to prevent the thrombus from increasing in size.
02. The answer is: a. 30 minutes. The door to needle time is less than 30 minutes.
03. The answer is: c. 90 minutes
04. The answer is: d. II, III, aVF. These are contiguous leads for the inferior wall of the left ventricle.
05. The answer is: d. Lateral wall of the left ventricle (I, aVL, V5, V6). Answer A: Anterior wall (V3-V4), Answer B: Tall R waves and ST depression in V1-V3 suggest a posterior wall MI. Answer C: Septal (V1-V2 septal) Answer E: Right ventricular infarction (V4R)
Monday, November 21, 2016
01. The answers are: a. A 34 year old with an aspirin allergy, b. A 45 year old with active peptic ulcer disease, and c. A 56 year old with nausea and vomiting
02. The incorrect answer is: b. A MAP < 65 mm Hg. Avoid administering nitroglycerin for b. A MAP < 65 mm Hg, c. Marked bradycardia (< 50 bpm) or tachycardia, d. Recent phophodiesterase inhibitor use (within last 48 hours), and e. Right ventricular MI. If used in conjunction with phosphodiesterase inhibitors the patient may develop severe hypotension which is refractory to treatment with vasopressors.
03. The answers are: a. A right ventricular infarction may be an extension of an inferior wall infarct, c. The healthcare provider should avoid administering pre-load reducing medications, and d. If a right ventricular infarct is suspected then a right sided EKG should be performed. Answer B: Patients with a suspected RV infarct are very dependent on adequate volume in order to maintain the cardiac output, so large volumes of fluid may be required. Answer E: Morphine causes venodilation and may reduce blood return to the heart and decrease right ventricular filling pressures and cardiac output.
04. The incorrect answers are: c. Tamsulosin (Flomax) and d. Finasteride (Proscar)
05. The answer is: c. ≥ 94%. Oxygen should be administered if the patient is dyspneic, hypoxemic, has obvious signs of heart failure, has an arterial oxygen saturations < 94%, or the oxygen saturation is unknown.
Friday, November 18, 2016
01. The answer is: c. 32 – 36. Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF). It should be maintained for at least 24 hours after reaching target temperature.
02. The answer is: a. Septal wall infarction
03. The incorrect answer is: c. Prophylactic administration of an antiarrhythmic medication should be initiated to suppress further dysrhythmias.
04. The answer is: c. 72 hours. The earliest time for prognostication using clinical examination in patients treated with TTM, where sedation or paralysis could be a confounder, may be 72 hours after return to normothermia. This approach minimizes the possibility of obtaining false-positive results (ie, inaccurately suggesting a poor outcome) because of drug-induced depression of neurologic function
05. The answers are: a. Hypotension, b. Distended neck veins, c. Muffled heart tones, and d. Pulsus paradoxus. Collectively, hypotension, distended neck veins, and muffled heart tones are called Beck’s triad.
Thursday, November 17, 2016
01. The answer is: c. 94%. When resources are available to titrate the Fio2 and to monitor oxyhemoglobin saturation, it is reasonable to decrease the Fio2 when oxyhemoglobin saturation is 100%, provided the oxyhemoglobin saturation can be maintained at 94% or greater.
02. The incorrect answer is: c. During cardiac arrest, it may be used to detect increasing intrathoracic pressures.
03. The answers are: b. Epinephrine 0.1–0.5 mcg/kg/min (In 70-kg adult, 7–35 mcg/min) and d. Dopamine 5–10 mcg/kg/min. Both epinephrine and dopamine have alpha and beta adrenergic properties which will improve the heart rate and blood pressure. Norepinephrine and Phenylephrine have mostly alpha adrenergic properties which will improve the blood pressure. Dobutamine has beta adrenergic properties which will increase myocardial contractility.
04. The answer is: d. 45 – 55 mm Hg. Avoid excess ventilations. Begin at 1- - 12 breaths/min and titrate to a target PETCO2 of 35 – 45 mm Hg. Maintain FIO@ to a minimum to achieve SPO2 ≥ 94%
05. The answers are: a. Epinephrine 0.1 – 0.5 mgc/kg/min (7 – 35 mcg/min), b. Dopamine 5 – 10 mcg/kg/min, and d. Norepinephrine 0.1 – 0.5 mcg/kg/min (7 – 35 mcg/min). These are titrated to maintain a SBP over 90 mm Hg or a MAP over 65 mm Hg.