Cardio Notes First Degree Heart Block

2:1 Heart Block

Lead II long PR interval
Lead II 2 P waves per QRS complex
JNC Classification and Initial Drug Therapy NYHA FUNCTIONAL CLASSIFICATION FRAMINGHAMS CRITERIA FOR CHF DIAGNOSIS
ECG CLASS I No limitation of PA
Heart Rate = # of small boxes 1500 Digitalis Effect Lead II scooping ST segment No sx w/ ordinary exertion
<120/80 normal Major Minor
Hypercalcemia Lead II short/absent ST segment 120-139 PreHPN no antiHPN drugs indicated CLASS II Slight limitation of PA PND Extremity edema
Normal Cardiac Rhythm: Hyperkalemia Lead II tent-shaped T wave 80-89 Ordinary activity causes sx NVD Dyspnea on exertion
QRS width 0.08-0.12 sec Idioventricular Rhythm Lead II no P wave, bizarre QRS, 140-159 Stage I thiazide diuretic for most: ACE- CLASS III Marked limitation of PA Rales Hepatomegaly
P-R interval 0.12-0.20 sec (IVR) R 20-40 90-99 I,ARB,B-blocker, CCB or combination Less than ordinary activity causes sx Cardiomegaly Pleural Effusion
Q-T interval 0.30-0.40 sec Premature Atrial Lead II premature P wave, >160 Stage II 2-drug combination for most, Thiazide Asx at rest Acute Pulmonary Edema Vital capacity reduced by
Contraction (PAC) irregular P-P interval 100 diuretic +ACE-I or ARB or B-blocker, CLASS IV Inability to carry out PA w/o S3 Gallop 1/3 of normal
PR interval >0.20 sec Premature Ventricular Lead II wide QRS unrelated to P wave CCB discomfort Increased venous pressure Tachycardia >120 bpm
1st Degree AV Block - >0.20 sec Contraction (PVC) Sx at rest angina + hepatojugular reflus
2nd Degree AV Block Ventrricular Fibrillation Chaotic waves Hypertensive Urgency: Major or Minor: wt loss >4.5 kg over 5days of treatment
Type 1 (Mobitz I or Wenckeback) (VFib) no end organ damage; BP >180/>120mmHg, lower BP w/n 2-3 days; PO ANGINA PECTORIS: CCS CLASSIFICATION
-PR interval til QRS drop after 3 or 4 P waves(benign) Ventricular Tachycardia Bizarre, wide QRS,no P waves, R >100 meds I Ordinary PA does not cause angina
Type 2 (Mobitz II) (VTAC) II Slight limitation of ordinary activity DUKE CRITERIA: INFECTIOUS ENDOCARDITIS
-prog PR interval w/ unexpected QRS drop Hypertensive Emergency: (2 major; 1 major & 3 minor; 5 minor)
III Marked limitation of ordinary PA
3rd Degree (complete heart block) Presence of changes in sensorium, papilledema or heart failure; lower MAJOR:
P Wave IV Inability to carry out any PA w/o discomfort
no relationship bet P waves & QRS BP w/n 24 hrs; IV meds 1. (+) Blood culture
Upright in Leads I, II a. Typical microorgs for IE for 2 separate blood cultures: viridians
PR interval <0.12 sec..eval (WPW)
Negative in aVR
<3 small squares in duration CA drip KILLIP CLASSIFICATION OF MI strep, S. bovis, HACEK grp, S. aureus, or community acquired
2amps apresoline+2amps clonidine in 500cc D5W @ CLASS I No signs of pulmonary or venous congestion enterococci in the absence of primary focus
<2.5 small squares in amplitude b. Persistently positive blood culture, defined as a recovery of a
QRS Q wave in V1 V2 V3 (Infarct) 10ugtts/min,then titrate by increments/decrements of 0-5% mortality
Best seen in Leads II microorganism consistent w/ IE frm: blood culture drawn >12H
