Afib and Hyponatremia Flashcards
Hyponatremia diagnostic approach
Hyponatremia workup and management
Management and symptom control of Afib
When controlling heart rate for Afib. . .
. . . 110 is a decent target – you don’t need to fully normalize HR, you probably won’t be able to
Risk calculators in Afib management
CHADS-VASc (for stroke risk)
HAS-BLED (for major bleed risk)
In which patients are direct oral anticoagulants contraindicated?
Patients with some form of hemophilic disorder
Patients with prosthetic heart valves
Obese patients
In order to perform an elective cardioversion for someone, they need to be . . .
. . . anticoagulated for at least 3 weeks, OR have evidence showing there is no intracardiac clotting.
When deciding what treatment to use for atrial fibrillation, it is important to take into account whether or not the patient is in, . .
. . . congestive heart failure
Rate control agents like metoprolol or diltiazem may make CHF worse at high doses. Rhythm agents may be a better choice in these cases, however we don’t like to keep patients on them long-term if avoidable because of side effects.
Major side effects of amiodarone
Amiodarone can cause end-organ damage to multiple organs, but most importantly:
Lung
Liver
Thyroid
Nociceptive pain circuit
Neuropathic pain circuit
Drugs for nociceptive pain don’t work for. . .
. . . neuropathic pain
WHO Pain STEP diagram (nociceptive)
Ketoralac
Particularly strong NSAID for nociceptive pain.
Only available IV. Great for acute moderate pain, but due to effects on kidneys only safe for 3-5 days.
Adverse effects and contraindications of NSAIDs
Neuropathic pain step diagram
Only approved COX-2 selective inhibitor
Celecoxib aka celebrex
Contraindicated in patients with cardiac conditions.
Opioid receptors
Opioid analgesic mechanism of action
“Morphine equivalency”
Potency of opioids and other analgesics relative to morphine
Used to compare pain medications when switching for one reason or another.
Daily limit of tylenol
4000 mg
Anesthetic vs analgesic
Analgesics selectively deactivate pain pathways
Anasthetics deactivate all sensory and motor pathways (they usually target basic nerve depolarization pathways, like Na channels, think lidocaine)
Indications for pharmacoligically treatment of delirium
Patient is a threat to self or others
Patient is removing IVs or other medical equipment necessary to their treatment and immediate health or causing traumatic injury in the process
Delirium treatment algorithm
Haloperidol for delirium
1st line for delirium
2nd generation antipsychotics for delirium
Lorazepam for delirium
Trazodone for delirium
Adverse effects/contraindications of SSRIs
Classic appearance of a fractured femoral neck on X-ray
“Ice cream scoop that has slipped off its cone”
It is often hard to see the fracture line, but you can see some sclerosis. In comparison to a normal femoral neck, which is very clean and continuous, fractures look a little burrier and more granular.
If a patient presenting with acute fracture presents with afebrile leukocytosis, you should. . .
. . . not be surprised. Trauma alone can cause afebrile leukocytosis – there are a lot of DAMPs being released and white cells are being recruited to sterilize and occupy the injured site.
Fracture risk in patients with osteopoenia
Is normal! They are not at increased risk.
But, there is evidence of lower BMD, and so they may progress to osteoporosis. At that point, they would be at increased risk for fractures.
Bisphosphonate adverse effects
Why is it so important to distinguish between Afib and atrial flutter?
Because classic flutter has a defined circuit in the RA that can be ablated, effectively curing the patient, where as Afib is often a chronic condition.
LA flutter can also be seen and appears less “clean” than the RA version due to the more circuitous route it must take to complete a circle. Clockwise vs counterclockwise can also be determined by reading ECG.
Other name for AV reentrant tachycardia
Wolf-Parkinson-White syndrome!
They are the same thing.
For someone not on anticoagulation, past what timepoint of being in afib are you worried about there being a thrombus in the heart?
48 hours
