Vitals Flashcards
Hypotension mx (SBP <90, not absolute)
**caution in renal patients (see cardiogenic)
- Hypovolemic: gelofusine 500mL FR x1 +- NS 500mL q1H x 1+
- Cardiogenic: dopamine 200mg in 100mL NS, 10mL/H, escalate 5ml if need
- Septic: IV gelofusine 500mL FR x1 + IV tazocin 4.5g q8H (or more big guns) +- dopamine 200mg in 100mL NS, 10mL/H, escalate 5ml if need
CHECK:
- bp/p q1H x4, if stable q4H
- cardiac monitor
- blood x cbc +- txs, C/S, TnI, CK, LDH, random cortisol, ECG, CXR, W/H all antihypertensive
HTN (SBP >180, DBP>90)
**ischemic stroke: SBP>220; h’age stroke: >180; target >200 if ICP increase
PO preparation
Norvasc (amlodipine) 5mg PO stat x1/ daily
Adalat retard (nifedipine) 20mg PO stat x1/ BD
Captopril 6.24mg PO stat x1/ TDS
Betaloc (metoprolol) 25mg PO stat x1/ BD
Methyldopa 250mg PO x1/ TDS
IV preparation
Labetalol 5mg IV stat x1
\+ pain control!!! CHECK - bp/p q1H, q4H if stable - cardiac monitor - +- ECG, blood x TnI, CTB
Tachycardia (>100)
- check______ first before treat!
CHECK BP FIRST!!!!
100-140
- low bp: Gelofusine 500mL FR x1
- normal bp: NS 500mL q1H x1
- underlying cause: sepsis, pain
> 140
AF
- low bp: *cardioversion (synchronized 100-120J)
- marginal bp: digoxin .25mg q8H po x3 OR .25mg in 50mL NS q10min x3 then .25mg daily
- normal bp:
—–> L : amiodarone 150mg in 100mL D5 over 30mins x1 (check TFT) > M: 600mg in 500mL D5 q24H
—–> or dilatiazem 100mg in 100mL NS, infuse 10-20mL/H
SVT
- low bp: *cardioversion (synchronized 100-120J)
- normal bp: *IV ATP 10mg stat> repeat dose> IV amiodarone 150mg in 100mL D5 q30min x1> IV amiodarone 600mg in 500mL D5 q24H (w/h if HR <60)
W/H theophylline, erythromycin, ketoconazole, TA< levofloxacin, methadone
CHECK
- bp/p q1H, q4H if stable
- cardiac monitor
- blood x RFT (latest/ stat): K>=4, CaPO4, TSH (next blood) +- TnI, CK, LDH, ECG
Bradycardia (HR <60)
- low bp: atropine .4mg stat IV if symptomatic
- normal bp: *ECG if morbitz type II, 3rd degree HB> percutaneous pacemaker
W/H betablockers
CHECK
- bp/p q1H, q4H if stable
- cardiac monitor
- blood x RFT (latest/ stat): hyperk!, bone, TSH (next blod) +- TnI, CK, LDH, ECG
Desaturation (<92%)
DDx
- PnA
- IV augmentin 1.2g q8H
- HAP: IV tazocin 4.5g q8H
- Aspiration: consult ST - COPD exacerbation
- Ventolin (salbutamol) puff / Atrovent (ipratropium) puff to 4puffs q4H
- IV hydrocortisone ?????? q8H - PTX
- insert chest drain - Pleural effusion
- thoracocentesis - ACS
- aspirin 160mg daily PO stat, then 80mg daily PO
- +- enoxaparin 0.4mL SC q12H (if 40kg) - metabolic acidosis
- NaHCO3 8.4% 50mL q30min x1 - Anemia
- transfuse prn (1U rbc transfues, if Hb <7.0 transfuse another U), ?????post-transfusion lasix 10mg IV once
Fever (>38, WCC high; abx 2D still fever >38)
- *caution in renal patients
- check previous c/s results
- septic looking: IVF
- IV #augmentin 1.2g q8H / PO #levofloxacin 500mg q24H (=daily)
Bite wound/DM foot/AECOPD/ aspiration/CAP/pyelonephritis: IV #augmentin 1.2g q8H
HAP: IV superazone (cefoperazone/sulfabactam) 1g q12H (+ IV vitK1 10mg stat)/ IV tazocin 4.5g q8H
Cholangitis/ peritonitis/ PPU/ diverticulitis: #IV cefuroxime (G2ceph) 750mg q8H + IV metronidazole 500mg q8H
Liver abscess: IV ceftriaxone (G3ceph) 1g q12H + IV metronidazole 500mg q8H
IE: #IV ampicillin 2g q4H + IV gentamycin 1mg/kg q8H
Meningitis: IV ceftriaxone 2g q12H
Septic arthritis/cellulitis/osteomyelitis: #IV ampicillin 1g q6H + IV cloxacillin 1g q6H
any abscess: + IV metronidazole 500mg q8H
CHECK - blood x c/s, CBC d/c, LRFT, clotting - sputum x c/s - MSU stix, c/s - NPA x virus - CXR - PO panadol 500mg q4H prn ===================== #renal patient dose cut half for: ampicillin, augmentin, levofloxacin, tazocin, vancomycin, meropenem original dose for: ceftriaxone, cloxacillin, erythro/azithro/clinda/doxy, metronidazole
Hypothermia (<36)
- Bair hugger
- Septic workup (CBC d/c, TFT, blood c/s, sputum c/s, MSU stix c/s, NPA x virus, cxr)
- Abx
- IVF if septic shock
ddx: sepsis, hypothyroidism