Q wave in III, aVR (Normal) 5ugtts/30mins to maintain BP 140/90mmHg CLASS II Moderate heart failure w/ bibasal rales, S3 gallop,
tachypnea, or signs of R heart failure incl venous & - all of 3 or a majority of 4 or more separate blood cultures
R Atrial Enlargement w/ 1st and last drawn at least 1H apart
ST segment hepatic congestion
Depression ischemia
Tall (>2.5mm) pointed P waves Grading of Murmur: 10-20% mortality - single (+) bld culture for C. burnetti or phase I IgG Ab titer> 1:800
Elevation infarction 1 faintest murmur CLASS III Severe heart failure, rales >50% of the lung fields 2. Evidence of endocardial involvement (+) 2D echo
L Atrial Enlargement 2 soft but readily audible or pulmonary edema
Myocardial Infarction Prominent terminal P negativity (biphasic) in Lead V1(P terminal 3 prominent murmur, loudest without thrill 30-35% mortality MINOR:
Anterior wall infarct V1V2 force) 4 loud murmur with a palpable thrill CLASS IV Shock w/ systolic pressure <90mmHg evidence of 1. Predisposing heart condition or injection drug use
ST Lateral wall infarct V3V4 Duration > 0.04sec, depth >1mm 5 murmur audible with a portion of diaphragm off the chest peripheral vasoconstriction, peripheral cyanosis, 2. Fever >38C
Inferior wall infarct V5V6, I, aVL Notched/bifid P wave (P mitrale) in Limb Leads w/ the inter-peak 6 murmur audible with stethoscope held off the chest mental confusion & oliguria 3. Vascular phenomena: Major arterial emboli, septic pulmonary infarcts,
Posterior wall infarct V1V2, large R wave Duration >0.04sec(1mm)
85-95% mortality mycotic aneurysm, intracranial hge, conjunctival hge, Janeway lesions
Lateral wall l,V5,V6,aVL TROPONIN Levels INTERPRETATION
Inferior wall ll,lll,aVF Short PR Interval 4. Immunologic phenomena: GN, Oslers nodes, Roths spots, RF
<0.10 Negative 5. Microbiologic evidence: + blood culture or serologic evidence of active
Anteroseptal wall V1-V3 WPW(Wolf Parkinson White) Syndrome
0.10-0.63 Borderline infection w/ organism consistent w/ IE
Ant. & anteroseptal wall V3 0.61-1.53 Significant
Anterior wall V2-V4 QRS Complexes
>1.50 Positive
Posterior wall V1,V2 Nonpathological Q waves are often present in leads I,III,aVL,V5,V6 HACEK: Haemophilus species, Actinobacillus actinomycetemcomitans
Anterolateral wall l, aVL,V4-V6 The R wave in Lead V6 is smaller than the R wave in V5 Cardiobacterium hominis, Eikenella corrodens, Kingella kingae
The depth of the S wave, generally, should not exceed 30mm
Ischemia T wave inversion Pathological Q wave >2mm deep and >1mm wide or >25%
Hyperkalemia tall,peak T wave,flat P wave, wide QRS amplitude of the subsequent R wave
Hypokalemia flat T wave, v waves, u waves taller than T

Obstetrics IVF for prepartum (augment): D5LR 1L + 10u oxytocin to run at 5-

10ugtts to titrate to good uterine contractions
N ursery
Normal CBG: 60-140 Fast drip: 10cc/kg
IV rate/kg/H= IV rate in cc/H weight
TOD Pls admit to NICU under the service of Dr
Pregnancy 9 months/280days/40weeks IVF for postpartum: D5LR 1L + 10u oxytocin to run at 30ugtts/mi
BW TPR q15mins until stable
Bilirubin level: all values 17.1 IV set
& dc if with minimal bleeding Start phototherapy if w/ value 15 Enteric fever- soluset
BL Breastfeeding AGE/Dengue- macroset
Tetanus toxoid HC Labs: WBC 20,000, start meds
