Emergency Medicine Midterm Exam 6
Questions and Answers Latest Versions
2025 A+
accelerated idioventricular rhythm
- HR 60-100
- wide QRS, fang onaa table or on a vase
- bradycardia ACLS
- trx: atropine + transcutaneous pacing
3rd degree heart block
- if P's and Q's don't agree
- bradycardia ACLS
- trx: transcutaneous pacing
2nd degree heart block type 1
- longer longer longer drop
- bradycardia ACLS
- trx: if sx atropine + cutaneous pacing
2nd degree heart block type 2
- if some P's don't get through
- bradycardia ACLS
- trx: transcutaneous pacing
idioventricular rhythm
- HR <40
- ACLS bradycardia
- +/- p-wave, no association with QRS, wide QRS
- trx: atropine + transcutaneous pacing
how long do you check for pulse
10 sec
no breathing no pulse
- adult/kid CPR 30:2
- infant CPR - 1 person 30:2, 2 person 15:2
,- AED
- epi 1 mg q3min
adult compression rate
100-120 per min
pulse, no breathing
rescue breaths every 6 seconds (10 breaths/min)
depth of adult and kid CPR
- 2 inches
depth of infant CPR
- 1.5 inches
infant choking
- < 1 year old
- 5 back blows
- 5 chest thrust (two fingers)
- if you see object, remove it
- no blind finger sweep
ventricular fibrillation
- small weird mountains
- no cardiac output
- trx: immediate CPR, AED, epi 1 mg, intubate
reversible causes of no pulse
H's & T's
1. hypovolemia
2. hypoxia
3. hydrogen ion (acidosis)
4. hypo or hyperkalemia
5. tension pneumothorax
6. tamponade
7. toxins
8. thrombosis of pulmonary (PE)
9. thrombosis of coronary
ROSC stabilization phase
,- airway: intubate
- breathing: RR >10, O2 >/=92%, PaCO2 35-45 mmHg
- circulation: SBP > 90, MAP >65, IV crystalloid
how do you know when rosc is achieved
sustained end-tidal CO2 >/= 40 mmHg
ROSC continued management
- EKG (check STEMI)
- check for unstable cardiogenic shock
- if patient cant follow commands: manage temp, brain CT, EEG,
glucose
AVPU
1. awake
2. responds to verbal stimuli
3. responds to painful stimuli
4. unresponsive to stimuli
GCS </= 8
intubate
AEIOUTIPS
- possible AMS causes
1. alcohol
2. epilepsy, electrolytes, encephalopathy
3. insulin
4. oxygen, opiates
5. uremia
6. trauma, temp
7. infxn
8. poisons, psychogenic
9. shock, stroke, SAH, space occupying lesion
questionnaires for to determine level of orientation
1. six item screen (SIS)
2. quick confusion scale (QCS) - day month year, recall 3 items
QCS scale impairment likely
0-3 points
, dx for AMS
- O2 sat
- glucose
- CBC, BMP, UA, CXR, ECG, ammonia, UDS, ethanol, ABG
- +/- head CT, EEG, tox screen, T4/TSH
alcoholic ketoacidosis
- sx: N/V, tremors, agitation
- PE: alert & lucid (dif than DKA), HTN, tachycardic, +/- seizure
- trx: glucose (ex. 50D), thiamine, folate, electrolyte repletion (K,
Na, Mg, phos), +/- ativan
- often caused by alcohol withdrawal
hypothyroidism
- mmc: hashimotos
- sx: fatigue, weakness, dry skin, weight gain etc
- PE: bradycardia, dec DTR
- dx: T4/TSH
- trx: outpatient referral, levothyroxine
myxedema
- severe, rapid onset of hypothyroidism
- sx: hypothyroid sx, fluid retention, AMS, pericardial effusion,
ascites
- PE: hypothermia, hypoventilation, hypotensive, convulsions
- dx: CLINICAL
- trx: IV levothyroxine, hydrocortisone (if in coma), symptomatic
care
classic stroke sx
- numbness
- weakness of face, arm, leg (unilateral)
- confusion
- aphasia
- memory issue, disorientation
