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128 Cards in this Set
- Front
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overall Strategy: write down the following so you find it quickly
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Differential Diagnosis:
Allergies: Counseling: |
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Then, follow this order for each case:
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1) ABC's: stable or not?
2) PE: focused unless pt has a general complaint 3) Labs/ Rad 4) Triage/Meds 5) Counsel/Follow-up appt |
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General Orders:everyone
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CBC/CMP/TSH
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General Orders: Females:
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β-HCG
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General Orders: Infection:
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CXR/UA/ Cultures/Tylenol
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General Orders: Cardiac:
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EKG / CXR/Echo /Cardiac enzymes
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General Orders: Pulmonary:
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ABG/EKG/CXR
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General Orders: GI:
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Guaiac
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General Orders:
Renal |
UA
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General Orders:Heme:
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Guaiac/PT / PTT /Type and match
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general orders Ob-Gyn:
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β-HCG / Pap/ Prolactin/ ABO, Rh
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Cellulitis
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Clindamycin + Ciprofloxacin
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Prostatitis
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Ciprofloxacin + Ampicillin + Gentamycin
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Urosepsis:
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Ciprofloxacin + Ceftriaxone
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Diverticulitis
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Metronidazol + Ciprofloxacin
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Appendicitis
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Metronidazole + Cefazolin
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Septic Arthritis:
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Azithromycin + Ceftriaxone
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perforated ulcer
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Metronidazole + Ampicillin + Gentamycin
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Cholecystitis:
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Cefuroxime
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Sickle Cell:
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Azithtomycin + Cefuroxime
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Community-Aquired Pneumonia
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Azithromycin + Ceftriaxone
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Bacterial Meningitis
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Vancomycin + Ceftriaxone
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Bacterial Endocarditis
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Vancomycin+ Gentamycin
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Pelvic Inflammatory Disease
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Doxycyclin + Cefoxitin
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Febrile Neutropenia
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Ceftazidime
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Emergency Room:
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1) Pulse ox/ Oxygen
2) IV access/NSS (0.9%NaCl) 3) Vitals/Continuous (BP /Cardiac) |
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Ward Admission:
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''NAD HIC"
1) NPO/Foley/Urine outputs 2) Activity 3) Discomfort Meds: Mepiridine/ Phenergan 4) Home meds 5) Interval PE/Hx 6) Consults |
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ICU Admission:
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1) Prophylaxis: Pantoprazole/ Pneumatic compression stockings
2) Interval PE/Hx 3) Send to ward -> then home |
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Discharge:
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1) D/C IV access, D/C all tubes
2) D/C IVF 3) Change all meds to PO 4) Diet: disease-specific 5) Follow-up appt: 2wk unless specified |
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Counseling (at the 5min warning):
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'X-RATED SEX"
X: safe seX Rx: medication compliance/side effects Alcohol: limit intake Tobacco: cessation Exercise: program Directives: advance Seat belt: when driving Eat: diet X: no illegal drugs |
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Preventative Medicine:
21 y / o: |
Cholesterol/Pap smear
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Preventative Medicine: 40 y/o:
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Glucose/Mammogram/Prostate exam
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Preventative Medicine: 50 y/ o:
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Colonoscopy
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Preventative Medicine: 65 y/o:
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TSH/Female Pelvic exam