TT1-20wks AOG TT3-6mos TT5-1yr Diabetic Screening CC CBC APC NBS @ 24H old DEHYDRATION
TT2-1moAOG TT4-1yr AG BT w/ Rh typing IT ratio: stabs/juvenile total neutrophil = 0.2 infection
TB Classification Deficit <10kg(10-10.9) >10kg(11 & )
P IV Fluids
renatal ff-up
D
(OGTT 100Fever
engue grams) I
AS MMUNIZATION Meds: CLASSIFICATION
Mild (30-50) OF ASTHMA BY LEVEL OF CONTROL
50 30
FBS
2-7 days 105
fever,leucopenia, (+/-)thrombocytopenia,no95mg/dL
change in hct Temp BCG Terramycin ophthal ointment OU (GINA
<28wks q4wks Retic
Classcount= actualExposure
hct 0.40(desired
PPD hct)xSSxretic ct CXR Moderate (60-90) 100 GUIDELINES) 60
Na+ K+ Cl- Lactulose,etc Dengue
1H Grading: 190 180mg/dL <1yoVit K 1mg IM if no scar, rpt BCG
>28wks q2wks 1-fever, >1yoHep B vaccine if0.5ml IM yet, test for PPD,
no BCG I TB exposure N= 1-1.5
+ - - - Severe (100) 150 90
D5LRqwk 130 4 109 28 2H 165 155mg/dL Partly Uncontrolled
37wks (+)TT,platelet(100,000),hematocrit(20%) SO: If (-),give BCG II TB infection 1 hemolysis
+ + - - Characteristics Controlled Controlled
D5 0.3NaCl 51 51 3H 145
easy bruising
140mg/dL
OBAOG Routine newborn careIf (+), dont give BCG III TB disease <1 bone
+ marrow+failure + + Mild DHN: D5 0.3NaCl
# of days D5 0.45NaCl
0.14=1/7 75 75 Antibiotic
IV TB inactive + + - + Moderate DHN: D5LR(all,of D5
the ff) (any measure
0.3NaCl present
2-grade 1 symptoms + spont bleeding hemorrhages PAOGHepa B vaccine Gastric lavage FT PT
in any
D5 0.9NaCl
0.28= 2/7 154 154 Severe DHN: D5LR 1/3, D5 0.3 NaCl 2/3 week)
3-grade 2 + thread pulse,pulse pressure (20mmHg) Suction secretion
1st dose: at birthprn <7days old q12H <14do q12H
D5NR0.42= 3/7 140 5 98 50 R BS (50grams) hypotension MBT Thermoregulate
2nd dose: 6wks@(1month
36.5-37.5C& 2 wks) Daytime Sx None > 2x/wk
PPD>7days old q8H(volar area of >14do
D5IMB 0.57= 4/7 25 20 22 23 1H <130mg/dL
4-grade 3 + profound shock,(-)BP, (-)pulse BBT Daily
3rd cord
dose:care
14wksw/ 70%
(3mosIPA& 2wks) subcutaneous forearm)q8H
encircle Computation Sample (2x(DHN):
or </wk)
D5NM 0.71= 5/7 40 13 40 16 5 Tu or 0.1ml 7kg, moderately
Limitation of dehydrated,
none fast drip=70cc
any
Mat hx Hepa Watch out for tachypnea, tachycardia,alar flaring,
B (+) mother:
0.86= 6/7 * RBS/OGTT at 24-28 weeks,DHF
the soonest time if w/ hx of DM in the
Blood Products Retractions
If baby (-), vaccinate at least 12H of birth w/ HepBIg Intravenous
Day 1 = Fluid:
time & date 48 & 72 hrs activities Wt x 100 = 700 4 = 175
175-70cc(FD) = 105 D5LR
3 or more
AOG by LMP family FWB 20ml/kbw blood loss >25% Refer prn B vaccine
& Hep >20kg <20kg Nocturnal none any x 2H features of
175 x 3 = 525 8H = 65-66cc/H D5 0.3NaCl
partly x 8H
D eficits # of days in mos LMP, result + succeeding days hct 20% MMR PPD (+) if: D5LR D5 0.3NaCl sxs/awakening
ORS
Divide by 7 *2+ more values 1st dose: 15mos old 6-10mm
Maint: wheal D5NM D5IMB Need for None > 2x/wk controlled
PRBC 10ml/kbw blood loss <25% <2y0 50-100ml
AOG byNa+:
UTZ135-150mEq/L or 3-4mEq/kg/day
FFP 15ml/kbw prolonged PT (2x) N ewborn (Final Dx) 2nd dose: 4-6years 5mm= close to TB px w/ clinical or xray TB;Immunocompromised reliever/
2-10yo
(2x or </wk)
100-200ml
asthma present
in any week
Na+Result of AOG
def (mEq)= in UTZ(in
(desired days) +no.