- visual defect
Questions and Answers Latest Versions
2025 A+
accelerated idioventricular rhythm
- HR 60-100
- wide QRS, fang onaa table or on a vase
- bradycardia ACLS
- trx: atropine + transcutaneous pacing
3rd degree heart block
- if P's and Q's don't agree
- bradycardia ACLS
- trx: transcutaneous pacing
2nd degree heart block type 1
- longer longer longer drop
- bradycardia ACLS
- trx: if sx atropine + cutaneous pacing
2nd degree heart block type 2
- if some P's don't get through
- bradycardia ACLS
- trx: transcutaneous pacing
idioventricular rhythm
- HR <40
- ACLS bradycardia
- +/- p-wave, no association with QRS, wide QRS
- trx: atropine + transcutaneous pacing
how long do you check for pulse
10 sec
no breathing no pulse
- adult/kid CPR 30:2
- infant CPR - 1 person 30:2, 2 person 15:2
,- AED
- epi 1 mg q3min
adult compression rate
100-120 per min
pulse, no breathing
rescue breaths every 6 seconds (10 breaths/min)
depth of adult and kid CPR
- 2 inches
depth of infant CPR
- 1.5 inches
infant choking
- < 1 year old
- 5 back blows
- 5 chest thrust (two fingers)
- if you see object, remove it
- no blind finger sweep
ventricular fibrillation
- small weird mountains
- no cardiac output
- trx: immediate CPR, AED, epi 1 mg, intubate
reversible causes of no pulse
H's & T's
1. hypovolemia
2. hypoxia
3. hydrogen ion (acidosis)
4. hypo or hyperkalemia
5. tension pneumothorax
6. tamponade
7. toxins
8. thrombosis of pulmonary (PE)
9. thrombosis of coronary
ROSC stabilization phase
,- airway: intubate
- breathing: RR >10, O2 >/=92%, PaCO2 35-45 mmHg
- circulation: SBP > 90, MAP >65, IV crystalloid
how do you know when rosc is achieved
sustained end-tidal CO2 >/= 40 mmHg
ROSC continued management
- EKG (check STEMI)
- check for unstable cardiogenic shock
- if patient cant follow commands: manage temp, brain CT, EEG,
glucose
AVPU
1. awake
2. responds to verbal stimuli
3. responds to painful stimuli
4. unresponsive to stimuli
GCS </= 8
intubate
AEIOUTIPS
- possible AMS causes
1. alcohol
2. epilepsy, electrolytes, encephalopathy
3. insulin
4. oxygen, opiates
5. uremia
6. trauma, temp
7. infxn
8. poisons, psychogenic
9. shock, stroke, SAH, space occupying lesion
questionnaires for to determine level of orientation
1. six item screen (SIS)
2. quick confusion scale (QCS) - day month year, recall 3 items
QCS scale impairment likely
0-3 points
, dx for AMS
- O2 sat
- glucose
- CBC, BMP, UA, CXR, ECG, ammonia, UDS, ethanol, ABG
- +/- head CT, EEG, tox screen, T4/TSH
alcoholic ketoacidosis
- sx: N/V, tremors, agitation
- PE: alert & lucid (dif than DKA), HTN, tachycardic, +/- seizure
- trx: glucose (ex. 50D), thiamine, folate, electrolyte repletion (K,
Na, Mg, phos), +/- ativan
- often caused by alcohol withdrawal
hypothyroidism
- mmc: hashimotos
- sx: fatigue, weakness, dry skin, weight gain etc
- PE: bradycardia, dec DTR
- dx: T4/TSH
- trx: outpatient referral, levothyroxine
myxedema
- severe, rapid onset of hypothyroidism
- sx: hypothyroid sx, fluid retention, AMS, pericardial effusion,
ascites
- PE: hypothermia, hypoventilation, hypotensive, convulsions
- dx: CLINICAL
- trx: IV levothyroxine, hydrocortisone (if in coma), symptomatic
care
classic stroke sx
- numbness
- weakness of face, arm, leg (unilateral)
- confusion
- aphasia
- memory issue, disorientation
- visual defect
