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When the Nurse Calls at 3AM

When the Nurse Calls at 3AM. Mr. Jones’ BP is 85/40. •What are the rest of his vital signs? •What is his usual BP? •How does he feel? Was this found on routine vital sign check or is something wrong?. DDx : What you are thinking. • Cardiac: – Tachyarythmia – Bradycardia – MI

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When the Nurse Calls at 3AM

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  1. When the Nurse Calls at 3AM

  2. Mr. Jones’ BP is 85/40 •What are the rest of his vital signs? •What is his usual BP? •How does he feel? Was this found on routine vital sign check or is something wrong?

  3. DDx: What you are thinking • Cardiac: • –Tachyarythmia • –Bradycardia • –MI • Physiologic: • –ESLD, CHF • –Young and asleep • Sepsis • Meds • Hypovolemia: • –Dehydration • –Bleeding

  4. What do you do? •See the patient •Call your resident; Call MICU •Recheck vital signs, check orthostatics •IV Fluids •Get Access •Consider EKG, CBC, T&S, Broad spectrum ABx

  5. Ms Lewis’ is SOB •What are her vital signs? •How do her lungs sound? •What are her IV Fluids?

  6. DDx •Reactive Airway Disease/COPD •PE •Cardiogenic –MI, CHF •Too much IV Fluid •Pneumonia •PTX •Anxiety

  7. Collect the Data •Examine patient –listen to lungs, JVP, LE Edema •CXR •EKG; cardiac enzymes •ABG •I/Os •On DVT prophylaxis?

  8. Now What? •Oxygen •Diurese •Chest CT r/o PE •Nebulizer/BIPAP •Head of bed up •Nitro •Call resident

  9. Mr. Krafty has Chest Pain •What are his vital signs (check both arms)? •How does he look? •When did it start? •Get an EKG

  10. DDx •MI/aortic dissection •GERD •PE •Anxiety •MSK •Pneumonia; cholecystitis; pancreatitis •Pericarditis

  11. What do you do? •Evaluate patient •Treat as angina-tele, ASA, B-blocker, nitro, serial CKs, heparin, tell resident •Treat as GERD-mylanta •Treat as MSK-ibuprofen •Treat as anxiety-reassure; ativan? •Treat as PE –chest CT, heparin?, oxygen • Treat as dissection – CT chest, control BP

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