140-actual)x of days from date
TBW Cryoppt 1unit/5kg prolonged APTT >50sec Full term
Rotavirus
(_wks)vaccine:
PA, _kg xAGA,
2 doses,
cephalic
givenvia
<6mos
NSVD, old live Bb Girl, AS 10mm= <4yo
*Maintenance IV rateor w/
(wtmedical
x cc/kg conditions,
24H) exposure rescue tx
>10yo as many as they want
of Where TBW (L)= 0.6x body wt(kg) 9,10. N. sepsis, uninvestigated
- Lessen
physiologic
severity
jaundice
of AGE 15mm= 4yo0-3 or older w/o risk75cc/kg
factors Lung function Normal <80%
UTZ up to date of consult 10sec N 4-10 100cc/kg
Urine Output (N: 1-3cc/kg/H) predicted or
EDC K+: 3.5-6mEq/L 1st day or
of 2-3mEq/kg/day
LMP + 7 days 20sec control 1st 2 mos: 3 (IRP)11-20
Aminosteril
IPV: given
(dose=
on 0.5g/kg
months Feb-June
by 0.5/day,max 3g/kg) 75cc/kg personal
Mos(mmol)=
of LMP desired-actual
3mos Platelet conc 1unit/7kg plt <50,000 + bleeding Last 4 mos: 2 (IR)21-30 UO= total urine output weight
K+ def x 0.3 x wt(kg) or = wt x dose x 100 24H = __cc/H 60cc/kg best
yr of LMP += 1wtyear plt <20,000 # of Hrs admitted or IV inserted
(kg) x 50 x estimated % def PPV: pneumococcal
6(standard)
polysaccharide vaccine 31-40 50cc/kg Exacerbation none 1 or >/yr
Vit K 1mg/kg max of 10mg/amp OD x 3 Lung function 41-50 :<80% predicted Based on BSA
40cc/kg
TimingEstimated
from ovulation=last ovulation + 267days IV 2kg=give 1mg Exacerbation :1 or more /yr ABG
BSA= Height(cm) x weight(kg)
COMPUTATIONS
K def
<2kg=give 0.5mg
IVF:
>Vaccination
TFR x wt of 24H preterms
+ 20% is(ifineffective
w/ phototherapy)
due to underdeveloped organs. N ewborn: I. 3600 PaCO2= 713 (FiO2)-pCO2/0.8
K+ serum level Estimated def >2TFRlive xvaccines
wt 24H ofsame
feeding
route aminosteril
(parenteral) should be given with OFI=
Timing3-3.5mEq/L
from quickening 5% approx 200-400mmol(0.05) minimum interval
(use thisofformula
4 weeksifw/dueAminosteril
to presence&offeeding)
circulating antibodies
Age IV rate II. BSA x 500 + UO pO2/I
a/AO2=
16-18wks AOG multipara
2-2.5mEq/L 10% (0.1) that
e.g.may
wt=3kg
affect TFR=80
the live vaccines given less than 4wks interval. G ood X-ray film
0-1 day old 80cc/kg/24H III. = tot UO BSA
MIO 24H
FiO2= O2 reqt/II + pCO2/0.8
18-20wks AOG primipara
1-2.0mEq/L 20% (0.2) Typhoid Fever >Inactivated vaccines
80x324+20%=12
can be givenoranytime.
