LL

Dr. Pehle – Palpitations

• Unpleasant , alarming, painful, noticeable feeling in the chest. 
• Afib fairly common 13% diagnosis
  • Tachyarrhythmias
  • afibw/rvr, aflutter, svt, vfib, vtach, torsades
• H&P red flags
  • Chest Pain, exertional, triggers, syncope, AMS
  • Risk factors CAD, DM, CKD
  • Heart failure signs on exam jvd, BLE
• Holter monitor
  • Underlie structural heart disease
  • Fam hx of sudden cardiac death
  • Frequent palpitation that can reproduce their palpitations
• Smart watch?
  • Afib sens and specificity is pretty good
  • Will still miss stuff
• Metabolic/drug causes
  • Thyroid storm
    • Preceding symptoms, gi distress anxiety, trauma, pregnancy, constrast
    • Hyperthermia, tachycardia, AMS
    • Burch-wartofsky criteria – MD Calc likely hood of thyroid storm
  • Caffeine
  • Sympathomimetics
  • Electrolyte disturbances
  • EtOH
• PE and ACS cant miss

Dr. Graham – Back Pain

• DDx Musculoskeletal (DDD, spinal stenosis, herniation), ankylosiing spondylitis, sacroilliits, cauda equina/cona medulari, spinal epidural abscess, metastatic spinal disease, AAA
• Red flags
  • Recen infections, IV Drug use, recent spinal procedure, immunocompromised HIV/AIDs, immunosuppression, cancer, major trauma, weight loss, unremmitting pain / night pain, abdominal pain, fevers/chills, saddle anesthesia, bowel/bladder incontinence, retention
  • PE: motor strength, gait disturbance, BLE sensory loss, saddle anesthesia, DTR BLE, focal tenderness
• Workup – red flags – CT for fractures, CTA vessels, MRI for spinal cord and discs
• Treat NSAIDs, muscle relaxants
• Walking core strength

Dr. King – One Pill can kill

• Opioids
  • Narcan

• Calcium channel blockers, elevated blood glucose, decreased heart rate, can do high dose insulin, ionotropes
• Opiods, fix the airway before giving naloxone. Can give bolus of naloxone every hour instead of drip to expedite transport
• Salycilates
  • Oil of wintergreen 1 tsp = 7g
  • Tinnitus, vomiting, pulm edema, hallucinations, hyperpnea, agitation, delirium
  • NaBicarb, dialysis

– Sulfonylureas

– Need to observe 24hrs

– Octreotide and dextrose

– Clonidine / imidazolines (affrin)

– opioid toxidromes, bradycardia, decreased consciousness, respiratory depression

– tx naloxone, atropin

– IV fluids

– inotropes

Camphor

• Smells of moth balls

• The main route for toxicity is through ingestion. Onset of symptoms can occur as early as 15 minutes after ingestion ranging from sweating and agitation to seizures, cardiac arrhythmias, and cardiopulmonary arrest [1,2].
• Benzos, phenobarbital for seizures in camphor

Amitriptyline

• Na channel blockade, CNS, Cardiac, anticholinergic 
• Long QRS
• Na bicarb tx for cardiac dysrhythmias
• Benzos for seizure

Lomotil

• Imodium
  • Antimuscarinic and opioid symptoms

• Tx naloxone maybe gtt
• Need admission for 24hrs

Ethylene glycol

• Antifreeze degreaser engine coolants
• Oxalate binds with calcium and deposits causing hypocalcemia 
• Thiamine, pyridoxine,
• Tx: fomepizole, dialysis 

Dr. Platt – Syncope

• Reflex, orthostatic, cardiac
• Initial eval – detailed history: prodrome, extertional, position, family history, chest pain, palpitations, hypotension at triage
• Physical exam (cardiac, neuro, orthostatics
• EKG
• High Risk: syncope during exertion or while supine, abnormal cardiac exam, family history or sudden cardiac death, short/ absent prodrome
• RBBw/ LAFB syncope no prodrome and exertion needs admission. 
• Risk stratification tools
  • San francisco syncope rule: CHF, hct, ecg abnormal, sob, SPO2
  • CHESS risk factors 
  • Predicts 30 day serious outcome (arrhythmia death, cardiac event)
  • Scoring history, ekg findings, troponin, ED diagnosis 
• Canadian syncope risk score
  • 0- – 3 low, 1-3 medium, 4-7 very high
• Diagnostic yield – ekg highest at 5-15%

Dr. Harris – Shock small group

• Septic shock
• Pocus for shock, RUSH
• Cardiogenic shock
• Norepi frist line pressor for all shock