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ACEs Awareness- Training and Attestation
From the months of November 2020 until August 2021, we focused on creating 100% ACEs aware training and attestation on the ACEs Aware Website to have Saint Agnes Medical Center (SAMC) be ACEs Aware and so we could meet our deadline of beginning ACEs Screenings...
Clinic Implementation (September 2021- December 2021)
Here is the preliminary data we have for the number of screenings performed, and out of those screenings, how many patients have had community health workers provide them with resources that they need.
ACEing Residency- Links
This section includes links for the following: 1. CAFP ACEing Residency Poster 2. ACEs Video 3. ACEs White Paper
Newborn Service
Low urine output
Normal urine output - typically at least 0.5 cc/kg/hr. - Oliguria: urine output < 400cc/day- Anuria : urine output < 100cc/day Do you believe the numbers? - If patient has foley, flush tubing to make sure it is not clogged. - If no foley, ask about urine ...
Dyspnea
DDx (5 major categories of disease to consider) Pulmonary Pneumonia = fever, purulent vs dry cough, pleuritic chest pain Pneumothorax = acute onset, pleuritic chest pain. Consider in any intubated patient. Pulmonary embolism = Hx DVT, recent surgery, pleur...
Chest pain
I. DDx (Biggest killers) MI : Dull pressure pain associated with dyspnea, diaphoresis, radiation to left jaw/arm, N/V, cardiac risk factors present Aortic Dissection: Tearing pain that radiates straight to the back, associated with HTN, smoking Hx, unequal ...
Combative or Confused patients
Does the patient have altered mental status or is he/she upset over something? If there is any question of physical injury, call security (0). No matter how many years of commando training you have, it is not your responsibility to restrain patients in a sa...
Falls
Evaluation/Management Assess patients at bedside. Look for any injury; any locality on exam must be worked up in the appropriate manner (e.g. head CT, plain films, immobilization, etc). In particular, look for: ecchymosis, abrasions, fractures, pain, asymmetr...
Insomnia
Trial non pharmacological measures first: sleep hygiene, noise reduction (ear plugs/muffs), reduce lighting, avoid night time interruptions if able, turn off TV/radio/etc. In room Before using pharmacotherapy, check patient allergies Melatonin is generally a...
Hyponatremia
Definition Mild: Serum Na 130-134mmol/L Moderate: Serum Na 120-129mmol/L Severe: Serum Na <120mmol/L Acute: <48hrs since development of hyponatremia Chronic: >48hrs since development of hyponatremia. (hyponatremia should be considered chronic whenever the...
Hypernatremia
Definition: Serum Na >135 mmol/L. Chronic means > 48 hours. Acute means < 48hrs. Etiology: Renal water loss (U osm <700-800) loop diuretics Osmotic diuresis (hyperglycemia, mannitol, urea) Diabetes Insipidus: Central (trauma/post-surgical, pituitary le...
Hypokalemia
Definition: Serum <3.5mmol/L Etiology: Intracellular shifts: Hypothermia, Exogenous insulin/refeeding, beta-agonists GI Potassium loss Metabolic acidosis: diarrhea, laxative abuse Metabolic alkalosis: Vomiting, NGT Renal Potassium Losses Hypotensive...
Hyperkalemia
Definition Serum K+ >5.3-5.5 Etiology: Pseudohyperkalemia- K release from cells after blood draw, IVF with K Impaired excretion Low GFR (AKI or CKD) Drugs (spironolactone, ACEi, ARB, TMP-SMX, NSAIDs, digitalis overdose, heparin, chemo therapeutic agents)...
Hypomagnesemia
Definition Serum Mg++ <1.8 mg/dL Etiology: Malnutrition (assc. with heavy chronic alcohol use causing renal wasting) Malabsorption or diarrhea/GI loss PPI induced Renal losses (polyuria and high tubular flow, e.g., osmotic diuresis, post-ATN diuresis) H...
Hypermagnesemia
Definition Serum Mg++ >2.3 mg/dL Etiology: Insufficient excretion due to CKD Iatrogenic/excess intake due to overaggressive replacement, Magnesium-based laxatives/enemas use in CKD, Mg++ administration during preeclampsia/eclampsia treatment Clinical mani...
Hypocalcemia
Evaluation: verify with repeat measurement that there is a true decrease in the serum calcium concentration (total serum calcium corrected for albumin or ionized calcium) Note alkalosis augments calcium binding to albumin and increases severity of symptoms...
Hypercalcemia
Evaluation: verify with repeat measurement that there is a true increase in the serum calcium concentration (total calcium corrected for albumin or ionized calcium) Compare with previous values if available Clinical evaluation, including duration of hyper...
Hypophosphatemia
Evaluation: Serum phosphorus levels should be interpreted with concomitant evaluations of PTH, serum total and ionized calcium, urine phosphate and calcium and Vitamin D Medical history, physical examination and lab tests to determine etiology of hypophosph...
Hyperphosphatemia
Definition Serum Phosphate >4.5mg/dL. Etiology/Risk Factors Increased intake (external/internal): Excessive vitamin D (increases GI absorption of PO4) or vitamin A. Phosphate-containing enema, particularly in patients with kidney insufficiency. P...
Algorithm For Acid Base Disorders
Before You Begin: Gather Data What lab tests do you need? ABG vs. VBG VBG can provide reliable estimation for pH (0.02-0.04 lower than ABG) and HCO3 (1-2 mEq higher than ABG). pCO2 on VBG is higher than arterial PaO2 by 4-9mmHg. ABG is necessary to accura...
Assessment Of RTAs
Definition Renal tubular acidosis refers to an impaired acid-base metabolism by the kidney in the setting of normal glomerular filtration. These conditions are characterized by a non-elevated anion gap (hyperchloremic) metabolic acidosis. Kidney disease must...
Rule out MI
Admit to Telemetry Tele-nurse may reach out to you for > 6 PVCs/min, atrial fibrillation, ventricular fibrillation, > 3 beats of VT. Admit as “observation status” if the patient will likely be discharged within 24 hours. Activity Bed rest until rul...
CHF
Definition A condition in which the heart is not able to pump enough blood to meet the body’s metabolic needs or does so in the face of elevated filling pressure due to abnormalities of ejection or abnormalities of filling. Classification In patients presen...