2
5-6 anterior3 ribs
90
good inspiration
100
TFR = BSA x 500 + UO (prev day)713
Ingestion of contaminated food & water 80x3=240 x 0.2 =48, next Room air: 0.21
Height *1
of the 9-10 posterior
4 ribs 110 Oliguria= <1cc/kg/H
KClFundus
vial = 2mEqs/ml High grade fever >5 days 240+48= 288 24H = 12cc/H + diaphragm 5 120
1L=0.24 O2 reqt:
12 wks *1 NaCl vial
above sp
= 2.5mEqs/ml Headache, variable abdominal pain 1st 24H D10W,then 2L=0.28 COPD/BA=60
6 130
16wks halfway bet sp & umbilicus D10IMB CT Ratio 7 140
B
3L=0.32
lood Transfusion <60=80
20wks umbilicus IgM IgG D5IMB 4L=0.36
FFP 10cc/kg usually >60=140-age
28wks 6cm above umbilicus 8 diameter widest
Widest cardiac thoracic diameter
150(max) 5L=0.40
(Typhoid fever) + - Acute infection N: up to 0.5 PRP in 2H depending on the calculated weight
36wks 2cm below xiphoid + + Recent infection HBsAg reactive mother: give HB Ig 0.5ml deep IM w/in 12H of life F eeding 6L=0.44
PC PF ratio: 300-400
40wks 4cm below xiphoid - + Equivocal; past/ *CRP at 24hrs old, BCS anytime after birth 1cc Q3H, increase by increments of 1cc thereafter 7L=0.48 PF: pO2/FiO2
(Enteric fever) Recent infection *Allowable amount of blood for extraction in preterms: = wt x 80 x 0.10 8L=0.52
(10%) 9L=0.56 TV=wt x age
10L=0.60 BUR=18-20
FiO2=100%
PFR=40-60
Face mask=O2-1x10
 Normal Values:

pH=7.35-7.45
pCO2=35-45
pO2=80-100
HCO3=22-26mEq/L
BE=2mEq/
O2 sat= 97%

INTUBATION Neuro Notes STAGES OF DIABETIC NEPHROPATHY DETSKY et al GOLDMAN et al

Indication: I hyperfiltration (GFR)
pCO2 >50
SOL CRANIAL Nerves II incipient stage (microalbuminuria) MI in previous 6mos 10 Age >70 3
pO2 <60 Mannitol - cellular III overt stage (macroalbuminuria) MI>6mos previously 5 MI in prev 6mos 11
I intact sense of smell
acute pulmonary edema Steroids- vasogenic II ROR, papilledema, IV azotemia (crea) CCS A (Angina) Important AS 3
shock PERLA V ESRD Class III 10 Rhythm other than sinus or PACs
Problem: apnea, dyspnea, (-)BP, CP arrest, LOC III,IV,VI intact EOMs Class IV 20 On last preop ECG 7
- Hyperventilate patient now M eds Indications V (+) corneal reflex
CHILD PUGH CLASSIFICATION Unstable angina in previous 6mo 10 >5 PVC/min at any time b4 OR 7
- Diazepam 5mg ivtt now Ciprofloxacin VII (-)facial SCORE I Bilirubin=<2mg/dL Alveolar pulmonary edema w/in pO2 <60 or pCO2 >50; K<3 or
- Intubate patient now For cystic fibrosis Albumin=>35g/L 1wk 10 HCO3 <20;BUN >50 or or crea>30;
asymmetry
- Suction secretions now Prone to recurrent pseudomonas infection VIII (-) hearing loss PT=4sec,INR=<1.7 Newer 5 Abn AST, signs of chronic dse, or
- Attach to cardiac monitor & pulse oximeter Imepenem Ascites=none Suspected critical AS 20 Bedridden from noncardiac causes 3
IX, X (+) gag reflex
B URCH - & WARTOFSKYS
