Knowing is not enough; we must apply. Willing is not enough; we must do. -Johann Wolfgang von Goethe Welcome back to episode 19! We are certainly relieved to have this year’s in-training exam behind us, and we are sure you are too. We hope you recognized some of the content we reviewed in episodes 1-15 and were able to grab a few extra points. Now that we’ve all had a brief break, we are back with new material to help you prepare for next year’s exam and to help improve your clinical acumen. It is important to keep reviewing all year-round. * The Nexus criteria are used to rule out the need for cervical spine imaging. Use the mnemonic NSAID to remember the criteria: neurologic deficit, spinal tenderness, altered mental status, intoxication, and distracting injury. * A pneumothorax can be identified on lung ultrasound by the absence of lung sliding. * A simple pneumothorax, which is one involving less than 10% of the hemithorax, can be treated with a non-rebreather. Larger pneumothoraces will often require a chest tube or a pigtail catheter. * The most common EKG finding for a myocardial contusion is sinus tachycardia. The most common course is a spontaneous resolution of the symptoms. However, with severe injuries, the most serious complication is delayed rupture. Now onto this week’s podcast Question 1 A 55-year old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about 1 hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient? A. Cimetidine B. Glucagon C. Norepinephrine D. Octreotide Question 2 A 45-year-old woman with type I diabetes mellitus presents with fatigue in the setting of medication non-compliance. Her laboratory tests reveal a Na+ 125, K+ 3.1, chloride 97, bicarbonate 10, glucose 761, and pH 7.21. The patient is started on intravenous fluids. What therapy is most important to start next? A. Hypertonic saline B. Potassium repletion C. Regular insulin D. Sodium bicarbonate Teaching image Question 3  A 56-year old woman with a known left bundle branch block presents after a syncopal episode. EKG shows a regular, wide complex tachycardia with a rate of 160 beats/minute. Which of the following EKG features suggests a diagnosis of ventricular tachycardia over a diagnosis of supraventricular tachycardia with aberrancy? A. Absence of AV dissociation B. Capture and fusion beats C. Irregular rhythm D. QRS duration 110 milliseconds. Teaching Image Question 4  A 74-year-old woman with a history of congestive heart failure, hypertension, and coronary artery disease presents with confusion, abdominal pain, and nausea. Her medications include hydrochlorothiazide, aspirin, and digoxin. The patient’s ECG is shown above. She has a potassium level of 6.3 mEq/ml. Which of the following treatments should be initiated? A. Activated charcoal B. Calcium gluconate infusion C. Digoxin immune Fab D. Hemodialysis Teaching Image