PGY 1 teaching - 12/04/2023

STEMI can be diagnosed in a patient with previous Left Bundle Branch Block

• True - using the modified Sgarbossa criteria

• True - using Wellen's Criteria

• False - widened QRS means the ECG is uninterpretable

• False - abnormal repolarisation means ECG is uninterpretable

Answer explanation

What does "I" stand for in the Microbiology susceptibility report?

• Intermediate

• (Susceptible) Increased exposure

• Indeterminate

• ID referral needed to discuss

Answer explanation

Difference between ‘S’ and ‘I’ is the amount of drug at the site of the infection necessary to achieve an adequate clinical response.

The reporting of ‘I – Susceptible, increased exposure’ will help identify situations where alterations to standard dosing is recommended to optimize treatment outcomes

68M comes in with chest pain, dyspnea and ECG changes of STE in II, III and aVF.

He reports ongoing chest pain in ED. What is the most appropriate management?

• GTN spray SL

• Opioids

• IVF

• CCB

75F with HTN, T2DM and functionally independent, presents at 1am with acute left anterior chest pain. ECG shows STE in anterior septal leads. Initial troponin is 750, no previous levels. What is the most appropriate management?

• Wake up the cardiologist to discuss transfer to PCI capable centre

• Thrombolyse with Alteplase and reassess ECG and pain

• DAPT + LMWH + discuss with cardiologist in the morning

• GTN, opioids and await serial troponin and reassess

Its 2am on your first ever night shift. You are asked to review a 85YO lady POD2 for L) THJR for NOF# who has complained of intermittent sharp left sided chest pain with dyspnea.

BP 110/76mmHg HR 98 bpm Sats 92% OA.

Sleeping comfortably

Do you?

• Wake her up to review her as per usual

• Let her sleep since she looks comfortable

• Get the nurse to page you when she wakes up

• "team to review mane"