Insert NGT & foley DIAGNOSTIC
catheter CRITERIA FOR B acteremia :
Not recommendedpresence of bacteria
for CNS in the blood as evidenced by
infection XI can shrug shoulder
C omputations Hepatic enceph=none A CTRAPID
Rhythm SLIDING
other than sinusSCALE
or PACs on INSULIN DRIPintrathoracic, or Aortic
Intraperitoneal, 3
THYROID- STORM
Attach to VR w/ following set-up Inhibits GABA(+)bld culture SCORE II Bilirubin=2-3mg/dL HGT
Last preop ECG ACTRAPID 5 PNSS 250 mLoperation
Emergency + 50u Humulin R (cmc 0.2u/mL) 4
VR Set-up Meropenem Albumin=30-35g/L
Na def: desired- actual x 0.6 x wt >5 PVC/min at any <160
time b4 OR No coverage 5
Thermoregulatory FiO2dysfunction
100% S epticemia: presence
Less seizure of microbes & their toxins in blood
reported 2 PT=4-6sec,INR=1.7-2.3 Poor gen. med. 161-200
Status 3 units 5 Class
FBSI 0-5 pts Low risk
TemperatureTV 400-500 CNS Effect NaHCO3 = 1-2mEqs/kg Ascites=easily controlled Age >70 201-300 5 5 Class II Full
6-12diabetic diet 1800kcal/day
Intermediaterisk
in 3 meals + 2 snacks
Hepatic enceph=minimal
37.2-37.7C
VUR 5 20
37.8-38.2PFR 1040
Absent -
Mild -
0
10
S IRS 2 or more of the ff. conditions: Corrected Na: Na + 1.6
SCORE III
(glucose mg/dL-100)
Bilirubin5mg/dL
100
Emergency operation
301-400 7 10 Class III Diabetic
13-25 diet: 1800kcal
snacks;
Highinrisk
3 equal feedings including 2
Paracetamol
1. not given
Fever (oral<1mo
temp >38C 401-500 9 Class IV >26 no source ofHigh simple
risksugar
38.3-38.8ACmode 15 Moderate - 20 Albumin=>30g/L CBG TID premeals
Ambroxol2. not given <1yo
Tachypnea (>24) *<15 points >500
low risk 10
38.9-39.3 20 Delusion Ibuprofen PT=>6sec,INR=>2.3
HCO3 def: desired (24)-actual x 0.4 x wt >15 points high risk Triglycerides
E XTUBATION
39.4-39.9 (dislodged)
25 Psychosis Iterax
3. Leukocytosis (12,000/uL), leucopenia (<4000) or 10%
not given <2yo Ascites=partly
2 controlled H UMULIN R SLIDING SCALE Low fat diet
->40C PAI- w/ 30 1 neb salbutamol now Extreme lethargy Antamin bands; may have a non-infectious etiology Hepatic enceph=advanced Lipanthyl 160mg/tab OD
- Extubate patient now Severe(sz,coma) - 30 Salbutamol CLASS
Plasma A 5-6(mOsm/L):
osmolality CLASS C 10 ABOVE L HGT
EE et al ACTRAPID
<160 No coverage
-
GI-Hepatic Suction secretions thoroughly
Dysfunction S EVERE SEPSIS: Sepsisrecommended
Cetirizine w/ 1 or more signs of organ dysfunction
for <1yo CLASS B 7-92(Na+K)+ SEVERE OF 7 OR+MORE
BUN(mg/dL) RBS_ decompensated Intrathoracic, intraperitoneal,or
161-199 3 units
Uric acid
- Attach to 6Lpm O2 via face mask
Absent 0 1.
Muconase/salinaseCV: arterial SBP <90mmHg, or MAP <70mmHg that 2.8 18 Infrainguinal vascular sx 1 Low purine diet
-
-
PAIModerate
w/ 1 neb salbutamol
Rpt ABGDiarrhea,
30 mins after
N/V,extubation
abdl pain
15
2.
