A1c %Estimated average blood glucosemg/dLmmol/L612676.51407.871548.67.51699.4818310.1
ABCDE&rsquoSIf you notice one or more of the following ABCDE&rsquos below, please speak to you health care provider.When spotted early, melanoma has a cure rate of 85%. Check your skin monthly.ASYMMETRYThe two halves of the mole have diff
Source: http://www.aliem.com/paucis-verbis-card-abg-interpretation/ABG InterpretationHaber RJ. A practical approach to acid-base disorders. West J Med 1991 155:146-51. RULES OF THUMB:1. Look at pH. Whichever side of 7.4 the pH
Arterial Blood Gas ABGstandard nomenclature: pH / PaCO2 / PaO2 / HCO3 / O2Sat / BEnormal valuespH: 7.35-7.45PaCO2: 33 - 45 mmHgPaO2: 80 - 100 mmHgHCO3: 21 - 27 mEq/LO2Sat: 95-100%BE +/- 2 mEq/L Co
All Approximately Equivalent Doses Reasonable for Substitution in Most Cases Benazapril 10 mg PO DAILY max dose 40 mg PO DAILYCaptopril 12.5 mg PO TID max dose 50 mg PO TIDCilazapril 2.5 mg PO DAILY max dose 10 mg PO DAILY
Source: http://www.aliem.com/paucis-verbis-acls-2010-cardiac-arrest-flowchart/
PulselessIf VF/pVT->compressions, defibrillate 200J, give epi then amioIf PEA->compressions, give epiPulseBradyif stable->atropineIf unstable->pacing, if pacing doesn't work then epi or dopamine infusion
More info: https://radiopaedia.org/articles/acr-thyroid-imaging-reporting-and-data-system-acr-ti-rads
Call ophtho! Diamox 500 mg PO then 250 mg PO q6hPilocarpine i drop q5minutesCombigan i drop q5minutesPrednisolone i drop q5minutes If still healthy, pupil size reduces within ~30 minutes then pressure drops with some
ImagingCT may show diffuse thickening and edema of large bowel loops associated with peri-colonic fat stranding. There may be enlarged LNs in the mesentery and/or retroperitoneal region. DdxInfectious or inflammatory. Trea
EtiologyViral or idiopathicAutoimmune diseases e.g. SLEUremia acute of CKDPost-myocardial infarctionEarly: Per-infarction pericarditis usual onset is less than 4 days following acute MILate: Dressler syndrome usual onset i
See also:Paroxysmal supraventricular tachycardia Adenosine is indicated in the ACLS algorithm "[Adult] Tachycardia With a Pulse" for patients withstable tachycardia and narrow QRS complexstable tachycardia and
Psychotherapy: Cognitive Behavioral Therapy CBT has evidence for mood and anxiety and is considered first-line treatment. Acceptance and Committment therapy can also be of benefit. Supportive counselling can also be helpful.Investigations of possib
Current Legislation in NL see section 10 for determination of substitute decision maker in cases of no AHCD
http://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php
40 to 49 years: 0 to 2.5 ng/mL50 to 59 years: 0 to 3.5 ng/mL60 to 69 years: 0 to 4.5 ng/mL70 to 79 years: 0 to 6.5 ng/mL See also: http://www.uptodate.com/contents/screening-for-prostate
Impressive bed mnemonic for anion-gap metabolic acidosis:A CAT MUDPILE AspirinCyanide, carbon monoxide Acetaminophen Theophylline Methanol, metformin Uremia Diabetic ketoacidosis or alcoholic ketoacidosis Prop
See also:Alberta--Chronic Kidney Disease CKD Clinical PathwayKidneyWise Algorithm Ontario Health
See also:Akbari Algorithm--Detection, Monitoring & Referral of Chronic Kidney DiseaseKidneyWise Algorithm Ontario Health The Chronic Kidney Disease CKD Clinical Pathway is a resource for primary care providers to
Aclasta Zoledronic acid 5 mg IV once yearlyProlia Denosumab 60 mg sc q6months
By Dr. Tor Ercleve see also: http://lifeinthefastlane.com/the-art-of-infarct-localisation/
AMMI Association of Medical Microbiology and Infectious Disease Canada GuidelinesDownload PDF: Use of antiviral drugs for seasonal influenza 2019.pdf [1.69 MB]Selected figures:
First lineCBC w/diffRetic countRenal functionFerritinIron studiesB12TSHFolateColon cancer screeningUrinalysis Second lineSPEPIgG, IgA, IgMSerum free light chains Third line
Severe aortic stenosis diagnostic criteriaRequiredAortic jet velocity >=4.0 m/sORMean transvalvular pressure gradient >=40 mmHgOptionalValve area usually <=1.0cm^2 Indications
HistoryJoint distributionInflammationExtra inflammatory features PhysicalAnatomic sites, activity vs damage "Make up your mind after H&P, use labs to confirm your diagnosis" Lab
See also:
General Anesthesia
Normal
ASA Physical Status 1 - A normal healthy patient
