BSC MISC FAMILY MED EOR BLUEPRINT>Family Med EOR Guide.

FAMILY MED EOR BLUEPRINT URGENT CARE (4%) RESP FAILURE/ARREST  RESP DYSFUNCTION resulting in abnormalities of OXYGENATION or VENTILATION (CO2 elimination) severe enough to threaten function of vital organs  pO2 <60 mmHg + PCO2 >50 mmHg  CAUSES (full list on p 316 in Current)  ASTHMA  OBST  PULM EDEMA 2T ARDS, INJURY, ↑ HYDROSTATIC PRESSURE, MITRAL REGURG  AIR EMBOLISM  RIB FX, FAIL CHEST, PNEUMO  FEVER, INFECTION, DRUGS  SSX  those of UNDERLYING DZ combined w HYPOXEMIA (low O2 in blood) + HYPERCAPNIA (excessive CO2 in bloodstream)  HYPOXEMIA = cyanosis, restlessness, confusion, anxiety, delirium  HYPERCAPNIA = HA + dyspnea cardinal signs  LABS  obtain ABG  TX  treat underlying disease  RESP SUPPORTIVE CARE for adequate gas exchange  GENERAL SUPPORTIVE CARE  NONVENT ASPECTS OF TREATMENT  INSPIRED O2 CONC should be LOWEST VALUE -> ARTERIAL HEMOGLOBIN SATURATION of 90%  VENTILATOR ASPECTS  FULL FACE MASK or NASAL MASK of BiPAP  FIRST LINE COPD  pts w ARDS or SEVERE IMPAIRED OXYGENATION need to be INTUBATED  You can have NONINVASIVE, TRACHEAL INTUBATION, MECHANICAL VENT  comps w MECHANICAL VENT include: ET TUBE MIGRATION into MAIN BRONCHUS, loss alveolar integrity, ACUTE RESP ALKALOSIS 2T OVERVENTILATION (common), or PNA  GENERAL SUPPORT  adequate NUTRITION = key  Watch out for overfeeding of carbs with conventional enteral feeding methods because it can cause increase CO2 production  Watch out for hypokalemia and hypophosphatemia may worsen hypoventilation  Support from family DETERIORATING MENTAL STATUS  "CONFUSED" PT frequently comes to medical attn 2T judgment of someone  DELIRIUM = acute change in attn + mental fxn; disturbance of wake-sleep cycles and fluctuating confusion.  DEMENTIA = chronic confusional state with insidious onset.  The two conditions can and frequently do coexist. ALLERGIC RXN/ANAPHYLAXSIS  Allergen exposure followed by acute onset of illness involving the skin or mucosal tissue and either resp compromise of hypotension (systolic <90 mmHg) 1  Types of anaphylaxis  IgE dependent: acute syndrome initiated by new allergen exposure after prior silent exposure in which the pts body made IgE antibodies (can NOT occur on first time exposure)  Idiopathic anaphylaxis: without known immunologic mechanism and can occur with first time exposure  SSX  Occur within 30 min usually  First have skin manifestation like urticaria then respiratory distress, GI symptoms, and hypotension  Labs: elevated serum levels of mast cell mediators such as tryptase and histamine BURNS  The first 48hrs of burn care offer the greatest impact on morbidity and mortality of a burn victim.  Extent: Remember rule of nines for estimating total burn surface area  only 2 nd and 3rd degree burns are used to calculate this  Depth:  1 st degree may be red or gray but will demonstrate good cap refill and NO blister initially  2 nd degree the wound is blistered which shows partial thickness injury to dermis  3 rd degree is progressive loss of adnexal structures  Burns greater than 20% of total body surface area cause systemic metabolic derangements and can result in shock  You want to do a full trauma workup on these pts “ABCDE”  General edema may develop of soft tissue, upper airway, and in lungs as well  Generalized cap leak may occur in severe burns  need to replace volume with crystalloids  Management:  Pain control with NSAIDs or opioids is critical  Chemoprophylaxis: tetanus status, topical abx  Surgical management with escharotomy or fasciotomy (indicated for compartment syndrome)  DEBRDIEMENT with regular dressing changes and cleaning of the burn 3 RD TRIMESTER BLEEDING  5-10% of women have vaginal bleedi