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62 Cards in this Set
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Management for PID
Criteria Inpatient management? |
-Fever >102'F/Severe Abd Pain
-Inability to take PO N/V, or lack of response to PO, noncompliance -Pregnancy -Pelvic/tubo-ovarian Abscess |
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Antibiotic Management for Inpatient Tx of PID?
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-IV Cefoxitin/Doxy
-IV Clinda/Gent SWITCH to PO after 24hrs of improvement |
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Antibiotic Management for Outpatient Tx of PID?
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-CFX IM 1x + Doxy PO x14d
-Add Metro- bacterial vag, trichomonas, , pelvic abcess or recent gyn instrumentation -72hr FU |
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PID Diagnostic Tests?
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DO NOT WAIT TO START Emp TX
HCG, qualitative Cervix - Gram, Gono/Chlam Cx UA/UCx RPR HIV PAP CBC BMP |
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PID Counseling
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Treat Partner
Contraception Medication Safe Sex Smoking |
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PID Associated Symptoms tx?
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Diet/Ambulation
NPO/Bed rest -Morphine -Promethazine (safe in preg) -Acetaminophen -NS |
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62 Diabetic with Constipation in Clinic.
Differential Diagnosis? |
Fiber/Fluid, Medication, Obstruction - Tumor, Neuropathy, Hypothyroid
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Constipation - Clinic
Initial Tests? |
CBC, BMP, FOBT, Mg, Phos, TSH. HBA1C, Microalbumin, colonoscopy
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Outpatient Constipation Mgmt?
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High Fiber, Low Salt, Low Fat Diet
Oral Hydration DOC: PsylliumMethylcellulose, Milk of Mg 2nd line: Docusate, Lactulose, Sorbitol, Mg Citrate, Senna, Bisacodyl Exercise Program Counseling |
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Dysfunctional Uterine Bleeding.
Rule Out? |
Pregnancy -B-HCG
Endocrine -TSH/Prolactin CBC/PT/PTT -Anemia/Bleed Perimenopausal Endo Ca -Endometrial Biopsy PCOS/Ovarian Tumor -US Pelvis Liver Dz - LFT's |
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Treatment of DUB?
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Mild -Iron
Moderate (HGB 10-12) -Iron and -OCP - Progestin only Severe <10 -Hospitalize, Transfuse -Combination OCP Unstable IV Estrogen and D&C |
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Acute Pericarditis in the ER,
Initial Mgmt? |
Cardiac Tamponade - Echo
-need for Pericardiocentesis Hospitalization Fever >100.4, Cardiac tamponade, failure to respond to NSAIDS /1wk, immunosup, anticoag, acute trauma, elevated troponin |
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Acute Pericarditis in the ER,
Initial Treatment? |
Viral - NSAIDS-2wks and Colchicine-3mths
Post MI - ASA (avoid NSAIDS) Resistant/Autoimmune - Steroids Uremic - Dialysis |
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Blunt Abdominal Trauma, emergency orders?
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C-spine immobilization
IV access IV NSS 0.9% Pulse Ox Oxygen BP monitor Cardiac Monitor |
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Blunt Abdominal Trauma,
Orders? |
CBC Type n screen
LFTs amylase, lipase EKG ABG BMP, UA Spine xray, Chest xray SURGERY CONSULT all pts. Abd CT or US |
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Blunt Abdominal Trauma
Stable |
-CT with contrast
No Injry-> obs and serial exams Ward Monitor trauma -> conservative vs laparotomy ICU Monitor |
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Blunt Abdominal Trauma
Unstable |
Unstable, Unconscious, Intoxicated
-Abd US -> No trauma/hmg do a CT -> Trauma/HMG ->LAPAROTOMY |
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Blunt Abdominal Trauma
Therapy? |
Q6 -HxH and Serial Exams
NPO Foley cath IV analgesia IV antiemetic Counseling REPEAT US |
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Cellulitis
Mild Disease Management? |
NO DIAGNOSTIC INVESTIGATION.
O/P Emperic Abx -Purulent Drainage/ no abscess -> Clinda (MRSA), TMP-SMX, NON Purulent -> ClindaLinezolid |
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Cellulitis
Severe Disease Management? |
Systemic Tox, Extensive skin involement, failure of initial abx.
