AACN Flashcards
Anterior/Septal leads LAD
V1-4
Inferior leads L circ or RCA
II III or AVF
Anterior wall MI complications
VSD, LEFT HEART failure, acute MITRAL regurg
Most likely etiology of aortic valve disease over vs under 70
over is calcified aortic stenosis
under is congenital bicuspid aortic valve
Rheumatic fever and valves
most likely mitral vale
Mitral valve murmur
regurg of blood from Left ventricle to left atria for the entire systolic time(HOLOSYSTOLIC murmur) described as blowing and associated with S3 gallop
non mitral causes of holosystolic murmurs
VSD, Tricuspid regurg
SYSTOLIC EJECTION murmur with click
aortic stenosis
HYPERTROPHIC CARDIOMYOPATHY
ECG
MURMUR
SYMPTOM
SYNCOPY
ECG: Biphasic P in V1 and V2, deep narrow Q waves in 1, AVL, V5 and V6
MURMUR: non-radiating systolic
usually found in young adults
Hypertensive encephalopathy for hypertensive emergency:
HE: blurred vision associated with profound HTN
reduce slowly like 20% in the first 1-2 hrs
First steps in MI
NITRO, MORPHENE, antiplatelet
A-fib in COPD post coronary revascularization or CABG
goal is rate control: Dilt, cardizem
NO AMIODORONE because of risk of pulmonary fibrosis, (worse in old, long term use, and COPD)
NO BB because of bronchospasm- metoprolol is caridioselective but still
pericarditis
sharp CP worse on INSPIRATION
Diffuse ECG changes
pericardial friction RUB, muffled heart tones, and HYPOtension, maybe low temp
Costocondritis pain
reproducable by appling pressure to chest,
GERD sx
coorelate with eating or lying down
PULM edema
card causes
non card causes
Clinical presentation
CC: Heart failure,
mitral STENOSIS
non card: infection, aspiration and ARDS
CP: dyspnea parox nocturnal dyps wheezing frothy sputum cephalization effusions Kerley B
Pleurisy pleuritis
CP
worse on inspiration and no cough
Tamponade triad
muffled heart sounds, jugular venous distension, hypotension
narrowing pulse pressure
radial and brachial pulses may be weak or absent
HTN refractory to multiple meds think
pheocromocytoma: prolonged catecholane excess
or renal artery stenosis
OSA
pheocromocytoma DX
TSH is normal
Pasma free metanephrines
normetanephrine: over 2.5
metanehrine ove 1.4
24 hr urine to look for urine CATECHOLAMINES
TX with ALPHA adrenergic: phentolamine, (regitine) or phenoxbenzamine(dibenzyline)
valve disorder most associated with aortic aneurysm
associated with poorly controlled HTN, Ascending aneurysm can widen the aortic base and lead to regurg
S4 gallop
AS from narrowing of valve outflow
opening snap
mitral valve prolapse or regurg
antiplatlet pre cath
plavix 300 then 75 daily
asa 81-325
ADHF causes
change in diet (reversible) not taking meds dysthrymias anemia systemic infection
normal CVP
0-6
normal PAP
15-25sys /5-15dias )
PCWP
LVEDP
6-12
ISCHEMIC cardiomyopathy (in addition to ICD
antiplatelet and BBto reduce morbid and mortality but dont directly reduce the risk of sudden cardiac death
HTN urgency reduction schedule
10-20 in hr 1
5-15 in next 23
Constrictive pericarditis and restrictive cardiomypathy dx
cardiac MRI
CT or eccho
restrictive cardiomyopathy -
calcium deposits on pericardium
endomyocardial biopsy
bypass common complications
kidney dysfunction
throbocytopenia
systemic inflammatory response among other s
mechinical circulatory support indications
stabilization of cardiogenic shock with mechanical complication
mitral regurgitaiton
ventricular septal defect or free wall rupture
Lovenox and nstemi in the old
renally cleared and shuld be dose adusted based on creat
Angina therapies
BB< statin, and and ASA
supplemental 02 below
90
hyperoxia remote risk
vasoconstriction worsoning cardiac ischemia
secondary causes of dyslipidemia
hypothyroidism
DM
nephrotic syndrome
ischemic stroke HOB
less than 30 for 24 hrs
dialated left ventricle HF
heart failure with reduced EF
HFpEF mngmt
B control and diuresis but no therapy yet reduces morbidity and mortality
cardiogenic shock
epi
mirlinone, -primacor
dobutamine-dobutrex
or nitro
no BB beta ag vs beta antag
NSTEMI preferred treatment
not thrombolytics
PCI is preferred
target for ablation of a-fib
pulmonary veins are foci over 90% of the time
anticoag for 2-3 months following ablaiton, evaluate at that point
sinus node dysfunction and need for pacer in necessary in 10% of cases
seat belt sign
indicates intra abdominal injury up to 1/3 of pts
gallstone pancreatitis
common cause
CT with contrast most reliable can identify panc and complications to guide treatment
