WISER Exam

blood transfusion reaction

• sx

  • chills

  • fever

  • dizziness

  • CP

  • flank/back pain (from hemolyzation)

• stop infusion, call MD, tylenol benadryl, labs (see if blood is hemolyzing, send blood and tubing back, give fluids, collect urine (hematuria)

• stay close to patient within 15 misn of admin

• VS + temp right before and 15 mins after infusion and immediately once infusion is done

• premedicate before regiving if correct blood

symptomatic bradycardia

• sx

  • unresponsive

  • hypotensive

• atropine

  • 3mg max

  • FIRST LINE DRUG FOR BRADYCARDIA

  • if it doesn’t work 

    • epi (IVP), dopamine (DRIP), pacing

• 12-lead, troponin, lytes (hyperkalemia causes bradycardia)

SVT

• sx

  • excessive pumping in chest, neck, jaw

• stable vs unstable

  • can we give meds?

  • on a MS floor (unstable bc not as many resources)

• vagal response pre-hospital

• adenosine

  • 6 or 12 mg

  • FIRST LINE IN SVT

  • push fast, raise arm

    • short half life

  • chemically stops heart to put into NSR (sometimes arrhythmias)

• versed and cardiovert if unresponsive to adenosine

asthma → ARDS

• support breathing

  • albuterol

    • B2 agonist (nonselective)

      • tingly feeling is normal because it is agonizing B1

  • solumedrol

    • fights inflammatory response that causes bronchoconstriction in asthma

• speech can be measure of progression

  • if using words → cannot talk → worsening and not moving air (opposite means they are getting better)

  • wheezing → no LS → no air movement

• CXR, labs, swabs

• respiratory acidosis d/t mechanical failure because not breathing off CO2

STEMI + Arrest

• ST elevation = immediate intervention

• sx

  • generalized epigastric pain, (ALWAYS THINK CARDIAC)

  • CP that radiates

  • Females and diabetics have atypical symptoms

    • nausea, SOB, gastric sx

• MONA

  • morphine → pain relief (doesnt affect BP so much as RR)

  • O2 → increase coronary artery perfusion

  • Nitro → vasodilate (alwasy ask if taking PDIs)

  • ASA → antiplatelets (buys time to prevent full blockage)

    • need to know if already taken

• Hs&Ts

  • thrombus in the heart

• EPI FIRST LINE IF PULSELESS

PCA OD

• sx

  • hypotensive

  • hypoventilation

  • hypercapnic

• DC PCA pump and Bag patient

  • have doctor rewrite pain orders

• Narcan until reversed

• Cause

  • overmedicated, underreversal, medication naive

Adrenal crisis

• sx

  • low energy

  • achy joints

  • hypoglycemia

  • hyponatremia

  • can progress to coma and death

• MED RECONCILLIATION IMPORTANT

• HYDROCORTISONE STAT

• need to taper off steroids

  • takign steroids can inhibit natural processes by adrenal glands to physiologically produce cortisol

• cortisol

  • stress management (physiological, psychological)

• 5 Ss

  • Steroids

    • hydrocortisone

  • decreased Sugar

    • D5NS

  • decreased Sodium

  • Support

    • antiemetics, hydration, analgesics

  • Search for cause

    • flu, infection, primary endocrine problem

MI → Vtach → Vfib

• 3 things

  • CPR (ALWAYS FIRST), Defibrillation, epi

    • Defib vs Amio depends on what’s readily available

• EPI FIRST LINE FOR PULSELESS ARRHYTHMIAS

• AMIODARONE FIRST LINE IN VTACH

• cardiovert with midazolam for VTACH

  • with a pulse

hypoglycemia

• sx

  • unresponsive

  • diaphoretic

  • shaking

  • tachycardic

• amp of D50 → recheck sugar in 15 mins → continue with hypoglycemia protocol and update doctor

• must call rapid if not a patient because they are not under the medicine service

• can recommend seeing a doctor, but are allowed to refuse

• Oral DM meds - glipizides are more dependent on taking with food

anaphylaxis from abx

• sx

  • rash at IV site

  • cannto speak

  • angioedema

    • swelling tongue, eyes, lips (go numb too)

• IM Epi and Benadryl (upper thigh)

  • IM Epi works on the upper airway

  • Benadryl is pure H1

  • Sometimes Pepcid can help (H2 antagonist) because it has a longer half-life

• Always watch for a reaction when starting a new med

• Benadryl or Solumedrol required if needing a second epi dose

• life-threatening form of shock