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Cardiology SAQ’sSAQ 1A 60 year old male presents to you Emergency Department complaining of chest pain for the last 2 hours. He has no known medication history and does not take any regular medications.His ECG on arrival is below.What is your interpretation of his ECG ? (3 Marks)b. The patient's blood pressure is 80mmHg. Outline the key steps in managing his hypotension. (4 Marks)The cardiology team have advised you to commence the patient on a vasoactive agent to improve his blood pressure. List 3 appropriate inotropes / vasopressors and their dosing below. (3 Marks)AnswersInferior STEMI - 1 MarkComplete heart block - 1 Mark1 Mark for any of:Possible RV involvement (STE III>II)Possible posterior involvement (Flat ST depression V2-3)Bradycardiab. Main priority revascularisation - angioplasty / thrombolysis - 1 MarkCautious fluid bolus -must acknowledge risk of pulm odema or use bolus <500ml - 1 Mark1 Mark each for any two of:Atropine - likely to be inefffectiveAvoid / cease GTNTranscutaneous pacingInotropes as listed below onlyIABP - only acceptable if preceded by revascularisation c. AgentDose1.Dopamine3-5 mcg/kg/min to maximum of 20-50 mcg/kg/min2.Dobutamine2-5 mcg/kg/min to maximum of 20 mcg/kg/min3.Noradrenaline2 mcg/min up titrate to response1/2 Mark for each correctly completed box.Taken from Tintinalli's Emergency Medicine 7th Edition Chapter 54 Table 54-5 Pg 388 with Milrinone excluded. Consistent with management advice in Dunn Emergency Medicine Manual 5th Edition Vol 1 Chpt 28 Pg 440SAQ 2A 16 year old boy with a congenital heart problem presents to ED with episodes of syncope. This is his ECG.Describe the ECG (5 marks)Name 5 possible causes for this ECG (5 marks)AnswerPaced rhythm rate 75 bpmLoss of capturePeriod of ventricular standstillOccasional ventricular ectopic/escape beatsP waves rate 75 – 100 bpm, complete heart blockLead breakage or displacement causing pacemaker failureFibrosis causing pacemaker failureElectrolyte abnormalityToxicological causes – Ca channel/B blocker/digoxin toxicityFailure to capture/needs check of threshold for captureSAQ 3A 67 year old male was 6 weeks post an inferior myocardial infarction. He presents to ED with ‘light headedness’ worse on exertionHe has been started on a ‘whole lot’ of new medications since his heart attack and felels they may not be helping.Vital signs are:Temp 37.0 deg cBP 100/55 mmHgRR 16/minSa02 97% on air6286501778000GCS 15The following ECG is performed:Outline 4 important features of his ECGOutline you interpretationOutline treatment options(No answer available)SAQ 4A 35 year old woman presents with palpitations and shortness of breath. On arrival her BP is 70/40. An ECG is taken.What are 5 important features of the ECGList three possible differential diagnosesList important steps in your immediate managementAnswerRate @ 240, Rhythm irregular (AF),rightward access, Delta waves, / fusion beats in severalleads esp lead 2 and V1AF RBBB, WPW with aberrancy, VT, Torsades.Resus with full monitoring, supplemetal O2, iV access, fluid bolus, synchronised DC cardioversion 100J with sedation and analgesia ................
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