# Pimp Questions



## VFlutter

This thread is to share random pimp questions about whatever you want: Pharmocology, A&P, patho, clincal situations, etc. Anything goes! Hopefully this can be a fun way to kill time and learn something new. 

For those of you who do not kow what "Pimp questions" are they are difficult or obscure questions typically asked by instructors to students to test their knowledge. 

Try to answer questions without looking things up. If your not sure feel free to take a guess and brainstorm with others. 

Get yo' pimp on...:beerchug:


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## VFlutter

Explain the second stage of the Cushing reflex. Why and how does it occur? 

Explain the 3 types of Aortic Dissection


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## Aprz

Chase said:


> Explain the second stage of the Cushing reflex. Why and how does it occur?
> 
> Explain the 3 types of Aortic Dissection


I know only the answer to the first one. It's bradycardia, and it's because baroreceptors in the carotid detect an increase in pressure, and stimulate the vagus nerve to slow down the heart.

I don't have any pimp questions that I can think of. :[


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## NYMedic828

I vote Vene and JP aren't allowed to play this game. They gonna win :glare:


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## Sublime

Chase said:


> Explain the 3 types of Aortic Dissection




DeBakey (sp?) 1,2 and 3. Don't remember what the differences are without cheating.


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## VFlutter

Sublime said:


> DeBakey (sp?) 1,2 and 3. Don't remember what the differences are without cheating.



Type 1 (most common) originates in the ascending aorta and extends to at least the aortic arch or farther. 
Type 2 originates and is confined in the ascending aorta 
Type 3 orientates in the descending aorta and extends towards the abdominal aorta. 

I sometimes mix them up. Logically I think type 1 and 2 should be switched.


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## Aprz

Hey, I clicked on one of JPINFVs links that took me to #whatshouldwecallmedschool, and I was clicking previous. Saw these two that made me think of this post.

http://whatshouldwecallmedschool.tu...et-a-pimping-question-wrong-and-the-attending

http://whatshouldwecallmedschool.tu...when-the-attending-renowned-for-their-pimping

Edit: and http://whatshouldwecallmedschool.tumblr.com/post/38662377909/getting-pimped-on-step-1-material-during-rounds-as-a

Edit: Another one! http://whatshouldwecallmedschool.tumblr.com/post/37326500282/when-i-get-an-easy-pimp-question-wrong


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## mycrofft

Do we have to answer the prior question before we can ask one? Or drink a 1/2 liter of stout?


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## mycrofft

Pt c/o hemorrhoids. You flip him over, confirm then order a liver panel and ask if he has ever coughed up, spit up or vomitted blood.
Why? 
(PS: BP elevated)


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## VFlutter

mycrofft said:


> Pt c/o hemorrhoids. You flip him over, confirm then order a liver panel and ask if he has ever coughed up, spit up or vomitted blood.
> Why?
> (PS: BP elevated)



Anorectal varices* r/t portal hypertension associated with liver failure. Other common complications are esophageal and gastric varices. 

*Anorectal varices is the correct term even though many just refer to them as  hemorrhoids. They are similar but not the same thing.

Anyone know what a TIPS procedure is?


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## mycrofft

Winner winner chikkin dinner


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## mycrofft

Elderly pt c/o "ashy feet". On exam, has moccasin-shaped dry powdery skin on both feet. You also see another lesion, a 8mm fairly deep ulcer with red border and yellow floor, painless, been around about a "couple weeks".

Which lab order do you check off first before the obligatory CBC/diff&RDW+Chem4?


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## NomadicMedic

TIPS is a liver shunt to treat portal HTN. I only remember because I transported a patient who underwent one.


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## mycrofft

n7lxi said:


> TIPS is a liver shunt to treat portal HTN. I only remember because I transported a patient who underwent one.



http://en.wikipedia.org/wiki/Transjugular_intrahepatic_portosystemic_shunt


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## mycrofft

mycrofft said:


> Elderly pt c/o "ashy feet". On exam, has moccasin-shaped dry powdery skin on both feet. You also see another lesion, a 8mm fairly deep ulcer with red border and yellow floor, painless, been around about a "couple weeks".
> 
> Which lab order do you check off first before the obligatory CBC/diff&RDW+Chem4?



Hint:     Rhymes with "parakeet"...


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## VFlutter

*New Years Eve Mega Pimp Question*







You patient presents with ^ 

What is it? What is a common cause? Explain why it happens


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## mycrofft

Dos it extend up into the optic area?
Does it have to do with kissing the new secretary and finding out she's not as drunk as you thought?


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## VFlutter

mycrofft said:


> Dos it extend up into the optic area?
> Does it have to do with kissing the new secretary and finding out she's not as drunk as you thought?



Yes it does. Uh no


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## mycrofft

How long has it lasted and how rapid was it's onset?


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## mycrofft

I'm fishing, don't know. I'd palpate, look for blanching and rebound, sensation, local motor neuro signs. Suspect some sort of , er, lymphatic blockage?

Not cherubism...


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## VFlutter

mycrofft said:


> How long has it lasted and how rapid was it's onset?



Has progressed over the past few hours since waking up. 

PMH of HTN, CHF, and peanut allergy. HTN has been adequately controlled since changing medications 4 months ago.


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## mycrofft

Chipmunk Syndrome...saving peanuts for later.

Acute nut allergy? Could be exposed to it topically like in a cosmetic or other peanut oil -containing substance or object.


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## mycrofft

PS: My question's answer was "tertiary syphillis".


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## VFlutter

mycrofft said:


> Chipmunk Syndrome...saving peanuts for later.
> 
> Acute nut allergy? Could be exposed to it topically like in a cosmetic or other peanut oil -containing substance or object.



Claims to have not come into contact with any peanuts


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## mycrofft

Kissed new secretary after she ate PBJ.


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## mycrofft

I give up. Next batter!


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## JPINFV

Are we talking about the dude with the big lips who might have being taking an -pril drug, which prevents the breakdown of bradykinin. Bradykinin build up can also cause a cough (one of the major side effects of -prils, which normally requires switching to a -sartan).


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## VFlutter

JPINFV said:


> Are we talking about the dude with the big lips who might have being taking an -pril drug, which prevents the breakdown of bradykinin. Bradykinin build up can also cause a cough (one of the major side effects of -prils, which normally requires switching to a -sartan).



 that was too easy for you. I am sure you have a few pimp questions


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## Aprz

Edit: Never mind.


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## VFlutter




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## JPINFV

Chase said:


> [keep calm and get pimped]




I honestly can't stand the "Keep Calm and X" meme.


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## VFlutter

JPINFV said:


> I honestly can't stand the "Keep Calm and X" meme.



