Floor management 5 Flashcards
how to calculate insulin requirements
Sum daily insulin requirement then divide by 2. Half = basal dose.
Determining volume status on exam
1) assess for peripheral edema
2) mucous membranes
3) orthostatic vitals (confirm)
endocarditis treatment
- Acute endocarditis with native valve: Typically start vancomycin and gentamicin and then tailor based on culture results. Nafcillin is a superior agent to vancomycin if MRSA has been ruled out because it is bactericidal instead of static (vancomycin).
• Acute endocarditis with prosthetic valve: Typically start vancomycin, gentamicin, and rifampin if within one year of valve replacement and then tailor based on culture data
SIADH treatment
- Treat underlying disease/remove offending drug
• Asymptomatic hyponatremia
• Fluid restriction alone may be enough (1-1.5L day)
• If patient requires IVF switch all IVF to NS and consider lasix to keep I = O
• Liberalize salt in diet
• Correct hypokalemia if present
labs to order for new HIV infection
1) viral load
2) CD4 count
3) genotype
4) CBC/LFT’s/Chem 7
5) hep serologies
6) RPR
7) Toxo IgG
8) lipids
what to always do before intubating
check COR status
acute HF treatment
Lasix
CPAP
general threshold for fever
38.3
indications for intubation
1) Can’t protect airway
2) Don’t turn around for oxygen
what to always do before intubating
check COR status
acute HF treatment
Lasix
CPAP
general threshold for fever
38.3
uncontrolled HTN definition
SBP > 220 or DBP >125
when you should be careful prescribing ibuprofen
ARF/ESRD
surgery is planned
GI bleed
anticoagulated.
Goals of K, mag, and phos repletion
K = 4.0 Mg = 2.0 Phos = 3.0.
how to correct potassium
1) Never give more than 10 meq IV per hour as it can cause arrhythmias/death.
2) Give via PO route whenever possible
3) Give by both routes if the K is less than 2.5 and there is a high risk for the hypokalemia causing an arrhythmia or if multiple PVC’s are noted on telemetry.
4) If hypomagnesemia is present as well, this must also be corrected. Low magnesium levels can cause patients to be refractory to potassium repletion.
septic shock definition
Systolic blood pressure < 90 mm Hg, mean arterial pressure (MAP) < 65 mm Hg, or decrease of 40 mm Hg in systolic pressure compared with baseline; unresponsive to crystalloid fluid challenge of 20 to 40 mL/kg
band formation criterion of SIRS
greater than 10%
organ dysfunction criteria in severe sepsis
Skin: Areas of mottled skin or Cap Refill Test >3sec.
Neurological: New altered mental status.
Haematologic: Platelets < 100,000; INR >1.5; PTT >60 sec
Renal: creatinine > 2.0 mg/dL without prior chronic renal disease; or increase 0.5 mg/dL; acute oliguria urine output <0.5 mL/kg/hr for at least 2 hours despite fluid resuscitation.
Pulmonary: RR > 20, oxygen (O2) saturation < 90% or < 94% with supplement O2, or mechanical ventilation.
GI: Ileus; absent bowel sounds; hyperbilirubinaemia plasma total bilirubin >4 mg/dL.
Cardiovascular: Septic shock.
CRE
Carbapenem-resistant Enterobacteriaceae
suspected meningitis management
put pt on droplet for 24 hours
airborne precautions
- private room, negative pressure and/or HEPA filtration
- pt needs surgical mask out of room
- provider must wear N95 when in room
- for measles or varicella don’t enter room unless known to be immune.
pathogens requiring airborne precautions
Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis
droplet precautions
- wear a mask
- patient must also wear a mask
