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Acute Medical Surgic
Class Repeat Concepts
| Question | Answer |
|---|---|
| Sepsis | S/S: fever or hypothermia, tachy, hypotension, altered mentation, lactate↑ First: Cultures → broad abx → 30 mL/kg fluids if hypotensive/lactate≥4; pressors for MAP≥65 |
| Acute Coronary Syndrome/MI | S/S: pressure chest pain, diaphoresis, N/V, ECG changes First: ECG ≤10 min, chewable ASA, nitro if SBP≥100/no PDE-5, O₂ if SpO₂ <90–92% |
| Stroke | S/S: FAST, sudden neuro deficit First: Last-known-well, CT head, glucose check, permissive HTN if ischemic; tPA screen |
| Pulmonary Embolism | S/S: sudden dyspnea, pleuritic CP, tachycardia, hypoxemia First: High-flow O₂, HOB↑, notify, CT-PA prep, anticoag/thrombolysis if unstable |
| Heart Failure Exacerbation | S/S: dyspnea, crackles, JVD, edema, pink froth First: O₂, sit upright, diuretics, strict I&O, daily weights |
| DKA vs HHS | S/S DKA: hyperglycemia + ketones + acidosis; HHS: very high BG, dehydration, no ketones First: Fluids (often LR/NS), insulin drip per protocol, K⁺ replace as needed |
| Hyperkalemia | S/S: weakness, peaked T, arrhythmias First: Cardiac monitor; Ca gluconate, insulin/dextrose; consider loop/binder/dialysis |
| Hypokalemia | S/S: weakness, U waves, PVCs First: Replace K⁺ (PO preferred), check Mg²⁺, ECG |
| Pancreatitis | S/S: severe epigastric pain radiating to back, ↑lipase, N/V First: NPO, LR fluids, pain control; monitor Ca, watch for hypovolemia |
| Cholecystitis/Cholelithiasis | S/S: RUQ pain after fatty meal, Murphy sign, N/V, sometimes jaundice First: NPO, pain control, ultrasound, antibiotics if infected |
| GI Bleed (upper) | S/S: melena/hematemesis, hypotension First: Two large-bore IVs, type & cross, PPI, monitor H/H, prepare endoscopy |
| AKI/CKD fluid overload | S/S: edema, crackles, HTN, UOP↓ First: Hold nephrotoxins, diuretics if indicated, strict I&O, daily weights, renal dosing |
| COPD Exacerbation | S/S: ↑WOB, wheeze, hypoxemia, CO₂ retention First: Targeted O₂ (usually 88–92%), bronchodilators, steroids, consider BiPAP |
| Asthma Red Flag | S/S: silent chest, fatigue, SpO₂↓ First: Immediate bronchodilator, steroids, escalate care |
| DVT | S/S: unilateral calf swelling, warmth, tenderness First: Bed rest affected limb, no massage/SCD on that leg, anticoag per orders |
| Compartment Syndrome | S/S: 5 P’s (pain out of proportion, pallor, paresthesia, paralysis, pulselessness—late) First: Notify surgeon stat, keep limb at heart level, no tight dressings/ice |
| PPH (postpartum hemorrhage) | S/S: heavy bleeding, boggy uterus, tachycardia First: Fundal massage, uterotonics, IV access/fluids, QBL, call OB |
| Preeclampsia/Severe Features | S/S: BP↑, HA, vision changes, RUQ pain, proteinuria, hyperreflexia ± clonus First: Seizure precautions, MgSO₄ (monitor DTR/RR/UOP), antihypertensives |
| Infection + Indwelling Devices | S/S: fever, local erythema/drainage First: Assess site, cultures if ordered, remove/replace lines per protocol, antibiotics |
| Sepsis Meds | Broad antibiotics (start early): piperacillin–tazobactam ± vancomycin; or cefepime + vanco (tailor to source/cultures). Pearl: draw cultures first; monitor renal function.central line preferred; titrate to MAP. Vasopressor (if MAP <65 after fluids): nor |
| Pulmonary Embolism (PE) / DVT Meds | Anticoag: heparin IV → bridge to warfarin (INR 2–3) or start DOAC (apixaban/rivaroxaban). Thrombolytic: alteplase for massive/submassive PE with shock/right-heart strain. Pearls: bleeding precautions; renal dosing for DOACs. |
| Compartment Syndrome Meds | Definitive: surgical fasciotomy. Meds (adjunct): analgesia only. Pearls: time-critical surgical emergency. |