How could you hate any meme? Have you actually been to TheChive website? Best website to cure boredom


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## VFlutter

What is the difference between calcium chloride and calcium gluconate?

How can you assess for Hypocalcemia preshospitally?

Why can rapid infusion of blood products cause Hypocalcemia? 

How much wood would a wood chuck chuck if a wood chuck could chuck wood?


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## abckidsmom

Chase said:


> What is the difference between calcium chloride and calcium gluconate?
> 
> How can you assess for Hypocalcemia preshospitally?
> 
> Why can rapid infusion of blood products cause Hypocalcemia?
> 
> How much wood would a wood chuck chuck if a wood chuck could chuck wood?



This is a really great thread, but for simplicity's sake...one question at a time.


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## NYMedic828

Chase said:


> What is the difference between calcium chloride and calcium gluconate?
> 
> How can you assess for Hypocalcemia preshospitally?
> 
> Why can rapid infusion of blood products cause Hypocalcemia?
> 
> How much wood would a wood chuck chuck if a wood chuck could chuck wood?



Guess i'll just attempt to take a guess. I honestly have no idea.

1. I think chloride has a higher concentration of pure calcium hence why it causes more severe infiltration. Gluconate is safer without a central line.
2. Assess deep tendon reflexes? 
3. Pulls intracellular calcium into the new fluid volume causing a generalized hypocalcemic state?

4. The answer is 6. Thats an easy one.


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## medichopeful

Chase said:


> How can you assess for Hypocalcemia preshospitally?



Stroke their face if I remember correctly!  Taking a BP can also do it if they have muscle spasms.


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## abckidsmom

medichopeful said:


> Stroke their face if I remember correctly!  Taking a BP can also do it if they have muscle spasms.



Chvostek's sign.


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## medichopeful

abckidsmom said:


> Chvostek's sign.



Yes.

I also looked it up right after I said it to see if I was right, and "touch" would have been a better and more accurate word than "stroke!" :glare:


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## Brandon O

Chase said:


> Why can rapid infusion of blood products cause Hypocalcemia?



PRBCs are often stored with citrate as a preservative, which binds calcium (a necessary cofactor in the clotting cascade). Transfusing the product means infusing the still-present citrate. This is also why Ringer's is thought to be an incompatible solution for reconstituting red cells -- adding back that calcium means it'll clot in the line. (Turns out, not so much.)


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## Fish

mycrofft said:


> Pt c/o hemorrhoids. You flip him over, confirm then order a liver panel and ask if he has ever coughed up, spit up or vomitted blood.
> Why?
> (PS: BP elevated)



A concerne for Varices and Portal Hypertension causing liver cirrohsis?


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## JPINFV

medichopeful said:


> Stroke their face if I remember correctly!  Taking a BP can also do it if they have muscle spasms.


Trousseau sign.

Surgery on what organ, if not performed carefully, can cause hypocalcemia for life? Why?


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## medicsb

All your benzos have been stolen and you have a patient seizing, which ACLS drug can you give to try and terminate the seizure?


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## NYMedic828

medicsb said:


> All your benzos have been stolen and you have a patient seizing, which ACLS drug can you give to try and terminate the seizure?



Mag sulfate?

Or, all of them. Can't seize if they are dead...


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## Brandon O

JPINFV said:


> Surgery on what organ, if not performed carefully, can cause hypocalcemia for life? Why?



Parathyroids, I'd imagine.


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## NYMedic828

Brandon Oto said:


> Parathyroids, I'd imagine.



For the second half.

Parathyroids release PTH which increases osteoclast activity to break down bone calcium increasing levels in the blood.

No PTH, no calcium release to the bloodstream. 


Calcitonin would just run unopposed from the thyroid, taking up calcium from the blood.


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## JPINFV

Brandon Oto said:


> Parathyroids, I'd imagine.




Close, but how often is surgery performed on the parathyroid glands themselves?


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## NYMedic828

JPINFV said:


> Close, but how often is surgery performed on the parathyroid glands themselves?



thyroid then?


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## JPINFV

NYMedic828 said:


> thyroid then?




Yep... if the surgeon isn't careful during a total thyroidectomy, they can remove the parathyroid glands as well, which leads to hypocalcemia.


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## NYMedic828

JPINFV said:


> Yep... if the surgeon isn't careful during a total thyroidectomy, they can remove the parathyroid glands as well, which leads to hypocalcemia.



So technically the answer is still parathyroid, but it happens by accident during thyroid surgery? 

Was my mechanism accurate or am I out in left field?


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## JPINFV

NYMedic828 said:


> So technically the answer is still parathyroid, but it happens by accident during thyroid surgery?
> 
> Was my mechanism accurate or am I out in left field?




Technically, surgery is on the thyroid, which the parathyroid is attached to. Removing all of the parathyroids during a total thyroidectomy is an error that is known to happen. Think of the parathyroids as collateral damage. 

The mechanism of PTH is 1/3 right. It also increases renal reabsorption of Ca, and increases renal 1, 25 Vitamin D production which in turn increases gut absorption of Ca.

A common treatment for parathyroid removal is to simply have the person carry around a package of Tums (Calcium Carbonate) and take one when they start to feel their face become twitchy (aforementioned Chvostek's sign).


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## Brandon O

The real question is, if they remove the thyroid, where do they stick the parathyroids?


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## JPINFV

Brandon Oto said:


> The real question is, if they remove the thyroid, where do they stick the parathyroids?




If they can leave one in the neck, they do so.

If they need to be able to access it in case it needs to be resected further they stick it in the arm.


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## CANDawg

Inspired by a recent post in the 100% Directionless Thread...

Identify the medical term for the flab of skin that hangs below the belly button in obese individuals. (Reference: http://i758.photobucket.com/albums/...0-B124-4C86AF39DD4D-1335-000000D4CDDC6430.jpg)

Double points if you can name both the medical term and the closely related generalized term!


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## Anjel

dbo789 said:


> Inspired by a recent post in the 100% Directionless Thread...
> 
> Identify the medical term for the flab of skin that hangs below the belly button in obese individuals. (Reference: http://i758.photobucket.com/albums/...0-B124-4C86AF39DD4D-1335-000000D4CDDC6430.jpg)
> 
> Double points if you can name both the medical term and the closely related generalized term!



Actually learned this in class.

Pannus. 

And I don't know the generalized term. I call it FUPA. Fat upper pubic area.


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## STXmedic

FUPA.

Now give me my cookie. 

Dang it, Anjel!!!


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## Anjel

PoeticInjustice said:


> FUPA.
> 
> Now give me my cookie.
> 
> Dang it, Anjel!!!



I'll share my cookie.