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ALZHEIMER'S:
Labs: (4) Tests: |
Labs: TSH, Vit B12, Folate, UA
Tests: Head CT |
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ALZHEIMER'S:
(tx Alzheimer's) (tx delusions (tx anxiety) (tx depression) (tx insomnia) |
Donepezil (tx Alzheimer's)
• Olanzapine (tx delusions) • Buspirone (tx anxiety) • Fluoxetine (tx depression) • Triazolam (tx insomnia) |
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ALZHEIMER'S:
Location: Counsel: Follow-up: |
Location: Office
Counsel: No driving, Advance directives Follow-up: 2mo |
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BACTERIAL MENINGITIS:
Labs: CSF: Tests: |
BACTERIAL MENINGITIS:
Labs: Blood C&S, UA/C&S, PT / PTT CSF: Cells/Glucose/Protein/C&S + fungal/Gram/Meningococcal Ag Tests: EKG, LP |
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BACTERIAL MENINGITIS:
Rx Contact Prophylaxis Consult: Location: |
Rx Acetaminophen (rectal), Dexamethasone -> Vancomycin/Ceftriaxone
Contact Prophylaxis: Rifampin or Ciprofloxacin Consult: ID Location: Ward (isolation) |
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SUBARACHNOID HEMORRHAGE
Labs: Tests: |
"worst HA of my life"
Labs: ESR, PT / PTT Tests: EKG, Head CT (no contrast), Angiography (cerebral arteries) |
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SUBARACHNOID HEMORRHAGE Rx: tx pain, prevent vasospasm, prevent seizures, if HTN
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Ketorolac (tx pain), Nimodipine (prevent vasospasm), Phenytoin (prevent seizures), Labetalol (if HTN)
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SUBARACHNOID HEMORRHAGE: Consult, Location and management
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Consult: Neurosurgery, Location: ICU (Neurochecks q1hr)
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TRANSIENT ISCHEMIC ATTACK: Labs and Tests
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Labs: PT / PTT, Lipid profile, Tests: EKG /Echo, CXR, Head CT (no contrast), Carotid Doppler
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TRANSIENT ISCHEMIC ATTACK: Rx, Consult and when is an endarterectomy done?, Location
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Rx: ASA, Pneumatic compression stockings, Consult: Vascular Surgery (for carotid endarterectomy if 70-99% stenosis), Location: Ward
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ALCOHOL WITHDRAWAL: Labs and Tests:
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Labs: ABG, EtOH/Urine tox, Blood C&S/UA, Mg/Phos /Glucometer, PT / PTT, Tests: EKG, CXR, Head CT
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ALCOHOL WITHDRAWAL:
Rx: Location: |
Rx: NG tube suction, Thiamine -> Dextrose 50%, Folate, Lorazepam
Location: ICU |
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DEPRESSION: Labs, Tests, Rx
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Labs: TSH, Vit B12, Folate, Tests: EKG, Rx: Fluoxetine, Suicide contract
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DEPRESSION:
Consult Location: Follow-up: |
Consult Psychiatry
Location: Office Follow-up: 6wk |
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NARCOTIC OVERDOSE: Labs, Tests:
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Labs: ABG, Cardiac enzymes, EtOH/Urine tox/ Acetaminophen, Blood C&S/UA, Mg/Phos/Glucometer, PT/PTT, Tests: EKG, CXR, Head CT
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NARCOTIC OVERDOSE: Rx, Location
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Rx: NG tube suction, Naloxone, Thiamine -> Dextrose 50%, Charcoal (Gastric lavage if needed), Location: ICU
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PANIC ATTACK:
Sx Labs: Tests: |
palpitations, chest pain, dyspnea
Labs: TSH, β-HCG, UA/ Urine tox, Glucometer Tests: EKG, CXR |
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PANIC ATTACK:
Rx: Location: |
Rx: Alprazolam + Fluoxetine
Location: Office |
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AORTIC DISSECTION:
Sx: #1 Tests: |
Sx: sudden severe abdominal/pain radiating to back
#1IVF Tests: US (abdomen) if stable |
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AORTIC DISSECTION:
Rx: Labs: |
Rx: Vascular Surgery Consult (stat, for AAA repair)
Labs: Type x cross, PT /PIT |
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AORTIC DISSECTION:
Pre-op: Location: |
Pre-op: Analgesia, Consent, NPO?Foley, UA/ CXR (portable), CBC/CMP, EKG
Location: ER -> OR |
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ATRIAL FIBRILLATION:
Labs: Tests: |
Labs: Cardiac enzymes, TSH/Free T4, UA, PT /PTT
Tests: EKG, CXR (FA/Lateral), Echo |
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ATRIAL FIBRILLATION:
Rx: Location: |
Rx: Cardizem, Metoprolol (if HR >120), Heparin/Plt/Guaiac
Location: ward |
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CHF EXACERBATION:
Labs Tests |
Labs: cardiac enzymes
Tests: EKG,-CXR, Echo, Daily weights |
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CHF EXACERBATION:
Rx: Location: |
Rx: ASA,β-blocker, Cholesterol drug, Digoxin, Enalapril, Furosemide/K.Cl ''ABCDEF"
Location: ward |
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COMPLETE HEART BLOCK:
Sx: Labs: Tests: |
Sx: can occur secondary to trauma
Labs: cardiac enzymes, PT /PTT Tests: EKG, portable CXR, Echo |
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COMPLETE HEART BLOCK:
Rx: Consult: Location: |
Rx: Atropine. (stat),Pacemaker (temp transcutaneous)
Consult: Cardiology Location: ER -> Cardiac Cath lab |
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HYPERTENSION:
Labs: test: |
Labs: TSH, UA, Lipid profile
Tests: EKG |
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HYPERTENSION:
Rx: Location: |
Rx: ⇧Fiber/ ⇩Na Diet, Exercise, Meds as appropriate.
