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Hypertensive Emergency

A summary of the hypertensive emergency treatment guidelines from: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Full Text     PubMed Acute Aortic Dissection Preferred drugs: esmolol, labetalol Reduce SBP to < 120 mm HG within

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Pericarditis

Acute Pericarditis: A summary of the 2015 European Society of Cardiology Guidelines For The Diagnosis And Management Of Pericardial Diseases ( Full Text ) Diagnosis: Two or more of the following… Chest pain consistent with pericarditis (sharp, worse with laying flat and inspiration, better sitting up),  80-90% Pericardial friction rub (high pitched, scratchy , left sternal border),  <33% Typical ECG changes ,

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Asymptomatic Hypertension

Definition of hypertension:1 Normal: 120/80 or less Pre-hypertension: 120-139/80-89 Stage 1: 140-149/90-99 Stage 2:  >160/>100 Is there evidence to suggest that immediate and rapid blood pressure reduction is beneficial in patients with hypertension and NO other symptoms ? JNC-71 “However, there is no evidence to suggest that failure to aggressively lower BP in the ER is associated with any increased

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ICH and BP management

Spontaneous (non-traumatic) Subarachnoid Hemorrhage (SAH): Goal SBP < 140-160 mmHg Medication options: Labetalol IV 10mg boluses Nicardipine infusion Celvidipine infusion Avoid vasodilating agents like nitroprusside or nitroglycerin Spontaneous (non-traumatic) Intracerebral Hemorrhage: Goal SBP < 140 mmHg AHA / ASA guidelines (2015) give the following recommendation: “For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute

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Lithium Toxicity

Symptoms: (Neurological findings appear late in acute ingestion, but are common presenting complaints in chronic toxicity.) Nausea Vomiting Diarrhea QTc prolongation (rare) Lethargy Ataxia Confusion Tremors, fasciculations, or myoclonic jerks Seizures Encephalopathy Nephrogenic Diabetese Insipidus (in chronic toxicity) Testing: Lithium level Therapeutic  lithium level is 0.8 – 1.2 mEq/L  (mmol/L) 1.5-2.5 mEq/L (mmol/L) – mild symptoms, chronic toxicity, tremor, slurred

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Pediatric Seizure Recurrence

Recurrence rate after first unprovoked seizure 1: 6% recurrence within 48 hours ( 1 in 16 ) 15.8% recurrence within 14 days (1 in 6) 31.5% recurrence within 4 months ( 1 in 3 ) Age less than 3 yo at onset increases 14 days recurrence, OR 2.1 29% recurrence within 1 year 3 37% recurrence within 2 years 3 43% recurrence within

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Hypokalemia

Hypokalemia <3.5 mmol/L Severe < 2.5 mmol/L ECG changes ST depression U wave QT prolongation (>450 ms) PVCs AV block Bradycardia Vtach Vfib Treatment- Replacement Each 10 mEq raises K 0.1 mmol/L PO replacement preferred ECG changes require admission and IV + oral replacement. Magnesium replacement is also indicated. Many foods contain potassium. Replacement need not be tablets only. See list here. Symptoms

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Hyperkalemia

Hyperkalemia >6.0 mmol/L EKG changes (not necessarily in order, especially if chronic renal failure patient) Peaked T waves PR prolongation Short QT (<350 ms) Widened QRS Flat P waves Heart Block Sine wave V. Fib. Treatment: Stabilize, Shift, Excrete Stabilize: Calcium stabilizes myocardial membrane with onset in 15-30 minutes. Calcium gluconate IV 10 ml of 10% solution over 10 minutes may cause

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Ectopic Pregnancy

American College of Obstetrics and Gynecology Practice Bulletin – Tubal Ectopic Pregnancy, 2018 Location: >90% of ectopics are fallopian, 1% abdominal, 1% cervix, 1-3% ovarian, 1% c-section scar Heterotopic pregnancy risk 1/4000 – 1/30,000 in general population Heterotopic pregnancy risk in patients receiving in vitro fertilization, up to 1/100 Epidemiology: Incidence is estimated to be 1-2% (25 per 1000 pregnancies per

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DKA and HHS

Definitions: Diabetic ketoacidosis (DKA)1,2– uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketones Hyperosmolar hyperglycemic state (HHS)1,2– severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis Treatment: Fluid resuscitation:1,2 NS (0.9%NaCl) 15-20 ml/kg or 1-1.5 liters in first hour … THEN If corrected serum Na is low, cont. NS @ 250-500 ml/hr If corrected serum Na is high

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