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## JPINFV

Anjel said:


> I'll share my cookie.


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## CANDawg

Anjel said:


> Actually learned this in class.
> 
> Pannus.
> 
> And I don't know the generalized term. I call it FUPA. Fat upper pubic area.



Actually, pannus IS the generalized term, although I'm not entirely sure that 'generalized' is the right word. Popularly adopted perhaps.

In the strictest sense, the flap is not a pannus but a *panniculus adiposus*, because it is hanging. (Pannus refers only to an abnormal layer of tissue.)


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## VFlutter

Great job guys...and girls.

What are the signs/symptoms of Grave's disease?


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## VFlutter

NYMedic828 said:


> 2. Assess deep tendon reflexes?





NYMedic828 said:


> Mag sulfate?




We check deep tendon reflexes with Mag sulfate infusions


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## Anjel

Chase said:


> Great job guys...and girls.
> 
> What are the signs/symptoms of Grave's disease?



Mi madre has Grave's.

Bulging eyes, rapid heart rate, hair loss, anxiety, always hot, irritation, fatigue and weight loss.


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## Anjel

A common lower back complaint is hyperlordosis. What are the major causes?


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## VFlutter

Correct.

The build up of ______ in the blood causes hepatic encephalopathy? What drug do we give for it?


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## medicsb

NYMedic828 said:


> Mag sulfate?
> 
> Or, all of them. Can't seize if they are dead...



True, seizing is difficult when dead, but that answer I was looking for was lidocaine, which acts similarly to phenytoin, which is also consider a class 1b antiarrhythmic like lidocaine.

Am J Emerg Med. 1993 May;11(3):243-4.
Lidocaine in refractory status epilepticus: a forgotten drug in the emergency department.
Aggarwal P, Wali JP.


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## Fish

medicsb said:


> True, seizing is difficult when dead, but that answer I was looking for was lidocaine, which acts similarly to phenytoin, which is also consider a class 1b antiarrhythmic like lidocaine.
> 
> Am J Emerg Med. 1993 May;11(3):243-4.
> Lidocaine in refractory status epilepticus: a forgotten drug in the emergency department.
> Aggarwal P, Wali JP.



Damn! Was going to say Lidocaine, but could not give a good enough rational


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## JPINFV

Anjel said:


> A common lower back complaint is hyperlordosis. What are the major causes?




Somatic dysfunction!

/troll face.


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## VFlutter

Anjel said:


> A common lower back complaint is hyperlordosis. What are the major causes?



Ballerinas :wub:


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## Brandon O

What's the common element between the Korotkoff sounds when you take a blood pressure, the thrill you feel over a dialysis fistula, and the bruit you might hear from the carotids?


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## VFlutter

Brandon Oto said:


> What's the common element between the Korotkoff sounds when you take a blood pressure, the thrill you feel over a dialysis fistula, and the bruit you might hear from the carotids?



Turbulent blood flow?


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## CANDawg

Chase said:


> Turbulent blood flow?



Seconded.


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## Brandon O

Chase said:


> Turbulent blood flow?



Indeed!

For bonus points: why might this be bad in the atria of an A-fib patient, but good at the site of a laceration?


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## VFlutter

Brandon Oto said:


> Indeed!
> 
> For bonus points: why might this be bad in the atria of an A-fib patient, but good at the site of a laceration?



Clotting 

#winning


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## CANDawg

Brandon Oto said:


> Indeed!
> 
> For bonus points: why might this be bad in the atria of an A-fib patient, but good at the site of a laceration?



Turbulent blood flow can activate platelets. Good for lacerations. However, valvular atrial fibrillation and clotting = not good.


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## CANDawg

Chase said:


> Clotting
> 
> #winning



Damn you and your quick responses!


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## VFlutter

dbo789 said:


> Damn you and your quick responses!



Step your game up 


And I'm on my iPhone. But your response was more detailed


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## Brandon O

dbo789 said:


> Damn you and your quick responses!



You win, better answer.

Continuing the theme of Clotting Tuesdays, give me three (not one, not two) mechanisms by which direct pressure helps control bleeding?


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## NYMedic828

I'm not smart enough for this thread.

:sad:



Brandon Oto said:


> You win, better answer.
> 
> Continuing the theme of Clotting Tuesdays, give me three (not one, not two) mechanisms by which direct pressure helps control bleeding?



Can only think of two


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## Thricenotrice

Brandon Oto said:


> You win, better answer.
> 
> Continuing the theme of Clotting Tuesdays, give me three (not one, not two) mechanisms by which direct pressure helps control bleeding?



Because that's what they taught me in EMT school, then medic school, and it decreases blood flow at the site due to minimizing lumen size?

That's three reasons.


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## CANDawg

Limits blood flow through the vessels, allowing time for the clotting mechanism to take effect.
Increases the turbulence of the blood flow, thereby further activating platelets.
Increases the surface area of the damaged endothelium exposed to blood causing further clotting.

The last one was a total guess.


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## mycrofft

disregard


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## Brandon O

Tee hee... I was mainly curious what people would come up with for the third. But the main three I had in mind were...

1. Tamponade proximal flow, reducing hydrostatic pressure (i.e. pinching the hose)

2. [As dbo said] Produce stasis at site of injury, allowing platelets to aggregate and adhere (i.e. "hey, don't go, the party's right here!")

3. Degranulates platelets by direct squishing, stimulating further activation (releasing all their juicy components like serotonin, ADP, thromboxane, etc). Also squeezes some good stuff from other tissue, such as tissue factor.

And perhaps, with gauze or a similar dressing...

4. Provides a suitably rough surface for platelet adhesion.


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## phideux

http://i758.photobucket.com/albums/...0-B124-4C86AF39DD4D-1335-000000D4CDDC6430.jpg

Front Butt.  :rofl::rofl::rofl:


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## medichopeful

phideux said:


> http://i758.photobucket.com/albums/...0-B124-4C86AF39DD4D-1335-000000D4CDDC6430.jpg
> 
> Front Butt.  :rofl::rofl::rofl:



Thanks for the contribution!


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## VFlutter

What is a Chiari malformation? What other congenital disorder usually occurs with it?


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## abckidsmom

Chase said:


> What is a Chiari malformation? What other congenital disorder usually occurs with it?



When the cerebellum protrudes through the foramen magnum as part of a fetal development anomaly. 

Spina bifida.


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## VFlutter

abckidsmom said:


> When the cerebellum protrudes through the foramen magnum as part of a fetal development anomaly.
> 
> Spina bifida.



Correct. Spina bifida is also known as Myelomeningocele. It confused me my first Peds test.

What prenatal supplement can be taken to help prevent neural tube defects?


