Term
| CHEST PAIN- don't miss diagnoses |
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Definition
MI, PE, dissection, pneumothorax
-EKG
-CXR, cardiac enzymes
-SL nitro- don't if clinical picture suggestive of acute R side MI
-ASA 325 mg
-Morphine IV
--> Cards consult |
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Term
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Definition
Current vitals
--> CXR
--> EKG
---> VBG or ABG
--> medications such as Lasix
-oxygen requirement
-work of breathing
-PE? (wells citeria, CT PE protocol- check renal function!! emperic anticoagulation)
Anxious?
Ativan 0.5mg IV once
Trazadone 25mg once |
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Term
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Definition
Consider low dose haloperidol if EKG checked and QTc interval ok
-starting dose 0.25mg-0.5mg PO, IV ok if to agitated to get PO, may repeat if needed
-Trazodone 25mg PO q6H PRN |
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Term
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Definition
All at once:
-IVFs (500ml bolus NS)
-anti-nausea (compazine)
-pain med (ex. NSAID or Ketorolac (Toradol))
Tylenol
Motrin (ibuprofen)
Tramadol
Fioricet (acetaminophen, butalbital, and caffeine) |
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Term
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Definition
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Term
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Definition
Precontemplative
Contemplative
Preparation
Action
Maintenance
Recurrence |
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Term
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Definition
MOA: complement, bradykinin, mast cell degranulation
w/u: c4 level, c1 inhibitor level
Tx:
-Prednisone 40mg qDaily
-Ranitidine (Zantac) 150mg PO BID
-Benadryl (diphenhydramine) 25mg q8
-Montelukast for mast cell degranulation |
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Term
| Community Acquired Pneumonia |
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Definition
| Azithromycin and ceftriaxone |
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Term
| Complications of Cirrhosis (FYI you can give up to 2 grams Daily of Tylenol short term to cirrhotic pt) |
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Definition
#Esophageal varices 2/2 portal HTN
-scope last?
-BB propranolol
#Encephalopathy HE--> Clinical dx (confusion and asterixis in the setting of cirrhosis)
Tx:
#1) lactulose--> titrate to 3-4 BMs
#2) Rifaximine
#3) Zink
Never follow ammonia- look that they get better clinically
#Ascites--- SBP
-abolute neutrophil count >250
-cell count/ culture
-SAAG
If protein <1g SBP ppx
SBP ppx cipro 500mg qDaily
#HCC
hypervascular lesion- best way to find is with a triple phase CT abdominal scan (will have a "late wash out")
Quick way to see is w/ RUQ US
PVT- Portal Vein Thrombosis w/Doppler
Always Calculate a MELD Score- heavily based on INR + Bili
Plt count- specific for cirrhosis (get splenomegaly)
INR- part of synthetic fxn- so increases with worsening liver failure
Hyponatremia- 120's can be normal
Large volume paracentesis >5L or abnormal kidney function need to give albumin with the tap
6-8g/kg/L
25 or 50g bottles (25% albumin) |
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Term
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Definition
-2 large bore IVs
-PPi drip pantoprazole 80mg over first 30 mins and then 8mg/hr for 72 hours
-type/ cross/ consent blood products!
-h/h q6hours
-CBC for plts
-check INR!
-NPO
-GI consult
-prior EGD/ colonoscopy?
-heme positive stool?
-NSAID use?
UGIB
PUD vs. gastritis vs. AVM vs. CA |
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Term
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Definition
Get EKG!
-over 6.5= treat!!!
-calcium gluconate 2mg (use with caution in pts getting digoxin)
-10 units regular insulin with 1 amp D50--> check pts BG hourly after |
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Term
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Definition
Cause: any cause/ irritation can cause it
-tsh
-fluids
-valves (TTE looks for this)- with valvular a fib you NEED to anti-coagulate
Stable? v/s?