responds to administration of IV fluids
Renal:
NST UO <0.5ml/kg/hr for 1 hr despite adequate fluid
- <6mos
E N: 280-300mOsm/L
STIMATED CREA CLEARANCE (mL/min)
Hx of IHD
Hx of CHF
200-249
250-299
4
5
1
1
Allopurinol 300mg/tab OD

- Chest xray post intubation

Severe(jaundice) 20 Crea
H2O def:clearance
Na-140 = 140-age x wt(kg) Insulin tx for DM 300-349 6 1 SGPT w/ symptoms
resuscitation
ANST - >6mos
- Standby intubation set 72 male x s. crea(mg/dL)
140xTBW *0.4 female*or 85 female s. crea >2 350-399 7 1
3. Respiratory: PaO2/FiO2 <250 or if the lung is the only Livolin forte
CV Dysfunction dysfunctional organ *0.5 male Hx of CVD 400-449 8 1 Godex
CVP (N: 8-12mmHg H20)
Tachycardia Normal: 100-125mL/min(male)
4. Platelet: Glasgow
Plt ct <80,000/uL or 50% dec in plt ct from
Coma Scale 450-499 10 Essentiale
: auscultate 99-109 5 85-105mL/min
Anion gap: Na (Cl+HCO3) (female) *0-1 low risk
Eye highest value recorded
Verbalover previous 3 days Motor >500 12
(+) crackles: give furo now w/ BP precautions 10 Opening 50-80=renal impairment 2 intermediate risk
110-119 5. Unexplained metabolic acidosis: pH <7.30 or Activitybase N: 10-12 mmol/L Albumin
120-129 15 Non-intubated
deficit >5mEq/L and plasma Intubated
lactate level >1.5x upper 10-50=CRI INSULIN3 or SLIDING
more pointsSCALE
high risk Req 50cc 25% HA;transfuse once
S PUTUM 130-139 20 4
Spontaneous
5 Oriented &
limit of mmol
talking
5 seems able
talk
6 verbal
command
5-10=CRF HGT ACTRAPID HUMULIN R Available
Sputum graded GS,>140 proceed to CS if epithelial cells
25 <10/Hpf & <5=uremia <160 No coverage
PMNs >25/Hpf CHF (good specimen)
6.
3 verbal
stimuli
Adequate
pressure
fluid resuscitation:
4 disoriented &
talking>12mmHg or cvp >8mmHg
pulmonary artery
to
wedge
5 localizes D OPAMINE DOSE
161-199 3 units 2
Or
Moriamin cap OD
*include KOH Absent
& AFB x 3 determinations 0 pain Dopa (single dose) Renal
Aminoleban sachet
Mild(pedal edema) 5 SEPTIC SHOCK 3 inappropriate
2 painful 3 4 withdraws 1-3mg/kratio:
BUN/crea x wt 200-249 4 4
Aminovita cap OD
250-299 5 6
P neumothorax Moderate(bibasal rales) 10 Sepsis w/ hypotension
stimuli words(arterial BP 90 0rquestionable
40mmHg less thantopxs
abilityresuscitation
to
13.3 BUN: mmol/0.356
300-349 6 8 Na
Severe(pulmonary
(1 diameter of hemithorax) x 100 edema) 15 normal BP) for at least 1 hr despite adequate fluid or pain
need Dopa (double dose) Crea:
Inotropic
mmol/88.4
talk 350-399 7 10 PNSS 1L + 1 vial (30meqs) NaCl
AF Absent 0 for vasopressors to maintan SBP 90 or MAP 70mmHg 3-5mg/k x wt >20 pre-renal
Diameter of pneumothorax
>15% - significant Present 10
1 no
response
2
incomprehensibl
3
decorticate 26.6 <5-10 intrinsic renal 400-499 9 12& refer Rapid K Replacement
Dopa (single dose)- adrenergic >500 10 -In a soluset, incorporate 10mEq KCl + 90cc PNSS x 1H x 3cycles
Precipitant history R EFRACTORY SEPTIC
e
SHOCK
words
(flexion)
5-8mg/k x wt -rpt s. K after last cycle
Negative 0 Septic shock that lasts for >1H & does not respond to fluid or pressor 13.3 GLUCOSE INSULIN DRIP ( Na) *Incorporate 20mEqs KCl to present IVF x __bottles
Positive 10 administrator 1 vial D50 in 10u actrapid or humulin R x 1H x 2/3
SCORE: cycles
45 0r > - thyroid storm
25-44 impending storm MODS Rpt K often last cycle HYPERKALEMIA
Dysfunction of more than 1 organ requiring intervention maintain Nondiabetic:
<25 unlikely to represent thyroid storm Calcium gluconate 1 amp slow IVTT c/o
homeostasis D5W 50cc + 10u regular insulin to run for 1H
Rpt K 2H after last cycle
BLOOD CS: No K containing IVF BLADDER TRAINING
No fruits in diet Clamp foley catheter for 2H then release for 30mins or anytime if
Hgt now, then G1 drip is done w/ sensation to void.
