Can't Miss Diagnosis

Question 1

PE - classic vitals? - What to do?

Answer 1

HR up, BP nl/down, RR up

LMWH or heparin (with bolus), CT angio; if hypotensive STAT echo; consider lysis in massive/submassive

Question 2

CVA, acute hemmorrhagic - classic vitals? - What to do?

Answer 2

HR down, BP up, altered breathing

STAT head CT, call neurosurgery

Question 3

Cardiac tamponade - classic vitals? - What to do?

Answer 3

HR up, BP down, RR variable

check puls paradoxysm if > 15 STAT echo, call CCU, bolus fluids

Question 4

Tension PTX - classic vitals? - What to do?

Answer 4

HR increased, BP decreased, RR increased

Call CT surg for chest tube. If arresting, 14g to 2nd intercostal space at midclavicular line

Question 5

Ischemic bowel - classic vitals? - What to do?

Answer 5

HR variable, BP variable, RR increased

“pain out of proportion to exam”, often hypoglycemia, check lactic acid, call gen surg, consider CT angio of abdomen

Question 6

Severe sepsis - classic vitals? - What to do?

Answer 6

HR increased, BP decreased, RR increased
Fluids, fluids, fluids, broad spectrum abx as early as possible, 2x BCx peripherally, Cx any indwelling catheter, UCx, CXR, If BP doesnt respond to fluids –> MICU

Question 7

Acute coronary syndrome - classic vitals? - What to do?

Answer 7

no classic vitals, all variable
ECG, STAT trop/CK-MB, aspirin 325, Plavix load, atrova 80, heparin drip with bolus, O2 if stats < 93, nitroglycerin, morphine, call CCU

Question 8

Aortic disection/ acute hemorrage - classic vitals? - What to do?

Answer 8

HR increased, BP up early down late, RR increased

2 large bore IVs, IVFs, blood, platelets, call surg

Question 9

Status epilepticus - classic vitals? - What to do?

Answer 9

no classic vitals, all variable,
Ativan IV 1mg q1min (0.1mg/kg max); page neuro; stat electrolytes, phenytoin or keppra load, intubate if any decreased in oxygenation