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## abckidsmom

Chase said:


> Correct. Spina bifida is also known as Myelomeningocele. It confused me my first Peds test.
> 
> What prenatal supplement can be taken to help prevent neural tube defects?



Folate. And it doesn't take much. Foods rich in folate are fortified commercial breads, dark green veggies, beans and legumes, citrus fruits and liver. 

Very easy to get enough except by eating at McDs.


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## mycrofft

Anjel said:


> A common lower back complaint is hyperlordosis. What are the major causes?



1. high-heeled shoes
2. prolonged leaning forwards to use computer*, esp. if seat is too low
3. Marfanoid trait





*or kyphosis


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## mycrofft

Chase said:


> Correct.
> 
> The build up of ______ in the blood causes hepatic encephalopathy? What drug do we give for it?



NH3.
Lactulose


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## mycrofft

medicsb said:


> All your benzos have been stolen and you have a patient seizing, which ACLS drug can you give to try and terminate the seizure?



Do you stock phenobarb?


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## mycrofft

and moderating etoh intake


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## chaz90

I'm thinking Lidocaine to stop a pt. in seizure with no benzos available. If I recall correctly Lidocaine and Phenytoin are closely related, and Phenytoin can also be used as an anti arrhythmic.


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## VFlutter

What do we use to treat seizures in a patient with eclampsia?


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## NYMedic828

Chase said:


> What do we use to treat seizures in a patient with eclampsia?



Mag sulfate drip.

A protocol based question can't be a pimp question chase!  People actually know the answer :lol:



What neurotransmitter stimulates the contraction of muscle fibers? (or more specifically, the myofibrils inside the muscle cell)


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## JPINFV

NYMedic828 said:


> What neurotransmitter stimulates the contraction of muscle fibers? (or more specifically, the myofibrils inside the muscle cell)


Acetylcholine


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## usalsfyre

Chase said:


> What do we use to treat seizures in a patient with eclampsia?



Benzos. Then you try to treat the toxemia of pregnancy causing the seizures with mag. But benzos to actually treat the seizures.


What common vasopressor works outside the normal adrenergic system and is thus useful in shock refractory to other agents?


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## VFlutter

usalsfyre said:


> Benzos. Then you try to treat the toxemia of pregnancy causing the seizures with mag. But benzos to actually treat the seizures.
> 
> 
> What common vasopressor works outside the normal adrenergic system and is thus useful in shock refractory to other agents?



Vasopressin and maybe Phenylephrine?


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## Anjel

NYMedic828 said:


> Mag sulfate drip.
> 
> A protocol based question can't be a pimp question chase!  People actually know the answer :lol:



Ours is an IVP.


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## STXmedic

Seconded on vasopressin. Not leaning towards phenyl, though.


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## Brandon O

usalsfyre said:


> What common vasopressor works outside the normal adrenergic system and is thus useful in shock refractory to other agents?



You probably didn't mean this, but there's methylene blue...


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## usalsfyre

Vasopressin it is.

What is one of the primary reasons for propofol's rapid onset, why must the infusion be changed on a regular basis and why is it not generally used for ongoing sedation in children?


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## VFlutter

Brandon Oto said:


> You probably didn't mean this, but there's methylene blue...



I have heard about that on the anethesia forums and apparently it works great


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## VFlutter

usalsfyre said:


> Vasopressin it is.
> 
> What is one of the primary reasons for propofol's rapid onset, why must the infusion be changed on a regular basis and why is it not generally used for ongoing sedation in children?



Because it is in a very lipid soluble emulsion and is also suspetiable to microorganism growth. I think it also has a lot of calories and fat.


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## Fish

Chase said:


> Because it is in a very water soluble emulsion and is also suspetiable to microorganism growth. I think it also has a lot of calories.



Add that one to my knowledge bank


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## MediMike

But MJ didn't LOOK that fat...


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## VFlutter

Fish said:


> Add that one to my knowledge bank



It's 1 cal per ml IRRC


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## Brandon O

I thought that propofol was lipid-soluble.


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## VFlutter

Brandon Oto said:


> I thought that propofol was lipid-soluble.



I think your right. It's lipid soluable not water soluable.


What can cause a brown or tea colored urine?


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## Nattens

Chase said:


> I think your right. It's lipid soluable not water soluable.
> 
> 
> What can cause a brown or tea colored urine?



Variety of different kidney or liver diseases would be your most common causes.


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## VFlutter

Nattens said:


> Variety of different kidney or liver diseases would be your most common causes.



What about orange urine?


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## NomadicMedic

Pyridium.


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## VFlutter

n7lxi said:


> Pyridium.



Correct. That questions is always on nursing exams


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## JPINFV

Chase said:


> I think your right. It's lipid soluable not water soluable.
> 
> 
> What can cause a brown or tea colored urine?




Paroxysmal nocturnal hemoglobinuria.



Chase said:


> What about orange urine?



Rifampicin.


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## Brandon O

It's a beautiful day for infectious disease!

What are two common pathogenic microorganisms resistant to most contact antimicrobial agents except bleach?


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## Fish

Chase said:


> I think your right. It's lipid soluable not water soluable.
> 
> 
> What can cause a brown or tea colored urine?



Rabdo


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## STXmedic

Fish said:


> Rabdo



Myoglobinuria


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## VFlutter

Brandon Oto said:


> It's a beautiful day for infectious disease!
> 
> What are two common pathogenic microorganisms resistant to most contact antimicrobial agents except bleach?



MRSA and VRE? Or maybe Ebola h34r:


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## mycrofft

Brandon Oto said:


> It's a beautiful day for infectious disease!
> 
> What are two common pathogenic microorganisms resistant to most contact antimicrobial agents except bleach?



Define "common", otherwise I'd say Tuberculosis (Mycobacterium tuberculosis) and malaria (Plasmodium sp.). Very common worldwide and both buggers to kill _*IN VIVO.*_ (TB pretty tough in vitro too).


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## STXmedic

Micro is currently a weak area for me  Just got in my copy of Medical Microbiology yesterday, though!  So ask me again in a month


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## mycrofft

Chase said:


> What can cause a brown or tea colored urine?


Clear or cloudy?
Urates can cause a variable range from yellow to reddish to brownish but tends top be a little turbid.

Myoglobinemia with dehydration early-on can appear brownish rather than wine red.

Let's put urine centrifuges in ambulances.


----------



## mycrofft

n7lxi said:


> Pyridium.



Was getting ready to spin a urine spec thatb looked like Tang breakfast drink from pyridium, turned it on, left the room and heard a "crack" noise. Plastic tube had failed, pyridium urine had done spin art all over the room.


