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Family Practice Notebook Updates 2016

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121. Richmond Agitation Sedation Scale

interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 10/2/2016 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

122. Prothrombin Complex Concentrate

clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 6/3/2016 and last published on 3/2/2019 . Contact 2019 Family (...) Practice Notebook, LLC. | | | |

2018 FP Notebook

123. AUDIT-C

, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 3/15/2016 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

124. Cricothyrotomy

reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 11/18/2018 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) kit Scalpel is ready to make incision Make vertical incision Feel the cricothyroid membrane Perform circothyrotomy See No-Drop technique as below References Weingart et al in Herbert (2016) EM:Rap 16(11): 4-5 EMCrit Blog (Scott Weingart, MD) VI. Protocol: No-Drop Technique Identify the landmarks cartilage Cricothyroid membrane Cricoid cartilage Mark the incision line with skin marker Draw vertical line down midline from mid- cartilage to cricoid cartilage Consider (linear probe) to identify

2018 FP Notebook

125. Sepsis in Children

and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 4/20/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) or Ongoing evaluation for by (e.g. , ) Ongoing evaluation for by examination (e.g. pulmonary rales or ) Correct and calcium Correct Correct Administer brioad-spectrum empiric antibiotics early (associated with best outcomes) See for age <1 month See Cover for Pneumococcus, Group A Strep, (as well as N Meningitidis, and the rare H. e) 50 mg/kg IV q8h or 100 mg/kg IV q24h (or Zosyn 75 mg/kg IV q6h) AND 15 mg/kg IV q6h (or 10 mg/kg IV q8h) (2015) Sanford Guide to Antibiotics, accessed IOS app on 4/20/2016

2018 FP Notebook

126. Six Item Cognitive Impairment Test

and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 3/15/2016 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

127. Pediatric Assessment Triangle

is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 6/1/2015 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) , and other signs of respiratory distress and increased work of breathing are initial warning signs of impending respiratory decompensation is a late finding of decompensation, with little warning before complete Documentation Triage note evaluation Investigate and explain any abnormal findings in the triage note Confirm accuracy of recorded s Serial exams Document repeat exam with updated status prior to discharge Percussion Abdominal percussion may provoke percussion may identify Bone percussion may

2018 FP Notebook

128. Nasotracheal Intubation

of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 7/17/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) Distorted airway (e.g. neck hematoma) (or suspected based on facial ) Mid-face s Upper airway abscess or other infection or obstruction (e.g. ) Rapid intubation is critical Employ Other techniques are faster with lower failure rates VIII. Resources Awake nasal intubation (HQMedEd, Hubbard, Reardon, Jubert) IX. References Goodwin in Walls (2012) , 3rd Ed, Lippincott, Philadelphia, p. 105-11 Levitan (2013) Practical Airway Management Course, Baltimore Mason, Herbert, Weingart and Merriman in Herbert (2016

2018 FP Notebook

129. Ultrasound

, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 11/5/2018 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) as E- ) for excellent resolution and fast real-time updating Allows for deep penetration (up to 40 cm with some phased array probes) Among the most useful probes in the Emergency Department arsenal Modes A-Mode (Amplitude Mode) Original Ultrasound delivered only a wave form B-Mode (Brightness Mode) Typical 2-Dimensional Ultrasound image M-Mode (Time series of superimposed B-mode images) Typically used for heart imaging to demonstrate cardiac cycle activity and associated abnormalities Send/Receive

2018 FP Notebook

130. High Sensitivity Cardiac Troponin T

is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 12/5/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

131. Induced Therapeutic Hypothermia

is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 4/9/2018 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) standardized guidelines for cooling protocol Start protocol as early as possible following ( ) In one study, every hour of delay in starting protocol was associated with a 20% increase in mortality Transfer post-arrest patients to larger tertiary centers Initiate external cooling prior to transfer Best maintenance of core target, even when target is near normal at 36 C Larger centers have available equipment, practiced protocols to maintain consistent Post-arrest care is complex, multidisciplinary