SBP dx
with para
Broad spectrum ABX
Cefotaximine
can also treat with NA restriction and diuretics
transudative fluid
protein pleural/serum less than 0.5 LDH plerual/serum less than 0.6 Pleural LDH less than two thrids upper limit of normal serum LDH 140-280
cirrhosis, nephrotic syndrome
CHF
Constrictive pericarditis
Exudative effusion
protein pleural/serum more than 0.5 LDH plerual/serum more than 0.6 Pleural LDH more than two thrids upper limit of normal serum LDH 140-280
murphys sign
acute cholecystitis - deep breath while palpating gallbladder which slips down producing pain
giradia incubation
7-21
metro for 7 days
C difff incubation
12-36 hours
Gram plus
vanc and metro
e coli incubaiton
3-4 days
gram neg
ammox-
Staph aureus incubaiton
1-8 hours
gram positive
cefazolin, cephalothin and cephalexin
gastroparesis sx
common complication of uncontrolled hypoglycemia
early satiety
post prandial fullness
chrons def
inflammatory bowel disease afffecting ileum and colon,
diarrhea and bloody stool
endoscopy
treat with immunosuppressants
nutritional support guide
25-30x wght in KG
protein
1.2-1.6xkg
H pylori eradication
gram neg
MOC- metro, omep, clarithromycin (biaxin) for 7 days
AOC ammox, omepp, clarithromycin,
or metro and ammox 7-14
PUD
free ab air absent recet sx is perf
PUD is most common cause of stomach and duodonal perf
bowel perf tx is fluids NPO and broad spectrum abx
meld score calculation
creat
bili
inr
significant post cabg bleed
150mL in 1st 30 minutes
> 250mL in 1st hour (call surgeon and intensivist)
> 150mL in 2nd hour
> 100mL in subsequent hours
restrictive cardiomyopathy
least common
amaloidosis or sarcoid
Diffuse myocardial infiltration leads to low voltage QRS complexes.
Atrial fibrillation may occur due to atrial enlargement; ventricular arrhythmias are also common.
Infiltration of the cardiac conducting system (e.g. due to septal granuloma formation in sarcoidosis) may lead to conduction disturbance — e.g. bundle branch blocks and AV block.
Healing granulomas in sarcoidosis may produce “pseudo-infarction” Q waves
dialated cardiomyopathy most common
treat with prils
cholesterol screen
goals
at 20 then q5
over 40 is every 2 or 3 or annualy with HLD
Total:
less than 200
200-239
greater than 240 is hi
HLD
men over 40
woman over 50
LDL
less than 100
greater than 190
Joint comission HTN class
Blood Pressure SBP DBP Classification mmHg mmHg Normal <120 and <80 Pre 120–139 or 80–89 Stage 1 140–159 or 90–99 Stage 2 Hypertension ≥160 or ≥100
HTN goal over 60
less than 150/90 unless ckd or DM
HTN urgency vs emergency
(ie, systolic BP >220 mm Hg or diastolic BP >120 mm Hg with or without end organ damage
carotid endartorectomy indicaton
over 70% stenosis with tia or stroke
pseudomonas infections abx
zosyn, cefe, imi, mero
plus
cipro or levoflox
m catorales
Amoxicillin-clavulanate, second- and third-generation oral cephalosporins, and trimethoprim-sulfamethoxazole (TMP-SMZ) are the most recommended agents
TB drugs
isoniazid, rifampin, pyrazinamide, ethambutol, if fully succiptable to INH and RIF then ethambutol can be dropped
2 monthos fo ISO, RIF, Pyrazin
then two of ISO, RIF
HIV for 9 weeks
postitive tb test
over 5 for HIV
over 10 for high risk,
over 15 for all other
Hospital aquired pnu
Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is thus distinguished from community-acquired pneumonia. It is usually caused by a bacterial infection, rather than a virus
low risk HCAP tx
> mild: augmentin or benzylpenicillin + gentamicin
-> moderate/severe: ceftriaxone or cefotaxime or tazocin or timentin
HCAP high risk of MDR treatmet
cover MDR organisms
stop antibiotics for VAP at 6-8 days (evidence that longer courses lead to colonisation with MROs)
treat Pseudomonas aeruginosa, Acinetobacter species or Stenotrophomonas maltophilia for 15 days
-> tazocin or timentin or cefepime
-> if suspected MRSA add in vancomycin (pre-existing longterm lines, prior MRSA, in hospital > 7day or recent admission <3 months)
-> add gentamicin if critically ill (ventilated) to cover MDR organisms (use ciprofloxacin if age >65y, GFR <50 or recently on gentamicin)
-> add teichoplanin if VRE colonized
predicted post op pft for volume reduction
Predicted post-operative PFTs = Preop Value (5 – number of lobes resected)/5
aspergillus s and s
Fever and chills. A cough that brings up blood (hemoptysis) Shortness of breath. Chest or joint pain. Headaches or eye symptoms. Skin lesions.
