Vm cardiac critical care noon conf answers and review

1. Critical Care Triva
Loosely based on the heart
February 14, 2019
Blake Mann, R10

2. SVC
IVC
In a normal heart in resting conditions, rank
the following locations in order from least
oxygenated to most oxygenated blood
SVC, RA, IVC, RV, PCW, LV
Oxygen
Saturation Location
76% SVC
79% RA
83% IVC
95% PCW
97% LV
Most oxygen
poor due to brain
consumption
Less oxygen used
from lower body
Mixing of SVC
and IVC
Some oxygenation
at the capillary
Fully oxygenated
for circulation
Fick equation can be used to determine cardiac output
" the total uptake of (or release of) a substance by the peripheral tissues is equal to
the product of the blood flow to the peripheral tissues and the arterial-venous
concentration difference (gradient) of the substance."
Measured by ABG Measured as Mixed venous oxygen
saturation – Pulmonary Artery
Which location is considered most useful as a reflection of cardiac output and why?

3. Match the waveform tracing to the corresponding location of the PA catheter
1. D 2. B 3. A 4. C
A B C D

4. Normal cardiac chambers
Usually normal or increased contractility
Small cardiac chambers
Normal or high contractility
Large ventricles
Poor contractility
Small ventricles, pericardial effusion
Dilated IVC
Dilated right ventricle, small left ventricle
Dilated IVC
Match each of the 5 echo findings on the left to the corresponding type of shock
Hypovolemic
Cardiogenic
(primary)
Distributive
Obstructive
(Cardiogenic due to obstruction)
• Dobutamine
• Low dose dopamine (given)
• High dose dopamine
• Low dose epinephrine (given)
• High dose epinephreine
• Milrinone
• Norepinephrine
• Nitroprusside
• Phenylephrine (given)
• Vasopressin
Name the vasoactive medication
that corresponds to each symbol:
Low dose epinephrine
Low dose dopamine

5. Diastole Systole
What is one name for the findings illustrated in the echocardiogram above? (2 points)
Takotsubo Cardiomyopathy
Apical Ballooning Syndrome
Broken Heart Syndrome
Stress Cardiomyopathy

6. Takotsubo Cardiomyopathy. à Octopus Trap
Apical Ballooning Syndrome à Echo Findings
Broken Heart Syndrome à Associated with emotional stress
Stress Cardiomyopathy à Associated with emotional or physical stress
A
C
D
B
For each ECG, what coronary vessel is the most likely culprit? (2 points each)
1. _____D________
2. _____A________

7. Virginia Mason is changing it’s defibrillators to a new device that allows for
monitoring of waveform capnography during CPR. For 2 points name one
change that could lead to the increase in end-tidal CO2 demonstrated by the
arrow above. (Extra point if you can name two reasons for the increase)
Return of Spontaneous Circulation
Improvement in Chest Compressions (Improved cardiac output)
What study is illustrated in these images? (2 points) Bubble Study
Name at least one etiology for the findings on image B. (2 points)
Right to Left Shunt:
PFO, ASD, VSD, Pulmonary AVM, Hepatopulmonary Syndrome
A B

8. Peaked T waves à loss of P waves à widened QRS
à Sine wave à Ventricular arrhythmias à Asystole
Osborne waves (J waves), bradycardia, prolonged
PR/QRS/QT, Atrial fibrillation, tremor artifact
Broad QRS complexes, sinus tach, first degree AV
block (P hidden in T), R’ wave in aVR
Broad and flat T waves, U-waves, ST-depression, QT
prolongation, ventricular arrhythmias
Sinus tachycardia, increased QRS voltage, Atrial
fibrillation, Arrhythmias (A flutter, SVTs, PAC, PVC, MAT)
Sinus bradycardia, prolonged QT, flat/inverted T,
heart block, low QRS voltage, IVCDs, PVCs
Short QT Interval
A
B
C
D
E
F
G
H
ECG
(1-8)
Findings
(A-G)
Hyperkalemia 1 B
Hypokalemia 7 E
Hypothermia 2 C
Thyrotoxicosis 3 F
Hypothyroidism 8 A
Hypercalcemia 4 H
Subarachnoid
Hemorrhage
6 G
Tricyclic Overdose 5 D
1 2 3
4
5 6 7 8
________
16 points
ST depression / elevation – T wave inversions
(mimics ischemic changes)
alentine’s Day Bonus!
How many married couples can you name that work at Virginia Mason
(Must be able to be validated by someone else in the room)
_________________________________________
_________________________________________
_________________________________________
_________________________________________
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________
bonus points