e.g.

Weight = 40 kg • Pericarditis
ABG Interpretation Na Deficit = 10 × 40 × 0.6 Dressler’s Signs of • Pneumonitis
Hyponatremi Na Deficit = 10 ÷ 12 × = 240 meqs Post-Myocardial Infarction • Pleuritis
a TBW …using PNS 1L Pericarditis • Pyrexia
FiO2 FM 240 meqs ÷ 154 meqs/L = 1.6 • Pain
RA = 0.21 5-6 = 40% L
I (FiO2 × 713) – pCO2 NP = Lpm × 4 + 20 6-7 = 50% 1600 ml/24 hrs = 67 cc/hr
0.8 FM = Lpm × 10 -10 7-8 = 60%
RB = Lpm × 10 Bacteremia Bacteria in the Blood (positive Blood Culture)
II PaO2 VR = 100% TP Water Deficit = (Actual Na – 140) × TBW
I AB = 80 6 = 40% 140
CPAP = Lpm × 4 + 20 7 = 70% Hypernatrem Septicemia Presence of Microbes & their Toxins in the
III Target FiO2 + pCO2 8 = 80% ia TBW Males = Weight (kg) × 0.6 Blood
II 0.8 Target FiO2 9 = 90% TBW Females = Weight (kg) × 0.5
× 100 < 60 yo = 80 10 = 100% Requires ≥ 2 of the Following:
713 > 60 yo = 80 – (age – • Temperature > 38°C or < 36° C
60) Systemic Inflammatory • Respiratory Rate > 24 breaths/minute
COPD = 60 Serum Normal 280-300 Response Syndrome • Cardiac Rate > 90 beats/minute
Expected PF = Age × 5 Osmolalit [2 (Corrected Na + K)] + RBS (SIRS) • White Blood Cell Count > 12000 or < 4000
y (mOsm/ (mmol/L) DKA 300-320 • > 10% Bands
L)

[H+] = 24 × pCO2 < 0.3 Chronic Renal Failure HHS 330-380 Sepsis SIRS with proven/suspected Microbial etiology

Delta H HCO3 0.3-0.7 Acute Renal Failure on Urine Specific Gravity – 1 × 40000 Sepsis with ≥ 1 Signs of Organ Dysfunction
top of Chronic Renal Osmolalit • Cardiovascular: SBP < 90 mmHg or MAP ≤
!H = [H+] – 40 Failure y 70 mmHg responding to IV administration
pCO2 – 40 • Renal: UO < 0.5 ml/kg/hr for 1 hr despite
adequate fluid resuscitation
> 0.7 Acute Renal Failure • Respiratory: PaO2/FIO2 < 250 or if the
(Intubate!) Mean Arterial SBP + (2 × Normal: 70-110 mmHg Severe Sepsis Lung is the only Dysfunctional Organ ≤ 200
Pressure DBP) 60 mmHg is enough to sustain (Sepsis Syndrome) • Hematologic: Platelet Count < 80000 µl or
3 organs 50% decrease in Platelet from highest
recorded over the previous 3 days
[Weight (kg) × 0.4] × [Desired HCO3 – Actual Desired HCO3 • Unexplained Metabolic Acidosis (pH ≤ 7.3
HCO3 HCO3] Normal = 20 Cerebral Normal: 70-90 mmHg
Perfusion MAP – ICP > 90 = Increased ICP or Base Deficit ≥ 50 meq/L & Plasma
Deficit CRF = 15 Lactate > 1.5x upper limit of normal
**Give only ¼ of the computed deficit Pressure < 70 = Ischemia
• Adequate Fluid Resuscitation (PAWP ≥ 12
1 amp = 44 meq NaHCO3 mmHg or CVP ≥ 8 mmHg)

Normal < 18.5 Septic Shock Sepsis with Hypotension (Arterial BP ≤ 90

FEMALES MALES Body Mass Weight mmHg or MAP < 70 mmHg)
[(140 – Age) × Weight (kg)] × [(140 – Age) × Weight (kg)] Index (kg) Underweight 18.5 – 24.9
0.85 Creatinine (mg/dl) × 72 Height
(m)2 Refractory Septic Shock Septic Shock lasting > 1 hour & does not
Creatinine (mg/dl) × 72 respond to Fluid or Pressure Administration
Overweight 25-29.9

Normal 80-120
Obese ≥ 30 Multi-Organ Dysfunction Dysfunction of > 1 Organ requiring intervention
Estimated Syndrome (MODS) to maintain Homeostasis
Creatinin Renal Impairment 50-80
e
Clearance IBW × 35 cal/kg = Total cal/ CHO 60% ÷ 4
Chronic Renal Injury 20-50
(ECC) Diabeti day Pre-Renal Renal Failure Post-Renal
c Diet Failure Failure
CHON 20% ÷ 4
Chronic Renal Failure 5-20 IBW = [Height (in) × 2.54 –
150] Urine > 500 < 350 < 350
(– 10% if female) Fats 20% ÷ 9
End-Stage Renal Disease <5 Osmolality

Stag Description GFR (ml/min/1.73 Specific > 1.018 < 1.015 --

e m2 ) Glucose Na+ Cl- K+ Ca++ HCO3 Gravity

I Kidney Damage with Normal ≥ 90 D5W 50 -- -- -- -- -- U/P Crea Ratio > 40 < 20 --
or Increased GFR
D10W 100 -- -- -- -- -- Urine Na+ < 20 > 40 > 40
II Kidney Damage with Mild 60-90
Decreased GFR BUN/Creatinine > 20 < 15 > 15
0.9 NSS (PNSS) -- 154 154 -- -- --

III Moderately Decreased GFR 30-59

D5LR -- 130 109 4 3 28 FE Na+ (%) <1 >1 >4

IV Severely Decreased GFR 15-29 Renal Failure <1 >1 --

D5NM -- 40 40 13 -- --
Index
V Kidney Failure < 15 or Dialysis
D5NR -- 140 98 5 -- --
Acellular, Muddy Brown
Sediment Transparent Granular Cast Hyaline Casts
D5 0.9 NaCl 50 -- -- -- -- --
Normal/Post-Renal 10-20 Hyaline Cast
BUN:Creatinine (BUN ÷ Crea) Failure
D5NMK 50 40 40 30 -- --
Ratio × 247 Hypovolemia,
Causes Decreased CO, GN Vasculitis, Calculi,
Pre-Renal Failure > 20
3% NaCl -- 513 513 -- -- -- Increased ATN, Nephritis Carcinoma,
Resistance Fibrosis
Intrarenal Failure < 10
ECF Mg = 3 142 103 4 5 27