----------



## Brandon O

PoeticInjustice said:


> Micro is currently a weak area for me  Just got in my copy of Medical Microbiology yesterday, though!  So ask me again in a month



Some good answers, but I really had in mind C. Diff and the norovirus. Both really need either a good soap and water washing, or bleach in order to decontaminate. Alcohol-based and other antiseptics are ineffective.


----------



## Farmer2DO

How does the typical reptile heart differ from the heart of the human?

And how does this relate to disorders in human hearts?


----------



## mycrofft

Farmer2DO said:


> How does the typical reptile heart differ from the heart of the human?
> 
> And how does this relate to disorders in human hearts?



Offhand, crocodilian hearts have no coronary artery system as we know it, they just use whatever's being pumped. Experiments were done where instead of grafting a vein to replace an artery, pits similar to the  reptiles' were one to the human hearts. I don't think it worked very well...

Or I'm missing your point entirely.


----------



## Farmer2DO

mycrofft said:


> Offhand, crocodilian hearts have no coronary artery system as we know it, they just use whatever's being pumped. Experiments were done where instead of grafting a vein to replace an artery, pits similar to the  reptiles' were one to the human hearts. I don't think it worked very well...
> 
> Or I'm missing your point entirely.



That's a valid point.  I'll grill my next newbie with that.

What I was referring to, however, is that most reptiles have a "3 chambered heart", with blood from the ventricles mixing, and the correlation to a ventricular septal defect in humans, and the pathophysiology that would go along with it.


----------



## mycrofft

My brain has a habit of looking for an opening and making for it when questioned.

EDIT: That's not a question.


----------



## VFlutter

What is tetralogy of fallot? Ah peds


----------



## NomadicMedic

Chase said:


> What is tetralogy of fallot? Ah peds



Blue baby syndrome! A sepal wall shunt, RVH, aortic displacement and pulmonary arterial stenosis.


----------



## VFlutter

n7lxi said:


> Blue baby syndrome! A sepal wall shunt, RVH, aortic displacement and pulmonary arterial stenosis.









"Tet Spells" 






What is a simple position that may help with tet spells? And why?


----------



## Dwindlin

Chase said:


> What is a simple position that may help with tet spells? And why?



Squatting.  Increases SVR which will decrease right-to-left shunting.


----------



## NomadicMedic

I would have guessed left lateral...


----------



## systemet

PoeticInjustice said:


> Seconded on vasopressin. Not leaning towards phenyl, though.



Can confirm that phenylephrine works via the alpha adrenoceptor like levo --- it just has minimal affinity for the beta receptor, so it increases SVR without the added inotropic support of levo.


----------



## TheLocalMedic

I recall having a Tetralogy of Fallot question for national registry.  Also got to see a tet spell because I know a woman whose child had Tetralogy of Fallot.  Very interesting...


----------



## Thricenotrice

Never heard of that.... Glad that wasn't on my registry. Got some reading to do.


----------



## NomadicMedic

It was a registry question for me, as well. Also, my next door neighbor was a tet baby. I didn't know what was wrong with him until years later.


----------



## Dwindlin

This may be a gimme based on the questions answered thus far, but since people seem interested in Tetrology, please explain how increased SVR decreases shunting.


----------



## VFlutter

Dwindlin said:


> This may be a gimme based on the questions answered thus far, but since people seem interested in Tetrology, please explain how increased SVR decreases shunting.



TOF has a R-L shunt. Squatting decreases venous blood return and increases SVR which creates a pressure gradient that temporarily reverses the R-L shunt creating a L-R flow.


----------



## CANDawg

Describe the method of how sodium bicarb acts as a treatment for TCA overdose.


----------



## VA Transport EMT

it acts as an antidote...probably due to the polarity and salt stuff.


----------



## VFlutter

albertaEMS said:


> Describe the method of how sodium bicarb acts as a treatment for TCA overdose.



^ could you be more specific? :blink:

I will take a stab...

The more alkaline the blood pH is there is a greater affinity for TCA to bind to protein therefore reducing serum levels. Also the increase in pH causes unbinding of TCA from Sodium Chanel Receptors (which is what is causing most of the problems). There may be a few other mechanisms I can't think remember. 

Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.


----------



## mycrofft

Chase said:


> ^ could you be more specific? :blink:
> 
> I will take a stab...
> 
> The more alkaline the blood pH is there is a greater affinity for TCA to bind to protein therefore reducing serum levels. Also the increase in pH causes unbinding of TCA from Sodium Chanel Receptors (which is what is causing most of the problems). There may be a few other mechanisms I can't think remember.
> 
> Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.



Define the Universe. Give three examples. 
Ready? 
GO!


----------



## abckidsmom

Oh, one of my favorite pimp questions ever. I first heard it from a psychiatrist who probably studied with Freud: what's the best part about Xanax?


----------



## mycrofft

You can't spell it backwards. Easy Rx'ing


----------



## abckidsmom

mycrofft said:


> You can't spell it backwards. Easy Rx'ing



Confirmed. You are definitely the old guy.


----------



## CANDawg

Chase said:


> ^ could you be more specific? :blink:
> 
> I will take a stab...
> 
> The more alkaline the blood pH is there is a greater affinity for TCA to bind to protein therefore reducing serum levels. Also the increase in pH causes unbinding of TCA from Sodium Chanel Receptors (which is what is causing most of the problems). There may be a few other mechanisms I can't think remember.
> 
> Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.



That's pretty much what I was looking for.  

How much of lidocaine is metabolized prior to elimination?

Can any one guess that I'm studying pharmacology right now?


----------



## mycrofft

A dental patient is prepped for a root canal and the assistant hands the dentist the carpuject full of lidocaine. The pt is resting comfortably,receives the injection, then begins to grunt and say "Ah kah' beef, ah kah' beeve", then loses consciousness.

The dentist sees a medicalert tag, reads it and calls 911 while stripping off the dental dam which muffled the pt's voice.:blush:

The tag doesn't say "lidocaine" or any variant. 

What happened?


----------



## bigbaldguy

mycrofft said:


> A dental patient is prepped for a root canal and the assistant hands the dentist the carpuject full of lidocaine. The pt is resting comfortably,receives the injection, then begins to grunt and say "Ah kah' beef, ah kah' beeve", then loses consciousness.
> 
> The dentist sees a medicalert tag, reads it and calls 911 while stripping off the dental dam which muffled the pt's voice.:blush:
> 
> The tag doesn't say "lidocaine" or any variant.
> 
> What happened?



Well he can't breath so the dental dam blocked oral airway which left the nose so I'm assuming the lidocaine caused something that blocked that route as well. Maybe some kind of airway collapse from the numbness similar to what happens in sleep apnea.

