430 Notes Notes Appendix A ADVANCED CARDIAC LIFE SUPPORT American Heart Association (AHA), European Resuscitation Council (ERC), and International Liaison Committee on Resuscitation (ILCOR) 2005 Guidelines Circulation 2005; 112[Suppl I]:IV1 211 Assess ABC If pulseless, proceed to CPR right away If pulse present, check pulse, BP, O2 sat Give O2, monitor rhythm, IV access Tachycardia 12 lead ECG Pulseless Start CPR Check Asystole, PEA Bradycardia 12 lead ECG rhythm VF/pulseless VT Unstable Stable Unstable Stable Airway Mx IV access Epinephrine mg IV or Vasopressin 40 U IV Reassess ABC/rhythm Atropine mg IV f bradycardia Reassess ABC/rhythm Repeat epiatropine cycle q3−5min Tx Causes 12 lead ECG NS L IV HCO3 amp MgSO4 g IV Chest decompression Transvenous pacing Cease resuscitaion? CPR × then Defibr llate x1 150−200 J (biphasic), or 360 J (monophasic) If rate >150, immediate cardioversion If rate 150 Wide complex VT (most common) SVT with BBB AF with WPW antidromic AVRT Narrow complex (irregular) Narrow complex (regular) AF, Atrial flutter, MAT Atrial (atrial flutter, ectopic), Junctional, PSVT (AVNRT, orthodromic AVRT WPW) CPR min, IV IV access Airway Mx Epinephrine mg IV q3min, or Vasopressin 40 U IV × CPR Reassess ABC/rhythm Def brillate 360 J (monophasic) if sti l VF/pulseless VT Premedicate Midazolam mg IV q2−3min and Fentanyl 50− 150 µg IV q5min Ensure IV access, O2 sat monitor, intubation equipment, and suction available CPR Reassess ABC/rhythm Consider amio darone 300 mg IV, lidocaine, mg/kg IV, or MgSO4 g IV CPR Reassess ABC/rhythm Def brillate 360 J (monophasic) if sti l VF/pulseless VT CPR Reassess ABC/rhythm Repeat epi shock− drug shock cycle Asystole PEA DDx Hypovolemia hypoxia Hypothermia hyper/hypoK H+ (acidosis) Tablets Tamponade Tension pneumothorax Thrombosis CAD Thrombosis PE Asystole/PEA drugs Epinephrine mg IV push, q3 5min, or 2 5× IV dose down endotracheal tube in 10 mL of NS followed by hyperven ilation if IV not available Atropine mg IV push, q3 5min, max total 04 mg/kg (approximately doses), 2 5× IV dose down endotracheal tube in 10 mL NS f needed Synchronized cardioversion 30J, 70J, 100J, 150J (biphasic) or 50J, 100J, 200J, 300J, 360J (mo nophasic) Monitor ABC, prepare to intubate and give antiarrhythmics prn VF/pulseless VT drugs Epinephrine mg IV push, q3 5min Vasopressin 40 U IV push×1 dose Amiodarone 1st dose 300 mg IV push, 2nd dose 150 mg, max total 2 g/24 h Lidocaine mg/kg IV push, and repeat 75 mg/kg q5 10min to max mg/kg Procainamide 50 mg/min IV MgSO4 g IV if torsades de pointes or suspect hypo Mg HCO3 amp IV push f hyper kalemia, metabolic acidosis, TCA overdose, barbiturate overdose, ASA daily, etc Avoid f respiratory acidosis If monomorphic VT and no heart failure Amiodarone 150 mg IV bolus over 10 min, or Procainamide 20 mg/min (max 17 mg/kg) If polymorphic VT w/prolonged QT MgSO4 g IV Isoproterenol 0.02−0.04 mg IV push Overdrive pacing Vagal maneuvers Diltiazem 10−20 mg IV over (carotid massage Valsalva) or Metoprolol Adenosine mg mg IV,or rapid IV push Amiodarone May repeat 12 mg 150 mg IV up to 2× over 10 min, or Digoxin 4−0 mg IV If healthy heart Diltiazem see ATRIAL 10−20 mg IV over FIBRILLATION min, or for further details Metoprolol (p 39) mg IV Synchronized cardioversion see ATRIAL FIBRILLATION (p 39) Synchronized cardioversion see unstable tachycardia Primary AV block Type I and II Secondary AV block Tertiary AV block Primary AV block Type I Secondary AV block Type II Secondary AV block Tertiary AV block Monitor ABC Transcutaneous pacemaker