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EM Clerkship

NBME Shelf Review (Part 9) – Cardiopulmonary

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 25 November 2018

⏱️ 14 minutes

🧾️ Download transcript

Summary


Pulmonary Embolism



* Three types of pulmonary embolism* “Massive”* Hypotension or severe bradycardia* Treat with tPA or thrombectomy* “Submassive”* Normotensive but with Right Heart Strain* S1Q3T3 on EKG* Elevated BNP* Elevated troponin* Dilation of RV on ultrasound* Treat with heparin/lovenox and admit* “Low Risk”* Treat with anticoagulation* Outpatient vs inpatient treatment* Testing* CTA of the Chest* If severe contrast allergy or other contraindication* Ventilation/Perfusion (V/Q) Scan



Inferior STEMI



* EKG shows ST elevation in 2, 3, aVF* Can involve AV node (bradycardia)* Avoid beta blockers* Treat with atropine* Can involve RV (preload dependent)* Avoid nitroglycerine* Treat with fluids



Common to Nitroglycerine



* Hypotension* Current sildenafil usage



Aortic Dissection



* Type A (ascending) Dissection* Surgical emergency* Type B (descending) Dissection* Medical management* Testing* CTA of the chest* Chest X-Ray SOMETIMES shows a widened mediastinum* Treatment* Esmolol (decrease heart rate)* Labetelol (decrease blood pressure)* PEARL: Aortic dissection can cause STEMI



Heart Failure



* Treatment* Diuresis* Nitroglycerin* BiPAP* If patient needs fluids* Decrease size of fluid bolus



COPD



* Treatments* Albuterol/Ipratropium* Antibiotics* Steroids* BiPAP



Pneumonia



* If alcoholic/homeless/dementia/parkinson’s* Treat for aspiration (anaerobes)* If recent hospitalization/ventilator* Treat for pseudomonas and MRSA* If pneumonia PLUS atypical symptoms* Treat for legionella* If recent influenza* Treat for MRSA



Additional Reading



* Pulmonary Embolism Basics (EM Clerkship)* Pulmonary Embolism Severity (PubMed)




Transcript

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0:00.0

Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of

0:07.1

endless charting once you become a doctor? Do you think that doctors should be spending more

0:11.9

time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a

0:20.4

secure, hippocompliant scribe that anybody can use.

0:24.7

Focus your energy on what matters, providing good patient care.

0:29.5

Use coupon code EM50 to save 50% the first month you try it,

0:34.1

and you can cancel at any time if you decide it's not right for you. You can learn more at

0:39.3

www.gitfreed.a.i. Hey everyone, what's going on? This is Mike Estefan from the University of

0:49.1

Rochester School of Medicine, bringing you episode nine in the Emergency Medicine shelf exam review series.

0:56.0

This week's episode is going to be focused on cardiopulmonary emergencies.

1:00.8

A lot of what I'm going to be covering in this episode is considered to be the bread and

1:04.4

butter of emergency medicine. Most of you probably have the clinical presentation for many

1:10.4

of these diseases drilled into your head from your clerkship.

1:13.6

For example, pulmonary embolism, myocardial infarction, aortic dissection, etc.

1:19.6

So I'm mostly going to be focusing on ways that the exam will try to trick you with these questions.

1:24.6

I'm not really going to be focusing on the disease presentations.

1:28.3

And just a heads up guys, I'm currently getting over a viral pharyngitis, so if my voice

1:34.3

sounds a little different or softer than the previous weeks, that's why.

1:37.3

Alright, let's start off with pulmonary embolism.

1:41.3

So for pulmonary embolism, the exam typically won't make you calculate a well

1:46.1

score or figure out if you can perk rule them out or whatever. Instead, usually it'll give you a

1:52.0

vignette with a disease presentation that is obvious for a pulmonary embolism, and then it will

...

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