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 Perform the procedure  Find the appropriate procedure note in the EMR  Complete the procedure note  Sign and send the note to the attending you did the procedure with

When called for a patient’s death, ascertain that the patient is unresponsive to verbal and tactile stimuli without spontaneous respirations (visually and by auscultation), is pulseless and without heart sounds, and that pupillary reactivity is absent. Further...

Evaluation Check if the patient is stable or unstable Get a complete set of vital signs and EKG If concerned, have pacer pads and atropine at the bedside (if unstable, see ACLS bradycardia) Determine whether this is sinus bradycardia based on EKG Take his...

Narrow complex tachycardia Evaluation Obtain EKG and complete set of vital sign to check for hemodynamic instability If unstable follow ACLS protocol Management Unstable: follow ACLS protocol and do not delay synchronized cardioversion  Try vagal maneuve...

Evaluation Decreased SVR: Exam = warm extremities, sometimes flushing Sepsis: common cause. Obtain blood culture x2, CXR, UA/micro/culture, and lactate. Rapid administration of IVF and antibiotic Medications: Look for antiHTN, pain meds, sedative, if concer...

Evaluation Physical examination Brain: headache, confusion, lethargy, stroke Eye: blurred vision Heart: Chest pain, dyspnea Kidney: low urine output, edema Lab: not always required. Use selectively to determine cause and whether patient meets criteria fo...

Differential - Infection (lung, heart, brain, urine, sinuses, prostate, abdomen, skin, joints, lines, etc) - Infammation (Collagen vascular disorder, neoplastic disorder) - Mucositis- Atelectasis- Blood product reaction- Drug fever (beta lactam antibiotics an...

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 ...

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...

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 ...

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...

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...

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...

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...

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...

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...

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)...

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...

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...