Electrolytes
Meds
CXR
Underlying etiology (CHF, COPD, etc)
Tachy
-metoprolol 5mg IVP (esmolol drip)
-diltiazem 20mg IV (if CHF or COPD)
amioderone 150mg load-- tapper (rate or rhythm control)
Rate vs. rhythm control
Cardiovert <48 hours
Chemical or electrical w/out anticoagulation
CHADs-vas
0-1 ASA
2 anti-coagulate |
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Term
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Definition
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Term
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Definition
-BB
-Lisinopril
-ASA
-statin
Lovenox
Plavix |
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Term
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Definition
TSH
BG
Neuro-- HCT
CV-- EKG
Infectious
VBG
Ingestions
UDS! |
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Term
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Definition
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Term
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Definition
1 amp D50 its 50ml
50g/100ml
25g/50ml<---- |
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Term
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Definition
Volume overload
Weight
Urine
I/Os
-aggressive diereses 3-4L day |
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Term
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Definition
No NSAIDS or ACE-I!
FEna or FEurea if on diuretics |
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Term
| most common kind of hernia in adults |
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Definition
Direct inguinal hernia
-hesselbach's triangle (A direct inguinal hernia protrudes through a weakened area in the transversalis fascia near the medial inguinal fossa within an anatomic region known as the inguinal or Hesselbach's triangle, an area defined by the edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery. These hernias are capable of exiting via the superficial inguinal ring and are unable to extend into the scrotum.) |
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Term
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Definition
In medicine, Carnett's sign is a finding on clinical examination in which (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed.[1][2] For this part of the abdominal examination, the patient can be asked to lift the head and shoulders from the examination table to tense the abdominal muscles. An alternative is to ask the patient to raise both legs with straight knees.
A positive test increases the likelihood that the abdominal wall and not the abdominal cavity is the source of the pain (for example, due to rectus sheath hematoma instead of appendicitis).[3][4] A negative Carnett's sign is said to occur when the abdominal pain decreases when the patient is asked to lift the head; this points to an intra-abdominal cause of the pain.
If MSK:
-hot pack
-Lidocaine patch |
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Term
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Definition
TSH
ECHO
Holter if not found
AFFIRM trial- rhythm and rate control the same
Need anticoagulation 3 WEEKS before-- cardioversion-- and 4 WEEKS after
TTE- no clot first
Amidarone- NOT GOOD if increased QT, or lung Dx
Would need to fall more than 300 times a year to outweight benefit of anticoagulation |
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Term
| Multifocal Atrial Tachycardia |
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Definition
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Term
| antiarrhythmic drug classes |
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Definition
1c- Na channels
II- BB
III- K channels
IV- Ca channels |
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Term
CHADS2 Score for Atrial Fibrillation Stroke Risk
CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk |
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Definition
CHF, HTN, Age >75, DM, Stroke/TIA
Vasc= Age( 0 if under 65, 65-74 +1, 2+ over 75), Sex (FM+1), vascular hx (prior MI, PAD, aortic plaque)
Use MedCalc to get number! |
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Term
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Definition
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Term
| Acute AMS things to check first |
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Definition
DONT
Dextrose (check BG!)
O2
Narcan
Thiamine |
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Term
| Hypertensive PRN Blood Pressure drugs |
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Definition
Hydralazine
Labetalol
Clonidine |
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Term
| QRS w/RBBB incomplete and complete |
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Definition
100-200 (incomplete)
complete (>120) |
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Term
| Weight based insulin dosing |
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Definition
100kg person/2--> 50kg--> 25kg Basal (Latus, NPH q6-12 Hours, levamir)
25kg--> TID w/meals (lispro, aspart, regular)
25 Lantus
8 units lispro TID
Insulin Sensitivity Factor
1800/50= 40 (each unit of lispro will decrease the BG by 40)
Adjust insulin
if hypo 50-60 give one juice= 15 grams carb
hyper if Fasting:
>200 inc basal 10%
>300 inc basal 20% |
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