Rearview Mirror: Ectopic Must be Dead!

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i need to dictate some charts. im 40 or so in the hole.. peace
 
maybe ill pad for each chart i dictate
 
Malaria presents with paroxysmal fever q2-3days, chills, anemia, splenomegaly, and even black urine 2/2 hemolysis (blackwater fever)
Usually incubates 6-16 days, but this can vary if the patient was given prophylatic meds (Delayed 8-12 mos)
Pts should get chloroquine 1-2 weeks before leaving and 4 weeks after returning; if going to a chloroquine-resistant area, they will need malarone/proguanil 1 day before and 1 week after returning.
Diagnosis, of course, is by blood smear
 
Heroine overdose presents with stupor/coma, miotic pupuils, slow breathing, cool, mottled skin - takes 6-8 hours to wear off
They should be hit with narcan, which lasts only 1-2 hours, so you will probably have to give multiple times
Withdrawal signs include agitation, lacrimation, diarrhea, abd cramps, tachycardia, hypertension. These symptoms last 7-10 days and peak at 2-3 days
 
EM2BE said:
at least hard24forget is using her sdn time wisely
Click to expand...

Thanks, I was just learning about ecstasy:

an analogue of methamphetamine, it can cause jaw clenching/muscle spams/rhabdo, nystagmus, seizures, widely dilated pupils, arrythmias, N/V, fever, diaphoresis, and even DIC. All deaths thus far are related to thermoregulation problems
Treatment includes rapid cooling, rehydration, organ monitoring
 
Phenylcyclidine (PCP) should be the first thing you think of if someone comes in comatose with their eyes open, displayed muscle rigidity and nystagmus. Also causes tachycardia and htn. This drug can cause anything from CNS stimulation to depression (catatonia to seizures), flushed skin with dilated pupils. These patients are known for their agistation and violence, they will need benzos +/- haldol and cooling. Gastric lavage can be used and pts need to be watched for rhabdo.
 
Let's talk about the poor little old ladies, etc that overdose on prescribed meds:

Class IA drugs like quidinide, procainamide prolong the QT interval --> torsades ---> code. Treat with magnesium sulfate or pacing, avoid other QT actors

Class IB include lidocaine, tocainide, these shorten the AP and prolong the refractory period - supportive care
Class IC include flecainide and propaferone, which prolong the AP - supportive care
 
Class II meds are more high yield because they include beta-blockers, which just about everybody with CAD is on. These drugs block beta-1 receptor, which usually stimulate cAMP. Overdosers present with bradycardia and hypotension.

Bypass the Beta receptor by using glucagon. Atropine will also oppose paraympathetics so may work. Most pressors would compete with the same receptor, so they are usually used the next go round
 
I forgot to mention glucagon works b/c it directly stimulates cAMP

Class III antiarrythmics include amiodarone and bretylium (does anyone use bretylium?). Plenty of folks are on amiodarone, and they, like the Class Is, will have a prolonged QT interval --> torsades --> code. Treat the same as the Is, with mag and overdrive pacing
 
you guys are making me proud...
 
Class IVs include the ca channel blockers, which also present with bradycardia and hypotension like Class II (beta blockers). These drugs hae a prolonged release from the stomach, so lavage!
Compete with the blocked channels using calcium, glucagon and pressors are less effective than with Beta-blockers. Calcium-channel blockers are pretty fatal; people think insulin ad glucose might help to resuscitate the many organs these drugs poison.
 
padders then im going into work
 
Had to go season up dinner. 😀

Anyway, seems the bottom line is the even anti-arrythmics are the ones we are used to, and we treat those overdose with glucagon, calcium, and pressors, whereas the odd ones cause torsades, which you treat with Mg

Pretty simple, but good to review

In the case of digoxin, overdose causes frequent PVCs, blocks, junctional tach, and there is a digoxin Fab antibody antidote. Don't give calcium if these patients are hyperkalemic, because dig block the Na/K atpase, resulting in tons of calcium - the more you gie, the longer it takes the heart to relax (stone heart)
 
Let's see, I've got a spec sheet on U of MD here, which is a 3yr program. It basts 52 beds i their ED and 20% admission rate. More importantly, it has electronic patient records!
 
Kinda weird that there's no medicine or surgery mos, but there is alot of ICU time and shock trauma. Lot's of cool trauma research - this place is definitely on my list 😀
 
Emory has 100 ED beds - WOW!
Also a 3yr program, I am diggin the varied 1st year. TBI bench research, too! I wonder if they have electronic records? Their website is super sexy, I hope I can get my hubbie to Atlanata - would hate to leave him :meanie:.
 
Ah yes, Christiana - a rotation I am very much looking forward to! 3yr program, all electronic, 56 beds, time at Wilmington, 9hr shifts - all great. Looks like they have a new PD? 😕
 
Denver, talk about a sexy time! 😀

4yr program, 42 beds integrated peds, electronic records, lots of critical care, surg, and medicine experience, interesting research (really into this id of HIV infection stuff). I suspect this place will be quite high on my list, assuuming I even get an interview :scared:
 
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