Atropine mg IV Transvenous pacemaker Transcutaneous pacemaker Permanent pace maker Dopamine 5−20 µg/kg/min IV or Epinephrine 2−10 µg/min IV Transvenous pacemaker If LV failure D ltiazem 10−20 mg IV over min, or Digoxin 4−0 mg IV, or Amiodarone 150 mg IV over 10 Synchronized cardioversion see unstable tachycardia Tachycardia drugs Amiodarone 150 mg IV bolus over 10 min, then mg/min (60 mg/h) for h, followed by mg/min (30 mg/h) for 18 h Maximum total 2 g/24 h Procainamide 20 30 mg/min IV, maximum infusion at 17 mg/kg, maintenance at mg/min Indicated particularly for WPW with AF (wide complex irregular achycardia) Administer until maximum dose reached, dysrrhytmia suppressed, QRS widens >50%, or hypotension occurs Adenosine mg rapid IV push, 2nd dose 12 mg, 3rd dose 12 mg Indicated in PSVT Avoid if WPW with AF Amiodarone 150mg IV bolus over 10 min, q10 15min Alternatively, infusion 360 mg over h, then 540 mg over 18 h Maximum total 2 g/24 h Good for most SVT β-Blocker: Metoprolol mg IV q5min, may repeat ×2 Maximum total 15 mg, Labetalol 10 mg IV q10min Maximum total 150 mg Calcium channel blocker: Diltiazem 25 mg/kg (10 20 mg) IV over min, 2nd dose 35 mg/kg (25 mg), then infusion at 10 mg/h Verapam l 5 mg IV over min, repeat 15 30 Avoid if WPW with AF Digoxin mg IV, then mg q6 8h Then 125 mg IV/PO daily Bradycardia drugs Atropine mg IV repeat q3 5min, max total 04 mg/kg (ap proximately doses), 2 × IV dose down endotracheal tube in 10 mL NS f needed Unlikely beneficial in third degree or Mobitz type II block Dopamine 20 µg/kg/min IV, after max dose of atropine Epinephrine 10 µg/min IV, if severe bradycardia with hypoten sion Important Principles CPR—ensure good compressions by allowing chest to recoil fu ly and minimizing interrupt ons Aim for 100 compressions per m nute for m n each cyc e Continue until regain pulse The focus for nitial resuscitation shou d be on per orming h gh-quality CPR Frequent pulse check, intubat on, central line insert on, and medicat ons may sometimes distract the team from this important task Airway—avoid hyperventilat on as this could increase ntrathoracic pressure Initial use of oropharyngeal airway with bag-valve mask is reasonable, with breaths given after every 30 CPR compress ons Once switched to advanced airway (laryngeal mask airway, combitube, or endotracheal tube), breaths should be given every s Access—the preferred route is through a perpherial intravenous (IV) l ne, which can usually be estab ished easi y The ntraosseous (IO) route represents a second choice, while central l nes and endotracheal tube should be the last resort for medication access D Hui, Approach to Internal Medicine, DOI 10.1007/978 4419 6505 18, ể Springer ScienceỵBusiness Media, LLC 2006, 2007, 2011 431 Appendix B LIST OF COMMON ABBREVIATIONS % sat 5-FU 5-HIAA 5HT AAA ABC Abd ABG ABPA ABx ACE ACR ACS ACTH ADL ADP AF AFB AFP AG AIDS AIN AJR AKI ALI ALL ALND ALS ALT AMA AML ANA ANC ANCA AP APA APACHE APC APS ARB ARDS ARR AS ASA ASD ASO AST ATC ATN AV AVM AVNRT AXR BAC Percentage saturation 5-Fluorouracil 5-Hydroxyindoleacetic acid Serotonin Abdominal aortic aneurysm Airway, breathing, circulation Abdomen Arterial blood gas Allergic bronchopulmonary aspergillosis Antibiotics Angiotensin-converting enzyme American College of Rheumatology Acute coronary syndrome Adrenocorticotropic hormone Activity of daily living Adenosine diphosphate Atrial fibrillation Acid fast bacilli Alpha fetoprotein Anion gap Acquired immunodeficiency syndrome Acute interstitial nephritis Abdominal jugular