- Last edited on February 4, 2024
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on-call:approach-to-im-on-call-emergencies-issues [on February 19, 2023] psychdb [Hypotension/Hypertension] |
on-call:approach-to-im-on-call-emergencies-issues [on February 19, 2023] psychdb [Constipation] |
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| ===== Hypotension/Hypertension ===== | ===== Hypotension/Hypertension ===== | ||
| When managing issues around blood pressure, there are only four possible scenarios: | When managing issues around blood pressure, there are only four possible scenarios: | ||
| - | <WRAP col2> | ||
| - **Hypotensive Bad**: BP is //low// and the patient is dying! | - **Hypotensive Bad**: BP is //low// and the patient is dying! | ||
| - **Hypotensive Fine**: BP is //low//, patient is fine, should we hold antihypertensives? | - **Hypotensive Fine**: BP is //low//, patient is fine, should we hold antihypertensives? | ||
| - **Hypertensive Fine**: BP is //high//, patient is fine, do we treat with antihypertensives? | - **Hypertensive Fine**: BP is //high//, patient is fine, do we treat with antihypertensives? | ||
| - **Hypertensive Bad**: BP is //high//, and patient is having associated symptoms | - **Hypertensive Bad**: BP is //high//, and patient is having associated symptoms | ||
| - | </WRAP> | ||
| ==== Hypotension ==== | ==== Hypotension ==== | ||
| <WRAP group> | <WRAP group> | ||
| Line 301: | Line 299: | ||
| * 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 ===== | ===== Tachycardia ===== | ||
| - | <WRAP group> | + | ==== Stable or Unstable ==== |
| - | <WRAP half column> | + | |
| - | == Stable or Unstable == | + | |
| * First question is always "is the patient stable?" | * First question is always "is the patient stable?" | ||
| - | * If unstable | + | * If unstable: |
| * Call a ''CODE BLUE'' or activate Rapid Response | * Call a ''CODE BLUE'' or activate Rapid Response | ||
| * If stable: | * If stable: | ||
| Line 311: | Line 307: | ||
| * Get an ECG | * Get an ECG | ||
| - | </WRAP> | ||
| - | <WRAP half column> | ||
| <callout type="info" title="ECG Strip Reading" icon="true"> | <callout type="info" title="ECG Strip Reading" icon="true"> | ||
| Is the QRS narrow or wide? | Is the QRS narrow or wide? | ||
| Line 327: | Line 321: | ||
| * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | ||
| </callout> | </callout> | ||
| - | </WRAP> | + | |
| - | </WRAP> | + | |
| == Atrial Fibrillation Management == | == 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). | A HR <110 is acceptable. Don’t need to be aggressive unless there are ischemic symptoms (angina, troponin bump, ECG changes, etc). | ||
| Line 368: | Line 361: | ||
| ===== Constipation ===== | ===== Constipation ===== | ||
| - | Assess the timeline of symptoms. It is only urgent if there is impaction with large fecaloma (bacterial translocation, mucosal ischemia) | + | * Assess the timeline of symptoms |
| - | == Treatment == | + | * Constipation is only an emergency if there is impaction with large fecaloma (bacterial translocation, mucosal ischemia) |
| + | |||
| + | ==== Treatment ==== | ||
| + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
| + | See main article: **[[meds:antipsychotics:constipation|]]** | ||
| + | </alert> | ||
| Lactulose (30cc PO can give BID) or PEG 3350 (17g PO) are most effective. Never use docusate sodium (//Colace//), it is not an effective drug! | Lactulose (30cc PO can give BID) or PEG 3350 (17g PO) are most effective. Never use docusate sodium (//Colace//), it is not an effective drug! | ||