Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
76 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Agitation / Violence
Questions to ask |
- Delerious? Dementia?
- Reason for admission - History of alcohol abuse? |
3
|
|
|
Agitation / Violence
Overview |
- Stay calm
- Assess why patient acting the way and treat it. No to physically control |
|
|
|
Agitation / Violence
DDx |
- Delerium
- Dementia - Alcohol withdrawal o Minor, 6-36h → resolves within 48h of last drink Insomnia, Anxiety, headache, diaphoresis, palpitations, o DT, onset within 48-96h Hallucinations, fever, agitation, hypertension, tachycardia, disorientation, |
3
|
|
|
Agitation / Violence
Evaluation |
- Review meds
- Hx + PE: if possible - Glucometer - Bloods: FBC, Lytes, BUN, Creat, Ca, LFT, Ammonia, Glucose, TSH, B12, Folate - Consider o Cardiac markers o ABG o Tox o ECG o UA/Culture o Sputum culture o DRE o Imaging CXR CT/MRI head |
|
|
|
Agitation / Violence
Treatment |
- If cooperative: Lorazepam PO/SL. NB ELDERLY PATIENTS
- Uncooperative: Haloperidol 2-5mg IM/PO - Quetapine - Special o Geriatric: Lower dose o Parkinson: Atypical antipsychotics |
|
|
|
Anaphylaxis
Questions to ask |
- Vitals?
- Utricaria? - Beta blockers? - Known allergy? Hold suspected agent |
4
|
|
|
Anaphylaxis
Evaluation |
- Plasma histamine
- Serum/Plasma Tryptase |
2
|
|
|
Anaphylaxis
DDx |
- Acute generalized utricaria
- Angioedema - Acute asthma exacerbation - Aspiration - Vasovagal reaction - Anxiety attack |
6
|
|
|
Anaphylaxis
Treatment + Special patients |
- ABC! Help!
- Supine position if possible - Epinephrine - Methylprednisolone - Ranitidine (Low evidence) - Hold: alpha/beta blockers, ACEi - Special patients o Beta blockers → Glucagon o Bronchospasm → Salbutamol |
6
|
|
|
Bleeding
Questions to ask |
- Vital signs + Postural
- Obvious site? History of bleeding? - Quantity of blood lost? - Last Hb, INT, PTT? - Good IV access - Meds: Hep, Warfarin, Clopidogrel, ASA |
6
|
|
|
Bleeding
Etiology |
- Upper GI
- Lower GI - Gross hematuria - Hemoptysis - Obvious site |
|
|
|
Bleeding
DDx |
- Melena (DDx: Bismuth, Iron supplement, Red wine)
- Hematochezia - Shock |
|
|
|
Bleeding
Evaluation |
- Hx (Epigastric pain, Ulcer hx, Cirrhosis, Coagulapathy)
- PE (Postural vitals, Epistaxis, Abdo exam, DRE) - STAT: CBC, Lytes, BUN/Cr, INT, PTT, GXM (>2) - Localise site: Consider NGT - ECG +/- Cardiac markers - Hematuria → C+S, UA |
|
|
|
Bleeding
Management |
- ABC + Help
- Transfer to monitored bed - Hold anticoagulants + Reverse INR - Follow Hb - Treat cause |
5
|
|
|
Chest pain
Questions to ask |
- Vitals?
- History of CAD? - What’s been done? - Ask for STAT ECG |
|
|
|
Chest pain
DDx: |
- MI – Symptoms, ECG, Q-wave, Imaging. Cardiac markers (time), nb renal
- AD - HTN - PT - PE – Tachy, Desat, Right heart failure |
|
|
|
Chest pain
Evaluation |
- Hx: SRCOPDSARA, Prev episodes? RF? Recent use of sildenafil
- PE: Vitals, ↑Pain on palpation? |
|
|
|
Chest pain
Investigations |
- ECG
- Imaging: CXR - Blood: CBC, Lytes, BUN, CR, Glucose, CD, Cardiac series |
|
|
|
Chest pain
Management |
- ABC + Call cardiology
- Nitro puff >90mmHg - Oxygen >90% - Morphine for pain - ASA 325mg Chew - Following help: Clopidogrel, Heparin, BB, IV nitro, Statin, ACEi |
|
|
|
Constipation
Questions to ask |
- When was last BM
- On opiods? |
|
|
|
Constipation
Etiology |
- Opiods
- Post op ileus - Hypokalemia - Impaction |
|
|
|
Constipation
Evaluation |
- Hx: What does mean? What normal? Last bowel movement? Abdominal pain? N/V?