Oliguric Renal Failure 10-15

Diabetic Hyperosmolar,
Ketoacidosis Hyperglycemic Syndrome
(DKA) (HHS)
24-Hour Convert to mmol/L: • Chest Pain consistent with Acute Myocardial
Creatinine Urine Cr (mg/dl) × Volume (ml/ BUN (mg/dl) × 0.357 Infarction Glucose 13.9-33.3 mmol/L 33.3-66.6 mmol/L
Clearance min) Crea (mg/dl) × 88.4 • ECG Changes 250-600 mg/dl 600-1200 mg/dl
(ml/min) Plasma Cr (mg/dl) × Time (min) o ST Segment Elevation ≥ 1 mm in at least 2
Indications for contiguous Leads
Sodium (meq/L) 125-135 meq/L 135-145 meq/L
Thrombolytic o ST Segment Elevation ≥ 2 mm in at least 2
Therapy contiguous Chest Leads
Anion Na – (Cl + HCO3) Increased: Ketoacidosis, Lactic Acidosis, o New Left Bundle Branch Block (LBBB) Potassium Normal/Increased Normal
Gap Renal Failure (GFR < 20-30), Methanol & • Time from Chest Pain to Thrombolytic Treatment
Normal = 8-16 meq Ethylene Intoxication o < 6 hours (most beneficial) Magnesium Normal Normal
o 6-12 hours (lesser but still important
benefits)
o 12-24 hours (diminishing benefits but may Chloride Normal Normal
Correcte Actual Calcium + [(40 – Albumin) × 0.02] still be useful in selected patients)
d Ca++
Phosphate -- Normal
• Bleeding Diasthesis
Correcte Actual Na + 0.016 × (RBS – 100) RBS (mmol/L) × 18 = __ • Previous Streptokinase Treatment for the past 6-9 Creatinine Slightly Increased Moderately Increased
d Na+ mg/dl
months
Relative • BP ≥ 180/100 mmHg on at least 2 readings
Osmolality 300-320 330-380
Na+ (140 – Actual Na) × (0.6 × BW) Actual Na – Desired Na Contraindicatio • Active Peptic Ulcer Disease
(mOsm/L)
Deficit Desired Na ns for • History of Thrombotic Cerebrovascular Accident
Thrombolysis • Prolonged CPR ≥ 10 minutes/Traumatic CPR
(Desired K – Actual K) × 100 Desired K:
• Diabetic Hemorrhagic Retinopathy or other Plasma Ketones ++++ +/-
K+ Deficit 0.27 Cardiac: 3.5 Hemorrhagic Ophthalmic Conditions
Non-Cardiac: 4.5
• Pregnancy Sodium < 15 meq/L Normal/Slightly Increased
Bicarbonate
• Active Internal Bleeding (except Menses)
Sodium – 140 × TBW Desired:
Absolute • Recent (within 2 weeks) Invasive/Surgical
H2O 140 CKD: 15 Arterial pH 6.8-7.3 > 7.3
Contraindicatio Procedure
Deficit Non-CKD: 18
ns for • Suspected Aortic Dissection
Thrombolysis • Previous History of Hemorrhagic CVA or SAH Arterial pCO2 20-30 Normal
• Recent Head Trauma or known Intracranial
Neoplasm Anion Gap Increased Normal/Slightly Increased
• Persistent BP > 100/120 mmHg
 Classification of Chronic Kidney Disease • Gross Pus on Thoracocentesis Diaz Stroke Scale
• Presence of Organism on Gram Stain of the
Indications for Pleural Fluid
I Injury not Acute with GFR > 90 Dx & Tx progression, Vomiting 4
Chest Tube • Pleural Fluid Glucose < 50 mg/dl
preserved GFR Comorbid Conditions,
Thoracotomy • Pleural Fluid pH < 7 & 0.15 units < Arterial pH
decrease CV Risk Unarousable 4
• Pneumothorax, Pleural Effusion, Chylothorax,
Empyema, Hemathorax, Hydrothorax Level of Consciousness 2
II Mild Kidney Disease GFR 60-89 Eliminate progression rate Drowsy 0
Awake
• Bottle I – Cells, Differential Count, Total
III Moderate Kidney D/E GFR 30-59 Tx Cx, ESRD, Education Thoracentesis Protein, LDH
• Bottle II – AFB, Gram Stain, Culture & Sensitivity Fever 3 Scoring:
IV Severe Kidney GFR 15-29 Prepare ESRD Treatment • Bottle III – Cytology & Cell Block ≥ 7 = 90% Probable
Disease Ataxic/Apneustic 3 Bleed
Respiratory 2 < 7 = Probable Infarct
Hyperventilation 1
V Kidney Failure GFR < 15 ESRD Treatment Transudate Exudate Pattern 0
Cheynes-Stokes
Specific Gravity < 1.016 > 1.016 Regular/Normal
I Dyspnea with Greater than Ordinary
New York Heart Physical Activity (Climbs ≥ 2 Flights of Pleural/Serum < 3 g (0.5) > 3 g (> 0.5) Upper Gastrointestinal Bleed 3
Association (NYHA) Stairs with Ease) Protein
Classification of
Neurologic Deficit (maximum at onset) 2
Congestive Heart II Dyspnea with Ordinary Physical Activity Fibrinogen (-) (+)
Failure (Climbs > 2 Flights of Stairs with Difficulty)
Headache 2
Red Blood Cells < 10000 > 10000
III Dyspnea occurs with Less than Ordinary
Nuchal Rigidity 2
Physical Activity (Climbs ≤ 2 Flights of
White Blood Cells < 1000 > 1000
Stairs)
< 90 mmHg -2
IV Dyspnea present even at rest Serum LDH < 0.6 > 0.6 Diastolic Blood Pressure 0
91-99 mmHg 2
Pleural LDH < 200 IU > 200 IU > 100 mmHg
A No Restrictions
Therapeutic
< 150 mmHg -2
Classification of B Severe Effort Restricted pH > 7.3 < 7.3
Systolic Blood Pressure -1
Congestive Heart
151-169 mmHg 0
Failure Glucose Plasma Decreased --
C Ordinary Effort Moderately Restricted 170-180 mmHg 2
181-199 mmHg
D Ordinary Effort Markedly Restricted Amylase -- > 500 u/ml

Differential Count > 50% Lymphocytes > 50% PMN Motor Neuron Lesions
E Confined to Bed/Chair

Cholesterol < 45 mg/dl > 45 mg/dl Character Upper Motor Neuron Lower Motor Neuron
• Stable Oxygenation (PaO2/FiO2 > 200, PEEP ≤ 5
Light’s Criteria – EXUDATE if any of the following: Tone Hypertonic Clonus Hypotonic Clonus
cmH2O) • Pleural/Serum Protein > 0.5
• Intact Cough & Airway Reflexes • Pleural/Serum LDH > 0.6
• No Vasopressor Agents being Administered Fasciculations (-) (+)
• Pleural LDH > 2/3 the Upper Limit of Normal Serum LDH
Indications FAILURE Wasting (-) (+)
for Weaning • Respiratory Rate ≥ 35 breaths/minute for 5 minutes
• O2 Saturation < 90% De Bakey Classification of Stanford Classification of
• Cardiac Rate > 140 beats/minute (20% increase/ Aortic Aneurysms Aortic Aneurysms Reflexes Exaggerated (-)
decrease from baseline)
• Systolic Blood Pressure < 90/> 180 mmHg
Type I Ascending Aorta & Beyond Type A Ascending Aorta
• Increased Anxiety Diaphoresis
Neurologic Localizations
Type II Ascending Aorta Type B Descending
SUCCESSFUL: Aorta • Limb/Truncal Ataxia
Breathing Ratio of Respiratory Rate to Total Volume in Lung Cerebellum • Intent Tremors
< 105 • Dysmetria & Dysdiadokinesia
Type Aorta Distal to Subclavian --
III Artery
• Prominent Cranial Nerve Deficit (CN III-XII)
• Respiratory Rate > 28 breaths/minute Brainstem • Ipsilateral CN Deficits with Contralateral Limb
• Blood Pressure < 90 mmHg or 30 mmHg below Motor/Sensory Deficits
Criteria for baseline Murmur Grading • Cerebellar Signs
Admission for • New onset confusion or altered consciousness
Community- • Hypoxemia (PO2 < 60 while breathing Room Air Grade I Faint • Disturbed Higher Intellectual Functions
Acquired or O2 Saturation < 90%) Cerebrum • Emotional & Behavioral Disturbances
Pneumonia • Unstable Co-Morbid Conditions • Speech Disturbances & Seizures
• Multi-Lobular Infiltrates Grade II Audible by Stethoscope
• Pleural Effusion
Grade III Moderately Loud • Involuntary Movement
Basal Ganglia • Rigidity
• Bradykinesia
Kilips Classification of Acute MI with Expected Hospital Mortality Rate Grade IV Loud with a Palpable Thrill
• Upper/Lower Motor Neuron Disturbances
Class I No signs of Pulmonary/Venous Congestion 0-5% Grade V Very Loud & Audible with Stethoscope partly off the Chest Spinal Cord • Sensory Disturbances
• Autonomic Disturbances
Moderate Heart Failure or (+) Bibasal Rales, S3 Grade VI Very Loud & Audible with Stethoscope removed from the
Class II Gallop, Tachypnea, or signs of Right-Sided Heart 10-20% Chest • Distal & Symmetric Lower Motor Neuron
Failure, Venous & Hepatic Congestion Peripheral Nerves Disturbances
• Sensory Disturbances
Class Severe Heart Failure, Rales > 50% of Lung Fields or 35-45%
• Autonomic Disturbances
• Impending Respiratory Failure, Apnea
III Pulmonary Edema • Respiratory Rate > 35 breaths/minute
• Inspiratory Force < 25 cmH2O Myoneural • Muscle Fatigability
• Tidal Volume < 3-5 ml/kg Junction • Proximal Weakness of Muscles
Shock with Systolic Blood Pressure of < 90 mmHg &
Class evidence of Peripheral Vasoconstriction, Peripheral 85-95%
• Vital Capacity < 10-15 cc/kg
IV Cyanosis, Mental Confusion, & Oliguria Indications for • PaO2 < 60 mmHg with FiO2 > 60% Muscles • Proximal & Symmetric Motor Disturbances
Mechanical • PaCO2 > 50 mmHg with pH < 7.35
Ventilation • Forced Expiratory Volume < 10 ml/kg
• VQ/VT > 0.6
Leads Cardiac Area • To Deliver High FIO2 Hepatic Encephalopathy
• pH < 7.35
• Absent Gag Reflex
I, aVL, V5, High Left Lateral Circumflex Artery Stag Mental Status Asterixi EEG
V6 Wall e a
• Tidal Volume = 500
• FiO2 = 100
II, III, aVF Inferior Wall Right Coronary Artery • Assist Control/Synchronized Intermittent 1 I Euphoria/Depression, Mild Confusion, (+)/(-) Normal
Ventilator Settings mV Mode Blurred Speech, Disorientation, Asleep
aVR Right Lateral Wall Right Coronary Artery • BUR = 16
• PF = 50 II Lethargy, Moderate Confusion (+) Abnorma
• PEEP = 5 cmH2O l
V1, V2 Septal Wal LAD • Pale = 6-20

