- Last edited on February 4, 2024
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on-call:approach-to-im-on-call-emergencies-issues [on February 19, 2023] psychdb [Treatment] |
on-call:approach-to-im-on-call-emergencies-issues [on February 19, 2023] psychdb [Seizures] |
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| <imgcaption image1|>{{ :on-call:schematic_of_atrial_repol_wave_from_my_book.png?600 |The ECG In Acute MI, Stephen W. Smith, MD}} | <imgcaption image1|>{{ :on-call:schematic_of_atrial_repol_wave_from_my_book.png?600 |The ECG In Acute MI, Stephen W. Smith, MD}} | ||
| </imgcaption> | </imgcaption> | ||
| + | |||
| + | ===== Tachycardia ===== | ||
| + | ==== Stable or Unstable ==== | ||
| + | * First question is always "is the patient stable?" | ||
| + | * If unstable: | ||
| + | * Call a ''CODE BLUE'' or activate Rapid Response | ||
| + | * If stable: | ||
| + | * What is the rhythm of their pulse? | ||
| + | * Get an ECG | ||
| + | |||
| + | <callout type="info" title="ECG Strip Reading" icon="true"> | ||
| + | Is the QRS narrow or wide? | ||
| + | * If wide: it is VT until proven otherwise | ||
| + | * If narrow: it is either sinus tachycardia vs SVT | ||
| + | * Sinus tachycardia | ||
| + | * ECG shows: P before every QRS, QRS after every P, P is upright in leads I, II, PR is fixed | ||
| + | * Differential diagnosis: Pain, agitation, withdrawal, sepsis, volume depletion, PE, heart failure, pain, agitation, withdrawal, sepsis, volume depletion, heart failure | ||
| + | * SVT | ||
| + | * Most commonly will be due to Atrial fibrillation (AF) or Atrial flutter | ||
| + | * How fast is the HR? | ||
| + | * Are they on rate control agents already? | ||
| + | * Again, if unstable, call for help! | ||
| + | * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | ||
| + | </callout> | ||
| + | |||
| + | == Atrial Fibrillation Management == | ||
| + | A HR <110 is acceptable. Don’t need to be aggressive unless there are ischemic symptoms (angina, troponin bump, ECG changes, etc). | ||
| ===== Hypotension/Hypertension ===== | ===== Hypotension/Hypertension ===== | ||
| Line 298: | Line 325: | ||
| * ABGs are useless in an acute respiratory emergency. If the patient is already desaturating or having low normal saturation on high FiO2, then they are hypoxic. Doing an ABG will NOT help you in this acute situation. | * ABGs are useless in an acute respiratory emergency. If the patient is already desaturating or having low normal saturation on high FiO2, then they are hypoxic. Doing an ABG will NOT help you in this acute situation. | ||
| * You may send a VBG if a RN is taking blood work, and this would be to rule out a hypercapnic component to the respiratory failure | * You may send a VBG if a RN is taking blood work, and this would be to rule out a hypercapnic component to the respiratory failure | ||
| - | ===== Tachycardia ===== | ||
| - | ==== Stable or Unstable ==== | ||
| - | * First question is always "is the patient stable?" | ||
| - | * If unstable: | ||
| - | * Call a ''CODE BLUE'' or activate Rapid Response | ||
| - | * If stable: | ||
| - | * What is the rhythm of their pulse? | ||
| - | * Get an ECG | ||
| - | <callout type="info" title="ECG Strip Reading" icon="true"> | ||
| - | Is the QRS narrow or wide? | ||
| - | * If wide: it is VT until proven otherwise | ||
| - | * If narrow: it is either sinus tachycardia vs SVT | ||
| - | * Sinus tachycardia | ||
| - | * ECG shows: P before every QRS, QRS after every P, P is upright in leads I, II, PR is fixed | ||
| - | * Differential diagnosis: Pain, agitation, withdrawal, sepsis, volume depletion, PE, heart failure, pain, agitation, withdrawal, sepsis, volume depletion, heart failure | ||
| - | * SVT | ||
| - | * Most commonly will be due to Atrial fibrillation (AF) or Atrial flutter | ||
| - | * How fast is the HR? | ||
| - | * Are they on rate control agents already? | ||
| - | * Again, if unstable, call for help! | ||
| - | * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | ||
| - | </callout> | ||
| - | |||
| - | == Atrial Fibrillation Management == | ||
| - | A HR <110 is acceptable. Don’t need to be aggressive unless there are ischemic symptoms (angina, troponin bump, ECG changes, etc). | ||
| ===== Altered Level of Consciousness ====== | ===== Altered Level of Consciousness ====== | ||
| Line 371: | Line 373: | ||
| ===== Seizures ===== | ===== Seizures ===== | ||
| - | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[neurology:approach-seizures#treatment|Approach to Seizures: Treatment]]**</callout> | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> |
| + | See main article: **[[neurology:approach-seizures#treatment|Approach to Seizures: Treatment]]** | ||
| + | </alert> | ||
| If you witness a seizure, call for help, as the patient will likely have decreased LOC following the event. It is appropriate to call a code blue (“Medical Emergency”) if you need medications or more support. The first line treatment is with benzodiazepines either IV (preferred or IM). Give lorazepam 2mg, or midazolam 2mg, or diazepam 5mg q2-5minutes PRN until seizures are controlled. If not already on antiepileptics, it is reasonable to load them with dilantin (20mg/kg) to prevent further seizures. | If you witness a seizure, call for help, as the patient will likely have decreased LOC following the event. It is appropriate to call a code blue (“Medical Emergency”) if you need medications or more support. The first line treatment is with benzodiazepines either IV (preferred or IM). Give lorazepam 2mg, or midazolam 2mg, or diazepam 5mg q2-5minutes PRN until seizures are controlled. If not already on antiepileptics, it is reasonable to load them with dilantin (20mg/kg) to prevent further seizures. | ||
| ===== Resources ===== | ===== Resources ===== | ||