- PE: Surgical abdo? DRE to R/O impaction - Imaging: PFA (r/o Toxic mega, free air) - Blood: Lytes, TSH |
|
|
|
Constipation
Management |
- Mild:
o PO fluids, fruit, fibre o Docusate sodium, Sennosides o Lactulose 30ml od prn - Mod (>48h) o Titrate docusate sodium and sennosides o Titrate lactulose (bid/tid) o Milk of magnesia - Severe o R/O impaction, disimpact PRN – osten with glycerine suppository before, follow with phosphate enma o Phosphate enema |
|
|
|
Decreased LOC
Questions to ask |
- Vitals + Glucose
- Similar episodes? Talking - Last time seen normal? Fluctuating - Last ABG - Opiods, Benzo |
|
|
|
Decreased LOC
Common DDx |
- Hyper/Hypoglycemia
- Opiod overdose: Miosis, hypotension, bradycardia - Benzodiazepine overdose (Elerly) - Delirium tremens: Confusion, fever, tachycardia, dilated pupils, diaphoriesis, tremors, hallucinations - Stroke, Infections, Post ictal episode, Hypercapnea, Wernicke’s, Alcohol withdrawal, Hypertensive encephalopathy, Heart failyre, Electrolyte imbalance |
5+
|
|
|
Decreased LOC
Evaluation |
- See patient
- History: Mental status - PE: Vitals, Neuro, Glascow, Ventilatory pattern. If normal brain stem reflexes, no focal findings → Look for metabolic aetiology - Review meds - Blood: Glucometer, CBC, Lytes, Ca, Mg, PO4, Glucose, BUN, Creat, LFTs, Albumin, INR, Ammonia, B12/Folate, Tox, ABG, TSH - Drug levels: Digoxin, Lithium, ASA, Antiepileptics, Acetominophen, Alcohol - ECG, LP, UA, Blood culture - Imaging: CT head, CXR, AXR |
|
|
|
Decreased LOC
Management |
- GCS<8 Intubation
|
|
|
|
Diarrhea
Management |
- Immodium/Loperamide 4mg PO
|
|
|
|
Dyspnea
Questions to ask |
- Saturation (Match pulse? Test on own finger?), Vitals
- Acute onset - Sedatives/Opiods - Ins/Outs - Last ABG - Is RT Involved |
6
|
|
|
Dyspnea
Overview |
- Anxiety will not cause saturation to drop
- Look for cause of fluid overload (e.g. transfusions) - BiPAP only non invasive way of removing CO2. C/I: Aspiration risk, Decreased LOC, Hemodynamic instability - Furosemide PO/IV: 2:1 |
|
|
|
Dyspnea
DDX |
- MI
- PE - PND - Pulmonary edema: Look for ECHO/CXR - Bronchospasm: COPD/Asthma - Other: Pneumonia, Pleural effusion, Pulmonary fibrosis, pain |
|
|
|
Dyspnea
Evaluation |
- Hx: Prev episodes, Pleuritic, Cough
- PE: Gen, Accessory muscles, Vitals/Saturation, JVP, Make patient cough, Calf swelling - ECG - Imaging: CXR, CT-PA, Doppler lower extremities - Blood: CBC, Lutes, BUN, Creat, CK, Trops, VBG, BNP - ABG |
|
|
|
Dyspnea
Management |
- Raise head
- O2, Pulse oximetry |
|
|
|
Fever
Questions to ask |
- Vitals
- Known infectious disease - Antibiotics |
3
|
|
|
Fever
Definitions - Fever - Neutropenic fever - RF MRSA |
- >38 / >100.4
- Febrile neutropenia: <500mm3) + Fever - RF MRSA: Hospitalisation, ABx, HIV, IVDU, Homosexual, Dialysis, Incarceration, Long term care, Military, Sharing sport equipment |
|
|
|
Fever
Etiology |
- Infection
o Pneumonia o Pyelonephritis o Infectious diarhea, Abscess, wound infection, Endocarditis, Pancreatitis, Meningitis o Foreign body - Thrombosis – DVT/PE - Inflammation without infection – Hematoma, Gout, AI disease - Mediation: Abx, Heparin, Anticonvulsive - Other: Serotoniergic syndrome, Malignant neuroleptic syndrome |
|
|
|
Fever
Evaluation |
- History: Headache
- PE: Look for sign of early sepsis - Workup o CBC, Lutes, BUN, Creat o Septic screen: CXR, Sputum for culture, UA, Blood culture from 2 sites |
|
|
|
Fever
Managment |
- Acetaminophen 650mg PO/PR q4 PRN, comfort, but will make temp difficult
|
|
|
|
Headache
Questions to ask |
- Febrile?