V3, V4 Anterior Wall Left Coronary Artery, LAD III Marked Confusion, Incoherent Speech, (+) Abnorma
• Awake, Alert Sleeping, Arousable l
• PaCO2 > 60 mmHg with FIO2 < 50%
• PEEP < 5 cm IV Coma, Initially Responsive to Noxious (-) Abnorma
Small 10 ml • PaCO2 < pH Stimuli, Later Unresponsive l
Pericardial Effusion • Spontaneous TV < 5 ml
Indications for • Vital Capacity > 10 ml/kg
Moderate 10-20 ml Weaning • MIP > 25 cmH2O
• Respiratory Rate < 30 breaths/minute Criteria for Rheumatoid Arthritis
Large > 20 ml • Rapid Shallow Breathing Index < 100 (1987 American College of Rheumatology)
• Stable Vital Signs in 1-2 hours

1 Morning Stiffness in & around the joints 1 hour before maximal

• FIO2 Room Air = 21% improvement
• O2 via Nasal Prong = Lpm × 0.4 × 20
2 Arthritis of ≥ 3 Joint Areas observed by the physician spontaneously
with Soft Tissue Swelling or Joint Effusion (not just Bony Overgrowth)
3 Hand Joint Arthritis, which includes Wrist Joints,
Metacarpophalangeal Joints, & Proximal Interphalangeal Joints
4 Symmetric Arthritis (same joint areas on both sides of the body)
7 Hematologic Disorder – Hemolytic Anemia, Leukopenia (< 4000/µl), Eye Response
Lymphopenia (< 1500/µl), or Thrombocytopenia
4 Eyelids open, tracking, blinking to command
8 Renal Disorder – Proteinuria > 0.5 g/day or > +3, Cellular Casts
3 Eyelids open but not tracking
9 Antinuclear Antibody – Abnormal Titer by Immunofluorescence or
Equivalent Assay at any point in the absence of Drugs
2 Eyelids Closed but open to a loud voice

5 Rheumatoid Nodules over Bony Prominences, Extensor Surfaces, or 10 Immunologic Disorder – (+) Lupus Erythematosus Cell Preparation, 1 Eyelids close but open to pain
Juxta-Articular Regions observed by the physician Anti-ds DNA, or Anti-SM Antibodies

0 Eyelids close even with pain

6 Serum Rheumatiod Factor (+) in < 5% of the normal control subjects 11 Neurologic Disorder – Seizure or Psychosis without any other cause

Motor Response
7 Radiographic Changes on the posteroanterior hand & wrist (Erosions • (+) = 4 OF THESE CRITERIA
or Uniequivocal Bony Decalcification) adjacent to the involved joints • Some may present with 1-2 Criteria but still with SLE
• Rule out Drug-Induced SLE (Hydralazine, Isoniazid, Procainamide, 4 Thumbs Up, Fist, or Peace Sign
Criteria 1-4 must be present for AT LEAST 6 WEEKS Chlorpromazine) & other Vasculitides
Criteria 2-5 must be observed by the Physician 3 Localizes Pain

Common Murmurs 2 Flexion Response to Pain (Decorticate)

Jones Criteria for Rheumatic Fever
Aortic Stenosis Crescendo-Decrescendo Systolic Murmur 1 Extension Response to Pain (Decerebrate)
• Polyarthritis
• Carditis Aortic Regurgitation High-Pitched Blowing Diastolic Murmur 0 No response to Pain/Generalized Myoclonus
Major Criteria • Subcutaneous Nodules
• Erythema Marginatum Mitral Stenosis Rumbling Late Diastolic Murmur following a Brainstem Reflexes
• Sydenham’s Chorea Snap
4 (+) Pupil, Corneal, & Cough Reflexes
• Fever
Ventricular Septal Defect/
Minor Criteria • Polyarthralgia
Mitral Tricuspid Holosystolic Blowing Murmur 3 One Pupil Fixed & Wide, (+) Corneal & Cough Reflexes
• Increased ESR/CRP/Leukocytes
Incompetence
• Prolonged PR Interval
• Previous Rheumatic Fever/Rheumatic Heart 2 (-) Pupil OR Corneal Reflex, (+) Cough Reflex
Disease Mitral Valve Prolapse Systolic Murmur with Mild Systolic Click
seen in Young Women
1 (-) Pupil AND Corneal Reflex, (+) Cough Reflex
• Increased ASO Titer
Required • (+) Throat Culture for GABHS Patent Ductus Arteriosus Continuous Machinery Murmur
0 (-) Pupil, Corneal, & Cough Reflex
Criteria • (+) Rapid Ag Test for GABHS
o Anti-Deoxyribonuclease B
o Anti-Hyaluronidase Respiration
• Recent Scarlet Fever Acute Respiratory Failure

4 (-) Intubation, Regular Breathing Pattern

Positive Diagnosis: Acute Hypoxemic Respiratory Failure
• 1 Required Criteria + 2 Major Criteria Type I • Alveolar Flooding & Intrapulmonary Shunt
• Low-Pressure Pulmonary Edema, Pneumonia, Alveolar 3 (-) Intubation, Cheyne-Stoke Respirations
• 1 Required Criteria + 1 Major Criteria + 2 Minor Criteria
Hemorrhage
• Diffused Bilateral Airspace Edema 2 (-) Intubation, Irregular Breathing

Approaching Patients in Coma
• Cortical – Thought Content
Level of Consciousness • ARAS & Brainstem – Arousal & Wakefulness
• Medullary – Waking & Sleeping
• Cheyne-Stoke – Diencephalon, Diffuse
Respiratory Pattern Cervical
• Hyperventilation – Brainstem
• Apnea – Pons
• Ataxic Cluster – Medulla
• Hypercarbia (e.g. Pneumothorax, Pleural Effusion, 1 Breathing > Ventilation Rate
Atelectasis) with or without Hypoxemia
• Alveolar Hyperventilation & inability to eliminate CO2
0 Breathing at Ventilation Rate, Apnea
• Impaired CNS drive to breathe & impaired strength with
Type II failure of Neuromuscular Function in the Respiratory Tract
• Drug Overdose, Brainstem Injury, Sleep Breathing Disorder Minimum Score = 0
• Respiratory Overload Maximum Score = 16
o **The lower the score, the greater the Coma**
Increased Resistive Load (Bronchospasm)
o Reduced Lung Compliance (Alveolar Edema)
o Reduced Chest Wall Compliance (Pneumothorax)
o Increased Minute Ventilation (Pulmonary Embolus)
Muscle Strength

Perioperative Respiratory Failure

• Small Reactive – Metabolic, Diencephalon Type • Post-Surgical Patients or after General Anesthesia 0/5 No Muscular Contraction
Pupillary Size & • Midpoint, Fixed – Midbrain III (decreased Functional Residual Capacity of dependent
Reaction • Pinpoint – Pons Lung Units) 1/5 Slight Contraction
• Large, Fixed – Tectal • Lung Atelectasis

Diencephalic Reflexes • Brainstem 2/5 Active Movement with Gravity Eliminated

Type • Shock (Respiratory Muscle Hypoperfusion)
IV • Pulmonary Edema, Lactic Acidosis, Anemia
3/5 Active Movement against Gravity
Motor Responses • Decerebrate – Brainstem
• Decorticate – above the Internal Capsule
4/5 Active Movement against Gravity with Slight
Glasgow Coma Scale Resistance

