Dx with 4 of these criteria, sensitivity is ~75%, specificity is ~95% Anion Gap Acidosis: Methanol Uremia DKA Paraldehyde INH/ Iatrogenic Lactic Acid Ethylene Glycol Salicylates Obstruction, sm bowel: Adhesions Bulges Cancer
Obstruction, lg bowel: Cancer Diverticulitis Volvulus Lower GI Bleeds: Hemorrhoids Diverticulosis IBD Ischemic Colitis AVMs Upper GI bleed Mortality Benefit in CHF: Beta-blocker ACE inhibitor Spironolactone if Class IV CHF AICDs ECG changes with PE: Sinus tachycardia Specific but not sensitive: S1Q3T3 sign - an S wave in lead I, Q wave in lead III, and inverted T wave in lead III Common bone mets: Breast Lung Thyroid Kidney Prostate BLT w/ Kosher Pickle Emergent Dialysis: Acidosis / hypoAlbumin / Anorexia Electrolyte imbalance (inc K) Ingested toxins Overload (volume) Uremia with Sx (cns changes) Potassium repletion: Goal > 4.0 Every 10 mEq K will raise serum K by 0.1 PO: K-Dur, can give 40-60 mEq at once IV: KCl 10 mEq IV peripherally; need central line to give 20 mEq Magnesium Repletion: Goal > 2.0
Each 1 g Mg will raise serum Mg by 0.1-0.2
Give IV in multiples of 2 grams IV Fluids (4:2:1 rule): 4ml/kg/hr for first 10kg 2ml/kg/hr for second 10kg 1ml/kg/hr for remaining kg
Shortcut for pts >60kg: Weight in kg + 40 = cc/hr CHADS2 Score: Risk stratification for anticoagulation in A-fib CHF = 1 pt HTN = 1 pt Age > 75yo = 1 pt DM = 1 pt Stroke or TIA hx = 2 pts
Score 2 : warfarin (unless poor candidate) Modified Wells criteria for Pulmonary Embolism PE as likely or more likely than alternate dx; clinical s/sx of DVT 3 each HR > 100 bpm; prior DVT or PE 1.5 each Immobilization (bed rest >= 3 d) or surgery w/in 4 wks 1.5 Hemoptysis or malignancy 1 each
Score <= 4: PE unlikely, no CTA; consider D-dimer. Score >4: PE likely, order CTA