Spring 2006 St Francis PA prog prof Bunn
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Laryngoscopic Views Grade I | can see the epiglottis, vocal cords, posterior structures of the larynx
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Laryngoscopic Views Grade II | can see the epiglottis, but only posterior elements of larynx
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Grade III Laryngoscopic Views | can only see the epiglottis
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Laryngoscopic Views Grade IV | none of the above are seen
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Mallampati Classes of Laryngoscopic Views | Grade I – (best view possible) can see the epiglottis, vocal cords, posterior structures of the larynx
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Why doEnd-tidal carbon dioxide detection? | Confirmation of Endotracheal Tube Placement
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Confirmation of Endotracheal Tube Placement name 4 ways | Clinical assessment 2)End-tidal carbon dioxide detection 3)Aspiration techniques 4)Chest radiograph
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Clinical Assessment of Confirmation of Endotracheal Tube Placement name 6 | 1) Visualize ET tube passing through 2)Chest auscultation 3)Gastric auscultation 4)Bag resistance 5)Condensation within ET tube 6)Pulse oximeter reading
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best way : Confirmation of Endotracheal Tube Placement | End-tidal carbon dioxide detection
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what drug:Reduces the :intracranial response to laryngoscopy ? | Lidocaine (used during intubation)
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What drug:Reduces the bronchospastic response to laryngoscopy and intubaton | Lidocaine (used during intubation)
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Do not forget to__?____ to patients after they are placed on the ventilator! | sedate patients after they are placed on the ventilator!
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Plastic double-lumen tube with one lumen functioning as an esophageal airway and the other lumen functioning as a tracheal airway. whats it called? | Combitube (Esophagotracheal)
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DOC for SVT ? | Adenosine
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Drug forsymptomatic sinus bradycardia ? | Atropine... dopamine is second line
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Vasopression.. What is it? | naturally occurring antidiuretic hormone; potent vasoconstrictor
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What drug? use for known or suspected hyperkalemia? | Calcium chloride
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Adenosine DOC for what? | SVT DOC
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Shock name 6 types | 1) hemorrhagic 2)septic 3)cardiogenic 4) Anaphylatice shock 5) Anaphylactoid 6) spinal shock
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Give crystalloids in what 3 types of shock ?: | hemorrhagic, septic, and anaphylactic shock
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Pt presents with = bradycardia + peripheral vasodilatation after an MI. Whats this reflex called? | Bezold-Jarish reflex
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hemorrhagic shock is what?... By how much? | decrease intravascular volume by 20%
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pts. with adequate oxygenation but impaired ventilation whats good to give'em? | Heliox
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rapid sequence intubation ..what do you want to give them? (hint :K____) | Ketamine – sedation
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RV enlargement secondary to malfunction of the lungs causing pulmonary artery HTN | Cor Pulmonale
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ST-T changes most common but non-specific of what? | PE
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PE EKG b. Most common rhythm? | tachycardia
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Whats the name of the condition: pulmonary edema in the absence of volume overload or depressed left ventricular dysfunction | ARDS
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b. PE – GOLD standard imaging ? | Angiogram
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a. 3rd trimester normal BP ? | 125/75 mm Hg
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What you give'em??? for HTN Emergency.... quick think fast! | nitroprusside
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what is a HTN emergency in a pregnate patient? | BP > 140/90 w/ signs and symptoms
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How fast do you reduce BP in a Patient with diastolic over 115 but NO endorgan damage? | reduce BP over 24 – 48 hours
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mild HTN how is it defined? | less than 115 diastolic w/ no organ damage
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HTN Urgency how defined ? | diastolic over 115 with no end organ damage
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How fast do you reduce BP in an HTN urgency? | a. reduce BP over 24 – 48 hours
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kids who present with bradycardia .. what endocrine problem do you suspect? | hypoglycemia do an Accucheck
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adults have focal neurologic deficit what endocrine problem do you keep in you dif dx | 1. Suspect hypoglycemia
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combo of lack of insulin & excess stress hormones what endocirne emergency? | DKA .
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IV TX for Hypoglycemia | – D50
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In DKA acidosis masks what ? | low potassium
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DKA TX | 1 L of NS in the first hour
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5. HH Nonketotic Coma – underlying illness such ... | Infection
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5. HH Nonketotic Coma –slow increase in ___? How high?? | sugar; usually gets at least 800 -1000
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5. HH Nonketotic Coma –underlying illness such? | infection
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6. Alcoholic ketoacidosis what do you give them? | b. Give D5NS, thiamine prior to glucose;
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6. Alcoholic ketoacidosis : Dont give them what? | Do NOT give insulin!!!!!!
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myxedema coma: the pt HYPO or HYPER thermic? | 7. Hypothermia is a very common symptom of myxedema coma
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goiter, exophthalmous, pretibial edema what disease? | Graves Disease
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in hyperthyroidism .. do you give ASA? | NO! Donot give ASA to hyperthyroid Pt.
