Category: Education Description: SchulichMed T2R app was created using Appy Pie, World's #1 App Builder for creating Android & iPhone Apps. It is a Education category app. Click below to download the SchulichMed T2R app.
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FIRST TIME SEIZURE
- Airway: Is the patient talking? Completing full sentences?
2. Monitor Patient
- HR, BP, O2 Sat, Temperature, RR
- Electrolytes + Extended lytes (Ca, Mg, Phos)
- POC BG
- CT Head
DEFINITION: as 5 minutes of continuous seizure activity, or ≥ 2 convulsive seizures within 5 minutes without recovery to baseline consciousness in-between.
1. ABC (***Be ready to protect the patients airway)
2. IV access
3. IV lorazepam 2 mg per injection to a maximum of 6–8 mg.
4. Load with an anti-epileptic drug:
- Phenytoin (Dilantin): Loading dose of 15–20 mg/kg [Max infusion rate: 50 mg/min (1 g: 20 min)]
4. Call CCOT/ICU (33333) (patient will most likely require intubation, midazolam infusion, phenobarbitol, or propofol to stop seizure).
5. Call Neurology.
ACID BASE NOMOGRAM
How to Use:
1. Find the pH on the X-Axis
2. Find the HCO3 on the Y-Axis
1. Recognize Shock: HR, BP, RR, Temp
2. End of the Bed Test
2. DDx: CHAOS
3. Managing Shock
- Tachycardia (HR>100)
*** [PITFALL: be aware of ß-Blockers)
THE DYING PATIENT
THE DYING PATIENT
How to have a Crucial Conversation:
• Understand an approach that works for you
• Keep language straightforward and avoid technical terms
• Consider who you are having the conversation with, and who needs to be involved
• Remember the decision is not static, and often it is the starting point to a conversation
• Sometimes the physician has to lead in situations where decisions have to be made quickly-make sure you debrief afterwards
• Patients “die”-keep the language reflective
• Make sure you find time to discuss things with those you work with and/or those that care about you
• When you stop having any reaction, you need to take pause
• References: https://www.cancercare.on.ca/toolbox/symptools/ and www.palliativecareswo.ca
• PPS (Palliative Performance Scale) and PPI (Palliative Prognostic Index),
• ESAS are key tools to measure progress
• Pain – think about opioid naïve patients, start low and titrate slow
1. CARDIAC WORK UP
2. DDX OF LIFE THREATENING CAUSES
3. ACUTE MANAGEMENT OF ACS
4. PULMONARY EDEMA
5. NARROW COMPLEX TACHYCARDIA
6. WIDE COMPLEX TACHYCARDIA
CARDIAC WORK UP
• Assess stability
• History and physical
• Blood work
• Stat ECG
• Portable CXR
1. RECOGNIZE RESPIRATORY DISTRESS
2. DETERMINE THE CAUSE
3. ESCALATION OF FIO2
RESPIRATORY DISTRESS: END OF THE BED TEST
Use the 10 second Organized Head to Toe Approach
1. Head: tachypnea, pursed lip breathing, unable to finish a senten...
2. Neck: Stridor, wheezing, poor airflow
3. Chest: Tripod positioning, Accessory muscle use
4. Level of Consciousness: Is the patient anxious? or Obtunded?
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