Admit: Xray of extremity, CBC, BMP, Blood Cx IV Vancomycin (until MRSA r/o) |
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RIb Fracture
Therapy? |
CXR, Pulse Ox -Chest CT Ibuprofen
Chest Physiotherapy Incentive Spirometry |
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Child Abuse
Management |
CBC BMP (dehydration)
PT/PTT BT Skeletal Survey ***<2 Head CT +\- MRI Therapy towards Injury Abd Injury- CT, LFT,Amy,Lip, UA/Stool for blood; UDS Routine Psych Consult - FM STAT Child Protective Serv phone and write report; ADMIT Optho Consult |
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Amenorrhea >45 year old.
Diff Workup? |
No confirmatory test is really needed.
if unsure - HCG, FSH, TSH and PL COUNSEL -Estrogen Therapy -Exercise, Ca, Vit D Low Na, Medication |
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Furthery workup in menopause?
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Pap smear, Mammography, Colonoscopy, lipid profile, DEXA
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DVT
Indications for hospitalization? |
Massive DVT
suspicious for PE risk of bleeding underlying condition requiring inpatient care |
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DVT
Outpatient mgmt? |
Lovenox
with Warfarin. (INR 2-3) for 24hrs Stop Heparin if plts drop 100 or 50% |
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DVT
Inpatient mgmt? |
Heparin drip (goal PTT 60-80)
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Duration of Warfarin?
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First DVT - 3mths
DVT/PE or Recurrent or continued risk factors (malignancy, thrombophilia) - Indefinite |
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DVT
Monitoring? Orders? |
Bed Rest
Counseling [Med compiance/SE, no smoking] INR goal 2-3 Platelet count on day 3 and 5 |
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Emergency orders in suspected PE, PNA, PERICARDITIS, MI?
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IV Access
Cardiac monitor Pulse Ox Q2hrs BP Monitor EKG Consider: ASA NITRO-if bp tolerates |
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PE suspected
Do Next? Initial Tests? |
CBC, BMP, PT/PTT
ABG DDimer CE CXR |
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Wells Criteria
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Clinical symptoms of DVT (3 points)
Heart rate >100 (1.5 points) Immobilisation or surgery in previous four weeks (1.5 points) Previous DVT/PE (1.5 points) Haemoptysis (1 point) Malignancy (1 point) PE likely (score >4) PE unlikely (score <=4) |
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DVT
Noted High DDimer/ hypoxia and normal CXR |
1- Heparin/(bmp ok? Lovenox)
PTT Q6hrs Spiral CT (pending CT transfer to Ward/ICU) |
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DVT
Inpatient? Monitoring? |
CBC Daily
INR Daily Bed Rest/Reg Diet Couseling [no smoking, med compliance, side effects] Heparin PTT 60-80 Warfarin INR 2-3 |
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>50 Fatigue
Differential? |
Psychiatric
Malignancy Chronic Fatigue Syndrome Endocrine / Metabolic AutoImmune Infectious |
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>50 Fatigue
Initial Order? |
CBC, BMP, LFT's, ESR ,TSH
age appropriate screen: FOBT, Colonoscopy-golytely High Risk: HIV and PPD |
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Colon Ca
Initial Mgmt? |
Transfer to Ward
Staging: CT Abd, CEA Preop: CXray, UA, EKG, PT/PTT, Blood type and cross Consult Onc/Surgery Couseling - Ca / Smoking /Alcohol |
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Colon Ca
Staged, Next? |
SURGERY
Hemicolectomy Consider Chemo NPO Metro/Cipro ONE time Manage Pain Follow Up Revaluate 12-24hrs Interval Cancel NPO Reg Diet with Counseling |
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Suspected Bipolar/Manic Episode in ER?
Initial Orders? |
CBC with Diff
BMP TSH UTox Olanzapine IM Continous -aggitation/manic episode in bipolar Transfer to WARD -psych consult stat -SUICIDE CONTRACT |
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Suspected Bipolar
want to start Li, what do you need to order? |
Cr/BUN, Ca, TSH, EKG >40
BHCG in women |
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Bipolar Counseling?