Eye Response (E) 5/5 Active Movement against Full Resistance

Cerebrospinal Fluid Analysis

4 Spontaneous Eye Opening

Normal Bacterial Viral Tuberculosi
s Grading of Dengue Fever
3 Opens to Verbal Command

Color Colorless Turbid, Clear/Cloudy Xantochromi Grade I Fever, Non-Specific Symptoms (Anorexia, Vomiting, Abdominal
2 Opens to Pain ≤8 Severe
Greenish c Pain),
(Coma)
(+) Tourniquet Test
9-13 Moderate
Protein 15-45 mmHg Increased Mild Increase Mild 1 No Eye Opening 14-15 Mild
Increase Grade II Grade I + Spontaneous Bleeding
Verbal Response (V)
Pressur 30-180 200-500 Normal to Normal to Grade III Grade II + Severe Bleeding + Circulatory Failure
e mmH2O mmH2O Mild Increase Mild 5 Oriented
Increase Grade IV Grade III + Irreversible Shock + Massive Bleeding
4 Confused/Disoriented
Glucose 45-70 mg/dl Decreased Normal Decreased

3 Inappropriate Words Ranson’s Criteria for Acute Pancreatitis

Cells <6 1000-10000 Increased Increased
Lymphocytes WBC Lymphocytes Lymphocyte
(increased s 2 Incomprehensible Words • Age > 55 years old
PMN) AFB Stain • Leukocytosis > 16000/mm3
1 No Response At Admission/ • Hyperglycemia > 11 mmol/L (> 200 mg/dl)
Diagnosis • Serum LDH > 400 IU/L
• Serum AST > 250 IU/L
1982 Criteria for Classification of Systemic Lupus Erythematosus (SLE) Motor Response (M)
• Decreased Hematocrit by > 10%
1 Malar Rash – Fixed Erythema, Flat/Raised 6 Obeys to Command • Fluid Deficit > 4000 ml
During Initial 48 • Hypocalcemia < 1.9 mmol/L (< 8 mg/dl)
5 Localizes Pain Hours • Hypoxemia (PO2 < 60 mmHg)
2 Discoid Rash – Erythematous Raised Patches with adherent Keratotic • BUN > 1.8 mmol/L (> 5 mg/dl) after IV Fluids
Scaling & Follicular Plugging • Hypoalbuminemia < 32 mg/L (< 3.2 g/dl)
4 Withdraws to Pain
3 Serositis – Pleuritis/Pericarditis on ECG or Pericardial Rub or
evidence of Pericardial Effusion Increased Mortality Rate: ≥ 3 Factors (1 at the Time of Admission/Diagnosis
3 Decorticate (Flexion)
& 2 during the Initial 48 Hours); requires close monitoring at the Intensive
Care Unit
4 Oral/Nasopharyngeal Ulcers 2 Decerebrate (Extension)

5 Arthritis – Non-Erosive, involves ≥ 2 Peripheral Joints characterized 1 No Response

by Tenderness, Swelling, or Effusion Pulmonary Tuberculosis Classification

Class 0 • No Exposure, Infection, Radiographic Evidence, or Active

6 Photosensitivity
Full Outline of Unresponsiveness (FOUR) Scale Disease
 • History of Exposure Brainstem Pontomedullary Brainstem, Lateral Medulla Dopamine 2 amps (400 mg) +
Class I • No Infection, Radiographic Evidence, or Active Disease Junction • Vertigo Dobutamine 250 mg/amp + 250cc D5W
• (-) Tuberculin Skin Test • Basilar Artery • Nystagmus D5W 250 cc x ___ µgtts/min (max: 10-20 mg/kg/min)
• Facial Paralysis • Horner’s Syndrome (max rate: 60 µgtts/min)
• Paresis of Abduction of Eye • Ataxia Renal Vasoconstriction = 0-5 mg/
• History of Exposure & with Infection • Paresis of Conjugate Gaze • Falling Toward Side of lesion Rate drip kg/min
Class II • No Clinical, Bacteriologic, or Radiographic Evidence of TB • Hemifacial Sensory Deficit • Impaired Pain & Thermal Drip mcg x kg BW Renal Vasodilation = 2-5 µg/kg/
• No Active Disease • Horner’s Syndrome Sense over Half Body with/ 16.6 min
• (+) Tuberculin Skin Test • Diminished Pain & Thermal without Face Inotropic = 5-10 mg/kg/min
Sense over Half Body with/ For patients with CHF: Vasoconstriction = > 15 mg/kg/
Class III • Clinically Active Tuberculosis without Face Dobutamine 2 amps (500 mg) min
• With Clinical, Bacteriologic,or Radiographic Evidence of TB • Ataxia + Mild Increase in Myocardial
D5W 250 cc Contractility & Rate = 5-16 µg/kg/
• Tuberculosis Not Clinically Active (Treated TB) (max rate: 30 µgtts/min) min
Class IV • History of Exposure and Infection • Infection Rate (µgtts/min):
• Abnormal but Stable Radiographic Evidence of TB
Complications of • Perforation mg/kg/min x BW
• No Clinical or Radiographic Evidence of Current TB
ERCP • Pneumothorax 13.3 or 26.6
• Bleeding
• Suspect Tuberculosis
• History of Exposure, Infection, & Radiographic Evidence
Class V • May or may not have Active Disease Epinephrine Drip Single BW × Desired Dose
• Pending Diagnosis Actrapid Drip Actrapid Drip for Gestational DM Strength 13.3
• Tuberculosis should be ruled out within 3 months BW × Desired Dose
16.6
Epinephrine 5 amps (5 mg) +
Drug Dosage Action Side Effects 20 “u” Actrapid + 100 cc 10 “u” Actrapid + 100 cc PNSS 500cc D5W to run for 6 cc/hr
BW × Desired Dose
PNSS Double 16.6
Isoniazid 5 mg/kg Cidal, Hepatitis, Peripheral Fraxiparine Drip Strength BW × Desired Dose
(max 300 both Neuropathy, SAFEST in HGT Actrapid (cc/hr) 33.2
mg) Pregnancy HGT Actrapid < 120 Close
< 160 (cc/hr) 121-14- 6 Cardiac =
Fraxiparine 2 amps in 1 L 5 Renal =
10-20 mg/kg Cidal, Hepatitis, Hemolysis, 160-199 Close 141-160 8 D5W or D5NSS
200-249 3 161-180 10 5-10
Rifampicin (max 600 both Thrombocytopenia, Red/ 88 “U”/kg BW or 0.1 cc/kg x
mg) Orange Urine 250-299 8 181-220 14 24H
300-349 10 221-240 16
350-399 15 241-260 18
Pyrazinamide 20-30 mg/kg Cidal, IC Hyperuricemia, Most Furosemide Drip
400-499 20 261-280 20
(max 2 g) Hepatotoxic
≥ 500 25 281-300 22
30 & Refer > 300 Refer
Ethambutol 15-20 mg/kg Static, Optic Neuritis
both Furosemide 3 amps + 54cc
Actrapid Sliding Scale
PNSS in a soluset x 10 cc/hr
Streptomycin 10-18 mg/kg Static, CN VIII Damage
EC Furosemide 80 mg in 80cc Furosemide-Albumin Drip
CBG Coverage CBG Coverage (units) PNSS via soluset x 10 cc/hr
< 160 (units) ≤ 200 No Coverage
Categor Description Intensiv Maintenanc 161-200 No Coverage 201-250 3 Dr. Caro 25% Albumin 50cc + Furosemide 20
y e Phase e Phase 201-249 3 251-300 5 In a soluset: Furosemide 3 mg to run for 4hrs
250-299 5 301-350 7 amps + 54 cc PNSS x 10 cc/hr
• New Smear (+) with Extensive 300-349 7 351-400 8
Albumin 50cc + PNSS 950cc +
I Parenchymal involvement 2 RIPE 4 RI 350-399 9 401-450 9 D5W 250cc + Furosemide Furosemide 100mg x 24hrs
• New Severe Extrapulmonary 400-449 11 451-500 11 250mg/amp x 5-30 µgtts/min
TB 450-499 13 > 500 12 & Refer Conc: 1 mg/mL Albumin 100cc + Furosemide 40mg
≥ 500 14
to run for 4-6hrs
15 & Refer PLR 500cc + 18 amps
• Sputum Smear (+) Relapse 2 RIPES
II • Treatment Failure + 1 RIPE 5 RIE Furosemide x 18-20 µgtts/ Dr. Caro
• Treatment Interruption CA Drip Aminophylline Drip min Furosemide 60mg + PNSS 54cc x
10cc/hr
SD: Plasbumin 25% 100cc to run for
III • New Smear (-) with less 2 RIP 4 RI
6 hrs
severe Extrapulmonary TB Clonidine 2 amps (150 mg/ Aminophylline 4 amps in 500 cc
amp) + Apresoline 2 amps (20 D5W x ___ µgtts/min
mg/amp) in 500cc PNSS or Glucose-Insulin-HCO3 Drip Glucose-Insulin Drip
D5W x ___ µgtts/min LD: 5-6 mg/kg BW
Cushing’s Triad Hemorrhagic Stroke Beck’s Triad MD: 0.2-0.5 mL/hr
Triad Titrate by increments of __
D5W 150 cc + D50W 1 vial + (Hyperkalemia ≥ 6)
µgtts to maintain BP ___ mm
NaHCO3 1 amp + Actrapid 8
• Increased Systolic • Papilledema • Muffled Heart Hg (up to 60 µgtts/min)
units to run for 6 or 8 or 12 In a soluset, 50 cc D50W + Actrapid
BP • Headache Sounds hrs 8-10 units x 1 hour x 3 cycles
• Widened Pulse • Vomiting • Hypotension Clonidine Drip Apresoline Drip
Pressure • Distended Neck Repeat K post-drip CBG monitoring hourly while on
• Bradycardia/ Veins drip
Cheyne-Stokes Glucose
Respiration Clonidine 2 amps in 50 cc
HGT < 60 – D50W 1 amp Repeat K+ 1 hour after the last
PNSS Apresoline 2 amps (20 mg/amp) in
HGT < 40 – D50W 2 amps cycle
PNSS 250cc

