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ABI Ranges
- 0.9 to 1.3 is NORMAL
- 0.89 to 0.6 is MILD PAD
- 0.59 to 0.4 is MODERATE PAD
- < 0.39 is SEVERE PAD
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DTR Ranges
- 4+ - very brisk, hyperactive
- 3+ - brisker than average
- 2+ - average or NORMAL
- 1+ - diminished, but low normal
- 0 - No response
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Pluse Grading
- 3+ Bounding
- 2+ Brisk, NORMAL
- 1+ Diminished
- 0 Absent
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Murmur Grading
- Grade 1 -very faint
- Grade 2 -quiet but heard immediately with stethoscope
- Grade 3 -moderatedly loud
- Grade 4 -loud with PALPABLE THRILL
- Grade 5 -very loud with PALPABLE THRILL
- Grade 6 -very loud with PALPABLE THRILL and an be heard without stethoscope
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Muscle Strength Grading
0 -No muscle contraction detected
1 -a barely detectable flicker or trace of contraction
2 -active movement ob boy part with GRAVITY ELMINATION
3 -active movement AGAINST GRAVITY
4 -active movement AGAINST GRAVITY with SOME RESISTANCE
5 -active movement against FULL RESISTANCE: NORMAL muscle strength
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Metabolic Syndrome
Abdominal Obesity: male waist circumference >102cm; female waist circumference > 88cm
Triglycerides: greater than or equal to 150mg
HDL: Male < 40; Female < 50
BP: greater than or equal to 130/85
Fasting Glucose: >110
bates p. 344
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JNC 7 BP Assessment
Normal: <120/80
Pre-HTN: SBP 120-139; DBP 80-89
Stage 1 HTN: SBP 140-159; DBP 90-99
Stage 2 HTN: SBP > 160; DBP >100
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Heart Rate: Birth to 1 year
- Birth 0-2 months Avg: 140; Range: 90-190
- 0-6 months Avg: 130; Range: 80-180
- 6-12 months Avg: 115; Range: 75-155
p. 758 bates
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Gestation Time
- Preterm: < 37 weeks
- Term: 37-42 weeks
- Post-term: > 42 weeks
Bates
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Birth Weight
- Etremely Low Birth Weight - < 1000g
- Very Low Birth Weight - < 1500g
- Low Birth Weight - < 2500g
- Normal Birth Weight - > or = 2500g
bates
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1 min APGAR SCORE
- 8-10 normal
- 5-7 some nervous system depression
- 0-4 severe depression requiring immediate resuscitation
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5 min APGAR SOCRE
- 8-10 normal
- 0-7 high risk for subsequent central nervous system and other organ system dysfunction
bates
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Miliaria Rubra
scattered vesicles on an erythematous base, usually on the face and trunk, result from obstruction of the sweat gland ducts; this condition disappears spontaneously within weeks
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Erythema toxicum
Usually appearing on days 2 to 3 of life, this rash consists of erythematous macules with central pinpoint vesicles scattered diffusely over the entire body. They appear similar to flea bites. These lesions are of unknown etiology but disappear within 1 week of birth
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Pustular melanosis
sceen more commonly in black infants, the rash presents at birth as small vesiculopustules over a brown macular base; these can last for several months
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Milia
Pinhead sized smooth white raised areas without surrounding erthema on the nose, chin, and forehead result from retention of sebum in the openings of the sebaceous glands. Although occasionally present at birth, milia usually appears within the first few weeks and disappears over several weeks
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First drug for most forms of stable narrow-complex SVT. Effective in terminating those due to reentry involving AV node or sinus node.
May consider this drug for unstable narrow-complex reentry tachycardia while preparations are made for cardioersion.
This drug does not conert A.Fib, A. Flutter, or VT
- Adenosine
- Dose:
- 1. Place patient in mild reverse trendelenberg position before aministration of this drug
- 2. initial bolus of 6mg given rapidly over 1 to 3 seconds followed by NS flush (20ml) then elevate arm
- 3. a second dose of 12mg can be given in 1 to 2 mins if needed. remember to flush and elevate
- p. 165 ALS Book
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Because this drug is associated with toxicity, it is indicated for use in patients with life-threatening arrhythmias when administered with appropriate monitoring:
-VF/pulselss VT unpresonsive to shock delivery. CPR, and a vasopressor
-Recurrent, hemodynamically unstable VT
- Amiodarone
- First Dose = 300mg IV/IO
- Second Dose = 150mg IV/IO
p. 165 ACLS Book
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First drug for symptomatic sinus bradycardia.
what is the dosage?