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I am having a thyroid storm what can you give me? help I may die! | Beta blockers
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12. insufficient glucocorticoid & mineralcorticoid is | primary adrenal insufficiency
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Coma cocktail whats in it? | Glucose, Oxygen Narcan
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Toxicology: Pinpoint pupils .. what? | narcotics
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dilated pupils .. what? | sympathomimetics & withdrawal
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Cholinergics what sx/signs? (hint there is a 6 letter word that helps remembering) | SLUDGE – Salivation, lacrimation, urination, defecation,gastric cramping, emesis
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Cholinergic poisening ...Most common is..what ?and who? | organic phosphate poisoning seen in farmers
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Tocicology :sedative-hypnotics what skin sign? | Bullae
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8. Goosebumps (piloerection) are characteristic of ? | withdrawal
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The best airway | endotracheal tube
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Tox.: High BP & tachycardia | amphetamines, cocaine
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Tox: BP & bradycardia | opiates, barbiturates, beta blockers
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Tox: Tachycardia & low BP | Tricyclics
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Tox: Rapid respirations | Acidosis, sepsis
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Tox: Hypothermia | narcotics
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Tox: vii. Diaphoresis & salivation | cholinergics
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Tox:dry skin & dry mouth | Anticholinergics
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Tox: Rotational nystagmus | PCP
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Tox: Horizontal nystagmus | ETOH
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11. Arterial Blood gases detectwhat 3 things: | PH (acidosis); CO2 (ventilation); O2 = hypoxemia
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what is Na – (HCO3 + Cl) calculating? | Anion gap
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Anion gap how do you calculate? | Na – (HCO3 + Cl)
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iii. Accumulation of inorganic acids (hint : At Mud Piles) cause what? | High anion gap: ( think of a High mud pile)
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ii. Loss of bicarb via diarrhea what does that do to Anion gap? | Nothing ,its a Normal Anion gap
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AT MUD PILES what is it a reminder of:? | Alcohol, Toluene, Methanol, Uremia, DKA, Paraldehyde, Iron, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates, Strychnine
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i. Osmolar gap = calculated osmoles – serum osmoles; Whats the most common cause? | ethanol - most common cause of osmolar gap
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(ME DIE) or 1. Methanol, Ethanol, Diuretics, Isopropanol, Ethylene glycol do what to the 13. Osmolar gap? | i. > 10 is abnormal: caused by ME DIE
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CHIPES stands for what? | i. Chloral hydrate, heavy metals, iron, phenothiazines, enteric coated tabs, solvents
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CHIPES effect what ? How? | Radioopaque ( or white on Xray) :Chloral hydrate, heavy metals, iron, phenothiazines, enteric coated tabs, solvents
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I am having a seizer and injested a caustic subtance what poisen TX do you AVOID giving me? | Syrup of ipecac
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I have a nonobstruvtive nonsharp FB in my Bowl what can you givw me? | GoLYTELY or whole bowel irrigation
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liquification necrosis of an eye is caused by | Alkaline material
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definitive therapy for ASA overdose is? | ???? Im confused
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with your wood’s lamp you see a Pts urine fluoresces what did they drink? | Antifreeze ingestion
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Antifreeze ingestion : what do you look for in the urine | Oxalate crystals seen in urine ( and wood’s lamp to see if urine fluoresces)
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POSTERIOR CIRCULATION includes what vessel and what 7 areas? | Vertebral artery : brain stem, cerebellum, thalamus, auditory and vestibular centers, medial temporal lobe and the visual cortex
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ANTERIOR CIRCULATION what vessel and what areas? | optic nerve, retina,and frontal, parietal, and anterior-temporal lobes
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What vessel perfuses the largest portion of the brain? | Carotid circulation & perfuses 4/5 of brain
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area of the brain in which small amounts of flow are preserved by collateral circulation what is it called? | Ischemic Penumbra
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ischemic penumbra is it electricaslly active? | Electrically silent
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What overdose will cause pulmonary edema? | Narcotic overdose
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What is drug of choice for cocaine O.D.?? | Diazepam
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TX for OD of Sulfonylurea? | hypertonic dextrose
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Antizol what does it do? | prevents the formation of oxalate crystals
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CCB overdose: what can your give? | 20. Calcium, glucagons, & phosphodiesterase inhibitors
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TX for Cyanide ? | w/ oxygen, bicarb, nitrates, thiosulfates (cyanide kit)
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Tylenol overdose < 8 hrs | i. don’t initiate NAC therapy
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Tylenol overdose > 8 hrs | NAC (N-acetylcysteine) or Mucomyst
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Methanol injestion TX for ? | ethanol, formepizole, or hemodialysis
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slow onset disturbance of cognitive functioning, NO clouding of consciousness what is it called? | Dementia
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acute onset impairment of cognitive functioning with rapid deterioration what is it called? | Delirium
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Delirium name 3 things it can be caused by? | overdose, intercerebral hemorrhages, and electrolyte imbalances
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same symptoms as schizophrenia but they are present less than 6 months.. whatit called | 3. Schizophreniform disorder
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5. Most common types of delusional disorders ? | – persecutory
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c/o of symptoms but no medical disorder can be identified what is it called? | Somatoform disorder
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social and occupational functioning impairment.. what is it called? | Personality disorder
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Psych patients: first thing you asess? | ABC’s !
