1. 100 200 300 400 500 Punctures & Bites Antibiotics for who? Card’s ACS
ACS Intervention
State Laws
100
200
300
400
500

2. In This State…
Persons may not spit on the steps of the opera house.

3. New Mexico

4. In This State…
You can get out of paying for a dependent's medical care by praying for him/her.

5. Indiana

6. In This State…
It is illegal to eat in a place that is on fire.

7. Illinois (Chicago)

8. In This State…
It is illegal to kill a dog using a decompression chamber.

9. Michigan

10. In this State…
One may not camp in a wagon on any public highway or risk a fine of up to ten dollars

11. Wisconsin

12. What are the indications for a temporary transvenous pacemaker?

13. Asystole
Unresponsive symptomatic bradycardia
Type II 2nd degree or higher AV node block
New or indeterminate LBBB
Alternating BBB
RBBB or LBBB with 1st degree AV block
Overdrive pacing in unresponsive VT
Unresponsive recurrent sinus pauses (>3s)

14. What are the indications for a temporary transcutaneous pacemaker?

15. Unresponsive symptomatic bradycardia
Type II 2nd degree or higher AV node block
New LBBB & bifascicular blocks
RBBB or LBBB with 1st degree AV block
Some cases of stable bradycardia & new RBBB

16. How do beta blockers reduce morbidity & mortality in acute myocardial infarction?

17. Beta blockers reduce myocardial oxygen demand by:
Decreasing heart rate
Decreasing systemic arterial pressure
Decreasing myocardial contractility

18. Why should nitroglycerin be used with caution in patients with acute inferior wall ischemia?

19. Because of Hypotension
1/3 of patients with inferior wall ischemia will also have right ventricular involvement

20. Treatment for Non-ST elevation MI includes the following:

21. Aspirin
Nitroglycerin
Morphine
Oxygen
Beta Blockers
Heparin (or Enoxaparin)

22. Complete heart block can occur with which 2 myocardial infarctions
Complete heart block can occur with which 2 myocardial infarctions? Why does this happen?

23. Complete heart block occurs with Anterior & Inferior wall MI’s
AV conduction system receives blood supply from the right coronary artery & septal branch of the LAD artery

24. What are the most common dysrhythmias (Brady & Tachydysrhythmias) that occur during an acute myocardial infarction?

25. Bradydysrhythmias Tachydysrhythmias Most frequent is Sinus Bradycardia
Most frequent is PVC’s
PAC’s & V-tach also very common

26. What is Dressler’s syndrome, and when does it occur?

27. Dressler’s syndrome (aka post-MI syndrome), occurs 2-10 weeks after an acute MI & consists of chest pain, fever, and pleuropericarditis

28. What are the ECG findings for an acute lateral wall MI
What are the ECG findings for an acute lateral wall MI? What vessel is usually involved?

29. Q waves in leads I & aVL
Traditionally, ST changes in I, aVL, V5, V6
Circumflex artery

30. What is the single best test to identify patients with acute myocardial infarction upon ED presentation? What time frame should this test be obtained?

31. ECG
Should be obtained within 10 minutes of presentation

32. Compare CK-MB to myoglobin in the evaluation of chest pain from an acute myocardial infarction:

33. CK-MB (specific for heart muscle)
First detected: 4-8 hours after symptom onset
Peaks: hours
Gone: by 48 hours (normal renal function)

34. Myoglobin (skeletal & cardiac muscle)
First detected: within 3 hours of symptoms
Peaks: 4-9 hours
Gone: by 24 hours (normal renal function)

35. What are the absolute contraindications to exercise testing (Stress Test)?

36. Absolute Contraindications
Acute myocardial infarction (within 2 days)
Unstable angina not controlled by meds
Uncontrolled cardiac dysrhythmias
Severe aortic stenosis (symptomatic)
Symptomatic heart failure
Acute pulmonary embolism or infarction
Acute myocarditis or pericarditis
Acute aortic dissection

37. Relative Contraindications
Left main coronary stenosis
Moderate stenotic valvular disease
Electrolyte abnormalities
Severe arterial hypertension
Tachy or Brady dysrhythmias
Hypertrophic cardiomyopathy
High-degree AV node block
Inability to exercise adequately

38. Define unstable angina:

39. New onset (less than 1-2 months)
More frequent or more severe episodes
Occurs at rest (lasts longer than 20 min)

40. What is the most frequently diagnosed cardiac valvular abnormality?

41. Mitral valve prolapse
women > men

42. What are 3 important causes of acute chest pain, and give an example of each (hint: table 49-1):

43. Chest wall pain
Pleuritic pain
Visceral pain

44. Chest wall pain Costosternal syndrome Costochrondritis
Precordial catch syndrome
Slipping rib syndrome
Xiphodynia
Intercostal nerve syndromes
Fibromyalgia!

45. Pleuritic pain Pulmonary embolism Pneumonia Pneumothorax Pericarditis
Pleurisy

46. Visceral pain Typical & atypical angina Unstable angina
Myocardial infarction
Aortic dissection
Esophageal spasm or reflux
Esophageal rupture
Mitral valve prolapse

47. Antibiotics for open fractures:

48. 1st line is anti-staph penicillin or 1st gen. cephalosporin
2nd line is vancomycin

49. Antibiotics for barnyard injuries, contamination with poo:

50. 1st line is augmentin or 2nd generation cephalosporin
2nd line is fluoroquinolone plus either:
clindamycin
metronidazole

51. Antibiotics for uncomplicated cellulitis:

52. 1st line is an anti-staph penicillin or 1st gen. cephalosporin
2nd line is a macrolide

53. Wounds with saltwater exposure:
What are you covering for?
Wounds with freshwater exposure:

54. Saltwater (covering for Vibrio sp.):
1st line is 3rd gen. cephalosporin + doxycycline
2nd line is fluoroquinolone
Freshwater (Aeromonas, Pseudomonas):
1st Antipseudomonal PCN or aminoglycoside

55. Prophylactic antibiotics for post-repair wounds should be used on whom?

56. Human bites
Dog & cat bites on the extremities
Intraoral lacerations
Open fractures
Risk of infective endocarditis
Wounds with exposed tendons & joints
Patients with “hardware”
Patients with lymphedema

57. What is the second-line antibiotic therapy for patients who are penicillin-allergic and are bitten by:
Dogs
Cats

58. For dogs: For cats: Clindamycin + a fluoroquinolone Doxycycline
Cefuroxime

59. Keflex, Dicloxacillin, Erythromycin, or Clindamycin should not be used alone, as their spectrum does not cover Pasteurella species

60. A 6 y/o boy presents to your ED after being bitten by a wild hamster
A 6 y/o boy presents to your ED after being bitten by a wild hamster. His mother is worried about rabies. What should you tell her?
What animals are natural reservoirs for rabies?

61. Natural rabies virus carriers include:
Tell her small rodents, rabbits, & hares are very unlikely to carry the rabies virus
Natural rabies virus carriers include:
Bats
Skunks
Raccoons
Foxes

62. Back

63. What is the first-line antibiotic therapy for dog, cat, & human bites?

64. Augmentin for 5-7 days

65. What percentage of untreated dog bites versus cat bites become infected?

66. Untreated dog bites: 5-6%
Untreated cat bites: %

67. Rapid infection after a cat bite is likely due to which pathogen?

68. Pasteurella Multocida