Excess free H2O relative to Na → serum Na < 135 mEq/L. Neurologic spectrum 2/2 water shift in cells: Fatigue → lethargy → AMS (altered mental status) (usually starting <120 mEq/L) → seizure → coma
While it is not the only state that defines a critically ill patient, shock is considered by many to be the prototypical derangement of the critically ill. With our bedside…
Bronchodilators Narrowing of bronchioles raises airway resistance, e.g., in bronchial or bronchitic asthma. Several substances that are employed as bronchodilators are: β2-sympathomimetics (given by pulmonary, parenteral, or oral route)methylxanthine theophylline…
The approach to the woman with pelvic pain is to start with the initial resuscitation and β-HCG. Then the focus should be on emergent gynecologic disease, such as ovarian torsion and PID / TOA (Tuboovarian Abscess)
Oral anticoagulant medications are commonly prescribed. Whether it is a traditional vitamin K antagonist (VKA) or a novel oral anticoagulant (NOAC) medication, all carry the risk of serious hemorrhage. Traditional…
ACE inhibitors, such as captopril and enalaprilat, the active metabolite of enalapril, occupy the enzyme as false substrates. Affinity significantly influences efficacy and rate of elimination. Enalaprilat has a stronger and longerlasting effect than does captopril.
Work-up for lower abdominal pain begins with resuscitation and exclusion of critical diagnoses: AAA (Abdominal Aortic Aneurysm); Mesenteric Ischemia; Perforation; SBO (small bowel obstruction); ectopic pregnancy
Sodium bicarbonate is an important antidote in the treatment of the critically ill poisoned patient. This contrasts with the general approach to acidosis due to other conditions, where sodium bicarbonate…
The term Calcium (Ca2+) antagonist is applied to drugs that inhibit the influx of Ca2+ ions without affecting inward Na+ or outward K+ currents to a significant degree. Other labels are Ca-entry blocker or Ca-channel blocker.
Begin work-up by ruling out emergent/urgent conditions and evaluating/charting the absence of red flags that can signal the presence of an emergent condition. Then consider other visceral causes of low back pain. If no red flags are present and patient does not need further work-up, then the likely default diagnosis is benign mechanical (lumbar strain) Low Back Pain