strep pnu treatment
macrolide (MYCINS)or tetra if healthy
floroquinolone (floxacin) + or betalactam (combos pip/tazo) plus macrolide if not
p aregunosa treatment
pip/tazo (betalactam) or mero- carbepenam or cefepime (cephalo sporin)
plus
AMG(gent)/azithro (macrolide
add
vanc or linezolid for MRSA
fever-sob-pleural effusion with blunting of costovetebrial angle
empayema
scleroderam
anti-centromere antibodies (80%)
mmunosuppression (methotrexate) steroids care with vasoconstrictors risk of ileus, malabsorption, nutritional deficiencies, GORD, stress ulceration optimise right ventricular function
COPD
quit smoking
no steroids for mild stable disease
LABA for moderate disease
COPD EKG
ECG: right heart strain, RV hyperthrophy, P pulmonale, RAD, RBBB, ST depression or inversion in V1-V3
COPD staging
In patients with FEV1/FVC < 0.70:
GOLD 1—mild: FEV1≥ 80% predicted
GOLD 2—moderate: 50% ≤ FEV1 < 80% predicted
GOLD 3—severe: 30% ≤ FEV1 < 50% predicted
GOLD 4—very severe: FEV1 < 30% predicted
laba for-sal
LABAs include: Salmeterol (Serevent Diskus) Formoterol (Perforomist) Arformoterol (Brovana)
saba
albuterol
lama
tio
ICS for eos over 300
beclomethasone dipropionate (Qvar Redihaler) budesonide (Pulmicort Flexhaler) ciclesonide (Alvesco) flunisolide (Aerospan) fluticasone propionate (Flovent) mometasone (Asmanex)
normal creat clearence
Normal creatinine clearance is 88–128 mL/min for healthy women
and 97–137 mL/min for healthy men.
gfr
over 90 is good 60-90 30-59 15-30 under 15
indications for hd pneumonic
Acidosis electrolyte intox overload uremea
acute SOB and normal chest films
PE
gold standard is CT with contrast
vent perfusion substitue for CKD players
acute copd excerab
NON invasive positive pressure bipap 10/5
azithromycin
methylpred
taccy and tubed outside other causes
pneumothorax high plt
ARDS
lung protective vent peep sedation prone paralytic
pseudomonas
levoflox, ciproflox or mero
R heart cath
R side pressures and pulm art pressure
cardiac mri
congenital disease, structural disorders of the heart
L heart cath
CAD
needle decompress
2nd intercostal mid clavicular
cor pulmonale
R heatr failure from underlying lung disease
hypoxemea LT vasoconstriction and pulm htn LT afterload on RV LT peripheral edema and big liver/spleen
OBese hypo syndrom e
BMI over thirty, awake PC)2 over 45.
idiopathic pulmonary firbosis sound
fine crackles at bases
lung nodule treatment
surgical excision
one lobe only -no pneumonectomy
LYmph positive- may need chemo/rads
ppe for tb
airborn
AFB to determine active TB
alpha 1 antityrpsan defficiency
COPD should get tested
angio edema
laryngeal swelling
benedryl and H2 blocker
epi -stridor etc
sulfonureal -glyburide
DiaBeta, Glynase, or Micronase (glyburide or glibenclamide) Amaryl (glimepiride) Diabinese (chlorpropamide) Glucotrol (glipizide) Tolinase (tolazamide) Tolbutamide.