Systolic BP Dose Target FBS 60-90, RBS 80-120

Meig’s Syndrome
• Pleural Effusion
• Polycystic Ovary/
Fibromatosis
• Hypoalbuminemia
Anatomic Localizations in Stroke
Cerebral Hemisphere (Lateral
Aspect)
• Middle Cerebral Artery
• Hemiparesis, Hemisensory
Defect
• Motor Aphasia (Broca’s Area)
• Central Aphasia (Wernicke’s
Area)
• Unilateral Neglect, Apraxia
• Homonymous Hemianopsia or
Quadrantanopia
• Gaze Preference
Contralateral to the Lesion
Cerebral Hemisphere (Posterior
Aspect)
• Posterior Cerebral Artery
• Homonymous Hemianopsia
• Cortical Blindness
• Memory Deficit
• Dense Sensory Loss,
Spontaneous Pain,
Dysesthesias, Choreoathetosis
Horner’s
Syndrome
• Ptosis
• Miosis
• Anhydrosis
Cerebral Hemisphere (Medial
Aspect)
• Anterior Cerebral Artery
• Paralysis of Foot & Leg with
or without Paresis of Arm
• Cortical Sensory Loss over Leg
• Grasp/Sucking Reflexes
• Urinary Incontinence
• Gait Apraxia
Brainstem & Midbrain
• Posterior Cerebral Artery
• Third Nerve Palsy &
Contralateral Hemiplegia
• Paralysis/Paresis of Vertical
Eye Movement
• Convergence Nystagmus
• Disorientation
Max: 400 mg/day
< 160 Close
160-180 20
180-200 25 Isoket Drip NaHCO3 Drip
> 200 30
Burinex Drip Calcium Gluconate Drip
Isoket 10 mg/amp (1amp) +
PNSS 90 cc x 10 µgtts/min (1 NaHCO3 2 amps (50 cc/amp) in D5W
mg/hr) x 24 hrs
Burinex 3 amps in 54 cc PNSS Calcium Gluconate 4 amps (10mg/
x 10 cc/hr amp) in 500cc D5W x 24hr NaHCO3 3 amps in 100cc D5W x
24H
Miacaicic Drip
Bricanyl Drip Calcium Glucose Drip
Miacalcic 2 amps (200 IU) +
Bricanyl 5 amps in 500cc D5W Ca gluconate 4 amps in 500cc D5W D5W 250 cc x 15 hour
x 24H x 24hr
Increase to 30-40 cc/hr See to it that the patient has no ß- Heparin Drip Heparin For Flushing
Bricanyl 2.5 mg/tab TID blocker
Cordarone Drip Diazepam Drip
D5W 250cc + Heparin 10,000
units x 10-20 µgtts/min via > 500 ‘U’ Heparin in 100 mL PNSS
infusion pump
Cordarone 4 amps + 500cc Diazepam 10 mg/100cc D5W
PNSS x 60 cc/hr x 1st 6 hours Diazepam 20 mg/100cc D5W Conc.: 50 U/mL
Hepamerz Drip
Subsequently 25 cc/hr Drip of 500-1000 ‘U’ ~ 10-20
Initial: 50-100 mg IV µgtts/min
Cordarone 150 mg IV now Max: 60 mg/day OR
Cordarone 4 amps + 500cc Diazepam 50 mg in 100cc PNSS x 6 In a soluset, Heparin 4cc in
D5W x 24H cc/hr to titrate to control seizure 36cc D5W (Heparin 1000 IU/ < 4 amps in 500cc D5W x 12hrs BID
Cordarone 4 amps + 500cc Hold for BP < 90/60 mm Hg cc)
D5W x 25 µgtts/min x 6H, OR
then 12 cc/hr Heparin 5000 ‘U’ IV initially,
IVIG
then 4000 ‘U’ in 36cc PNSS
via soluset x 1000 ‘U’/hr
Dilantin Drip Dormicum Drip
LD: 3000-5000 ‘U’ slow IV LD: 2 g/kg given in 5-6hrs in 3-5
days
500 mg slow IVTT as Loading Dormicum 3 amps (1.5 mg/amp) + LD = 80 U/kg
Dose with PNSS as Main Line 500cc PNSS x 2 mg/hr MD = 18 U/kg MD: 400 mg/kg or 0.4g/kg
to be given at 110 mg/min
then 300 mg IV q6hrs APTT det’n q6h
Insulin Drip
APTT 1.5-2x the baseline
Dobutamine Drip Dopamine Drip
 S. Bilirubin µmol/L < 34 34-51 > 51 Timing of • Clinical & Radiologic evidence of complete expulsion
PNSS 250cc + Humulin R 50 ‘u’ Chest Tube of all Pleural Cavity contents with complete
Removal expansion of the Lung
mg/dl <2 2-3 >3
Conc.: 0.2 ‘U’/mL • Minimal Drainage within 24 hours (< 25 ml/kg)
• Cough/Valsalva Maneuver = should not have Air Leak
Drip of 5-50 µgtts/min ~ 1-10 ‘u’ S. Albumin g/L > 35 30-35 < 30
Humulin
g/dl > 3.5 3-3.5 <3
CHADS2 Scoring