Atropine
Dose: 0.5 mg IV every 3 to 5 mins as needed not to exceed 3mg
p.166 ACLS Book
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second-line drug for symptomatic sinus bradycardia
Dopamine
p.166 ACLS Book
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first line drug during cardiac arrest: VF, pulseless VT, asystole, PEA
Dose?
Epinephrine
- Dose: 1mg (10ml of 1: 10,000 solution) administered every 3 to 5 mins during resuscitation
- Follow each dose with NS flush and raise arm
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Alternative to amiodarone in cadiac arrest from VF/VT
Dose?
Lidocaine
Dose: 1 to 1.5mg/kg IV/IO
p. 167 ACLS Book
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May be used as alternative pressor to epinepherine in treatment of adult shock-refractory VF
Dose?
Vasopressin
Dose: One dose of 40 units IV/IO push may replace either first or second dose of epi.
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What are the treatable causes that you should remember when evaluating a pt during ACLS? (H's and T's)
- Hypoxia
- Hypovolemia
- Hypothermia
- Hypo/Hyperkalemia
- Hydrogen Ions
- (Consider Hypomagnesemia -alcoholics, eating d/o's, chemo)
- Toxins (Beta blockers- give glucagon and dextrose, CCB- give glucagon and dextrose and calcium chloride)
- Tension Pneumo
- Tamponade
- Thrombosis (PE)
- Thrombosis (ACS)
- Trauma
ACLS handout
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Describe and Treat MILD Anaphylaxis
Urticaria, Rhinitis, Conjunctivitis, Mild Bronchospasm
- Treat:
- Epi 1:1000 give 0.3cc SC (may repeat every 5-20 mins)
- Benadryl 25-50mg PO or IM
Consider giving cimetadine or ranitdine, or prednisone, inhaled beta agonist
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Describe and Treat MODERATE anaphylaxis
Angioedema or hypotension with BP > 80 mm Hg
- IV, O2, Monitor
- Epi Sc or IM
- Benadryl 25-50mg IM or IV
- Cimetidine 300 mg IV
- Solu-Medrol 40-125mg IV
- Consider Local Measures
- loose tourniquet proximal to antigenic site -remove 1 min every 10 mins
- dependent position of extremity
- ice to site for 15 mins at a time and repeat every 30 mins
- local infiltration of epi
- get the stinger out!
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Describe and Treat SEVERE anaphylaxis
- Laryngeal edema, Re
- spiratory Failure, Shock
Epi 1cc of 1:10,000 IV over 5 mins, repeat every 3-5 mins prn (smae as ACLS)
Benadryl 50-100mg IV push over 3 mins
Oxygen
Crystalloid WIDE OPEN IV
Cimetidine or Ranitidine
Solu-Medrol or Hydrocortisone
- If upper airway signs: racemic epi 2.25% neb
- If bronchospasm: albuterol 5mg/cc by neb
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What if your patient is experiencing consistent Bronchospasm assocaited with anaphylaxis?
- albuterol by continuous neb
- aminophylline 5.6mg/kg IV over 20-30 mins
- Atrovent 0.5mg in 2.5cc NS by neb
- steroids
- intubate and ventilate PRN
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What if your patient is experiencing perisitent hypotension with anaphylaxis?
- Trendelenberg position
- volume repeltion with minimum 2 large bore IVs
- infuse crystalloid
- monitor uirne output and CVP
- consider: naloxone 0.4-0.8 mg IV; if responsive IV drip infusion
- vasopressors: dopamine 5-20mcg/kg/min
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When is glucagon used?
- when epinephrine is contraindicated (beat blocker overdose)
- it is a positive inotropic and chronotropic cardic drug
- mediated independently of alph and beta receptors
- thought to enhance cAMP synthesis in myocardium
- GI and GU tracts
- Consider Glucagon in:
- patients on Beta Blockers
- patients with known CAD
- pregnant women (category B drug)
- patients not responding to other drugs
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What is the disposition post anaphylaxis?
- regardless of response to therapy, all patients with systemic features must be observed for 6 ro 8 hours
- there is no accurate way to predict which patients will experience a biphasic reaction
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Post anaphylaxis, when is admission mandatory?
- for any patient with moderate to severe reaction, even if they respond rapidly to emergency intervention
- this includes anyone who showed signs of upper airway obstruction or hypotension
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What is outpatient management for anaphylaxis?
- two-day course of H1 antihistamine: benadryl q6h x 48 hrs
- two-day course of H2 antihistamine: cimetidine BID x 48hr
- two-day course of steroid: prednisone 50mg/day
- AND REFERRAL TO AN ALLERGIST
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