1. 2-2.5x the IV route. Drugs: NAVEL- naloxone, atropine, vasopressin, Epi, Licocaine
2. during PEA/asystole
3. EKG, ABG, serum electrolytes, CXR, US
4. rapid defibrillation. biphasic: 200. Monophasic: 360
5. Epi 1mg (1:10,000), vaso 40U, amiodarone 300mg >150mg
1. 30-80% having pt sit upright 10mins incr sens.
2. CT most sens & spec
3. type/cross, H/H, PT/INR, WBC, lactate, lipase, LFTs, BMP
4. 2 IVs, O2, IVF, Abx (cipro, metro, Pip/Tazo, imipenem)
5. up to 50%
1. methylene blue, chlorophyll, Br, I, Fe, cupric SO4
2. Antacids, Bile, vitamin C
3. diverticulosis > CA > rectal, colitis, ischemia, angiodysplasia. L = R side.
4. PUD. DDX: gastritis, varices, mallory-weiss tear, aortoenteric fistula
5. Campylobact, E. coli 0157, Salmonella, Yersenia
6. Hb drop >3 acutely, Hb <9 and actively bleeding, massive bleed (1L). HCT q 6h
1. intraperitoneal space, retroperitoneal space, thorax, GI
2. ABCs, SpO2, rewarming if hypothermic, CXR, C-spine eval if suspect trauma, EKG. NO role for abx!
3. Below 32 celcius
4. 28-32 celcius: AMS, bradycardia, bradypnea
5. T <28. Mgmt: core active rewarming w warm IV fluids
-Withdrawal (alcohol, barbiturates, benzodiazepines)
-Acute metabolic disorder (electrolyte imbalance, hepatic or renal failure)
-Trauma (head injury, postoperative)
-CNS pathology (stroke, hemorrhage, tumour, seizure disorder, Parkinson's)
-Hypoxia (anemia, cardiac failure, pulmonary embolus)
-Deficiencies (vitamin B 12 , folic acid, thiamine)
-Endocrinopathies (thyroid, glucose, parathyroid, adrenal)
-Acute vascular (shock, vasculitis, hypertensive encephalopathy)
-Toxins, substance use, medication (alcohol, anesthetics, anticholinergics, narcotics)
-Heavy metals (arsenic, lead, mercury)
1. epidermis only; red, painful, well-demarcated
2. epidermis & part of dermis. Blisters/painful/wet.
3. full thickness. Painless. Leathery, white, brown, or black
4. CXR, oropharyngeal exam, laryngoscopy or bronchoscopy, pulse ox, CO, CH3-Hb
1. scorpion stings are painful @ site. black widow bite has localized diaphoresis & possible lymphangitis
2. pain @ site, numbness, tingling, N/V, blurred vision, hypersalivation, clonus, abn eye movements, cholinergic syndrome
3. supportive only: ABCs, tetanus ppx, local wound care, opioids for muscle pain, benzos for NMS Sx. Last line: Anascorp (antivenom)- routine use not indicated bc most Sx resolve by 2d; Complic: serum sickness
1. right axis deviation, peaked p waves in II, III, avF, R atrial hypertrophy.
2. multifocal atrial tachycardia
3. Duobens MC. Stacked albuterol treatments, ipratropium q4. PO prednisone or IV methylprednisolone.
4. increased sputum production, change in color sputum, or fever. Levaquin, macrolides, cephalosp, tetracycline
5. walk around ED with continuous pulse ox
1. type & Rh, quantitative bHcG, CBC, transvaginal US. RhoGAM if Rh -. If unstable- emergent surgery (ObGyn)
2. visualization of yolk sac on transvag. US
3. 1500-2000 (5 wks). Abd: 6,500. DDx: ectopic, molar, cervicitis, septic abortion, trauma
4. empty uterus, extraovarian mass
5. methotrexate. May need 2nd dose if bHcG not decreasing
6. d/c with Ob/Gyn f/u within 48-72 hrs for serial bHcG & US examinations
7. 25%. of these, 50% will miscarry
1. either sudden or severe chest/back pain AND tearing/ripping/stabbing, recent aortic procedure, CT d/o, diagnosed thoracic aneurysm, FHx aortic dissection, aortic valve DZ
2. palpable pulse deficit, hypoTN, BP diff > 20mmHg, aortic insuff. murmur, neuro deficit
3. All 3 get EKG. Low & Medium get CXR. If Medium->can't confirm alternative Dx-->get advanced imaging. If Hi (>/= 2RF): 1st imaging should be advanced, NOT CXR
1. CRP, Creatinine, glucose, Hb, Na <135, WBC = CBC, BMP, CRP
2. not affected by age, gender, or meds
3. Immediate surgical consult, Clinda (inh toxins) + Vanc (MRSA) + Zosyn OR Linezolid + Zosyn
1. Door to seen by Doc: 10mins. Door to CT in 25 mins. Read by radiologist in 45mins. Door to labs back: 45mins. Door to needle goal (tPa) < 60min. FDA: up to 3hrs since Sx onset. >4.5 hrs can't give. BP must be <185/110. INR <1.7, PT <15 sec. Other CI: GI/GU bleed w/in 3mo. Gluc <50.
2. EKG, O2 Sat, POC glucose, CBC, BMP, LFTs, PT/PTT, UA, ESR & BCx if suspect bacterial endocartitis
3. Stat LP
4. TIA, intracranial bleed, neoplasm, transient global aphasia, hypoglycemia, encephalopathy, peripheral neuropathy, MS, seizure d/o
1. Age >80, oral anticoagulant use (regardless of INR), NIHSS >25 or <1/3 MCA involved, Hx previous stroke AND DM
2. Alteplase (tPa): 0.9 mg/kg. 10% IV push, remaining infused over 1 hr. ASA 81-325. Labetalol for BP
3. 2nd line: Clopidogrel, Enalapril, Hydral, Nicardipine, Nitroprusside, Mannitol
4. Anyone with CVA gets admitted. Anyone with tPa goes to the ICU.
6. Give in pts not receiving tPa w ischemic stroke. If given w/in 48hrs, reduces rate of early recurrent stroke
1. 90% renal. 10% GI
2. Diet, mineralcorticoids, acid/base status, distal renal tubular fcn
3. renal DZ, distal tube defect (acute interstitial nephr, RTA), Mineralcorticoid def (Addisons, hypo-Ald), Drugs (BB, ACEI, NSAIDs, Lithium, cyclosporine).
4. Acidosis, BB, chemo, digitalis, rhabdo, hemolysis, a-agonists, succinylcholine
5. MC ASx, even @ hi levels!
1. Bupivicaine IM, Toradol IM, Flexeril po, ibuprofen po
2. sustaine seizure for 5-10mins or recurrent seizures w/out return to baseline in b/w. Highest <1 yr and >60 yrs
3. w/in 24hrs
4. hypo/hyper-Na, hypo-Ca, hypo/hyperglycemia, uremia
5. BMP w Ca, P, tox screen, pregnancy test, head CT, LP if fever/severe HA/immunocompromised.
1. retrosternal pain that is exacerbated by exertion and relieved by rest. "crushing, tight, squeezing, or pressure" Radiation to R arm > both arms > left arm. Also: jaw, arms, neck. +/- N/V, diaphoresis, dyspnea
4. >60 yo male or post-menopausal F, HTN, DM, HLD, tobacco use, truncal obesity, sedentary lifestyle, FHx