Question 18

18.   Your patient is a 29 year old male who comes in complaining of chest pain and a fever or 102.4 F.  He relates he is an IV drug user.  He also has noted to have splinter hemorrhages under his nails.  Which of the following is the best test to evaluate this patient to diagnose his condition immediately?

A.   Blood Cultures times 5.

B.   Cardiac Catheterization

C.  VQ scan.

D.  Echocardiogram

Answer 17

17.  The correct answer is C.  While management of this patient may involve getting a follow up CT scan at some point, this patient is actively bleeding in his brain and it is life threatening and needs to be reversed.  So giving the patient Vitamin K and FFP is the most important.  Protamine is the antidote for heparin and would not be helpful.  Intubating the patient unnecessarily may raise ICP and hyperventilation has not been shown to lower ICP for a prolonged period of time.

Question 17

17.  You are evaluating a  45 year old patient with a history of recurrent DVT, last was 6 years ago and has a greenfield filter.  He is on warfarin.  He was just involved in a motor vehicle collision and has a large subdural hematoma with a  3 mm midline shift.  His INR is 5.5.  Which of the following is the best immediate intervention.

A.   Order a follow up head CT for 12 hours from now to see if it has progressed.

B.  Intubate the patient and hyperventilate the patient.  This has been shown to decrease intracranial pressure.

C.  Give the patient 10 mg of Vitamin K and 2 units of Fresh Frozen Plasma

D.  Give the patient Protamine right away.