SAEM EMERGENCY MEDICINE EXAM
What are the top 3 causes of morbidity/mortality in acute chest pain? - Answers - ACS
pulmonary embolism
aortic dissection
What is the cardioversion and defibrillation joules? - Answers - cardioversion = 50-100 J
defibrillation = 200 J
What is the most common EKG finding in a pulmonary embolus? What should you be
on the lookout for? - Answers - most common = sinus tachycardia
look for = "S1Q3T3" (large S wave in lead I + Q wave in lead 3 + T wave inversion in
lead 3)
What should you worry about if a patient's EKG shows electrical alternans? What does
this look like? - Answers - cardiac tamponade! looks like alternating big and small spikes
Describe the basic evolution of the EKG of a patient having a STEMI - Answers - 1-
normal
2- T waves become wide and tall
3- ST elevation
4- Q waves and T wave inversion
5- Q waves persist but T wave normalizes
chest pain, weakness, nausea, fatigue
classic presentation of ___________________ - Answers - ACS!
pleuritic chest pain, shortness of breath, anxiety
classic presentation of ___________________ - Answers - pulmonary embolism
a patient with SOB is found on physical exam to have tachycardia, clear lung sounds,
and a swollen leg
classic presentation of ___________________ - Answers - pulmonary embolism
sudden on set severe chest pain that rips through to the back; unequal blood pressures
on PE
classic presentation of ___________________ - Answers - aortic dissection
How does cardioversion work? - Answers - used to stop tachyarrhythmias --> the
impulse is delivered at the peak of an R wave (prevents going into v fib)
, What are 5 indications for cardioversion? - Answers - 1. ventricular tachycardia with a
pulse
2. supraventricular tachycardias with hypotension
3. atrial fibrillation
4. atrial flutter
5. AVNRT
What are three indications for defibrillation? - Answers - ventricular tachycardia without
a pulse
ventricular fibrillation
torsades de pointes without pulse
What are five indications for ICD? - Answers - 1. hx of sudden cardiac death
2. Brugada syndrome
3. CHF patients with EF < 35% on max medical therapy
4. long QT syndrome
5. hypertrophic cardiomyopathy
CPR should be conducted with chest compressions and breaths via bag mask in this
ratio - Answers - 30 chest compressions then 2 breaths
(if intubated then continuous compressions and 1 breath every 6 seconds)
Describe high quality chest compressions - Answers - 100-120 compressions per
minute at a depth of 2 to 2.4 inches
patient on hard surface or back board
watch for full chest recoil in between
During CPR, providers giving chest compressions should switch every - Answers - 2
minutes (5 cycles of 30 compressions and 2 breaths)
Describe ventricular tachycardia - Answers - wide regular QRS complexes
absent P and T waves
rate usually around 180
Which three electrolytes should you check in a patient with QT prolongation? - Answers
- 1. hypokalemia
2. hypocalcemia
3. hypomagnesemia
what should you give a patient in torsades de points? - Answers - magnesium 1-2
grams IV diluted in 10 mL normal saline over 30-60 seconds
What are the top 3 causes of morbidity/mortality in acute chest pain? - Answers - ACS
pulmonary embolism
aortic dissection
What is the cardioversion and defibrillation joules? - Answers - cardioversion = 50-100 J
defibrillation = 200 J
What is the most common EKG finding in a pulmonary embolus? What should you be
on the lookout for? - Answers - most common = sinus tachycardia
look for = "S1Q3T3" (large S wave in lead I + Q wave in lead 3 + T wave inversion in
lead 3)
What should you worry about if a patient's EKG shows electrical alternans? What does
this look like? - Answers - cardiac tamponade! looks like alternating big and small spikes
Describe the basic evolution of the EKG of a patient having a STEMI - Answers - 1-
normal
2- T waves become wide and tall
3- ST elevation
4- Q waves and T wave inversion
5- Q waves persist but T wave normalizes
chest pain, weakness, nausea, fatigue
classic presentation of ___________________ - Answers - ACS!
pleuritic chest pain, shortness of breath, anxiety
classic presentation of ___________________ - Answers - pulmonary embolism
a patient with SOB is found on physical exam to have tachycardia, clear lung sounds,
and a swollen leg
classic presentation of ___________________ - Answers - pulmonary embolism
sudden on set severe chest pain that rips through to the back; unequal blood pressures
on PE
classic presentation of ___________________ - Answers - aortic dissection
How does cardioversion work? - Answers - used to stop tachyarrhythmias --> the
impulse is delivered at the peak of an R wave (prevents going into v fib)
, What are 5 indications for cardioversion? - Answers - 1. ventricular tachycardia with a
pulse
2. supraventricular tachycardias with hypotension
3. atrial fibrillation
4. atrial flutter
5. AVNRT
What are three indications for defibrillation? - Answers - ventricular tachycardia without
a pulse
ventricular fibrillation
torsades de pointes without pulse
What are five indications for ICD? - Answers - 1. hx of sudden cardiac death
2. Brugada syndrome
3. CHF patients with EF < 35% on max medical therapy
4. long QT syndrome
5. hypertrophic cardiomyopathy
CPR should be conducted with chest compressions and breaths via bag mask in this
ratio - Answers - 30 chest compressions then 2 breaths
(if intubated then continuous compressions and 1 breath every 6 seconds)
Describe high quality chest compressions - Answers - 100-120 compressions per
minute at a depth of 2 to 2.4 inches
patient on hard surface or back board
watch for full chest recoil in between
During CPR, providers giving chest compressions should switch every - Answers - 2
minutes (5 cycles of 30 compressions and 2 breaths)
Describe ventricular tachycardia - Answers - wide regular QRS complexes
absent P and T waves
rate usually around 180
Which three electrolytes should you check in a patient with QT prolongation? - Answers
- 1. hypokalemia
2. hypocalcemia
3. hypomagnesemia
what should you give a patient in torsades de points? - Answers - magnesium 1-2
grams IV diluted in 10 mL normal saline over 30-60 seconds
