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Pulmonary Embolism Three types of pulmonary embolism “Massive” Hypotension or severe bradycardia Treat with tPA or thrombectomy “Submassive” Normotensive but with Right Heart Strain S1Q3T3 on EKG Elevated BNP Elevated troponin Dilation of RV on ultrasound Treat with heparin/lovenox and admit “Low Risk” Treat with anticoagulation Outpatient vs inpatient treatment Testing CTA of the Chest […]

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Acute Mesenteric Ischemia History of atrial fibrillation “Pain out of proportion to exam” Bowel Obstruction History Abdominal pain Bloating/Distention Vomiting Decrease stool/flatus Exam Abdominal tenderness and distention If guarding/rigidity/rebound tenderness (aka peritonitis) Consider perforated bowel Testing Obtain CT abdomen with IV contrast Treatment Fluids NPO NG Tube Acute Diverticulitis NOTE: DiverticulOSIS is what causes GI […]

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Hernia 3 classifications for hernia Reducible Able to be reduced (placed back into the abdomen) at bedside Incarcerated Cannot be reduced but not severely tender or erythematous Can occasionally cause bowel obstructions Strangulated Cannot be reduced but LOSING BLOOD SUPPLY Extremely tender and abnormal exam Needs emergent surgical consult Esophageal Varices Classic presentation Hematemesis/Melena Chronic […]

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“Unstable” Arrhythmias Arrhythmias that cause Hypotension Pulmonary Edema Chest Pain Altered Mental Status Supraventricular Tachycardia (SVT) Stable Vagal maneuver Adenosine Beta blocker or calcium channel blocker Unstable SYNCHRONIZED cardioversion Monomorphic Ventricular Tachycardia (VT) Stable Amiodarone Procainamide Lidocaine Unstable SYNCHRONIZED cardioversion Pulseless Defibrillation Polymorphic Ventricular Tachycardia (aka Torsades de Pointes) Known complication of prolonged QTc Side […]