Location: Office |
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HYPERTENSIVE EMERGENCY:
Sx: #1: Labs: T |
Sx: diastole > 120
#1: Head CT (⇧ICP or Stroke) Labs: UA, PT /PTT |
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HYPERTENSIVE EMERGENCY:
Tests: Rx: |
Tests: EKG, CXR
Rx: Arterial line, Nitroprusside -> Metoprolol |
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HYPERTENSIVE EMERGENCY:
Follow-up (1 wk): Location: |
Follow-up (1 wk): Lipid profile
Location: ICU |
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INFECTIVE ENDOCARDITIS:
Sx: Labs: Tests: |
Sx: splinter hemorrhages, painfulfinger nodes
Labs: Blood C&S, UA/C&S/Urine tox, PT /PTT Tests: EKG, CXR, Echo |
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INFECTIVE ENDOCARDITIS:
Rx: Location: Follow-up (1 wk): |
Rx: IVF /Central line, Vancomycin+ Gentamycin, Acetaminophen
Location: Ward Follow-up (1 wk): Hepatitis panel, HIV |
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MYOCARDIAL INFARCTION:
ST Labs: Tests: |
ST elevation
Labs: Cardiac enzymes q8hr x 3, Lipid profile, LFT Tests: EKG, CXR |
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MYOCARDIAL INFARCTION:
Rx: Discharge meds: |
Rx: 02, ASA, Metoprolol, Nitroglycerin, Heparin/Plt/Guaiac,"Morphine
Discharge meds: ASA + Metoprolol + Atorvastatin |
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MYOCARDIAL INFARCTION:
Follow-up: Location: |
Follow-up: cardiac Cath (if not improving), Cardiology Consult, Stress test
Location: ward |
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CROHN'S:
Labs: Tests: |
Labs: Stool: culture/O&P
Tests: Guaiac |
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CROHN'S:
Rx: Location: |
Rx: Colonoscopy, Biopsy (small intestine), GI consult, Mesalamine
Location: Office |
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DIVERTICULITIS:
Sx: Labs: |
Sx: RUQ pain
Labs: Amylase/Lipase, Blood culture, UA/C&S Stool: WBC/Cultute/O&P |
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DIVERTICULITIS:
Tests: Rx: |
Tests: EKG, Guaiac, X-ray (abdomen), CT (abdomen)
Rx: Acetaminophen (rectal), Ciprofloxacin/Metronidazole, GI consult |
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DIVERTICULITIS:
Location: Follow-up (4wk): |
Location: Ward
Follow-up (4wk): Colonoscopy |
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DIVERTICULOSIS:
Sx: Labs: |
Sx: bloody stool
Labs: Type x cross, PT/ PTT, H/H q6h |
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DIVERTICULOSIS:
Tests: Rx: |
Tests: Postural vitals (stat), Guaiac, EKG, Anoscopy
Rx: NG, NPO, Polyethylene Glycol, Colonoscopy (GI consult) |
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DIVERTICULOSIS:
Location: Follow-up (1 wk): |
Location: Ward
Follow-up (1 wk): high fiber diet, check H/H |
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DUODENAL ULCER (acute)
Sx: Labs: |
Sx: vomit blood. black stool
Labs: PT /PTT, Type x match, H/H q6h |
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DUODENAL ULCER (acute)
Tests: Rx: |
Tests: EKG, EGD, Biopsy (gastric), GI consult
Rx: NG, Gastric Lavage, Pantoprazole |
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DUODENAL ULCER (acute)
Location: Follow-up (2wk): |
Location: ICU
Follow-up (2wk): check H/H |
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DUODENAL ULCER (chronic)
Sx: Labs: |
Sx: weakness, SOB
Labs: β-HCG, Fe/Ferritin/TIBC, UA, Type x cross, PT /PTT, H. pylori Ab, Amylase /Lipase |
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DUODENAL ULCER (chronic)
Tests: Rx: |
Tests: Guaiac, CXR, EGD, Biopsy (gastric), GI consult
Rx: Fe/Vit C, Omeprazole + Clarithromycin + Amoxicillin (if H. pylori+) |
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DUODENAL ULCER (chronic)
Location: Ward Follow-up (2wk): |
Location: Ward
Follow-up (2wk): Urea breath test |