- Worst ever - History of headaches - Other red flags |
|
|
|
Headache
Etiology |
- Headaches that kill
o Infectious: Meningitis, Encephalitis, Abscess o Vascular: Stroke, Subdural/Epidural, Carotid, Hypertensive encephalopathy o Tumour o Glaucoma, Temporal arteritis - Benign o Migraine o Tension o Cluster o Withdrawal: Caffeine, Rebound, Temporal, Viral encephalitis, Sinusitis |
|
|
|
Headache
Evaluation |
- Mental status (ABC)
- History: SRCOPD, Past Hx, Neuro symptoms, Infection, Trauma, Trigger o Red F: Sudden onset, Worst headache ever, New pattern, Exercising/Cough/Valsalva, FND, Fever, LOC, Pain down neck/Shoulder, Immunosuppression - PE: Vitals, Gen appearance, Meningismus, Papilledema, Neuro exam with fundoscopy o Neck stiffness, Meningismus, Papilledema, FND, Toxic appearance, Cushing triad (Bradycardia, Hypertension, Abnormal breathing) - Imaging: CT head if indicated - Blood: CBC, Lytes, BUN, Creat, Glucose, ESR, Total protein, Lactate, Protein C, PT INR, Stat Culture |
|
|
|
Hypertension
Questions |
- Check again? Both arms? Manually?
- Known history of HTN? - Take Antihypertensive? When scheduled for next? - Renal failure |
|
|
|
Hypertension
Overview |
- Consider treatment: > 160 mmHg / >100mmHg
- Definitely treatment: >180mmHg / >120mmHg - Hypertensive emergency → End organ damage |
|
|
|
Hypertension
Etiology |
- Medication: BP (Held / Rebound effect), NSAID, MAO
- Pain - Stroke - Acute renal failure (Renal/Post renal) – Consider dialysis - New onset |
|
|
|
Hypertension
Evaluation |
- Review meds
- History - Physical: R/O hypertensive emergency, BP both arms, Cardio - Blood: CBC, Lytes, BUN/Cr - UA, CK, Troponins, - ECG - Imaging: CT, CXR |
|
|
|
Hypertension
Management |
- Lay down, quiet room
- Restart / Give BP meds early. Dose adjustment - Moderate o Amlodipine 5mg PO / Metopropolol 5mg IV / 25mg PO o Captopril / Furusemide / Hydralazine - Severe – 15% decrease in over 1 hr or DBP < 100 o Labetalol bolus / infusion |
|
|
|
Hypotension
Questions to ask |
- What is pt normal?
- BP meds? - Symptomatic? Shock |
|
|
|
Hypotension
Definition |
- <90 considered hypotension
- MAP <60 |
|
|
|
Hypotension
Etiology |
- Shock
- Medications: BP, Opiods - Volume depletion: Post-hemodialysis, Paracentisis, Bleeding - Cardiogenic - Massive PE - Addisonian crisis |
|
|
|
Hypotension
Evaluation |
- Hx
- PE: BP both arms, Volume status, Temp, Postural vitals - Review meds - Blood: CBC, Lytes, BUN, Cr o End target : ABG, Lactate, LFT, DIC workup - Foley to monitor UO |
|
|
|
Hypotension
Management |
- Pt lay down, trendelenburg
- Ensure good IV access - Medication o Hold BP o Switch morphine to hydromorphine. Consider nalaxone o NS PRN - Volume depletion o Normal: Bolus NS (500-1000ml over 5-30min) PRN. Repeat 2-3 times o CHF: Bolus 250ml NS, have furosemide ready o Hemodialysis: Review fluid removes (vs. normal). Consider Albumin 5% o Post paracentsis: Consider Albumin 5% |
|
|
|
Insominia
Questions |
- Pt normally use sleeping pills?