reflex Acute kidney injury Acute lung injury Acute lymphoblastic lymphoma Axillary lymph node dissection Amyotrophic lateral sclerosis Alanine aminotransferase Antimitochondrial antibody Acute myelogenous leukemia Antinuclear antibody Absolute neutrophil count Anti-neutrophilic cytoplasmic antibody Anterior–posterior Antiphospholipid antibody Acute physiology and chronic health evaluation Adenomatosis polyposis coli Antiphospholipid antibody syndrome Angiotensin receptor blocker Acute respiratory distress syndrome Absolute risk reduction Aortic stenosis Acetylsalicylic acid, American Society of Anesthesiologists Atrial septal defect AntiStreptolysin-O Aspartate aminotransferase Around the clock Acute tubular necrosis Atrioventricular or arteriovenous Arteriovenous malformation Atrioventricular nodal reentry tachycardia Abdominal X-ray Bronchioloalveolar carcinoma BAL BID Bili BIPAP BL BMD BMI BMT BNP BOOP BP BRBPR BRCA BSA BSE C&S Ca CA 125 CA 15.3 CA 19-9 CABG CAD CAH CA-MRSA CAP CBC CBCD CBE Cbl CCB CCP CCS CEA CHF Chol CK CKD CKMB Cl CLL CMA CMC CML CMML CMV CN CNS CO COP COPD COX CPAP CPR CR Bronchoalveolar lavage Twice per day Bilirubin Bilevel positive airway pressure Burkitt’s lymphoma Bone mineral density Body mass index Bone marrow transplant B-type natriuretic peptide Bronchiolitis obliterans organizing pneumonia Blood pressure Bright red blood per rectum Breast cancer gene Body surface area Breast self-examination Culture and sensitivity Calcium Cancer antigen 125 Cancer antigen 15.3 Cancer antigen 19-9 Coronary artery bypass graft Coronary artery disease Congenital adrenal hyperplasia Community-acquired methicillin-resistant Staphylococcus aureus Community-acquired pneumonia Complete blood count Complete blood count and differential Clinical breast examination Cobalamin Calcium channel blocker Cyclic citrullinated peptides Canadian Cardiovascular Society Carcinoembryonic antigen Congestive heart failure Cholesterol Creatine kinase Chronic kidney disease Creatine kinaseMB Chloride Chronic lymphocytic leukemia Canadian Medical Association Carpometacarpal joint Chronic myelogenous leukemia Chronic myelomonocytic leukemia Cytomegalovirus Cranial nerve, cyanide Central nervous system Carbon monoxide Cryptogenic organizing pneumonia Chronic obstructive pulmonary disease Cyclooxygenase Continuous positive airway pressure Cardiopulmonary resuscitation Controlled release D Hui, Approach to Internal Medicine, DOI 10.1007/978 4419 6505 19, ể Springer ScienceỵBusiness Media, LLC 2006, 2007, 2011 433 434 CrCl CRF CRH CRP CRT CT CVA CVD CVP CVVHD CXR D5W DAT DBP DC DCIS DDAVP DEXA DHEA DHEAS DI DIC DIP DKA DLBCL DLCO DM DM1 DM2 DMARDs DOT DPI DPT dsDNA DT DVT Dx EBV ECG EEG EF EGFR EHEC EIEC EMG ENA EPO ER ERCP ESAS ESBL ESR ESRD ET ETEC FAP Fe FEV1 FFP FH FHF FISH FL FNA FNH FOB FSGS FSH Appendix B Creatinine clearance Chronic renal failure Corticotropin-releasing hormone C-reactive protein Cardiac resynchronization therapy Computed tomography Cerebral vascular disease, costovertebral angle Cerebral vascular disease Central venous pressure Continuous veno-venous hemodialysis Chest X-ray 5% dextrose water Direct antiglobulin test Diastolic blood pressure Direct current Ductal carcinoma in situ Desmopressin acetate Dual-energy X-ray absorptiometry Dehydroepiandrosterone Dehydroepiandrosterone sulfate Diabetes insipidus Disseminated intravascular coagulation Distal interphalangeal joint Diabetic ketoacidosis Diffuse large B-cell lymphoma Diffusion capacity of lung for carbon monoxide