Or maybe he's just allergic to the latex dental dam.


----------



## Dwindlin

Chase said:


> Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.



Septic shock is due to massive vasodilitation secondary to inflammatory mediators. Neurogenic is also due to massive vasodilitation, though it is due to release of normal vasomotor tone generally because of severe spinal cord injury. Finally cardiogenic is due the heart physically not moving enough blood around to maintain a blood pressure.


----------



## VFlutter

Dwindlin said:


> Septic shock is due to massive vasodilitation secondary to inflammatory mediators. Neurogenic is also due to massive vasodilitation, though it is due to release of normal vasomotor tone generally because of severe spinal cord injury. Finally cardiogenic is due the heart physically not moving enough blood around to maintain a blood pressure.



correct. 

Compare Diabetes Insipidus and SIADH


----------



## JPINFV

Chase said:


> correct.
> 
> Compare Diabetes Insipidus and SIADH




Too little vasopressin (or kidneys don't respond like they're supposed to)... too much vasopressin.


----------



## Clare

Using Starlings Law of capillaries, explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law


----------



## JPINFV

Clare said:


> Using Starlings Law of capillaries, explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law



Are we losing whole blood or just plasma/dehydration? Assuming blood concentrations remain the same, then a decrease in hydrostatic forces results in less interstitial fluid production. If it's dehydration and the plasma protein amount (concentration increases) remains the same, then both a decrease in hydrostatic pressure coupled with an increase in the oncotic pressure results in less interstitial fluid production.


----------



## Clare

JPINFV said:


> Are we losing whole blood or just plasma/dehydration? Assuming blood concentrations remain the same, then a decrease in hydrostatic forces results in less interstitial fluid production. If it's dehydration and the plasma protein concentration remains the same, then both a decrease in hydrostatic pressure coupled with an increase in the oncotic pressure results in less interstitial fluid production.



Let's assume hypovolaemia.  

A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".

This was a written test question on the Paramedic course and it confused the hell out of me and I wonder if other people feel the same?


----------



## Brandon O

Clare said:


> A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".



Loss of intravascular hydrostatic pressure.

Followup: what is the main factor driving a subsequent shift from intravascular to interstitial?

Answer: annoying medics with bags of saline


----------



## JPINFV

Clare said:


> Let's assume hypovolaemia.
> 
> A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".
> 
> This was a written test question on the Paramedic course and it confused the hell out of me and I wonder if other people feel the same?




Non-hemorrhagic hypovolemia? Increased oncotic, decreased hydrostatic pressure.


----------



## lightsandsirens5

Brandon Oto said:


> Loss of intravascular hydrostatic pressure.
> 
> Followup: what is the main factor driving a subsequent shift from intravascular to interstitial?
> 
> Answer: annoying medics with bags of saline



Beat me to it.

I have totally jumped on the bandwagon with the folks in Baltimore. Permissive hypotension FTW!


----------



## VFlutter

lightsandsirens5 said:


> I have totally jumped on the bandwagon with the folks in Baltimore. Permissive hypotension FTW!



I'm right there with you. I wish more places would adopt their approach to trauma care and hemorrhage management. Shock Trauma is on the top of my dream job list.


----------



## mycrofft

Does the treatment maintain enough perfusion pressure to vital organs and the brain (note I differentiated those  ) versus need to abosultely keep pt volumed until they GET TO THE HOSPITAL ?


----------



## mycrofft

*WHen this subthread is over: 'Stuttering CVA"?*

There's an old thread about a pt with a "stuttering stroke" which sounds interesting.
http://www.emtlife.com/showthread.php?t=959
Maybe hijack it here?


----------



## VFlutter

It appears a stuterring stroke is a stroke with fluctuating symptoms as opposed to a steady progression. It sounds similar to a TIA except the stroke never completely resolves. Maybe vasospasm?

Here is one for you critical care guys. Name the various Swan wave forms... 
	

	
	
		
		

		
		
	


	




Hint: Even if you have never seen any tracings think about the anatomy of the heart and how a swan (PA cath)  is placed  and you should be able to guess the answers.


----------



## Fish

Chase said:


> What is the difference between calcium chloride and calcium gluconate?



The difference is the type of salt used along with the calcium, and the concerntration of the Calcium?

Calcium Chloride can be dangerous because of the Tachycardia and HTN it can cause, and if you infiltrate can cause Necrosis by the extreme draw of Fluid away from the surrounding tissue.

Also, you CAN give Gluconate IM, Chlodide version....... No


----------



## Fish

Chase said:


> What is the difference between calcium chloride and calcium gluconate?



The difference is the type of salt used along with the calcium, and the concerntration of the Calcium?

Calcium Chloride can be dangerous because of the Tachycardia and HTN it can cause, and if you infiltrate can cause Necrosis by the extreme draw of Fluid away from the surrounding tissue.

Also, you CAN give Gluconate IM, Chloride version....... No


----------



## Anjel

What is a lethal tx for a ventricular escape rhythm?


----------



## throcktharock

Anjel said:


> What is a lethal tx for a ventricular escape rhythm?



Lidocaine


----------



## Anjel

throcktharock said:


> Lidocaine



Why?


----------



## VFlutter

Anjel said:


> Why?



A ventricular escape rhythm is the heart's last ditch effort to conduct a contraction before asystole, all other pacemakers above the ventricles have failed to pace. Administering Lidocaine can suppress the ventricular escape rhythm and then __________ ruh roh


----------



## Merck

The PA cath one is simply the insertion waveforms as the catheter is introduced into the PA with the last likely a wedge (balloon inflated).

CaCl also provides about 3 times the elemental calcium over gluconate making it a decent choice in cases of arrythmogenic hyperkalemia or other cases with a severe deficit.  Sure it's bad if an IV is interstitial but you should probably know that first anyway.

As for the Swan, so rare these days I rarely see them anymore.  Mostly in CSICUs.


----------



## VFlutter

Merck said:


> The PA cath one is simply the insertion waveforms as the catheter is introduced into the PA with the last likely a wedge (balloon inflated).
> 
> As for the Swan, so rare these days I rarely see them anymore.  Mostly in CSICUs.



Correct. It would be RA - RV - PA - PCWP

Ya Swans are rarely used except for very critical patients (usually cardiac or septic). When I was in the Neuro ICU they used a LIDCO non invasive cardiac output monitor. Pretty cool machine but very complicated to work.


----------



## Clare

Anjel said:


> What is a lethal tx for a ventricular escape rhythm?



It would surprise, and perturb, me greatly if somebody gave lignocaine (or amiodarone for that matter) to a patient who is in a ventricular escape rhythm.