ASA Physical Status 2 - A patient with mild systemic disease
ASA Physical Status 3 -
Hx Location Quality Intensity Duration Radiation Timing relation to meals Associated sx &nbs
See also:
Vaginal bleeding Ddx
Medical abortion
Hx
Pregnant patient
Lower abdominal pain
Vaginal bleeding
Workup
Pelvic ex
Source: Academic Life in Emergency Medicine
Source: http://www.aliem.com/paucis-verbis-acetaminophen-toxicity/
Dx
The first data point on the Rumack-Matthew nomogram is at 4 hours
The decision of whether or not to administer the antidote can be made after four hours, based on the acetaminophen level. As long as it is admini
Source: http://siouxlookoutareadocs.libsyn.com/acne Remember to seek a secondary cause:PCOS esp if irregular periodsHigh-androgen OCP consider switchingPregnancyAnabolic steroid usePrimary hormonal acne, which may r
Sx Uncontrolled HTN Increase in ring size/hand size/feet size Sweaty hands/increased oiliness of skin Headaches Visual changes &nb
See also: Sore throat Ddx
Hx
IV drug use
Risky sexual practices
Sx
Sore throat
Fever
Rash
Weight loss
Workup
&nb
Source: Academic Life in Emergency Medicine
Acute MI 2 out of 3 criteria130 minutes retrosternal pain - must R/O MI, PE, Aortic dissection2Cardiac enzymes elevated3ECG changes Unstable Angina -Chest pain at rest - cardiac ischemia w/o ECG changes MI Causes
See also: Abdominal pain Ddx
Pathophysiology
Premature activation of pancreatic enzymes causing autodigestion of the pancreas.
Release of lipolytic enzymes from the pancreas causes significant inflammation o
Source: Academic Life in Emergency Medicine Gaze-Evoked NystagmusFrom: http://www.medscape.com/viewarticle/422863_3Action. Ask the patient to gaze at a target placed 20 to 30 degrees to the left and right of center for
Ddx, most likely
Flare-up of osteoarthritis
Crystal arthritis
Gout
Pseudogout
Bacterial arthritis
See also:
Abdominal pain Ddx
Biliary disease
Pathophysiology
May be caused by undiagnosed hereditary spherocytosis
Hx
Pain that is triggered by eating fatty food
Sx
&nb
Sx
Attention deficit common to all confusional states
Organic-causes
Acute onset
Abnormal vital signs
Fluc
Diagnostic action
Abolishes conduction through the AV node
E.g. PSVT
Terminates some re-entrant type tachycardias
Dose
3-12 mg rapid IV push
See also: Pediatric fever Ddx Terms:Fever without a source FWS: No adequate explanation for fever after H&P.Fever of unknown origin FUO: No adequate explanation for fever lasting at least 8 days' duration, af
Sx
Poor nutrition
Labs
Low thiamine levels due to poor nutrition
Low glucose due to suppression of gluconeogenesis by alcohol (give thiamine first to prevent precipitating Wernicke's encep
A BDZ, the #1 prescribed mental health drug
Mechanism
Binds GABA-alpha receptors
Enhances the affinity of GABA for the receptor, allows increased opening of the GABA-alpha channel
Indications
Hx
Primary vs. secondary
Duration
Possible pregnancy
Associated sx
Headache
Decreased peripheral vis
Treats
Atrial arrhythmias (+/- heart failure)
Ventricular tachycardia (+/- heart failure)
5 common side effects of amiodarone:
1. Pulmonary toxicity: Amiodarone lung toxicity is associated wit
Source: Academic Life in Emergency Medicine
First line:
1. Epinephrine 0.01 mg/kg (use 1:1000 sol) q5-15min IM (max dose 0.3 mg in kids or 0.5 mg in adults)
1. Methylprednisolone (Solumedrol) 1-2mg/kg/day IV (all ages) (usual dose is 125mg IV for most adults)
1. Benadryl 50 mg IV/
See also: Joint/limb pain Ddx
Hx
Left arm pain that starts during exercise
Pain relieved by rest
Workup
EKG
CK-MB, troponin
CBC
Source: Academic Life in Emergency Medicine
Source: Academic Life in Emergency Medicine
See also: Amenorrhea Ddx
Hx
Significant weight loss
Vigorous exercise
Cold intolerance
Amenorrhea
Workup
CBC
TSH
The perfusion territory of the anterior spinal artery includes the anterior horn cells and part of the pain and temperature pathways. Thrombosis of this artery causes flaccid paralysis, loss of bowel and bladder function and loss of pain and temperature se
HEENT
Otitis externa
Initial treatment in otherwise healthy people
Cipro/Dexamethasone otic <-can be used with perforated TM
Source: Academic Life in Emergency Medicine
Impede ACh signaling at nicotinic and/or muscarinic receptors.