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Psychotherapy
Counseling Medication compliance/SE Suicide Contract Regular Exercise Patient Education |
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Acute Bacterial Meningitis
Initial Orders? |
Pulse Ox Q2
CBC, BMP, CXR, UA, Blood Cx, Urine Q2, HEAD CT -INDICATIONS: Papiledema, Focal Neuro Def, Obtundation, Hx CNS Dz, Siezure, Immunocomp Routine Head elevation, Bedrest, IV access |
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Acute Bacterial Meningitis
Treatment? |
IV normal saline
IV Ceftriaxone + Vancomycin [>55/Immun comp Ampicillin] Dexamethasone Phenergan Acetaminophen |
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Acute Bacterial Meningitis
CT neg for HMG, Next? |
Lumbar Puncture
CSF -cell count -ptn/glucose -gram stain -fungal stain -bact antigen -culture/sensitivity Interval 8-12 hrs |
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CSF Results,
TAILOR ANTIBIOTICS: |
Gram Postive Cocci: Cephalosporin + Vanco
Gram Neg Cocci: Cephalosporin Gram Pos Bacilli: Ampicillin + Gentamycin Gram Neg Bacilli: Ceph + Gentamicin Cocci: Ceph G+ keep Vanco Bacilli: Gentamycin |
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Temporal Arteritis Suspected
initial orders? |
CBC, BMP, ESR, UA, UCx, CXR, head CT
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Temporal Arteritis suspected
HIGH ESR, next? |
Biopsy Temporal Artery
Prednisone PO Aspirin PO Pantoprazole PO Calcium PO Vit D PO SEND THEM HOME, your not going to do much else. Follow up in 2-4 weeks. Counsel-Medication |
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Temporal Arteritis
Follow up? |
Biopsy is consistent.
ESR, CBC, DEXA scan Follow up in 2-4 weeks |
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Stiffness in shoulder and hips over 6mths. Suspect
Polymialgia Rheumatica Initial Orders? |
CBC, BMP, ESR, CRP, ANA, RF, TSH, CPK, CXR
"routine' Follow up in 4-7 days |
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PMR,
results, anemai and elevated ESR. What next? |
Trial of Steroids
Prednisone Ca Vit D Counseling Medication Compliance Follow up in 2-4 weeks |
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PMR
Follow up? symptoms improve? |
ESR, CRP, CBC and DEXA scan.
Follow up in 2-4 weeks |
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Suspected Ovarian Cancer? Ascites with no liver symptoms?
Intial Orders? |
CBC, BMP, LFT, US
PELVIC US Follow up in 1 week. |
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Ovarian Cancer?
Seen on US what next? |
Abd CT
CA 125 CXR Colonoscopy, Mammogram PAP Gyn Consult Onc Consult Cancer Counceling PreOP: EKG, PT/PTT, Blood type n screen Follow up in 4-7 days |
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Ovarian Ca
Labs returned? |
Ward
NPO, Cefazolin once LMWH, Compression stock TAH-BSO py Laparotomy Reevaluate 12-24 hrs |
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Sigmoid Volvus suspected
Initial Orders? |
CBC, BMP, UA, Abd Xray
IV Access NPO IV Fluids |
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Sigmoid Volvus on xray
What next? |
Gastro Consult
NG tube IV morphine |
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Sigmoid Volvus
GI consult complete, what next? |
Flexible Sigmoidoscopy and Rectal Tube
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Acute Cholecystitis Suspected
Initial Orders? |
CBC, BMP, LFT, Amylase, Lipase, Blood Cx, Abd Xray
Abd US, IV access NPO NG tube if vomiting IV fluids Pipercillin- Tazo Ketorolac IM Phenergan IV |
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Acute Cholecycstitis on US
Next |
Admit Ward
Bed Rest with Bathroom Consult Gen Surgery PT/PTT, type n cross Advance 8-12 until pt improves and afebrile |
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Acute Cholecystectomy
Surgical Risk? |
Low - Emergent Cholystectomy on this admission
High - DC and refer NON surgical Gallstone therapy - Percutaneous Cholystectomy |
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Suspected AAA rupture
after Emergency Orders and Focused Physical |
Cancel All Medications
IV Fluids Morphine - Phenergan CBC, BMP, PT/PTT, Type n Cross, NPO, Bedrest US ABD stat Vasc Surgery Consult Transfer to ICU |
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AAA rupture seen on US
Next? |
CEFAZOLIN once
Unstable SBP<90 -Surgical Intervention without delay Repair AA stat |
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