- How old is patient - Delirious |
|
|
|
Insominia
Etiology |
- Stress
- Pain - Sleep hygiene - Medication – Steroids - Noise - Caffeine |
|
|
|
Insominia
Evaluation |
- Hx: Sleep pattern
- Med review: New or Held? - PE: Vitals |
|
|
|
Insominia
Management |
- Environment optimization
- Relaxation exercises, Decrease caffeine - Steroids: Last dose earlier in day - Manage pain - Pharamcologic therapy o Trazodone 50 mg PO qHS o Not past 2am o Do not give sedative-hyponotics to delirious patient/unexplained mental status change o NB! Apnea/Pulmonary disease o Only give 1 dose, review next day |
|
|
|
Meningitis
Overview |
- Triad: Fever, Altered mental status, Nuchal rigidity
- RF: Neurosurgery, Ventricular drains - LP: Relative CI (Raised ICP, Thrombocytopenia/bleeding diathesis, epidural abscess) - ICU indications: GCS < 10, Decreasing LOC, Seizure, Pulmonary infiltrates |
|
|
|
Meningitis
Evaluation |
- Mental status
- Hx: NEuro, Infections, Trauma, Articular pain - PE: Gen, Vitals, Meningismus, Papilledema, Petechia - Imaging: CT - Blood: CBC, Lytes, BUN/Cr, Glucose, ESR, Total protein, Lactate, Protein C, PT, INR, STAT Culture |
|
|
|
Meningitis
Management |
- Help
- Isolation - Monitor neuro signs - Empiric ABx |
|
|
|
Nausea / Vomiting
Questions |
- How much
|
|
|
|
Nausea / Vomiting
Etiology |
- Infections
- Endocrine - CNS - Medications: Opiods, Chemo - Obstruction |
|
|
|
Nausea / Vomiting
Evaluation |
- Hx
- PE: Look for signs of dehydration - Blood: CBC, Lytes, BUN, Creat - ABG |
|
|
|
Nausea / Vomiting
Management |
- Rehydrate, correct K
- Obstruction: NGT, Metoclopramide 10mg IV q4PRN - First line o Dimenhydrinate o Metoclopramide o Ondasetron 8mg, PO/IV q4h PRN o Prochlorperazine |
|
|
|
Pain
Questions |
- Different from usual?
- Normally on opiods? |
|
|
|
Pain
Overview |
- Hydromorphine/Fentanyl: better choices for renal failure patients
- NB! Paracetamol and Liver disease |
|
|
|
Pain
Evaluation |
- Hx: Intensity, Characteristics, Radiation, Make sure it’s the same pain as previous
- PE: Surgical abdomen? - Blood: Lactate |
|
|
|
Pain
Management |
- Readjust pain medication: 25% increase of opiod good starting paint
- Insert pain ladder |
|
|
|
Seizure
Questions |
- Still seizing? What type?
- Airway protected? - Diabetic – STAT glucometer - IV access |
|
|
|
Seizure
Overview |
- Usually stop within 2m
- Status epilepticus: >30min or not regaining full consciousness |
|
|
|
Seizure
DDx |
- Hypoglycemia
- Electrolytes (Na, Ca, PO4, Mg) - Wernickes / Alcohol withdrawal - Structural CNS disease: Previous CT head? Cancer Hx? - Meningitis/Encephalitis - Stroke - Non-compliance of drugs? |
7
|
|
|
Seizure
Evaluation |
- Hx:Most recent drug level
- PE: Note type of seizure - STAT glucometer - Blood: CBC, Lytes, Ca, Mg, PO4, BUN/Cr, Albumin, CK, Phenytoid level |
|
|
|
Seizure
Management |
- Lateral decubitus, protect airway, O2 by face mask/NP, monitor sat, lower bed as much as possible, suction available
- Thiamine 100mg IV over 3-5 min before glucose - Dextrose 50% 1amp IV - Replace lytes PRN - Seizure <3min o Observe o IV Lorazepam and phenytoi ready get BW - > 3min o Lorazepam 2mg/min until 0.1mg/kg. Can stop in about 5 min o Phenytoin 15mg/kg at max rate 50mg/min |
|
|
|
Tachycardia
Questions |
- Symptomatic? Blood pressure?
- Known afib? Did he get meds? |
|
|
|
Tachycardia
Overview |
- Treatment: Symptomatic / Sustained 110-120
- + Hypotension = R/O Sepsis |
|
|
|
Tachycardia
DDx |
- Irregular
o Afib o Multifocal atrial tachycardia, sinus tachycardia with PACs / PVCs - Regular o Atrial flutter o Sinus tachycardia Volume depletion Fever/Sepsis/Shock Anxiety - Antiarrythmics |
|
|
|
Tachycardia
Evaluation |
- Hx: Chest pain, SOB
- PE: BP, CHF, Hypovolemia, Shock - ECG - Bloodwork: PRN, CBC, Lytes, Mg, PO4, BUN/Cr, CK, Trops, Glycose, INR, PTT, TSH, Digoxin - Consider o Lower limb Doppler o CXR |
|
|
|
Patient fell
Evaluation |
- Examine patient, recreate scene
- CT scan o On anticoagulation o Head trauma o Mental status changes o Neurologic deficits - Assess meds - Were guard rails up? Are restraints needed? |
|