Both are used to terminate tachydysrhythmias and a ventricular escape rhythm is the total opposite, very slow and wide.

Not only that but amiodarone is also very negatively inotropic so the last thing we want to dish out to somebody who is already in a very slow rhythm is a negative inotrope; if anything we want to give them a positive one!

I am not even sure amiodarone is even useful in pre hospital care anymore; we know it increases ROSC but does not increase survival to hospital discharge, patients who in compromising tachyarrhythmias get cardioverted and those who are just in a fast rhythm but not compromised get no specific treatment so I don't really see the point personally but I am not an Intensive Care Paramedic (yet!) therefore don't use it so who knows....

I have the next question - why are medicines bound to different compounds e.g. morphine is bound to sulphate, ipratropium and suxamethonium is bound to bromide, ketamine is bound to hydrochloride and adrenaline is bound to the salt of tartric acid (tartrate)


----------



## mycrofft

Partly for patent reasons, especially when you see knockoffs appear with same basic active molecule but a different salt (say, sulphate versus chloride versus tartrate in an oral med.


Yeah, I know, "What's an oral med?".


----------



## silver

Chase said:


> Correct. It would be RA - RV - PA - PCWP
> 
> Ya Swans are rarely used except for very critical patients (usually cardiac or septic). When I was in the Neuro ICU they used a LIDCO non invasive cardiac output monitor. Pretty cool machine but very complicated to work.



I guess the follow up to this is what is PCWP? Why do we even care?

Edit:
And I guess, cardiac output. How do you measure it using a Swan? Explain mathematically as well.


----------



## Dwindlin

silver said:


> I guess the follow up to this is what is PCWP? Why do we even care?
> 
> Edit:
> And I guess, cardiac output. How do you measure it using a Swan? Explain mathematically as well.



*P*ulmonary *C*apilary *W*edge *P*ressure, essentially tells us the pressures in the left atrium.  Clinically can used to elucidate the cause of pulmonary edema.

You can use a PAC to measure CO by dilution methods (there are several), I couldn't begin to tell you the calculations involved, they are done automatically by monitors every time I've seen a PAC placed (which is only a few times, becoming a rare thing).


----------



## VFlutter

Describe the Doll's eyes test. What is a contraindication for the test?


----------



## usalsfyre

Chase said:


> Describe the Doll's eyes test. What is a contraindication for the test?



Open the unconscious patient's eyes. Turn their head rapidly to one side. If their eyes don't stay relatively fixed to the front it's bad news (brain stem issue).

Obviously it's got pretty limited utility without a c-spine CT in the trauma patient...

What unit of measure is used to describe pressures for mechanical ventilation?


----------



## VFlutter

usalsfyre said:


> What unit of measure is used to describe pressures for mechanical ventilation?



cmH2O?


----------



## Rykielz

^^ I think that's right. That's the unit of measure for CPAP.


----------



## silver

Rykielz said:


> ^^ I think that's right. That's the unit of measure for CPAP.



Why though?


----------



## Brandon O

silver said:


> Why though?



Frankly, that is my question. My best guess is that it relates to how it was originally measured (some kind of water manometer). It gets a little weird when comparing it to mmHg, although curiously the resulting numbers aren't far apart.


----------



## nemedic

Read this thread. NOT what I expected when I noticed the thread title.


----------



## fma08

Pt. presents with back pain, jaundice and dark orange orange urine. Describe why you already know there is a proportionally elevated direct bilirubin (vs indirect) in the labs and how these signs can focus your differential.


----------



## VFlutter

fma08 said:


> Pt. presents with back pain, jaundice and dark orange orange urine. Describe why you already know there is a proportionally elevated direct bilirubin (vs indirect) in the labs and how these signs can focus your differential.



Conjugated (direct) is water soluble and therefore excreted in the urine whereas uncojugated (indirect) is fat soluble and can not be excreted in urine. The dark orange urine indicates an increase in conjugated bilirubin. Various conditons cause hyperbilirubinemia, both direct and indirect, so we would focus on a DDx that specifically causes an increase in direct. Does our patient like to shoot up with used needles?


What is Tikosyn? How does it work? What is a life threatening side effect?

On a side note: how many of you have actually seen a patient on Tikosyn?


----------



## Aprz

silver said:


> Why though?


There would be little mmHg to measure?


----------



## fma08

Chase said:


> Does our patient like to shoot up with used needles?



Nah, just an adenocarcinoma of the pancreas impinging on the bile duct. I suppose I could have thrown in greasy, fowl smelling, clay colored stools to point to pancreas involvement too.

Also, fun fact to add on that I found, unconjugated bilirubin once broken down to urobillinogen is colorless when excreted in the urine. The conjugated form gives the color to urine and feces. But you are correct. Due to the jaundice with the dark color urine, we are looking for processes post conjugation (which we all know happens in the liver).

And I've never heard of Tikosyn. I'll be keeping my eye on that one.


----------



## Dwindlin

Chase said:


> What is Tikosyn? How does it work? What is a life threatening side effect?
> 
> On a side note: how many of you have actually seen a patient on Tikosyn?



Dofetilide 

Class III anti-arrhythmic drug, slows potassium flux, thus increasing refractory period.  The increased refractory period presents as an increased QTi on ECG .  Can progress to Torsades.  

And no I haven't, I have seen sotalol used which is also a class III (technically so is amniodarone, though it tough to actually classify).


----------



## VFlutter

Dwindlin said:


> Dofetilide
> 
> Class III anti-arrhythmic drug, slows potassium flux, thus increasing refractory period.  The increased refractory period presents as an increased QTi on ECG .  Can progress to Torsades.
> 
> And no I haven't, I have seen sotalol used which is also a class III (technically so is amniodarone, though it tough to actually classify).



Correct. I had a patient on it last week but it is pretty rare and I have only seen it a few times. It seems to be used when multiple other drugs and Ablation has failed. We keep them for 3 days and put them on telemetry with continuous QT alarms when starting it for the first time.


----------



## wyomingearth

*??*



Brandon Oto said:


> It's a beautiful day for infectious disease!
> 
> What are two common pathogenic microorganisms resistant to most contact antimicrobial agents except bleach?



staph aureus ans e. coli??


----------



## wyomingearth

*??*

...picked that because you said most common...though I would think pseudomonas and clostridium species would be more resistant.


----------



## Brandon O

What's the longest vein in the human body?


----------



## NomadicMedic

Brandon Oto said:


> What's the longest vein in the human body?



The great saphenous.


----------



## Brandon O

n7lxi said:


> The great saphenous.



Yep.

Describe a response that would be awarded an M5 on the Glasgow Coma Scale.