stims insulin scretion not for older adults -dehydration and AKI, not for gfr less than 60
DKA treatment
first correct fluid deficit
in most adults 1-3L in the first hour
serum electrolytes before initiation of insulin to make sure K is above 3.3
insulin
insulin prior to surgery
hyperglycemic
yes basal yes correctional no prandial (NPO)
SIADH cold intolerance
retention of free water
LOW serum NA
LOW osmolality below 280
and HIGH urine osmo over 100 and urine NA over 40
causes stroke, CNS disorder, trauma, infection, malignancies some meds
siadh treatment
serum na over 120 1000ml restrict
over 110 under 120
500ml
under 110 hypertonic and lasix
hypothroid
High TSH
low t4
hashimotos
pituatiry or hypothalmus dysfuction
cold intolerance, britle nails, puffy eyes, hair loss
low NA and sugar
synthroid
hypothyroid crysis
myxedema
tube
iv synthroid
slow rewarm’
hyper thyroid
20-40 years graves smooth moist warm skin lid lag HEAT intolerance
TSH low
T3 and 4 up
radioactive iodie uptake
high is graves
low is subacute
treat with propanool for tremor pctu tapazole lugols
thyroid crisisi
extension of hyper ptc uor tapazole with propanolol lugols sodium iodine hydrocort AVOID ASA
tacchy agitated tremor
thyroid storm, propanalol
adrenal insufficieny
early morning corticol less than 5 with increased ACTH (2 fold above normal limit ) is Primary
dex supression test
cushings - dex 1 time and then check in the morning
cushings
moon face and buffalo
urine metanephrines
pheocromocytoma normal TSH CT adrenals alpha block for HTN- phentolamine - regitine of phenoxybenzamine- dibenzyline
steroid for plama cortisol assy (does not interfere)
dexamethasone- can be given before ACTH test, switch to hydro or pred after test
Normal MCH
32-36
HCT
45% to 52% for men and 37% to 48% for women.
Normal MCV
80-96
coombs test
think hemolytic anemia
cancer and pE
lovonox
absolute contraindication to TPA
Significant head trauma or prior stroke in the previous 3 months.
Symptoms suggest subarachnoid hemorrhage.
Arterial puncture at a noncompressible site in previous 7 days.
History of previous intracranial hemorrhage.
Intracranial neoplasm,
AVM, or an aneurysm.
Recent intracranial or intraspinal surgery.
ANC
WBC x total neutrophils (segs% bands%)x10
normal is over 1000
An ANC (Absolute Neutrophil Count) measures the percentage of neutrophils (shown in this listing as Polys) in your white blood count. multiply your white blood count (WBC) x total neutrophils (segmented neutrophils% + segmented bands%) x 10 = ANC. A normal ANC is over 1,000.
transfuse hgb
between 7 and 8
most common risks in transfusion of blood
allergic reactions, volume overlaod, infection
bactericidal
beta-lactam antibiotics (penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems) and vancomycin.
principles of abx
degree of imunocompromise, prior infection history, local resistance, bactericidal preffered
CLL
lymphadenopathy, increased WBC, LYMPHOCYTES over 5K
splenomegaly
dx with peripheral smear
serum protien electrophoreisis
confirms multiple myeloma with gama spike
serum hapto
low in hemolytic anemia
below 50 or .5
clinical evaluation for staging
symptom directed with particular attention paid to non pulmonary symptoms that suggest mets
breast cancer genitic testing
DCIS and ca before 50
tow or more occurances of breast, ovarian, rostate, or panc on same side of family, maternal or paternal
male breast or triple neg breast.
multiple myeloma
crab
bone marrow plasma cells over 10%
c: calcium of 11 or higher
Renal- creat over 2
Anemia: hgm less than 10
Bone lesions one or more on imaging
hodkins
Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which a physician can identify using a microscope. In non-Hodgkin lymphoma, these cells are not present.
