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on-call:approach-to-im-on-call-emergencies-issues [on May 19, 2019]
 on-call:approach-to-im-on-call-emergencies-issues [on April 25, 2020]
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 ====== Approach to On-Call Internal Medicine Emergencies and Issues ====== ====== Approach to On-Call Internal Medicine Emergencies and Issues ======
 +{{INLINETOC}}
 ===== Primer ===== ===== Primer =====
 **Common Internal Medicine** issues and emergencies for psychiatric patients may occur. It is important for any psychiatrist to have  a good approach to these issues and to direct the right work up and medical care. **Common Internal Medicine** issues and emergencies for psychiatric patients may occur. It is important for any psychiatrist to have  a good approach to these issues and to direct the right work up and medical care.
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   * **Troponin**   * **Troponin**
     * **Troponins are NOT a substitute for clinical suspicion of an MI**.     * **Troponins are NOT a substitute for clinical suspicion of an MI**.
-    * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (e.g. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation),​ poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI)+    * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (i.e. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation),​ poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI)
     * Can order a serial CK and troponin in 4 hours to see if it trends upwards     * Can order a serial CK and troponin in 4 hours to see if it trends upwards
     * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI     * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI
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 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
-<callout type="​success">​{{fa>​arrow-circle-right?​color=green}} See main article: **[[neurology/​approaches/​1-neuro-emergencies#​altered-level-of-consciousness|Approach to Neurologic Emergencies:​ Altered Level of Consciousness]]**</​callout>​+<callout type="​success">​{{fa>​arrow-circle-right?​color=green}} See main article: **[[neurology:1-approach-neuro-emergencies#​altered-level-of-consciousness|Approach to Neurologic Emergencies:​ Altered Level of Consciousness]]**</​callout>​
  
 </​WRAP>​ </​WRAP>​
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 ===== Seizures ===== ===== Seizures =====
-<callout type="​success">​{{fa>​arrow-circle-right?​color=green}} See main article: **[[neurology:​approaches:seizures#​treatment|Approach to Seizures: Treatment]]**</​callout>​+<callout type="​success">​{{fa>​arrow-circle-right?​color=green}} See main article: **[[neurology:​approach-seizures#​treatment|Approach to Seizures: Treatment]]**</​callout>​
 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 =====