Chapter·CCS CasesTime Management

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1

A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How would this new test most accurately be described?

AValid and reliable

BReliable

CValid

DBiased

ENeither valid nor reliable

2

A 24-year-old man presents to the emergency department after a motor vehicle collision. He was in the front seat and unrestrained driver in a head on collision. His temperature is 99.2°F (37.3°C), blood pressure is 90/65 mmHg, pulse is 152/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for a young man who opens his eyes spontaneously and is looking around. He answers questions with inappropriate responses but discernible words. He withdraws from pain but does not have purposeful movement. Which of the following is this patient's Glasgow coma scale?

A9

B15

C7

D11

E13

3

A 66-year-old man presents to the emergency department with a 3-hour history of crushing chest pain radiating to the left shoulder and neck. Patient states that the pain began suddenly when he was taking a walk around the block and has not improved with rest. He also mentions difficulty breathing and prefers to sit leaning forward. He denies ever having similar symptoms before. Past medical history is significant for hypertension, diagnosed 10 years ago, and hyperlipidemia diagnosed 8 years ago. Current medications are atorvastatin. Patient is also prescribed hydrochlorothiazide as an antihypertensive but is not compliant because he says it makes him urinate too often. Vitals show a blood pressure of 152/90 mm Hg, pulse of 106/min, respirations of 22/min and oxygen saturation of 97% on room air. On physical exam, patient is profusely diaphoretic and hunched over in distress. Cardiac exam is unremarkable and lungs are clear to auscultation. During your examination, the patient suddenly becomes unresponsive and a pulse cannot be palpated. A stat ECG shows the following (see image). Which of the following is the next best step in management?

ASynchronized cardioversion

BAdminister amiodarone

CUrgent echocardiography

DAdminister epinephrine

EUnsynchronized cardioversion

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