| Postpartum Hemorrhage (PPH) MEDS | Uterotonics: oxytocin first-line; methylergonovine (avoid in HTN), carboprost (avoid in asthma), misoprostol. Antifibrinolytic: tranexamic acid. Pearls: fundal massage; 2 large-bore IVs; treat cause (4 Ts). |
| Pancreatitis MEDS | Analgesia: opioids (hydromorphone). Antiemetic: ondansetron. Antibiotics: only if infected necrosis/cholangitis (e.g., piperacillin–tazobactam). Pancreatic enzymes: for chronic malabsorption. Pearls: NPO initially; LR fluids; monitor Ca²⁺, glucose. |
| ACS / MI Meds | Antiplatelet: aspirin + P2Y12 (clopidogrel/ticagrelor). Anticoag: heparin (IV) or enoxaparin. Anti-ischemic: nitroglycerin (avoid with PDE-5 inhibitors, SBP <100), beta-blocker (metoprolol) if no shock/brady. Statin (high-intensity): atorvastatin 80 mg |
| Stroke Ischemic: Meds | Thrombolytic: alteplase/tenecteplase (strict inclusion/exclusion). BP control: labetalol or nicardipine (pre/post thrombolysis targets). Antiplatelet: aspirin (if no thrombolysis/after 24 h post-tPA). Hemorrhagic: Reverse anticoag: PCC + vitamin K (wa |
| Hyperkalemia Meds | Membrane stabilizer: calcium gluconate IV. Shift K⁺ into cells: regular insulin + dextrose, albuterol neb; sodium bicarbonate if acidotic. Remove K⁺: furosemide, sodium zirconium cyclosilicate/patiromer, dialysis. Pearls: continuous ECG; re-check K⁺. |
| Hypokalemia Meds | KCl PO/IV (IV ≤10 mEq/hr peripheral; ≤20 central with monitor). Magnesium sulfate if Mg²⁺ low (enables K⁺ correction). Pearls: ECG for ectopy; never IV push. |
| Cholecystitis / Cholelithiasis Meds | Analgesia/antiemetic: NSAID or opioid; ondansetron. Antibiotics: ceftriaxone + metronidazole (or piperacillin–tazobactam). Ursodiol (selected non-surgical stone dissolution). Pearls: NPO; surgical consult for cholecystectomy. |
| Upper GI Bleed Meds | PPI: pantoprazole IV bolus/infusion. Variceal bleed: octreotide infusion + ceftriaxone (SBP prophylaxis). Reversal: vitamin K, PCC if coagulopathy; platelets if severe thrombocytopenia. Pearls: 2 large-bore IVs, type & cross, endoscopy. |
| AKI/CKD Fluid Overload Meds | Diuretic (if making urine): furosemide ± thiazide synergy. Hyperkalemia meds: (see above). Erythropoiesis agents (chronic): epoetin alfa (not acute overload). Pearls: avoid nephrotoxins; strict I&O; renal dosing. |
| DVT (extremity) Meds | Anticoag: heparin → warfarin or DOAC (apixaban/rivaroxaban). Thrombolysis/thrombectomy for phlegmasia/limb threat (vascular). Pearls: no massage; no SCDs on affected limb. |
| Preeclampsia / Severe Features / Eclampsia Meds | Seizure prophylaxis: magnesium sulfate (monitor DTRs, RR, UOP; Ca gluconate antidote). Antihypertensives: labetalol, hydralazine, nifedipine. Antenatal steroids: betamethasone if preterm risk. Pearls: strict BP/urine monitoring; seizure precautions. |
| Device-Related Infection (lines, catheters, ports) Meds | Empiric antibiotics: vancomycin (MRSA) + cefepime or piperacillin–tazobactam (Gram-negatives) until cultures. Antifungal if indicated (e.g., micafungin). Remove/replace infected device per protocol. Pearls: source control is key. |
| COPD Exacerbation Meds | Bronchodilator: albuterol ± ipratropium. Systemic steroid: prednisone PO or methylprednisolone IV. Antibiotic (if sputum purulent/severe): azithromycin, doxycycline, or amoxicillin-clavulanate. Pearls: O₂ target 88–92%; consider BiPAP. |
| DKA / HHS Meds | Fluids: LR/NS. Insulin: regular insulin IV infusion with protocol. Electrolytes: potassium repletion; phosphate PRN. Bicarb: only if severe acidosis (per protocol). Pearls: check K⁺ before insulin; hourly glucose; close anion gap. |