----------



## Nattens

Brandon Oto said:


> Describe a response that would be awarded an M5 on the Glasgow Coma Scale.



Patient does not obey commands but is able to push away your arm with centralised sternal pressure is applied.

aka: Localises to Pain


----------



## Brandon O

Nattens said:


> Patient does not obey commands but is able to push away your arm with centralised sternal pressure is applied.
> 
> aka: Localises to Pain



Almost. By most interpretations, "localizes" requires you to cross the midline (e.g. to the opposite shoulder). That's one reason some people dislike sternal rubs; the localization you describe could be indistinguishable from other responses, such as flexion.


----------



## Nattens

Brandon Oto said:


> Almost. By most interpretations, "localizes" requires you to cross the midline (e.g. to the opposite shoulder). That's one reason some people dislike sternal rubs; the localization you describe could be indistinguishable from other responses, such as flexion.



I can see why many operators prefer the Trap squeeze to the Sternal Rub then. I should have been more specific, our service's Clinical Work Instruction on taking GCS requires the patient to localise to the sternal pressure with both hands, descerning the different to Flexion in which the pressure is applied to the nail bed.

"If there is no obeying motor response from either limb, apply pressure to mid-sternum as described in '1. Eye Opening'. If both hands move up towards the site of painful stimuli, score '5" for Localised motor response and record as such."

_Ambulance Victoria Clinical Work Instructions_


----------



## Brandon O

Nattens said:


> I can see why many operators prefer the Trap squeeze to the Sternal Rub then. I should have been more specific, our service's Clinical Work Instruction on taking GCS requires the patient to localise to the sternal pressure with both hands, descerning the different to Flexion in which the pressure is applied to the nail bed.
> 
> "If there is no obeying motor response from either limb, apply pressure to mid-sternum as described in '1. Eye Opening'. If both hands move up towards the site of painful stimuli, score '5" for Localised motor response and record as such."
> 
> _Ambulance Victoria Clinical Work Instructions_



There are some kinda obscure details behind grading the GCS responses; I don't have all the info here, but I do like the trap pinch (when you can get to a trap). The sternal rub has also been shown in some studies to take an awfully long time to produce a response (up to a minute), and can cause some harm due to all the rubbing. Nothing to move mountains but I usually recommend people choose a different go-to.

It's nice to have an arsenal, though. For instance, I've had drunks who were immune to all pain but woke up when we heaved them onto the stretcher. Nothing like a little (ob)noxious stimuli...


----------



## Brandon O

Approximately how long will a D-sized oxygen tank at 2000 PSI last until empty when running at 15 LPM?

How about an M tank at 2000 PSI?


----------



## JPINFV

Brandon Oto said:


> Approximately how long will a D-sized oxygen tank at 2000 PSI last until empty when running at 15 LPM?
> 
> How about an M tank at 2000 PSI?




About 30 seconds before I change it?

Can I punt to Epocrates?


----------



## Brandon O

JPINFV said:


> About 30 seconds before I change it?
> 
> Can I punt to Epocrates?



Yeah, I was just hoping you'd have to look up the formula and therefore possibly commit it to memory.

Myself, I look it up about once a year and then promptly forget it. But it actually can come in handy.


----------



## JPINFV

Brandon Oto said:


> Yeah, I was just hoping you'd have to look up the formula and therefore possibly commit it to memory.
> 
> Myself, I look it up about once a year and then promptly forget it. But it actually can come in handy.



To be fair... the tank my oxygen supply is more often hooked up to is rather large and requires a refrigerated tanker to refill.


----------



## Brandon O

JPINFV said:


> To be fair... the tank my oxygen supply is more often hooked up to is rather large and requires a refrigerated tanker to refill.



Well, if you're not careful I'm going to make you calculate gaseous O2 capacity for the liquid reservoir.


----------



## JPINFV

Brandon Oto said:


> Well, if you're not careful I'm going to make you calculate gaseous O2 capacity for the liquid reservoir.


Phone... dial zero... ask for transfer to facilities.

...and since I'm currently a traveler in the land of women...

Naegele's rule?


----------



## Brandon O

JPINFV said:


> Phone... dial zero... ask for transfer to facilities.



Jeez, you're gonna be a lot of help when the zombies come.


----------



## JPINFV

Brandon Oto said:


> Jeez, you're gonna be a lot of help when the zombies come.




A lot more help than Fartbongo and his 10 round clip [sic] limit. 

/That's a joke son.


----------



## VFlutter

JPINFV said:


> Naegele's rule?



Add one year, subtract 3 months, and add 7 days from the first day of the last menstrual period. 

Yay OB

What are the implications and treatment of Early, Late, and Variable decelerations?


----------



## fma08

Not sure Chase. I'll keep an eye out.

Based on another thread, why might one use gentamicin in cystic fibrosis for reasons other than an infection?


----------



## EMT B

here is one from my class that i just took...

In WPW type A, what ECG changes will you see?


----------



## fma08

EMT B said:


> here is one from my class that i just took...
> 
> In WPW type A, what ECG changes will you see?



Talking about a delta wave? ("Slurred" upstroke on the QRS) I personally haven't heard of different "types" of WPW... But of course that doesn't mean they don't exist.

My questions is the use of aminoglycosides in cystic fibrosis for reasons other than infection.


----------



## EMT B

type a has left atrioventricular connections (bundle of kent) showing a positive delta wave in V1

type b has right atrioventricular connections (bundle of kent) showing a negative delta wave in V1



Ok total shot in the dark here...do aminoglycosides help to repair/replace the malformed proteins that contribute to cystic fibrosis?


----------



## fma08

EMT B said:


> type a has left atrioventricular connections (bundle of kent) showing a positive delta wave in V1
> 
> type b has right atrioventricular connections (bundle of kent) showing a negative delta wave in V1
> 
> 
> 
> Ok total shot in the dark here...do aminoglycosides help to repair/replace the malformed proteins that contribute to cystic fibrosis?



Due to their intrinsic mechanism of action on the ribosomes, they can cause a read-through phenomenon. Useful in the particular subset of CF where their disease is caused by a premature stop codon in the CFTR gene.


----------



## EMT B

Wouldn't you worry about keeping a patient on aminoglycosides on a regular basis?


----------



## Brandon O

EMT B said:


> Wouldn't you worry about keeping a patient on aminoglycosides on a regular basis?



I believe this is typical anyway for CF patients (particularly inhaled) to manage their chronic pulmonary infections, particularly pseudomonas.


----------



## EMT B

injury to what cranial nerve often causes hemiatropy of the tongue


----------



## Anjel

EMT B said:


> injury to what cranial nerve often causes hemiatropy of the tongue



XII controls the tongue. So I'm going with that.


----------

