SAEM MS4 Curriculum Questions with Complete Solutions, Latest Updated 2024/2025 | Scored A+

First steps for SOB 1. Vitals 2. O2 via NC or NRB, BVM if not breathing adequately on their own 3. IV access 4. Cardiac and pulse Ox monitoring 5. EKG 6. CXR 7. US 8. Ddimer 9. BNP 10. trops When do you use Non-Invasive PPV? -moderate to severe dyspnea -accessory muscle use -paradoxical abdominal movement -fatigue -RR 25 bpm -pH 7.35 -pCO2 45 When do you not use NIPPV? -respiratory arrest -hemodynamic instability -aspiration risk -airway obstruction -unable to tolerate mask -AMS SAEM MS4 Curriculum Questions with Complete Solutions, Latest Updated 2024/2025 | Scored A+ DDx for SOB? - CHF exacerbation - ACS - Anaphylaxis - Asthma/COPD - Tamponade - PE - PNA - airway obstruction Causes of systolic heart failure Heart cannot "squeeze" due to: - ischemic heart disease - CAD - Hypertension - fluid overload - arrhythmia - renal DZ - regurgitant valvular disease Leads to eccentric hypertrophy Causes of diastolic heart failure Heart cannot "relax" due to: - hypertension - cardiomyopathy - CAD - DM - LVH - stenotic valvular DZ Leads to concentric hypertrophy S&S of CHF exacerbation? - dyspnea - orthopnea - exercise intolerance - PND - weight gain PE of CHF exacerbation? - respiratory distress - rales in dependent portions of lung (may be wheezes if bronchospasm, which makes it get confused with COPD) - S3 = fluid overload - S4 = stiff ventricle - JVD - pedal edema - hepatojugular reflux - hepatomegaly - venous stasis changes in legs Framingham Criteria major signs - pulmonary edema - cardiomegaly - hepatojugular reflux - neck vein distension - PAD/orthopnea - rales - S3 - weight loss 4.5 kg in response to Tx Framingham criteria minor - ankle edema - dyspnea on exertion - hepatomegaly - nocturnal cough - pleural effusion - Tachy 120 bpm Dx of CHF - EKG - cardiac enzymes (need to rule out new MI) - CMP (lytes and BUN:creat) - CBC - BNP (+ if 500 pg/mL) - CXR (cardiomegaly, Kerley B lines, pleural effusions) Tx of CHF - O2 (CPAP/BiPAP best) - nitrates to decrease preload - diuretics if evidence of fluid overload - be mindful of Pts in shock who need inotropes and pressors (not diuretics!)