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102 3. Calculate anion gap by Na- Cl- HCO3 (nl 8-12; if albumin is low reduce normal range by 2-3 for each 1 gm reduction of albumin below normal): Causes of AGMA: KUSMALE (ketones, uremia, salicylates, methanol, paraldehyde, lactic acidosis, or ethylene glycol) or GOLDMARK-paper submitted by Mehta et al (glycols, oxyproline, L-lactate, D-lactate, Methanol, Aspirin, Renal, Ketoacidosis) If anion gap, consider the following: urine and serum ketones, renal function, lactate, Utox, plasma osmolal gap. Osmolal gap: “Delta Osmoles” =measured plasma osmolality - calculated osmolality Calculated osmolality = (2xNa)+(glucose/18)+(BUN/2.8) Osmolal gap >15 suggests methanol or ethylene glycol If anion gap is decreased, you should suspect a decreased albumin or disorders that increase “unmeasured” cations such as multiple myeloma, extreme hypercalcemia, hypermagnesemia, lithium. 4. If there is a high anion gap, then calculate how much it is increased above the normal range (ie, Anion Gap Increase = observed anion gap-expected anion gap (8 - 12 if albumin is normal) Increase in Gap + measured HCO3 should = about 24 (The gap should go up about the same amount the HCO3 goes down) • If this is >24 consider concomitant metabolic alkalosis or severe chronic respiratory acidosis • If this is
103 ACUTE KIDNEY INJURY Acute Kidney Injury Network (AKIN) definition of AKI: (Have offered a modification/update of RIFLE) The proposed diagnostic criteria are an abrupt (within 48 hours): • Absolute increase in the serum creatinine concentration of ≥0.3 mg/dL from baseline, or • A percentage increase in the serum creatinine concentration of ≥50 percent, • Or oliguria of less than 0.5 mL/kg per hour for more than six hours. The diagnostic criteria should be applied only after volume status has been optimized and urinary tract obstruction has been ruled out if oliguria was used as the sole diagnostic criterion. The Acute Kidney Injury Network also includes a staging system that correlates to the RIFLE criteria. Stage 1 (risk), stage 2 (injury), and stage 3 (failure) are included and loss and ESRD are considered outcomes. RIFLE criteria proposed by the Acute Dialysis Quality Initiative (ADQI): • Risk — 1.5-fold increase in the serum creatinine or GFR decrease by 25 percent or urine output
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BUMC BASICS
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• Status Epilepticus • Stroke m
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5 Welcome to Baylor University Medi
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7 Rounding on your patients: • Se
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9 2. gloves only. During codes, if
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11 • There is one resident and 3
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Chest pain 13 DDx to consider • M
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SOB DDx • Pneumonia • PE • An
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17 • Heparin • Lidocaine • Ni
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19 TPC (cont’d) Pager Cell Phone
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21 Gen Surgery Neurologists Urgent
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23 OBTAINING A CONSULT AT BAYLOR Ob
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25 • Enter 2 initial zeros and th
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27 • Albuterol/Atrovent nebulizer
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29 CARDIOLOGY CCU IN GENERAL You ar
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31 Unstable Angina/NSTEMI • Can u
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33 Post PCI Complications — In yo
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35 function, elevated troponin T is
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37 **0-1 point non-cardiogenic, 2 p
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39 • Erythromycin • Phenothiazi
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41 Therapy — Therapy is guided by
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43 Nitroglycerine (Onset in 2-5 min
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45 Treatment: • Vasovagal: Recogn
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47 GI/HEPATOLOGY GI CONSULTS AND GR
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49 hepatitis, obesity), then they p
Page 51 and 52: 51 timing and necessity of ERCP for
Page 53 and 54: 53 the liver transplant ICU) where
Page 55 and 56: 55 GI bleeding (**See above under G
Page 57 and 58: 57 • Barium Enema (clear liquids
Page 59 and 60: 59 Pseudomonas: • Piperacillin/Ta
Page 61 and 62: 61 • Neoplasm: Lymphoma, leukemia
Page 63 and 64: 63 mortality. It lowers mortality i
Page 65 and 66: Pneumonia (immunocompromised) (cont
Page 67 and 68: 67 BRAIN DEATH EXAM • Can order b
Page 69 and 70: 69 SEIZURES Can use BZD ativan IV o
Page 71 and 72: 71 3. Stop anticoagulants and rever
Page 73 and 74: 73 ONCOLOGY THE ACUTE LEUKEMIC “T
Page 75 and 76: Timeline*: 75 Day 0 (admit) — Bon
Page 77 and 78: 77 PALLIATIVE CARE AND CLINICAL ETH
Page 79 and 80: 79 release oxycodone, and hydromorp
Page 81 and 82: 81 • Institutional Ethics and Pal
Page 83 and 84: 83 PULMONARY ARDS Definition: Need
Page 85 and 86: 85 MECHANICAL VENITALTION Oxygen su
Page 87 and 88: 87 • Ineffective respiratory effo
Page 89 and 90: 89 - Daily sedation vacations at 07
Page 91 and 92: 91 • After 1 wk of intubation det
Page 93 and 94: 93 - Sustained changes in the heart
Page 95 and 96: 95 PULMONARY EMBOLUS (PE) Evaluatin
Page 97 and 98: 97 RADIOLOGY RADIOLOGY HINTS IF YOU
Page 99 and 100: Superficial Abscess/Mass Abscess/Ma
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Page 107 and 108: 107 CHRONIC KIDNEY DISEASE Stage GF
Page 109 and 110: Hypovolemic Hyponatremia EABV low R
Page 111 and 112: 111 fluid pulled off and into the p
Page 113 and 114: 113 Colorectal Surgery, and Plastic
Page 115 and 116: 115 • Social work: Circle Social
Page 117 and 118: Ear Health Antipyrine/Benzocaine ot
Page 119 and 120: Magnesium Oxide 400mg tab Prenatal
Page 121 and 122: 121 DUEWALL’S FAVORITE MNEMONICS
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