MICRO less than 80, hypo less than 32 with low iron and ferritin
iron deff
micro less than 80
macro less than 32 with normal iron
thallasemia
no iron
splenectomy if severe
MCV 80-100
MCHC 32-36
chronic disease 2nd most common
macro MCV over 100
Normo MCHC over 32
with neuro is b12
without neuro is folic (pernicious)
ALL
pancytopenia and circulaton of blasts
CML has
philadelphia
lymphoma stage
1 single node or group
2 more than one node but only one side of diaphgram
3 spleen involved, both sides of diaphgrm
4 liver or bone marrow
ITP
steroids to pump up platelets
ivig for hi people
DIC
fibrin degraded products
hepatorenal syndrome
profound oliguria and na retention with liver dysfunction
oncentrated urine with low Na+ (<10mol/L)
few granular casts (doesn’t improve with fluid replacement)
no proteinuria
normal kidneys on U/S
pancreatitis
Symptoms consistent with pancreatitis (e.g. epigastric pain)
Elevation of serum amylase or lipase (to 3 times normal level)
Radiological features consistent with pancreatitis (e.g. CT or MRI)
refeeding syndrome
hypo phos
hypo k
hypo mag
resiliancy
ability to bounce back
complexity
two or more systems - body, family,
sability
ability to maintain equalibrium
vulnerabilty
suceptibility to actual or poential stresssors that may adversely affect outcomes
resource availability
what resources are around
participation in decision making
wht degree pt and family participate in decisions
clinical judgement
critical thinking, grasping of clinical situation, appling skills from guidelines, integrating ebp
clinical inqury
questioning, evaluating practice, creating change through research and learning
systems thinking
managing environmental, and system resources for pt fam and staff
caring practices
respond to the uniqueness of pt and family to promot comfort, limit suffering, respond to the patient as a unique individual
collaboraton
work with othes in a way that promots contribution from all
advocacy and moral agency
representing the needs of a patient or family or community and resolving ethical or clinical concerns
facilitator of learning
promote knowledge aquisition
nurse
physiological changes, presence or abcence of complications, attainment of care objectives
pt
functional change, behavioral change, trust, ratings, satisfactions, comfort, quality of life
system
recidivism, cost/resource utilization
delerium
t toxic situations h ypoxemia i nfection imobillazation n on pharma, environmental stim k potassium or electrolytes
high icp treatment
corticosteroids, mannitol and hypertonic salene
sbp goal after TPA
less than 180
GB
destruction of myelin sheath
viral LP
OP: normal
WBC: normal or mild elevatoin
Prot: normal or mild elevate
GLU: normal
SAH LP
elevated RBC and WBC with ration of 1RbC to 700 wbc
herpes LP
up wbc up rbc, up protein, normal or slightly down pressure
strep pneumoneae meningitis
cephalosporin and vanc
central cord injury
affects upper , lower is ok
brown sequard motor and nerv
same side motor, opposite side pain/propriaception
anterior cord
loss of all motor, pain and sensation below the level of injury
ICH on coum
always reverse first
hematoma may expand for 72 hours
pupil change think
elevated ICP
SAH managment
non con CT
LP
risk for early post traumatic seizure
over 65
amnesia
subdural hematoma
phenytoin for 7 days
cerebral edema from tumor
dexamethasone
pre tpa
less than 185/110
ICP monitoring in tbi
gcs 3-8
abnormal ct
parkinsons
bradykinesia, tremor, rigidity, and postural instability also referred to as parkinsonism. Tremor is the most apparent and well-known symptom.