Treat
Parkinson's disease (e.g. Trihexphenidyl)
Attempt to reduce acetylcholine signaling to match reduced dopamine signaling
Drug
See CHADS2 for guidance for patients with atrial fibrillation
Indications
Acute coronary syndrome
Low-molecular weight heparins
Atrial fibrillation
Anticoagulation in Atrial Fibrillation
Waldo AL. Cardiol Clin 2009; 27:125-35.
Atrial Fibrillation (AF) = 5x risk for CVA and increases with age
Stroke risk stratification for patients with AF:
Source: Academic Life in Emergency Medicine
all fractures
Lovenox, only while inpatients
all joint replacements
hips-Xarelto 35 days
knees-Xarelto 14 days
all gen surg
low risk-Heparin 5000 U SC bid
Treat
Influenza pneumonia
Oseltamivir
Zanamivir
CMV infections
Ganciclovir
HIV
Source: Academic Life in Emergency Medicine
Descending aortic aneurysms are usually fusiform and due to atherosclerosis.
PE
Early diastolic murmur in mild cases
Holodiastolic murmur in severe cases
Hyperdynamic "Water-hammer" pulse
Abrupt rise in systolic blood pressu
Source: Academic Life in Emergency Medicine
Source: Academic Life in Emergency Medicine
Adapted from Choosing Wisely NL Practice Points Volume 3 2018
Source: Academic Life in Emergency Medicine
Path
Due to its wider diameter and the fact it forms a more obtuse take-off angle with the trachea, the right mainstem bronchus is a more likely site of aspiration than the left mainstem bronchus in adults.
Dx
Mor
Effects
Characteristically causes metabolic acidosis mixed with a respiratory alkalosis
Stimulates respiratory center -> Tachypnea -> RESPIRATORY ALKALOSIS
Anion-gap METABOLIC ACIDOSIS by
See also:
Cough/shortness of breath Ddx
Asthma exacerbation
Hx
Shortness of breath
Cough
Wheezing
Worse in cold air
Source: Academic Life in Emergency Medicine
See also: COPD Exacerbation
Epidemiology
More common in male children than female children
More common in female adults than male adults
Higher prevalence in African-Americans than
Triggers
Ddx
Coarctation
BP in arm(s) greater than legs
BP in R arm greater than L arm
Subclavian artery atherosclerosis
&
See also:Ataxia DDxHINT exam for localizing the source of ataxia Acute hours to daysHypovolemiaInfectionsICHCVAMSToxinsDrug side-effect Antineoplastics, antiepileptics, antiarrhythics e.g. Amiodarone
See also:Ataxia by Time CourseHINT exam for localizing the source of ataxia VestibularAtaxia+vertigo+tinnitus+nystagmusPeripheralBPPVMeniere'sLabyrinthitisVestibular n
What&rsquos your name? What happened?100% O2 non-rebreather, pulse ox, cardiac monitor, BP, two large bore IVsPage lab, routine trauma labs including type & screen Airway Open or close
Key myotomesC5 deltoidC6 wrist extensors biceps, extensor carpi radialis longus and brevisC7 elbow extensors tricepsC8 finger flexors to the middle fingerT1 small finger abductors abductor digiti minimiL2 hip flexors iliopsoasL3,L
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Hx A common complication of CABGDx Absence of P waves Irregularly irregular rhythmClassifications Duration Paroxysmal <7 days du
PresbycusisSource link Noise-induced Hearing LossSource link or Download 3.52 MB PDF <-- a good summary of other conditions affecting hearing
Tend to be hemolytic and tend to have normal appearing erythrocytes on peripheral smear; autoagglutination of red cells may be seen in some types.
Ddx
Lupus
See also:
Anemia
Source: Wilderness Medical Society WMS, Advanced Wilderness Life Support AWLS