NBME Shelf Review (Part 9) – Cardiopulmonary

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 <a href="http://www.emclerkship.com/pulmonary-embolism-critical-diagnosis/">(EM Clerkship)</a>* Pulmonary Embolism Severity <a href="https://pubmed.ncbi.nlm.nih.gov/20696966/">(PubMed)</a>

NBME Shelf Review (Part 9) – Cardiopulmonary

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