- 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 |
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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 ===== | ||
| 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 300: | 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 ===== | ||
| - | <WRAP group> | ||
| - | <WRAP half column> | ||
| - | == 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 | ||
| - | </WRAP> | ||
| - | <WRAP half column> | ||
| - | <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> | ||
| - | </WRAP> | ||
| - | </WRAP> | ||
| - | == 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 368: | Line 363: | ||
| ===== 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 |
| + | * Constipation is only an emergency if there is impaction with large fecaloma (bacterial translocation, mucosal ischemia) | ||
| == Treatment == | == Treatment == | ||
| - | 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! | + | <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! | ||
| ===== Seizures ===== | ===== Seizures ===== | ||