NaHCO3 25 x 1 tab tid
 Albumin:
Request 50cc 25% human albumin, transfuse once available or
Drips Metabolic Syndrome Gram Stain Results
1.Abdominal obesity
Moriamin cap OD or aminolevan sachet or aminovita cap OD M >102cm(>40inch) NORMAL: Numerous epithelial cells seen no PMNs with or without
Dopa drip: F >88cm(>35inch) large Gram (+) bacilli.
ALBUMIN TRANSFUSION 200mg dopamine + 250cc D5W x 10ugtts/min to titrate by 2.Triglycerides >1.7mmol/L (>150mg/dL)
3.HDL
Transfuse albumin w/ incorporation of furosemide 20mg per 50cc of increments/decrements of 5 ugtts/min to maintain BP >90/60mmHg NORMAL: Few epithelial cells seen less than 20 PMNs/hpf, no
albumin to run for 6H M <1mmol/L(<40mg/dL) organism seen
F <1.3mmol/L(<50mg/dL)
Dobutamine drip: 4.BP 130/85mmHg
Dobutamine 250/amp + 250cc D5W at 10-60 ugtts/min CANDIDIASIS: Numerous epithelial cells seen, PMNs with or without
5. fasting glucose >6.1mmol/L(>110mg/dL)
HGT CONVERSION large gram (+) budding yeast cells with or without pseudohyphae
Mg% mmol (result x 0.055) Levophed/Noradrenaline drip:
Mmol mg% ( 0.055) 2 amps levophed + 250cc D5W at 15-60 ugtts/min to titrate by Appendicitis (Alvardo Scoring) BACTERIAL VAGINOSIS: Numerous epithelial cells seen few PMNs
Migrating R iliac fossa pain 1 and clue cells.
increments/decrements of 5ugtts/min to maintain BP >90/60mmHg
Nausea & vomiting 1 ( Clue cells epith cells covered with small gram (-) rods.)
DOSE reqt of Platelet Anorexia 1
Conc/kg BW Nicardipine drip: MIXED GONOCOCCAL & CHLAMYDIAL INFXN: Numerous
R iliac fossa tenderness 2
iU/10 kg BW 20 mg conc Nicardipine in 250cc D5W PMNs and gram (-) intracellular diplococci
Fever >37.8C 1
Rebound tenderness R iliac fossa 1
PREmedication (30min 1H prior BT) Cordarone drip: Leukocytosis >10,000 2
Paracetamol 300mg/IVTT 4 amps Cordarone in 250cc D5W x 24H *Patient has gonococcal cervicitis, this patient should also have non-
Neutrophilic shift to L >75% 1
Solucortef 50mg/IVTT gonococcal cervicitis, that is mixed gonococcal and chlamydial
10
Benadryl 25mg/IVTT Piracetam (Nootropil) drip: infection
Or 12 gm/vial x 24H
Paracetamol 500mg/tab
Prednisone 20mg/tab NON-GONOCOCCAL CERVICITIS but could still have
AC drip: gonococcal infection: More than 20 PMNs but no gram (-) intracellular
Benadryl 25mg/tab
Apresoline 20mg/amp, 2 amps + Clonidine 150mg/amp, 2 amps in diplococci
250cc D5W to run initially at 5 ugtts/min to titrate by increments/
HYPERSENSITIVITY RXN/ ANAPHYLACTIC SHOCK: decrements by 5 ugtts/min to maintain BP <150/90 mmHg
0.2cc of 1:1000 SQ now; 0.3 of 1:1000 SQ now
Heparin drip:
10,000 u Heparin + 250cc D5W via soluset to run at 10-20
H. pylori (+) Ulcer Treatment ugtts/min via infusion pump
PPI bid x 1 week
+ Streptokinase drip:
Amoxicillin 500mg/tab, 2 tabs bid x 1 week or 1,500 u Streptokinase + 90cc PNSS in a soluset to run x 1H
Metronidazole 500mg/tab, 1 tab bid x 1 week
+ Amiodarone (Cordarone) drip:
Clarithromycin 500mg/tab, 1 tab bid x 1 week 150mg/3ml of Cordarone, 5 amps in 500cc D5W x 24H

Aminophylline drip:
Aminophylline 250mg/amp + 250cc D5W at 15-40 ugtts/min
LD: 5mkbw in 30 ml D5W in a soluset
M: 0.4-0.8 mk/H