ST Depression (STD) - EMCrit Project CONTENTS Approach to STD: Initial considerations Causes of ST depression LVH Hypokalemia Digoxin RV strain (PE or RVH) Ischemia Inferior OMI (STD in aVL + - I) Lateral OMI (STD inferior leads) Posterior OMI (STD in ~V1-V4) Anteroseptal MI (inferior leads, V5-V6) De Winter pattern Subendocardial ischemia Exaggerated atrial repolarization morphology Scooped or down-sloping morphology: Ischemia
Submassive Massive PE - EMCrit Project vital signs Bradycardia is the most worrisome: This may be a harbinger of impending brady-asystolic arrest ; Shock index (HR SBP) >1 suggests poor hemodynamic reserve and a worse prognosis (30638984, 27800569, 27742425, 27107684, 25743032, 24973834, 23168283, 19649996, 18308025, 17804446, 12581684)Hypotension: Any of the following criteria would generally be defined as a massive PE:
Table of Contents - EMCrit Project SYSTEMS Cardiology Endocrinology Gastroenterology Hematology Oncology Infectious diseases Nephrology Neurology Obstetrics Pharmacology Pulmonology Rheumatology Toxicology Temperature Overview: Guide to supportive care in critical illness Medication reconciliation in the ICU About this book How to create your own IBCC smartphone app General Approaches to problems Cardiac arrest Cardio
Diagnosis of metabolic acid-base disorders AGMA introduction to the anion gap basic calculation interpretation of the anion gap Anion Gap (AG) = Na – Bicarb – Chloride; A normal anion gap is roughly 4-12 mM Historically, the normal range of anion gap was often quoted as being higher (e g up to ~16 mM) However, with newer electrolyte analyzers, the upper limit of normal has decreased to ~11-12 mM
Acetaminophen toxicity - EMCrit Project basics Acetaminophen doses above >10 grams or >200 mg kg (whichever is less) may be toxic However, this varies considerably between patients(29605069, 34053705) Ingestions >30 grams are classified as massive; this may require more aggressive therapy Peak absorption of immediate-release tablets usually occurs within 2-4 hours of ingestion
Alcohol withdrawal - EMCrit Project CONTENTS Rapid Reference Preamble disclaimer Diagnosis Alcohol withdrawal vs hepatic encephalopathy Therapeutic target (CIWA vs RASS) Treatment: Phenobarbital monotherapy Phenobarbital pharmacology Advantages of phenobarbital over benzodiazepines Contraindications to phenobarbital ️ Phenobarbital guideline Checking phenobarbital levels? ️ Pitfalls of phenobarbital Alternative agents
Diabetic Ketoacidosis (DKA) - EMCrit Project three ways to evaluate for ketoacidosis (#1) anion gap Anion Gap = (Na – Cl – Bicarbonate) Using this formula, an elevated anion gap is above 10-12 mEq L () Please don't correct for albumin, glucose, or potassium Don't make this unnecessarily complicated ; Anion gap may be elevated due to a variety of causes (with the differential diagnosis explored here)
Aortic dissection - EMCrit Project CONTENTS Epidemiology Symptoms Physical examination (including POCUS) Laboratory studies ECG Chest radiograph Clinical approach to the diagnosis [1] When to consider dissection [2] Dissection risk score [3] Further evaluation for score of 0-1 Radiologic approach Treatment Anti-impulse therapy The hypotensive dissection patient Surgery Prognosis Related topics Non-acute aortic dissection
Hyponatremia - EMCrit Project [1 5] non-hypotonic hyponatremia (serum osmolality >275 mOsm) causes of non-hypotonic hyponatremia Large amounts of other osmoles (translocational hyponatremia): (In this case, sodium is truly reduced The sodium reduction is due to other osmoles that pull water into the plasma – so the plasma tonicity is not low ) Severe hyperglycemia