Internal Med 2 Flashcards
What are components of qSOFA
Positive screen is associated with poor outcomes
Criteria (positive if >/=2)
- RR >/= 22
- AMS
- Systolic BP = 100
What are SIRS criteria
- T >38 or <36
- RR >20
- HR >90
- WBC >12,000 or <4,000
Definition of septic shock
Sepsis (SIRS + confirmed/presumed infectious source) + refractory hypotension despite adequate fluid resuscitation (30 cc/kg)
What bugs / empiric drugs should you use in sepsis before you have cultures
- MRSA = Vancomycin
- Gram neg rods (E. Coli) = Cefepime (CTX doesn’t cover psuedomonas)
- Psuedomonas = Cefepime
- Anaerobes = Metronidazole
What is your goal in a day for increasing Na in hyponatremic patients?
8-10 increase in sodium level in a day
What should be your initial questions/evaluation of a patient with upper GI bleed
- Liver disease
- ETOH
- NSAIDs
- h/o bleeding
- PMH
- Coagulopathy
- Past endoscopy
What meds should you give initially for an upper GI bleed
- PPI
- Octreotide
- Abx (Ceftriaxone for infection prophylaxis in ANY cirrhotic patient)
- Transfuse only when Hgb <7
How should you treat someone with persistent tachycardia
If hemodynamically unstable, will probably need electricity
If hemodynamically stable, need to slow heart rate to see underlying rhythm
- Valsalva, carotid massage
- Adenosine
Then assess underlying rhythm
Triggers of Afib
- Stress
- Structural abnormalities
- Hyperthyroidism
- Heart failure
- Alcohol
- PE (may be due to catecholamine surge)
Treatment of Afib
Per Dr. Soesilo
- Usually okay to control just the rate
- If symptomatic, then also want to control the rhythm
- Anticoagulation
What is CHADVASC score
Calculates the risk of stroke for patients with A-fib/A-flutter
Age, gender, DM, HTN, h/o prior embolic event, h/o CHF
What are the 4 components you must treat in CHF
- Preload = Volume status/Diuretics (e.g. Furosemide)
- Afterload = (decrease vasoconstriction)
- — ACEI
- — ARBs
- — Hydralazine (+ nitro)
- Beta blockers (remodelling)
- Aldosterone receptor antagonists (remodelling)
How do you determine anion gap?
Na - (Cl + HCO3)
>12 = anion gap 8-12 = non-anion gap
What are the causes of anion gap metabolic acidosis
Anion gap = adding acid to the blood o MUDPILES: ♣ M – Methanol ♣ U – Uremia (renal failure) ♣ D – Diabetic ketoacidosis ♣ P – Propylene glycol/Paraldehyde ♣ I – Isoniazid/Iron ♣ L – Lactic acidosis ♣ E – Ethylene glycol (antifreeze) ♣ S – Salicylates (aspirin)
What are the causes of non-anion gap metabolic acidosis
Non-anion gap = Losing excessive HCO3-
o Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide
Acronym for uses of acute dialysis
AEIOU
Acid, electrolytes, intoxication, overload, uremia
Describe cause and findings of immune thrombocytopenia (ITP)
o IgG autoantibodies to GP2b3a
o Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen
o Often associated with HIV
Treatment of ITP
♣ Steroids and IVIG (autoimmune treatment)
♣ Splenectomy
Describe cause and findings of thrombotic thrombocytopenic purpura (TTP)
o Platelets used up in pathologic formation of microthrombi in small vessels
o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣ No vWF degradation = abnormal platelet adhesion = microthrombi
o Findings (Pentad):
♣ Thrombocytopenia = platelets being used up
♣ Microangiopathic hemolytic anemia = RBCs sheared by microthrombi
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Neurological symptoms (confusion, HA, seizures, coma) – thrombi involve vessels of CNS
♣ Fever