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DUODENAL ULCER
Sx: (perforated): Labs: |
Sx: (perforated): free air under diaphragm
Labs: Amylase/Lipase, Type x cross, PT /PTT |
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DUODENAL ULCER
Tests: Rx: |
Tests: EKG, X-ray (abdomen)
Rx: NG, Ranitidine, Ampicillin+ Gentamycin + Metronidazole |
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DUODENAL ULCER
Pre-op: Location: |
Pre-op: Surgery consult (stat), Analgesia, Consent, NPO, CXR/UA
Location: ICU |
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GASTROENTERITIS:
Rx: Location: |
Rx: 02, ASA, Heparin/Ph/Guaiac, warfarin/INR/β-HCG
Location: ICU |
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SINUSITIS:
Rx: Location: |
Rx: Humidified air, Acetaminophen, Pseudoephedrine, Amoxicillin
Location: Office |
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TENSION PNEUMOTHORAX:
Sx: Rx: |
Sx: decreased breath sounds, hypotension
Rx: Needle thoracostomy (stat) ~>chest tube~>CXR Labs: ABG Tests: EKG, repeat CXR qam Location: Ward |
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TENSION PNEUMOTHORAX:
Labs: Tests: Location: |
Labs: ABG
Tests: EKG, repeat CXR qam Location: Ward |
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APPENDICITIS:
Labs: Tests: |
Labs: ABG, β-HCG, Amylase/Lipase, PT/PIT
Tests: Guaiac, X-ray (abd), CT (abd) for adults, or US (abd) for kids |
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APPENDICITIS:
Rx: Pre-op: Location: |
Rx: morphine, Cefazolin + Metronidazole, Appendectomy (Surgery consult)
Pre-op: Analgesia,Consent, NPO, Type x cross, CXR/UA Location: Ward |
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CHOLECYSTITIS:
Labs: Tests: Rx: |
Labs: β-HCG, Amylase/Lipase. PT /PIT
Tests: X-ray (abdomen), US (abdomen) Rx: NG tube, Demerol, Cefuroxime (Surgery consult) |
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CHOLECYSTITIS:
Rx: Pre-op: Location: |
Rx: NG tube, Demerol, Cefuroxime (Surgery consult)
Pre-op: Analgesia, Consent, NPO, IVF, Type x cross, CXR/UA Location: Ward |
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COLON CANCER:
Labs: Tests: |
Labs: TSH, CEA
Tests: Guaiac, X-ray (abdomen), CT (abdomen) |
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COLON CANCER:
Rx: Location: Follow-up (2wk): |
Rx: Fe sulfate, Docusate, Surgery consult/Oncology consult
Location: Office Follow-up (2wk): Colonoscopy (GI consult |
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CONSTIPATION:
Labs: Tests: |
Labs: TSH, Mg/Phos
Tests: EKG, Guaiac, X-ray (abd) |
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CONSTIPATION:
Rx: Location: |
Rx: High fiber diet, Docusate, Metamucil
Location: Office |
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CONSTIPATION:
Follow-up: |
Follow-up: NPO, Polyethylene Glycol Colonoscopy w/ consent (if symptomatic)
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CROUP:
Sx: Labs: Tests: |
Sx: barking cough
Labs: CBC Tests: Neck x-ray |
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CROUP:
Rx: Location: |
Rx: Cool mist ~> Dexamethasone (IM) ~> Epinephrine (inhaled)
Location: ER (observe for 4hr) |
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CYSTIC FIBROSIS:
Labs: Tests: |
Labs: Sweat Cl> 60, Fecal fat, Blood C&S, Sputum: Gram/C&S
Tests: CXR, Sinus x-ray |
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CYSTIC FIBROSIS:
Rx: Location: |
Rx: D5N5, Albuterol, N-acetylcysteine, Tobramycin + Piperacillin, Chest PT
Discharge: Pancreatic enzymes, Influenza/Pneumococcal vaccinations Location: Ward |
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LUNG CANCER:
Labs: Tests: Mets: |
Labs: ABG/PFT, Blood C&S, Sputum: Gram/C&S/Cytology
Tests: EKG, CXR (FA/Lateral), spiral CT (chest) Mets: Ca/ AlkPhos, CT (A/P), Brain MRI, Bone Scan |
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LUNG CANCER:
Rx: (2) |
Rx: Bronchoscopy/Biopsy lung, Branch: Cytology/Gram/C&S+Fungal/AFB
Rx: Albuterol/Iprattopium, Levofloxacin · |
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LUNG CANCER:
Consults: Pulmonary, Oncology Location: Ward |
Consults: Pulmonary, Oncology
Location: Ward |
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PLEURAL EFFUSION:
Sx: Labs: |
Sx: x-ray blunting of costophrenic angles
Labs: Cr/LDH/Protein, PT /PTT |
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PLEURAL EFFUSION:
Pleural Fluid: Tests: |
Pleural Fluid: pH/LDH/Protein/Glucose/Grarn/Cells/Cytology/C&S/ AFB
Tests: EKG, CXR (FA/Lateral/Decubitus) |
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PLEURAL EFFUSION:
Rx: Location: |
Rx: Thoracentesis (Pulmonary consult)
Location: Ward |
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PNEUMONIA:
Sx: Labs: Sputum: |
Sx: may present with RUQ pain
Labs: ABG, Blood ex, Urine ex, Sputum: Gram/C&S |
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PNEUMONIA:
Rx: |
Rx:
• Community Acquired: Azithromycin ( + Ceftriaxone if dyspnea) • Nosocomial: Piperacillin + Tazobactim • Aspiration: Clindamycin • Group B Strep: Ampicillin + Cefotaxime • Atypicals (Chlamydia/Mycoplasma/Legionella): Erythromycin |
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PNEUMONIA:
Tests: Location: |
Tests: EKG, CXR (FA/Lateral)
Location: Ward |
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PULMONARY EMBOLUS:
Labs: Tests: |
Labs: ABG, D-dimer, Cardiac enzymes, PT /PTT
Tests: EKG, CXR (PA), V /Q scan |
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PERICARDIAL TAMPONADE:
Sx: Rx: |
Sx: hypotention, muffled heart, ⇧ JVD
Rx: Pericarcliocentesis (stat), CT Surgery consult, Swan-Ganz catheter |
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PERICARDIAL TAMPONADE
Labs: Tests: Location: |
Labs: ABG, Pericardial fluid: cell count
Tests: EKG, CXR, Echo Location: ICU |
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PERICARDITIS:
Sx: Labs: Tests: |
Sx: worse w/ inspiration and leaning forward
Labs: Cardiac enzymes, Blood C&S, ESR Tests: EKG, CXR, Echo, Pulse ox, ABC |
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PERICARDITIS:
Rx: Location: |
Rx: 02, ASA, Pericardiocentesis (if febrile)
Location: Ward |
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UNSTABLE ANGINA:
Sx: Labs: |
Sx: chest pain at rest, ST depression
Labs: Cardiac enzymes, Lipid profile, PT /PTT |
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UNSTABLE ANGINA:
Rx: Tests: |
Rx: ASA, NGN, Metoprolol,02, Heparin/Pit/Guaiac, Morphine
Tests: EKG, CXR, Echo |
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UNSTABLE ANGINA:
Location: Follow-up |
Location: ICU
Follow-up (4wk): Stress test, Angiography (coronary) |
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ASTHMA EXACERBATION:
Labs: Tests: |
Labs: ABG, FEV/PEFR (peak expiratory flow rate)
Tests: EKG, CXR |
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ASTHMA EXACERBATION:
Rx: Location: Discharge: |
Rx: Albuterol, methyprednisolone ~> Ipratropium
Location: Ward Discharge: Beclomethasone (inhaled) |
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BRONCHIOLITIS:
Labs: Tests: Rx: |
Labs: ABG, RSV Antigen
Tests: CXR Rx: Albuterol, Humidified air, Suction airway, Chest PT, Ribavirin (if resp failure) |
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BRONCHIOLITIS:
Location: Follow-up: |
Location: Ward (isolation)
Follow-up: 24hr |
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COPD EXACERBATION:
Labs: Tests: Rx: |
Labs: ABG, PEFR/FEV1
Tests: EKG, CXR Rx: 02, Albuterol, Ipratropium, Prednisone, Levofloxacin |
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COPD EXACERBATION:
Location: Follow-up: |
Location: Ward
Follow-up: Influenza/Pneumococcal vaccinations, Home 02 (if p02<55) |