Nicardipine Drip Lidocaine Drip Protime seconds 0-4 4-6 >6

Estimates the risk of having Ischemic Stroke in patients with Non-
Rheumatic, Non-Valvular Atrial Fibrilation
INR < 1.7 1.7-2.3 > 2.3
Nicardipine 10mg in 90cc Give 50 as blous, then start drip as
PNSS or D5W in a soluset to follows: Congestive Heart 1 1 2.8%
Ascites -- None Easily Poorly Failure 2 4.0% Oral Anticoagulation
run for 10cc/hr, titrate by 1 g in 250cc D5W at 15cc/hr (1mg/
Controlled Controlled 3 5.9% is advised in scores
increments of 5 µgtts/min to h)
maintain BP at ____ mmHg increase by increments of 15 4 8.5% >2
Hypertension 1
Hepatic -- none Minimal Advanced 5 12.5%
Max of 150 cc/hr at 15mg/hr LD: 1mg/H Encephalopa 6 18.2%
Age < 75 years old 1
(0.5 mk/BW), give initial Conc: 4mg/cc thy
bolus of 2mg IVTT, titrate to Drip: 1-4mg/min
BP ___ Class A Decomposition – indicates Cirrhosis, Score of ≤ 7 Diabetes Mellitus 1
5-6 Class 8 – listing for Liver Transplantation
Morphine Drip Noradrenaline (Levophed) Drip Class B Hepatic Fibrogenesis – Stellate Cell Activation & Previous Stroke 2
7-9 Collagen Production
Class C ≥
10
MoSO4 10 mg/amp (1 amp) + Hypertensive Urgency Hypertensive Emergency
PNSS 60cc in a soluset x 10 2mg Noradrenaline/2ml amp
µgtts/min D5W 250cc + Levophed 1amp x
15-60 µgtts/min Hypertensive Crisis Malignant Hypertension
Clinical Stages of Hepatic Encephalopathy
MoSO4 1 amp (16mg/amp) + Conc: 8mcg Noradrenaline/ml
PNSS 50cc x 6 µgtts/min Drip of 2-8 mcg Noradrenaline ~ (-) End Organ Damage (+) End Organ Daage
(2mg/H) 15-60 µgtts/min Stage I Euphoira, Depression, Mild Confusion, Slurred Speech,
Sleep Disturbance
Oral Drugs Initially IV Medications
PRN: 1-3mg MoSO4 SQ Levophed 2 amps (2 mg/mL/amp)
in D5W 250cc x 10 µgtts/min Stage II Lethargy, Moderate Confusion
Goal: Lower BP within 24 hours Goal: Lower BP within hours
Nimotop Drip
Levophed 4 amps in D5W 500cc x
Stage III Marked Confusion, Incoherent Speech, Sleeping but
___ µgtts/min
Arousable
Nimotop ½ vial + D5W 500cc Retic. Count × (Hgb ÷ Hemolysis > 2.5
x 24H Stage IV Coma, Initially Responsive to Noxious Stimuli 15)
2
Reticulocy
Nootropil Drip te
Retic. Count × (Hct ÷ Hypoproliferative or <2
• Failure of Conservative Management Production
45) Maturation Disorder
• Management to Relieve Index
Indications for o Pulmonary Congestion unresponsive to high
Nootropil 12g in 60cc x 24H MC
Initiating dose Furosemide
Hemodialysis o Severe Metabolic Acidosis
o Severe Hyperkalemia Hematocrit (%) Maturation Correction (MC)
Pantoloc Drip • BUN < 100 mg/dl or Creatinine > 10 mg/dl
• Note: For Acute Renal Failure, it is best to start 36-45 1
Dialysis early

Maintain GI acidity to 26-35 1.5

stabilize clot
Pantoloc 80mg IV bolus then
5 amps in PNSS 1L x 24H for 3
days
Ocreotide (Sandostatin) Drip
Prep: 0.5 mg/mL
0.2 mg/mL IV bolus, give for
1 min, then start drip as
follows: 4 amps + remaining
0.03 mg in 500cc PNSS x 24H
Solumedrol Drip
Ideal Peak Flow 16-25 2
Males = Hg (m) – 100 × 5 + 175 < 15 2.5
Females = Hg (m) – 100 × 5 + 170
Sandostatin Drip
PEFR = Peak Flow Reading ÷ Ideal Peak Flow × 100
Normal = ≥ 80% Upper Motor Neuron Lesion Lower Motor Neuron Lesion
Sandostatin 0.5mg/amp 0.2mL now
then drip as ff: 0.8mL in D5W PEFR Variability = Highest Reading – Lowest Reading × 100
Movement Paralysis Muscle Maralysis
500cc x 8H Highest Reading
Follow up by 2 amps sandostatin
Slight/No Muscle Atrophy Severe Muscle Atrophy
0.5mg/amp + D5W or D5NSS 1L x
24H
Parkland Formula 4 × kg × TBSA Start initially with D5LR !
Spastic, Hypertonic Muscles Flaccid, Hypotonic Muscles
for Burn ½ 1st 8 hours D5NSS
Somatostatin Drip Replacement ½ next 16 hours
Increased Deep Tendon Reflex Decreased Deep Tendon Reflex

Solumedrol 2g + D5W 500cc x
20 µgtts/min
Somatostatin 250mcg IV bolus then (+) Babinski Reflex (-) Babinski Reflex
RHD Prophylaxis Ampicillin 2 g + Gentamycin 2 mg/kg
2amps (3mg/amp) + PNSS 1L x 24H
for 5 days w/o interruption Paralysis of Lower Face Facial Paralysis of Affected Side
Prednisone Tapering

Terbutaline (Bicanyl) Drip
D5W 250cc + Bricanyl 5amps
x 10-30 µgtts/min
Thiamine Drip
50-100mg IV (for 40-50 y.o.)
Toradol Drip
Toradol 30mg + PNSS 80cc via
soluset x 8H
Toradol 100mg + PNSS 80cc x
10cc/H
Tramadol Drip
Tramadol 100 mg + PNSS 80 Zantac 5 amps in D5W 500 cc x 16H
cc x 10 µgtts/min
Streptokinase Drip Contralateral Tongue Deviation Ipsilateral Tongue Deviation
1 tab after Breakfast & Lunch for 3 days
Prednisone 20 1 tab after Breakfast, ½ Tab after Lunch for 3 days
mg/tab 1 tab after Breakfast for 3 days (-) Fasciculations (+) Fasciculations
Streptokinase 1.5M units + D5W Discontinue
90cc x 100cc/H (1H running rate)
via soluset
Level
Give prior: Benadryl 50mg ivtt Framingham Criteria for Diagnosis of Congestive Heart Failure 3 L’s of Neurologic Lesion
Solucortef 250mg ivtt Assessment
Lateralize
• Paroxysmal Nocturnal Dyspnea
APTT monitoring q6H • Neck Vein Distention Localize
• Rales
Major Criteria • Cardiomegaly
• Acute Pulmonary Edema
• S3 Gallop Siriraj Stroke Score
• Increased Venous Pressure (> 16 cmH2O)
• (+) Hepatojugular Reflux
Clinical Features Scor
e
• Extremity Edema
• Night Cough
Consciousness Alert 0
• Dyspnea on Exertion
Minor Criteria • Hepatomegaly
Zantac Drip • Pleural Effusion Drowsy, Stupor 2.5
• Vital Capacity Reduced by 1/3 from Normal
• Tachycardia (> 120 beats/minute) Semi-Coma, Coma 5
Major/Minor • Weight Loss > 4.5 kg over 5 days of Treatment
Vomiting No 0
Criteria

Zithromax Drip Yes 2

1st Infusion = 50-100 mg/hr

Headache within 2 Hours of Stroke Onset No 0
Rituximab 90-120 Max = 400 mg/hr
Zithromax 500 mg in 90 cc IVF via soluset to run for 5 hours
mEqs/kg S/E: Pulmonary Events, Rapid Tumor Lysis
MOA: Binds to CD20 in pre-B & Mature B Yes 2
Lymphocytes
Diastolic Blood Pressure Actual DBP (mmHg) × 0.1
Child-Pugh Classification of Liver Cirrhosis
Atheroma Markers (including Diabetes, None 0
Factor Unit I II III Angina, Intermittent Claudication)
≥1 3
 Constant - 12 • Moderate Risk Criteria + Septic Shock & Need For • Age of Onset < 20 or > 50 years old
Mechanical Ventilation Clues for • No Family History of Hypertension
• ICU ADMISSION Suspecting • Diastolic BP > 110-120 mmHg
Interpretation
Secondary • Sudden increase in BP in Stable Stage I
• ≥+2 Most Likely HEMORRHAGE
Treatment Hypertension Hypertension
• -1, 0, +1 Equivocal Result (requires CT Scan)
High-Risk • No P Aeruginosa Risk = IV Non-Antipseudomonal ß- • Poor BP Control despite good compliance
• ≤-2 Most Likely INFARCTION
Lactam + IV Extended Macrolide or Respiratory • Systemic Findings (e.g. Weight Gain/Loss,
Fluoroquinolones Potassium Abnormalities, etc.)
• P Aeruginosa Risk = IV Antipneumococal
Stages of Brain Abscess Antipseudomonal ß-Lactam + IV Extended
Macrolide + Aminoglycoside
OR Risk Stratification Description Desired LDL
Stage I Early Cerebritis (Day 1-3) with marked Edema IV Antipneumococcal Antipseudomonal ß-Lactam +
IV Ciprofloxacin/Levofloxacin (High-Dose) Very High Risk ACS, CAD with DM < 70 mg/dl
Stage II Late Cerebritis (Day 4-9), Pus Formation
High Risk CAD or CAD < 100 mg/dl
Stage III Early Capsule Formation (Day 10-13) Burch & Wartofsky’s Diagnostic Criteria for Thyroid Storm Equivalents