tret with levadopa
TBI treatment goals
avoid hypoension, adn hypovolemia
treat hyperthermia
avoid abumin
tbi who gets a evd
moderate -> severe head injury who can’t be serially neurologically assessed
severe head injury (GCS < 8) + abnormal CT scan
severe head injury (GCS < 8) + normal CT if 2 of the following are present:
Age > 40 yrs
BP < 90mmHg
Abnormal motor posturing
bacterial prostatitis abx
bactrim or levoquin with sulfa allergy
ileal conduit surgery
bicarb is peed out in ileal urine so pt gets metabolic acidosis
AKI determination
bun to creat ration
urine NA - over 20 is kidney
under 10 is extrarenal
turp e imbalance
dilutional hyponatremia
bun to creat over 20 vs under 20
bun to creat over 20 is pre real
intrarenal is bun to creat of less than 20
pid
gon and clamid
gon dx: culture or gram neg
clymidia : culture is most definitive but Enzymime imunoassay EIA is preferred low cost and quick
treat ceftriaxone IM for gon
and azithromycin 1g po for clymidia
pid
sexual active female
pelvic or lower back pain
cervical or axonal tenderness
SJS/ten
painful red purple rash, peeling skin and mucosal lesisons
lamictal and anticonvulsants
sulfa abx
nasaids
nec fasch abx
carbapenem (mero) 0r beta lactam Combos- ammox/clauv
plus clinda
or a mrsa agent: vanc, linezolid, or dapto
indications for surgical debridment
Removal of the source of sepsis, mainly necrotic tissue
Removal of local infection to decrease bacterial burden, to reduce the probability of resistance from antibiotic treatment, and to obtain accurate cultures
Collection of deep cultures taken after debridement from the tissue left behind to evaluate persistent infection and requirements for systemic antibiotic treatment
Stimulation of the wound bed to support healing and to prepare for a skin graft or flap
diabetic foot ulcers
debridment, treatment of infection, pressure ofloading, meticulos wound care
abx for cellulitis
In mild cases of cellulitis treated on an outpatient basis, dicloxacillin, amoxicillin, and cephalexin are all reasonable choices. Clindamycin or a macrolide (clarithromycin or azithromycin) are reasonable alternatives in patients who are allergic to penicillin.
compartment syndrome
loss of sensation between first and second tows, weakness with dorsiflexion
associated with fractures
rhabdo triad
myalgia, gen weak, dark pee
cip
hyporeflexia, flaccid quadriparesis, SLOWED nerve conduction
mynsthenia g nerve conduction
is normal
fall prevention 9
1fix eyes-cataracts
2fix feet adn foot wear
3vitamin d
supplimentation
4rate and rythm abnormalities
5indiviually taylored exercise program
6minimize meds
7education and info
8 modify home environment
9: postural hypotension
tubing mg patinet
no rock, veck, or cist- unpredictable response, no sux- resistant- use etom
dominent vs non
People with left-sided strokes may have trouble with skilled movements, depression and speech. In contrast, the right side of the brain has a more big-picture, large-scale processing style. It pulls information together, seems better at handling new information, and is probably more responsible for negative feelings
spastic gait
dragging feet Brain abscess. Brain or head trauma. Brain tumor. Stroke. Cerebral palsy. Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck) Liver failure. Multiple sclerosis (MS)
types of gait
Propulsive gait – a stooped, stiff posture with the head and neck bent forward
Scissors gait – legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
Spastic gait – a stiff, foot-dragging walk caused by a long muscle contraction on one side
Steppage gait – foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
Waddling gait – a duck-like walk that may appear in childhood or later in life
Ataxic, or broad-based, gait – feet wide apart with irregular, jerky, and weaving or slapping when trying to walk
Magnetic gait – shuffling with feet feeling as if they stick to the ground
alzheimers
requires a gradual onset of memory impairment plus one or more of the following: aphasia (language disturbance); apraxia (impairment of motor activities despite intact motor function); agnosia (failure to recognize objects despite intact sensory function); and executive functioning disturbance (planning, organizing, sequencing, abstracting). The deficits cause a significant impairment that represents a considerable decline from previous level of function.
uncrosmatched blood is
O neg
treatment of serotonin sindrome
cryohepadine
amphotericin B
central line, premedicate with tylenol and benedri: chills nausea, emissi and rigors in 70%
uncomplicated pnu
levoflox
sofa score
PF ratio hypotension and pressor req bili level platelet count creat gcs
BB OD
atropine and ivf, if that fails insulin with glucagon
ethylene glycol
fomepizole
benzo
flumazenil
insecticide poision
atropine
failure to thrive
The Institute of Medicine as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, immune dysfunction, and low cholesterol.
FUO
Background. The syndrome of fever of unknown origin (FUO) was defined in 1961 by Petersdorf and Beeson as the following: (1) a temperature greater than 38.3°C (101°F) on several occasions, (2) more than 3 weeks’ duration of illness, and (3) failure to reach a diagnosis despite one week of inpatient investigation
FUO eitology and sub classees
classic, nosocomial, immune deficient, and human immunodeficiency virus–related. The four subgroups of the differential diagnosis of FUO are infections, malignancies, autoimmune conditions, and miscellaneous.
sepsis
Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%.
septic shock
Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. I