2018 FP Notebook

132. Left Ventricular Assist Device

should address specific medical concerns with their physicians. This page was written by , last revised on 4/8/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) organisms Evaluation and Management Consider CT chest and if mediastinitis, LVAD pump or pump pocket infection is suspected with cardiothoracic surgery Aim for MAP >65 mmHg in via IV fluids s may be needed Cover for listed below with broad spectrum antibiotics (preferred) or AND Cefepime (preferred) or or AND (preferred) or Voriconazole, Caspofungin, Micafungin, Anidulafungin References (2016) Sanford Guide, accessed 4/8/2016 XIII. Complications: Bleeding Most patients with LVAD or BiVAD are dual

2018 FP Notebook

133. Factor Xa Inhibitor

providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 7/9/2018 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) ( , to be released in 2018) Antidote for ( ) or ( ), but not other Xa agents Binds Factor Xa Inhibitors Limits progression of bleeding within 12 hours of dose (onset as early as 1 hour) Expensive: $25,000 to 50,000 per patient Risk of complications (CVA, VTE) References Deloughery and Orman in Majoewsky (2013) EM:Rap 13(9): 1 Sun (2016) Crit Dec Emerg Med 30(8): 28 VI. Management: Other bleeding complications Expect to be heavier than typical while on Factor Xa Inhibitors However, severe on Factor Xa Inhibitors

2018 FP Notebook

134. Thrombocytopenia Causes

was written by , last revised on 8/17/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) and miscellaneous causes or hypersplenism Cavernous Dilutional (e.g. excessive fluid ) disease (e.g. ) IX. References Holland (2016) in Children Lecture, ACEP PEM Conference, Orlando, attended 3/9/2016 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Thrombocytopenia Causes." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Platelet Disorders About

2018 FP Notebook

135. Ovarian Torsion

specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 5/2/2016 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | |

2018 FP Notebook

136. Necrotizing Enterocolitis

/18/2017 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) of Neonatal Care, Little Brown, Boston, p. 511-7 (2016) Sanford Guide to Antimicrobial Therapy, accessed IOS app 5/6/2016 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Necrotizing Enterocolitis." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Pneumatosis intestinalis (C1112565) Concepts Disease or Syndrome ( T047 ) Dutch pneumatosis intestinalis

2018 FP Notebook

137. Nicardipine

specific medical concerns with their physicians. This page was written by , last revised on 5/8/2012 and last published on 3/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nicardipine." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Cost: Medications nicardipine (on 12/21/2016 at ) NICARDIPINE 20 MG CAPSULE Generic $1.41 each NICARDIPINE 30 MG CAPSULE Generic $2.01 each FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only

2018 FP Notebook

138. Fascia Iliaca Block

providers. Patients should address specific medical concerns with their physicians. This page was written by , last revised on 9/2/2018 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) toward femoral nerve on Do NOT inject adjacent to femoral nerve (this is a compartment block) Inject the 20-30 cc of diluted anesthetic Injection should flow very easily (as if injecting into an IV) Withdraw or advance the needle 1-2 mm if resistance is met No swelling should be seen VII. Efficacy Highly effective and reproducible (even without ) as target is Will not achieve complete anesthesia in the leg VIII. Resources New York School of IX. References Eicken and Rempell (2016) Crit Dec Emerg Med

2018 FP Notebook

139. Malignant Hyperthermia

/28/2016 and last published on 3/3/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) Hyperthermia Muscle Rigidity VII. Lab: Abnormalities Phosphokinase (CPK) increased ( ) increased VIII. Complications (DIC) Cardiovascular Collapse IX. Management (specific treatment of choice) Adult: 1 to 3 mg/kg IV Child: 0.5 to 1 mg/kg IV Supportive measures (especially until available) s Cooling X. References (2016) , 14th Ed, 1:126 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Malignant Hyperthermia." Click on the image (or right

2018 FP Notebook

140. Cardiovascular Syphilis

/2/2019 . Contact 2019 Family Practice Notebook, LLC. | | | | (...) Aorta Rupture IX. References Green, Cohen, Billington (2016) Crit Dec Emerg Med 30(11): 4-10 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Cardiovascular Syphilis." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Syphilis, Cardiovascular (C0039130) Definition (MSH) Cardiovascular manifestations of SYPHILIS, an infection of TREPONEMA PALLIDUM

2018 FP Notebook

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