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continuous and chronic (at least 6 months) than panic disorder | Generalized Anxiety Disorder GAD
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Ovral | pregnancy prophylaxis given within 72 hours
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pregnancy prophylaxis given within 72 hours.. what substance? | Glycoprotein p30
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what substance?: high levels found in semen; use when no sperm is found | Acid phosphatase
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pessimistic outlook w/o psychotic features | Dysthymic disorder
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trauma is “converted” into physical signs and symptoms | Conversion disorder
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g. Genetic typing uses what 4 markers ?: | i. ABO blood group antigens, peptidase A, phospoglucomutase, DNA
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dissociative agent – produces “trancelike state” | Ketamine
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How to sedate kids? | , initial IM dose of Ketamine
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for sedation: opioid of choice? | Fentanyl
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for sedation: Benzo drug of choice? | Midazolam (Versed)
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Barbiturate drug of choice? | Methohexital (Brevital)
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benzo antagonist; IV what? | 12. Flumazenil (Romazicon)
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Ticlopidine (Ticlid) - PO is what class? | GP IIb/IIIa Inhibitors
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Abciximab (ReoPro) - IV is what class? | GP IIb/IIIa Inhibitors
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Lamifiban / Tirofiban (Aggrastat) is what class? | GP IIb/IIIa Inhibitors
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Clopidogrel (Plavix) - PO is what class? | GP IIb/IIIa Inhibitors
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Reduces preload and O2 requirements but SE include hypotension, histamine response...what drug? | Morphine
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Smooth muscle relaxant that Should NOT be used in right ventricular infarction | Nitroglycerin
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Why becarful with using Nitroglycerin during a inferior wall MI ? | It is the Rt side of the heart .. BP may tank
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Other then ischemic-type pain name 3 other conditions nitromay help | HTN, CHF, large anterior wall MI
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what drug good for all 3: Non-ST segment elevation MI, PTCA and PTCA? | plavix, Glycoprotein IIb/IIIa Inhibitors
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Convert PSVT, A-fib, A-flutter to NSR Can Beta Blockers do that? | YES Beta Blockers CAN Convert PSVT, A-fib, A-flutter to NSR
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Heparin Therapy optimal PTT ? | 50 to 70 seconds is optimal
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aPTT of >70 seconds increases risk of ??? | ICH
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Rate control for rapid atrial arrhythmias in patients with impaired LV function . What Drug? | Amiodarone
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Termination of ectopic or multifocal AT with preserved LV function what drug? | Amiodarone
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Polymorphic VT, wide-complex tachycardias of uncertain origin | Amiodarone
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Control of hemodynamically stable VT when cardioversion is unsuccessful, especially in patients with LV dysfunction | Amiodarone
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Dalteparin (Fragmin) and Nadroparin (Fraxiparin) are examples of what drug? | LMWH
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Rate control for AF/Afib when other therapies are ineffective | Amiodarone
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Amiodarone Precautions : others then CVS | renal failure use with caution and extremely long half life ( 40 days)
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Wide-complex tachycardias uncertain type? | Lidocaine , Amiodarone
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Wide-complex PSVT ? what drug | Lidocaine
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what is replacing Lidocaine in many cases? | Amiodarone
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Refractory VF after lidocaine | Magnesium Sulfate
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digitalis toxicity causing Life-threatening ventricular arrhythmias Drug TX? | Magnesium Sulfate
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Wide variety of arrhythmias: Proarrrythmic, especially in the setting of AMI, hypokalemia, hypomagnesemia | Procainamide
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Stable wide-complex tachycardia of unknown origin, Wide-complex tachycardias uncertain type | Procainamide, Lidocaine, Amiodarone, Procainamide.. looks like all 3 emailed J Bunn
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Diltiazem big percaution: | Do not use in wide-complex tachycardias or for poison/drug-induced tachycardia, WPW, SSS, or patients with AV block without a pacemaker
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Diltiazem is used to control : what? | ventricular rate in AF
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Alternative drug (after adenosine) to terminate PSVT with narrow QRS complex and adequate BP and preserved LV function | Verapamil, Diltiazem
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