Stage IV Late Capsule Formation (≥ Day 14), Thickened Capsule 37.2-37.7 5 Moderately High Risk > 2 Risk Factors < 100 mg/dl
Thermoregulat (10-Year Risk 10-20%)
ory Dysfunction 37.8-38.2 10
(°C) Moderate Risk > Risk Factors < 130 mg/dl
Metabolic Syndrome Criteria (≥ 3)
(10-Year Risk < 10%)
38.3-38.8 15
Central Obesity Waist Circumference > 102 cm (Males) or > 88 cm
(Females) Low Risk 0-1 Risk Factors < 160 mg/dl
38.9-39.3 20

Hypertriglyceride Triglycerides > 150 mg/dl or use of specific 39.4-39.9 25

mia medication Troponin I or T CK-MB
> 40 30
Low HDH HDL < 40 mg/dl (Males) or < 50 mg/dl (Females) or Initial Elevation 3-12 hours
Cholesterol use of specific medication
Absent 0
Central Peak Elevation 24 hours
Hypertension BP > 130/80 mmHg or use of specific medication Nervous System Mild (Agitation) 10
Effects Return to 5-14 Days 2-3 Days
Fasting Glucose > 100 mg/dl or diagnosed with Diabetes Mellitus Type Normal
II or use of specific medication Moderate (Delirium, Psychosis, Extreme Lethargy 20
• Done once at least 12 • Increased
Severe (Seizure, Coma) 30
hours after Chest Pain sensitivity with
Stable Angina Heaviness, Tightness, Squeezing, 2-10 minutes, Miscellaneous • Cut Off (Abnormal): > sampling q6-8 hrs
Retrosternal Gastrointestinal Absent 0 99% of reference • CK Activity > 2.5
-Hepatic control group suggest Myocardial
Dysfunction Mild (Diarrhea, Nausea, Vomiting, Abdominal 10 source for
Chest Pain plus at least 1 of the following: elevation
Unstable Angina • Occurs at rest > 10 minutes Pain)
• Severe & New Onset
• Crescendo Pattern (Severe, Prolonged, Severe (Unexplained Jaundice) 20
Frequent) • Aspirin • ACE-Inhibitors
99-109 5 Drugs Used in • Clopidogrel • Nitrates
NSTEMI Unstable Angina + Evidence of Myocardial Necrosis Tachycardia Acute Coronary • Reperfusion (in • GIIb-GIIIa Inhibitors
(elevated Cardiac Markers, Non-ST Segment (Beats/Minute) Syndromes STEMI) • Statins
Elevation) 110-119 10 (ACRUBANGS) • Unfractioned
Cardiovascular Heparin
Dysfunction 120-129 15 • Beta-Blockers
STEMI Unstable Angina + ST Segment Elevation

Prinzmetal Angina Ischemic Pain at rest but not with exertion; ST 130-139 20
Segment Elevation, Transient Epicardial Coronary ECG Intervals
Artery Focal Spasm > 140 25
P Wave 0.6-0.10 seconds
Absent 0
5 Medications to Treat Myocardial Infarction Cardiac PR Interval 0.12-0.20 seconds
Dysfunction Mild (Pedal Edema) 5
Nitrates Vasodilation & Analgesia QRS Complex 0.8-0.10 seconds
Moderate (Bibasal Rales) 10
Beta Blockers Decreased Myocardial Contraction, Decreased Heart QT Interval 0.35-0.42 seconds
Workload Severe (Pulmonary 15
Edema)
Statins Pleomorphic Effect Right Atrial Abnormality
Arrhythmia Absent 0 P-Wave Prominent Peaked P-Waves in Lead II (> 2.5 mm high)
Clopidogrel Anti-Thrombotic (Atrial Fibrillation) Configuratio
Present 10 ns Left Atrial Abnormality
Aspirin Anti-Thrombotic M-Shaped, Widened P-Waves in Lead II (> 0.1 seconds long)
Precipitant Negative 0
History
Positive 10 Right Ventricular Hypertrophy
Community Acquired Pneumonia
QRS Tall R Waves in Leads V1 & V2, Deep S Waves in Leads V5 &
Interpretation: Complex V6
• T = > 36°C or < 40°C, PR = < 125 bpm, RR = < 30 Configuratio
cpm, BP > 90/60 mmHg
• < 25 Storm Unlikely
• 25-44 Impending Storm ns
• No Acute Altered Mental State, No Suspected Left Ventricular Hypertrophy
Aspiration, Stable or No Comorbidities
• > 45 Highly Suggestive of Storm Tall R Waves in Leads V5 & V6, Deep S Waves in Leads V1 &
• Localized Infiltrates, No Pleural Effusions or V2
Low-Risk Abscess
• OUTPATIENT
TIMI Score
Treatment
• Detection of Rise &/or Fall of Cardiac
• Previously Healthy = Amoxicillin or Extended Age > 65 years old 1 1 5% Risk Biomarkers with at least 1 value above normal
Macrolide Criteria for Acute • Pathologic Q-Wave
• Stable Comorbidities = ß-Lactam/ß-Lactamase Myocardial • Imaging Evidence of new loss of Viable
> 3 CAD Risk Factors 1 2 8% Risk Infarction Myocardiardial or new regional wall motion
Inhibitor Combination or 2nd Gen Cephalosporin +
Extended Macrolide abnormality
• Alternative: 3rd Gen Cephalosporin + Extended Known CAD (> 50% Stenosis) 1 3 13% Risk • Sudden unexpected Cardiac Death
Macrolide
• For Percutaneous Coronary Intervention (PCI) or
Coronary Artery Bypass Graft (CABG)
Aspirin Use in the past 7 Days 1 4 20% Risk • Increased Biomarkers > 3x 99th Percentile
• T = < 36°C or > 40°C, PR = > 125 bpm, RR = > 30 • Pathological Findings of Myocardial Infarction
cpm, BP = < 90/60 mmHg Severe Angina in the last 24 Hours 1 5 26% Risk
Moderate-Risk • Altered Mental State, Aspiration Suspected, • Type I – Ischemia due to primary Coronary event
Decompensated Comorbid Conditions
Elevated Cardiac Markers 1 6 41% Risk • Type II – Ischemia due to increased O2 demand
• Multilobar Infiltrates, Pleural Effusions, Abscesses
or decreased O2 supply
• WARD ADMISSION
ST Deviation > 0.5 mm 1 7 50% Risk Classification of • Type III – Sudden Unexpected Cardiac Death
Myocardial (New ST Elevation/New Left Bundle Branch
Treatment
Infarction Block)
• IV Non-Antipseudomonal ß-Lactam (BLIC, • Type IVa – associated with PCI
Cephalosporin, or Carbapenems) + Extended
Hypertension Classification Systolic (mmHg) Diastolic (mmHg) • Type IVb – associated with Stent Thrombosis
Macrolide • Type IVc – associated with CABG
• IV Non-Antipseudomonal ß-Lactam + Respiratory
Fluoroquinolones Normal < 120 < 80
Troponin
ST Elevation > 0.1 mV = • 100 Large Acute MI
Pre-Hypertension 120-139 80-89
Reinfatrction • 10 Medium MI
• 1 Small MI
Stage I Hypertension 140-150 90-99

Stage II Hypertension > 160 > 100

Rome II • ≥ 12 weeks of Abdominal Discomfort
Criteria for • Relieved by Defecation
Isolated Systolic Hypertension > 140 < 90 Irritable Bowel • Change in Stool Frequency
Syndrome • Change in Stool Form
 - + - - - Immunization, Hepatitis B WHO Stages of HIV Infection
Hepatic Encephalopathy Remote Past; False (+)
Stage I HIV Infection, Asymptomatic, CD4+ Cell Count at least 500
Precipitating Factors
Mnemonic: HEPATICS (Hemorrhage in GIT/Hyperkalemia, Excess CHON, Stage II HIV Infection, CD4+ Cell Count = 350-499
Paracentesis, Acidosis/Anemia, Trauma, Infection, Colon Surgery, Sedatives)
Neck Lymph Nodes • Pre-Auricular
Stage III Advanced HIV Disease (AHD), CD4+ Cell Count = 200-349
Stag Mental Status Asterixi EEG (PPOTS SSPDS) • Posterior Auricular
e a • Occipital
• Tonsillar Stage IV AIDS, CD4+ Cell Count = < 200 or < 15% of all Lymphocytes
• Submandibular
I Euphoria/Depression, Mild Confusion, (+)/(-) Normal • Submental
Blurred Speech, Disorientation, Asleep • Superficial Cervical
• Posterior Cervical RIFLE Criteria for Acute Kidney Injury
II Lethargy, Moderate Confusion (+) Abnorma • Deep Cervical
l • Supraclavicular GFR Criteria Urine Output Criteria

