The only journey is the one within. – Rainer Maria Rilke Welcome back to Episode 31! We are continuing our collaborative effort with the EM Clerkship podcast – focusing this week on tachydysrhythmias in addition to a mixture of random topics. We start the episode off with another rapid review of a few of the recent blog posts by Yehuda Wolf. * In a gravid female, the uterus will be palpable at the umbilicus at around 20 weeks. At 12 weeks, the fundal height will be around the pubic symphysis. Lastly, at 36 weeks the fundus will be at the xiphoid process. * Patients with polycystic ovarian syndrome are often obese and complain of hirsutism, irregular menses, acne, and sleep disordered breathing. You might also notice acanthosis nigricans and fatty liver disease. * Management for PCOS is typically done in an outpatient setting, but a common regimen could include OCP’s, metformin, and lifestyle modification. Now onto this week’s podcast Question 1 A 58-year old man is brought to the ED for chest pain that started 30 minutes prior to arrival while he was jogging in the park. Initially, the patient’s cardiac monitor shows sinus tachycardia with a rate of 120 beats per minute. However, while you are interviewing the patient in the resuscitation bay, he suddenly becomes pale, pulseless, and the below rhythm is seen on the cardiac monitor. Which of the following is the definitive next step to manage this rhythm? A. Chest compressions B. Defibrillation C. Epinephrine D. Synchronized cardioversion Teaching Image Question 2 Which of the following treatments is contraindicated in a young person who has Wolff-Parkinson-White (WPW) syndrome with atrial fibrillation? A. Adenosine B. lbutilide C. Procainamide D. Synchronized cardioversion Teaching Image Question 3 In a patient with traumatic brain injury, which of the following secondary insults should be given the highest priority for correcting in the ED? A. Hypercarbia B. Hyperpyrexia C. Hypotension D. Hypothermia Question 4 A 45-year-old man with a history of opioid abuse presents to the ED with new onset syncope. While you are evaluating the patient, he becomes unresponsive and you note the rhythm below on the monitor. Which of the following medications is the most likely cause of this presentation? A. Buprenorphine/naloxone B. Fentanyl C. Ketorolac D. Methadone Teaching Image Question 5 An 84-year-old man presents from a nursing home. The patient is lethargic and unable to provide any history. The transfer record reports a new cough and chills. His vital signs are: T 102°F, BP 88/42, HR 118, RR 22, and oxygen saturation 95% on room air. In addition to an intravenous normal saline bolus of 30 cc/kg, which of the following is the most appropriate empiric treatment? A. Cefepime, vancomycin, and azithromycin B. Ceftriaxone and azithromycin C. Ceftriaxone, vancomycin and azithromycin D. Ciprofloxacin and metronidazole Teaching Image Question 6 What is the most likely underlying chronic medical problem in the patient with the following ECG? A.