Medical Archive

Chapter 11: Sudden Cardiac Death 

Chapter 12: Approach to Nontraumatic Shock 

Chapter 13: Approach to Traumatic Shock 

Hemorrhagic shock

• Control of external bleeding
  • Eg, compressive bandage, direct pressure, application of tourniquet
• Investigation
  • Eg, Fast for sources of internal hemorrhage that may require emergency surgery.
• Rapid resuscitation
  • Replacement of intravascular volume
    • Limit use of crystalloids to ~1L if patient is hypotensive
  • Transitioning from crystalloid to blood products ASAP.
  • Massive transfusion protocol
    • PRBC, platelets and FFP in a 1:1:1 ratio
    • To avoid coagulopathy from dilution of platelets and clotting factors.

Chapter 14: Allergy and Anaphylaxis 

Chapter 15: Acid-Base Disorders 

Chapter 16: Blood Gases, Pulse Oximetry, and Capnography 

Capnography

Goal ETCO2 level of 10-20mmHg.
Return of spontaneous circulation – denoted by a sudden increase in ETCO2

Chapter 17: Fluids and Electrolytes 

Aggressive crystalloid resuscitation

• Detrimental effects
  1. Coagulopathy
  2. Hypothermia
  3. Acidosis
     • Further worsen the performance of coagulation factors.

-> Increased mortality

Balanced resuscitation

• Limiting use of crystalloids (eg, ?1L), which dilute existing coagulation factors and platelets, thereby increasing coagulopathy
• Replacing lost intravascular volume with blood products, transfused in a ratio similar to that of whole blood (eg, 1:1:1 ratio of pRBCs/plasma/platelets)
• Permitting hypotension (ie, permissive hypotension) to limit ongoing hemorrhage and/or prevent clot disruption and rebleeding.

Chapter 18: Cardiac Rhythm Disturbances 

Tachycardia

• Algorithm
  • 100? ?? (?????? 150), ??? unstable?? ??. 
  • Shoke? ????? ECG ?? ? cardioversion
  • ? ? wide QRS (>0.12sec) ?? ??
  • narrow?? ventricle? ??? ???. A.fib, PSVT ?

A.fib	m/c	Multiple electrical wavelets
A.flutter	2nd	Re-entrant circuit (TV??)
A.tachy		Multiple atrial premature beat ? hypoxia, theophylline
Re-entry		AVNRT or AVRT

Treatment

• ?????? ????? ?? cardioversion
• ?? ??
  • NARROW : IV & ECG > vagal maneuver > adenosine/amiodarone > BB, CCB
  • WIDE      : Procainamide, lidocaine, Amiodarone, Sotalol

Chapter 19: Pharmacology of Antiarrhythmics and Antihypertensives

Antiarrhythmics

• Amiodarone (1st-line)
  • 300mg IV/IO bolus, then consider an additional 150mg IV/IO once
• Lidocaine (2nd-line)
  • 1~1.5mg/kg IV/IO first dose
  • Then 0.5~0.75mg/kg IV/IO at 5- to 10-minute intervals, to a maximum dose of 3mg/kg
• Magnesium sulfate (for TdP)
  • 1~2g IV/IO diluted in 10mL (eg, D5W, NS) given as IV/IO bolus, typically over 5-20 minutes.

Malignant hypertension

Presents with acute end-organ damage 
(e.g., acute renal failure, headache, and papilledema)

Hypertensive retinopathy

Grade III: ???? ??
Grade IV: + ????, ????

Treatment

• ????? ?????(2hr ? 160/110?? or ?25% of MAP), dissection, postop.? ? ??!
• Hypertensive endcephalopathy, stroke
  • Labetalol, Nitroprusside, Nicardipine
• Aortic dissection
  • Labetalol, Nitroprusside, Esmolol
• Pre~eclampsia
  • Labetalol, Nitroprusside, Nicardipine, Hydralazine
• Immediate onset
  • Nitroprusside, NTG, Diazoxide, Esmolol
  • Fenoldopam: short-acting, selective peripheral D1
• Delayed onset
  • Hydralazine, nicardipine, enalapril, labetalol

Chapter 20: Pharmacology of Vasopressors and Inotropes 

Chapter 21: Hyperbaric Oxygen Therapy