Oral Boards Review

• Always be reassessing the patient, especially after interventions are given
• Don’t be afraid to stand your ground when consults give pushback
• Think about what critical actions need to be taken for each patient
• Be thorough with your history taking, the examiner may not always be forthcoming with critical information

Cardiac Toxins

• When a pt presents with Bradycardia and hypotension, these medications should be on your differential
• Two different major categories: “Pump Killers” and “Electrical Disruptors”
  • Pump killers are your negative inotropes
  • In the setting of BB overdose, selective agents lose their selectivity and begin affecting both B1/B2 receptors
  • BBs in comparison to Ca channel blockers cause more profound AMS, classically cause hypoglycemia in contrast to Ca channel blockers which cause hyperglycemia
  • Early interventions include IVF, glucagon, atropine, and calcium. Consider placing a CVC early and gi decon
  • Bedside echo can be very valuable in helping guide management
    • If those interventions fail, move on to either Vasopressors or 1unit/kg insulin. End of the line is ECMO
    • In the setting of digoxin toxicity, potassium level is extremely valuable; One study found K+ >5.5 had a 100% mortality in those not given an antidote while <5.0 had 100% survival

EMS Radio Calls

• Main call-ins are for prearrival notification, requests for orders, requests to cease resuscitation or a patient refusing medical care
• There are strict guidelines for when we can vs cannot cease efforts in the field
• Often have to make critical decisions with very little information