commit f23003ae688f4f82e38f8f7c4b86863819bdae65
parent c293a0cb9a91e8beaee2118a651781f21ed8a72b
Author: C. Beau Hilton <cbeauhilton@gmail.com>
Date: Mon, 6 Jul 2020 12:52:08 -0500
memex update
Diffstat:
2 files changed, 64 insertions(+), 0 deletions(-)
diff --git a/index.md b/index.md
@@ -78,6 +78,7 @@ Vannevar Bush coined the term "memex" for a system of extending or indexing one'
### 2020
- [2020-07-02-noon-conference](learn/2020-07-02-noon-conference.md)
+- [2020-07-06-noon-conference](learn/2020-07-06-noon-conference.md)
## blogs
diff --git a/learn/2020-07-06-noon-conference.md b/learn/2020-07-06-noon-conference.md
@@ -0,0 +1,63 @@
+# Acute respiratory failure (most of this in Vandy handbook)
+
+## Modes of oxygen
+
+- NC - up to ~6L, ~40% FiO2
+- HFNC - up to ~15L, 80% FiO2
+- Venti mask - not used often, controlled with attachable and switchable filters
+- Non-rebreather - up to ~100% FiO2, turn flow up all the way, fill up reservoir first then apply
+- bipap - usu ICU, careful with aspiration risk, can adjust insp/exp pressures, up to 100% FiO2
+- optiflow - up to 60L, 100% FiO2, usu ICU
+
+## Get help
+
+- Esp if res-interning, don't hesitate to call/ask nurse to call Rapid Response Team (1-1111)
+
+## Differential
+
+(pt with known COPD desatting)
+
+- Most likely: COPD; other most common: CHF; must not miss: PE
+
+## Order
+
+- CXR, EKG, trop, BNP
+- bipap (not available on regular nursing floors), duonebs, lasix
+
+
+## COPD exacerbation
+
+- fairly algorithmic:
+ - bipap
+ - O2 for sat 90-94%, or >88% if on O2 at home
+ - Prednisone 40mg x 5d
+ - Albuterol/ipatropium q4-q6
+ - abx
+
+
+## LASIX
+
+- feel free to give big push (e.g. 160) of lasix if any concern for volume overload
+- even if AKI - oxygenation takes priority, can rehydrate kidneys later
+
+## Anaphylaxis
+
+- call RRT (have friends - pt can need intubation, etc.)
+- 0.3mg of 1mg/ml IM epinephrine (on crash carts) (if not responding, put on drip)
+- O2
+- stop offending meds/infusions
+
+
+## PE
+
+- ddx: PE, pneumonia, STEMI, PTX (hence EKG, CTA or CXR if can't get CTA quickly, trop, BNP)
+- if AKI: can get VQ scan instead of CTA, but if suspicion is high start treating
+- massive (+hypotension): catheter-directed thrombolysis
+- submassive (normotensive, RV dysfxn + inc trop or BNP): heparin gtt or lovenox (preferred if possible - therapeutic more quickly with less futzing)
+
+## Afib w RVR
+
+- HR >120 and stable: IV metop 5mg (up to 3x @ 5min intervals) or dilt (avoid if reduced EF, and often don't know, so usu metop)
+- HR <120 and stable: oral metop tartrate 25mg
+- unstable: cardioversion
+- also something about amio drip that I missed, usu done in MICU/CCU