| Heart Failure Exacerbation Meds | Loop diuretic: furosemide IV. Vasodilator (BP ok): nitroglycerin IV. Inotrope (hypoperfusion): dobutamine/milrinone (ICU). Pearls: I&O, daily weights, K⁺/Mg²⁺, renal function. |
| Hemoglobin (Hgb) | Normal: F 12–16 g/dL, M 14–18 Low (anemia): fatigue, pallor, dyspnea → Assess bleeding, O₂ PRN, type & cross if ordered High (polycythemia/dehydration): HA, HTN → Hydration, evaluate causes |
| Hematocrit (Hct) | Normal: F 36–46%, M 41–53% Low: same as Hgb → Bleeding check + labs High: dehydration → Fluids as ordered |
| Platelets | Normal: 150–400k/µL Low: petechiae, bleeding → Bleeding precautions, hold sticks, notify High: clot risk → Assess for thrombosis risks |
| WBC | Normal: 4.5–11k/µL High: infection/inflammation → Cultures, abx per orders Low (neutropenia): infection risk → Neutropenic precautions |
| Sodium (Na⁺) | Normal: 135–145 mEq/L Low: confusion, seizures → Seizure precautions; hypertonic saline if severe (per protocol) slow correction High: thirst, neuro changes → Free water replacement; monitor neuro |
| Potassium (K⁺) | Normal: 3.5–5.0 mEq/L Low: weakness, PVCs, U waves → Replace K⁺; check Mg²⁺; ECG High: peaked T, weakness → Stabilize (Ca), shift (insulin/dextrose), remove (loop/binder/dialysis) |
| Chloride (Cl⁻) | Normal: 96–106 mEq/L Low/High: often tracks Na⁺/acid–base → Treat underlying |
| CO₂ (HCO₃⁻ on BMP) | Normal: 22–28 mEq/L Low: metabolic acidosis → Check ABG, treat cause (DKA, diarrhea) High: metabolic alkalosis → Review diuretics, vomiting |
| BUN | Normal: 7–20 mg/dL High: renal dysfunction/dehydration → Hydration, trend with Cr |
| Creatinine (Cr) | Normal: ~0.6–1.3 mg/dL High: kidney injury → Hold nephrotoxins, adjust med dosing, monitor UOP |
| Glucose (fasting) | Normal: 70–99 mg/dL Low: diaphoresis, confusion → 15 g rapid sugar or IV dextrose High: polyuria, thirst → Insulin per protocol; fluids |
| Calcium (total) | Normal: 8.6–10.2 mg/dL (ionized 1.12–1.32 mmol/L) Low: tetany, tingling, Chvostek/Trousseau → IV Ca gluconate High: stones, bones, groans → Hydration, loop diuretic |
| Magnesium (Mg²⁺) | Normal: 1.7–2.2 mg/dL Low: torsades risk, tremor → MgSO₄ IV High: decreased DTRs, resp depression → Stop Mg, give Ca gluconate if severe |
| Phosphate (PO₄³⁻) | Normal: 2.5–4.5 mg/dL Low: weakness, rhabdo → Replete PO/IV High (CKD): pruritus, calcifications → Binders; diet |
| LFTs (AST/ALT/ALP, bili) | High AST/ALT: hepatocellular injury → Review meds (statins, APAP), hepatitis workup High bili: jaundice, clay stools → Assess obstruction, hepatitis |
| Albumin | Normal: 3.5–5.0 g/dL Low: edema, poor healing → Protein/nutrition support |
| Troponin (hs-Tn | Normal: assay-specific (often < 14 ng/L) High: myocardial injury → ACS protocol: ECG ≤10 min, ASA, nitro if appropriate |
| BNP/NT-proBNP | High: heart failure volume overload → Diuretics, I&O, daily weights |
| PT/INR (warfarin) | INR goal: usually 2–3 (afib) or 2.5–3.5 (mechanical valve) High INR: bleeding risk → Hold/adjust; vit K/PCC if bleeding |
| aPTT (heparin) | High: bleeding risk → Adjust drip; protamine if bleeding |
| Cellulitis is (Saunders) | infec tion of the Dermis and underlying hypodermis. the caustive organism is group A streptococcus or Staphylococcus |
| What are you assessing for Cellulitius(Saunders) | Pain and tenderness, Erythema and warmth, Edema, Fever |
| Interventions for Cellulitis(Saunders) | Promote rest of limb, Apply warm compresses to promote circulation, and decrease discomfort,erythema and edema. apply antibacterial dressings, ointments, obtain culture, administer ABX |
Created by:
Anmag002