Diabetes mellitus Type diabetes mellitus Type diabetes mellitus Disease-modifying agents of rheumatoid disease Directly observed treatment Dry powder inhaler Diphtheria, pertussis, tetanus Double-stranded DNA Delirium tremens Deep vein thrombosis Disease Epstein–Barr virus Electrocardiogram Electroencephalography Ejection fraction Epidermal growth factor receptor Enterohemorrhagic Escherichia coli Enteroinvasive Escherichia coli Electromyography Extractable nuclear antigen Erythropoietin Estrogen receptor, emergency room Endoscopic retrograde cholangiopancreatography Edmonton symptom assessment scale Extended spectrum b-lactamase Erythrocyte sedimentation rate End-stage renal disease Essential thrombocytosis Enteropathogenic Escherichia coli Familial adenomatous polyposis Iron Forced expiratory volume (1 second) Fresh frozen plasma Family history Fulminant hepatic failure Fluorescence in situ hybridization Follicular lymphoma Fine needle aspirate Focal nodular hyperplasia Fecal occult blood Focal segmental glomerulosclerosis Follicle-stimulating hormone FTA-ABS FUO FVC G6PD GBM Fluorescent treponemal antibody-absorption Fever of unknown origin Forced vital capacity Glucose-6-phosphate dehydrogenase deficiency Glomerular basement membrane, glioblastoma multiforme GBS Guillain–Barre syndrome GCS Glasglow coma scale GCSF Granulocyte colony-stimulating factor GERD Gastroesophageal reflux disease GFR Glomerular filtration rate GGT Gamma-glutamyl transpeptidase GI Gastrointestinal Gm Gram stain GN Glomerulonephritis GU Genitourinary GVHD Graft vs host disease GYN Gynecological H&N Head and neck Hb Hemoglobin HBV Hepatitis B virus HCL Hairy cell leukemia HCO3 Bicarbonate Hct Hematocrit HCV Hepatitis C virus HD Hemodialysis HDL High density lipoprotein HF Heart failure HHV8 Human herpes virus HITT Heparin-induced thrombocytopenia with associated thrombosis HIV Human immunodeficiency virus HLA Human leukocyte antigen HMG-CoA 3-Hydroxy-3-methylglutaryl coenzyme A HNPCC Hereditary non-polyposis colorectal cancer HR Heart rate HSP Henoch–Schonlein purpura HSV Herpes simplex virus HTLV Human T-cell lymphoma virus HU Hounsfield unit HUS Hemolytic uremic syndrome IADL Instrumental activities of daily living IBD Inflammatory bowel disease IBS Irritable bowel syndrome IBW Ideal body weight ICD Implantable cardioverter-defibrillators ICH Intracerebral hemorrhage ICP Intracranial pressure ICU Intensive care unit IDU Injection drug use IL Interleukin INF Interferon INH Inhaler INR International normalized ratio IPF Idiopathic pulmonary fibrosis IPI International prognostic index IR Immediate release ITP Idiopathic thrombocytopenic purpura IV Intravenous IVC Inferior vena cava IVP Intravenous pyelogram JVP Jugular venous pressure KOH Potassium hydroxide KPS Karnofsky performance status KUB Kidney, ureter, and bladder X-ray study LAA Left atrial abnormality LAD Left anterior descending LAE Left atrial enlargement ... then 540 mg over 18 h Maximum total 2 g/24 h Good for most SVT β-Blocker: Metoprolol mg IV q5min, may repeat ×2 Maximum total 15 mg, Labetalol 10 mg IV q10min Maximum total 150 mg Calcium channel... central l nes and endotracheal tube should be the last resort for medication access D Hui, Approach to Internal Medicine, DOI 10.1007/978 4419 6505 18, ể Springer ScienceỵBusiness Media, LLC 2006,... Continuous positive airway pressure Cardiopulmonary resuscitation Controlled release D Hui, Approach to Internal Medicine, DOI 10.1007/978 4419 6505 19, ể Springer ScienceỵBusiness Media, LLC 2006,