Monthly Archives: May 2013

Transtubular Potassium Gradient TTKG

Order: serum K and osmolality, urine K and urine osmolality

Formula: Uk/Pk / Uosm/Posm

Normal levels should be 8-9

In hyperkalemia, should be >10, if low <7 indicates mineralocorticoid deficiency

In hypokalemia, should be <3, if higher means renal K loss.

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Albumin: Indications and Dosages

Differential Diagnosis of Abdominal Pain

Not to miss:  AAA rupture, bowel rupture/perf/ischemia, ascending cholangitis, acute appy, retroperitoneal hematoma

Abd pain quadrants

EKG Stuff

Blood Transfusion Complications in Perspective

Treatment of Delirium + Doctor Order Set (Sample)

Suspected Delirium

History:

– establish baseline cognitive function, h/o dementia, depression, mania, psychosis

– CAM ICU

– identify possible causes: anticholinergics, benzos, steroids, infection, DHN, sleep deprivation, malnutrition, immobilization, metabolic derangement, decreased mobility, constraints / restraints

Laboratory Work-up

– CBC, chemistry (including LFTs)

– TFTs, B12

– Ammonia

– cortisol

– screen for infection

– consider brain imaging, LP, EEG

Treatment:

– reorientation, encourage family involvement

– eyeglasses / hearing aids

– order sitter, avoid restraints

– uninterrupted sleep at night; use of light/dark to preserve sleep-wake cycle

– mobility, physical / occupational therapy

– if severely agitated, started pharmacologic intervention:

1. Haloperidol 0.25-1.0 mg IM/IV, repeat q20-30m, max of 3-5mg in 24h; half loading dose and give in divided doses x 24h, then taper

2. Avoid benzos unless delirium is due to ETOH withdrawal or seizures

delirium treatment 01 delirium treatment 02Assessment_and_Rx_of_deliri

1

Delirium Order Set

REFERENCE:

Teaching Rounds: A Visual Aid to Teaching IM Pearls on the Wards, Chapter 73.

Algorithm: Evaluation of Arthritis