Flu like complaints in a 22yo followed by tachycardia and fever, I think? What lab marker helps to diagnose?
Myocarditis, troponin is elevated
Troponin level timeline
Rise within 3 to 6 hours of pain onset, peek at 12 to 24 hours, remain elevated for 7 to 10 days
Myoglobin timeline
Rises within 1 to 2 hours, peaks in 4 to 6 hours, returns to baseline in 24 hours
Absolute contraindications to TPA
Previous hemorrhagic stroke, Active known intracranial neoplasm, active internal bleeding, suspected aortic dissection or pericarditis
Relative contraindication to tPA
SBP greater than 180, anticoagulation, major surgery less than three weeks prior, active PUD
How to manage patient with food bolus stuck in esophagus but no respiratory distress
A minister 1 mg glucagon IV and plan for endoscopy
Glucagon causes relaxation of esophageal smooth muscle, It does not work endoscopy is definitive
When is TPA used in PE patients
In massive PE- embolus with sustained hypertension or hypotension requiring Inotropic support
or hemodynamic collapse
Still unclear for use in sub massive PE: RVD, no persistent hypertension –traditional anticoagulation
Congenital long QT syndromes
Romano Ward
Jervell
Lang-Nielsen
Beta blockers are the treatment of choice, ICDs are most definitive for high-risk patients
Management of small primary spontaneous pneumothorax impatience without underlying lung disease
Get initial chest x-ray, observe for six hours and repeat chest x-ray, discharge with follow up in 24 hours
Ace inhibitor angioedema
Can occur at any point in the course of taking the medication, unlike a true type one hypersensitivity reaction – occurs immediately after exposure
Mechanism of action: inhibition of bradykinin production
Treatment for HCAP pneumonia
Vancomycin, cefepime, Azithromycin
Covers Pseudomonas and MRSA
EKG findings in PE
Right heart strain: large R waves and inverted T-waves in leads V1-3
When to give steroids in PJP pneumonia
PA 02 less than 70, or A-a gradient greater than 35
abx for SBP
third generation cephs, i.e. cefotaxime