III Marked Confusion, Incoherent Speech, (+) Abnorma Risk Serum Creatinine > 1.5x < 0.5 ml/kg/h × 6 hours
Sleeping, Arousable l 1997 AJCC Nodal GFR decreased > 25%
Classification
• Level I – Submental &
IV Coma, Initially Responsive to Noxious (-) Abnorma Injury Serum Creatinine > 2x < 0.5 ml/kg/h × 12 hours
Stimuli (later Unresponsive l Submandibular
• Level II – Upper Jugular GFR decreased > 50%
• Level III – Middle Jugular
• Level IV – Lower Jugular Failure Serum Creatinine > 3x (> 4 mg/ < 0.3 ml/kg/h × 24 hours
Criteria for • Blood Glucose = ≥ 11.1 mmol/L (200 mg/dl) • Level V – Post Triangle dl; Acute Rise > 0.5 mg/dl) (Oliguria)
Diabetes • Fasting Plasma Glucose = 7 mmol/L (126 mg/dl) • Level VI –Hyoid Bone to GFR decreased > 75% Anuria × 12 hours
Mellitus • 2-Hour Plasma Glucose = > 11.1 mmol/L (200 mg/ Suprasternal Notch
dl) • Level VII – inferior to
Loss Persistent ARF: Complete Kidney Function Loss > 4 weeks
Suprasternal Notch

Sulfonylureas ESRD Complete Kidney Function Loss > 3 months

• 1st Generation – Acetohexamide, Chlorpropamide,
Tolazamide, Tobutamide Surgical Grading
• 2nd Generation – Glipizide, Hlyburide,
Oral Glibenclamide, Gliclazide • Emergent Operations (especially Elderly)
Hypoglycemics • 3rd Generation – Glimeperide
High • Aortic & Non-Carotid Major Vascular Surgery Hypertensive Bleed Signs Based on Location of Hemorrhage
(Endovascular & Non-Endovascular)
Biguanides – Metformin • Prolonged Surgery associated with large Fluid Shift/
Blood Loss • Depressed Sensorium
Putamen • Contralateral Hemianopsia & Hemiparesis
Alpha-Glucosidase Inhibitors – Acarbose, Voglibose • Normal Pupils
• Major Thoracic Surgery
Meglitinides – Nateglinide, Repaglinide • Major Abdominal Surgery
Intermediat • Carotid Endarterectomy Surgery
• Depressed Sensorium
e • Head & Neck Surgery
• Downward Eye Deviation
Thiazolidinediones – Pioglitazone, Rosiglitazone • Orthopedic Surgery Thalamus • Skew Deviation
• Prostate Surgery
• Hemisensory Loss
• Sluggish Pupils
• Deep Conjugate Gaze
Wagner Classification of Diabetic Foot Low • Eye, Skin, & Superficial Surgery
• Endoscopic Procedures
• No Coma, Normal Pupils
0 Intact Skin Cloxacillin/1st Generation Cephalosporin Lobar • Hemiparesis/Hemisensory Loss
Difficulty with Adult Activities of Daily Living • Seizures
Cannot Walk 4 Blocks or 2 Flights of Stairs or
1 Dermis Cloxacillin/1st Generation Cephalosporin
Functional Status unable to
meet a Metabolic Equivalent Task Level of
• Early Coma
Ampicillin/Sulbactam IV 4
• Pinpoint Pupils
2 Tendon 1stGeneration Cephalosporin + Aminoglycosides Inactive but no Limitations Pons • (-) Doll’s Eye Reflex
3rd Generation Cephalosporin + Metronidazole Active, Easily does Vigorous Tasks
• Quadriparesis
Performs Regular Vigorous Exercises
• Ocular Bobbing
• (-) Seizures
3 Septic Ampicillin/Sulbactam + Aminoglycosides
Arthritis 3rd Generation Cephalosporin + Metronidazole
METABOLIC EQUIVALENT OF TASK (MET) • Late Coma
Osteomyeliti
s • Small but Reactive Pupils
Cerebellum • Ataxic Gait
• Dizziness
Ceftazidime + Metronidazole • Vomiting
4 Dry Imipenem
Gangrene Piperacillin-Tazobactam
Neurosurgical Evaluation:
• Cerebellar Bleed/Infarct ≥ 15 ml
Imipenem + Co-Amoxiclav • Supratentorial Bleed ≥ 30 ml
5 Wet Ceftazidime + Clindamycin
Gangrene Oxacillin + Metronidazole + Co-Amoxiclav

CHADS2 Scoring

HBsAg IgM IgM Anti- Interpretation

Anti-HAV
+ -
+ -
Anti-HBc HCV Estimates the risk of having Ischemic Stroke in patients with Non-
Rheumatic, Non-Valvular Atrial Fibrilation
+ - Acute Hepatitis B
Congestive Heart 1 0 1.9% No Tx/Aspirin Daily
Failure
- - Chronic Hepatitis B

Aspirin Daily/Warfarin
Acute Hepatitis A
Hypertension 1 1 2.8% (Raise INR to 2-3) or
+ + - - Superimposed on
other Oral Anti-
Chronic Hepatitis B
Coagulants

+ + + - Acute Hepatitis A & B Age < 75 years old 1 2 4.0%

Warfarin (Raise INR to
- - + - Acute Hepatitis B 2-3) or any Oral Anti-
Diabetes Mellitus 1 3 5.9%
(HBsAg Below Coagulants
Detection)
• 150 ml (21 ml/day) Previous Stroke or 4 8.5%
• 90-100 mmH2O Opening Pressure Transient Ischemic 2
- + + - Acute Hepatitis A & B Attack (TIA)
• CHON = 15-45 mg/dl 5
(HBsAg Below
• Glucose = 50-80 mg/dl (2.8-4.4 mmol/L) 12.5%
Detection)
• Lactate = 10-25 mg/dl (adults); 10-40 mg/dl
(children)
- - - + Acute Hepatitis C • pH = 7.33 6
18.2%
CEREBROSPINAL
FLUID CSF Flow
• Lateral Ventricles
HBs Anti- Anti- HBe Anti- Interpretation • Interventricular Foramina (of Monro)
Ag HBs HBc Ag HBe Points for • Abscess > 2 cm
• Third Ventricle
Surgical • Accessible Location of Abscess
• Cerebral Aqueduct of Sylvius
Treatment • Abscess Stage 3-4 (do not Aspirate in the Cerebritis
+ - IgM + - Acute Hepatitis B High • Fourth Ventricle
of Brain Stage)
Infectivity • Foramen of Magendie (Midline) & Foramen of
Abscess • Unstable Neurologic Status
Luschka (Lateral)
• Subarachnoid Space
+ - IgG + - Chronic Hepatitis B High
Infectivity
Cardinal • Tremor at Rest (initially Unilateral)
Features of • Rigidity (Cogwheel/Lead-Pipe)
+ - IgG - + Late Acute/Chronic Hepatitis B • Structural Abnormalities (e.g. Calculi, Infected Parkinsonism • Akinesia (Bradykinesia/Hypokinesia)
(Low Infectivity); Pre-Core Cysts, Renal/Bladder Abscess), Pyelonephritis, Mnemonic: • Posture (Loss of Postural Reflexes, Neck & Trunk
Mutant Spinal Cord Injury, Catheters TRAP Flexion)
Complicated UTI • Metabolic/Hormonal Abnormalities (e.g.
- - IgM +/- +/- Acute Hepatitis B; Window Diabetes Mellitus, Pregnancy)
Period
• Impaired Host Responses (e.g. Transplant
Patients, AIDS)
• Unusual Pathogens (e.g. Yeast)
- + IgG - +/- Recovery from Hepatitis B • UTI in Men