Shock - Diagnosis and Management Summary • Hypotension: SBP<90, SBP drop >40, MAP<65 (Normotension, HTN possible w/ early shock state) • Tachycardia > 100 BPM • Oliguria • Altered Mental Status (SBP<60) • Elevated lactate • qSOFA/SOFA and SIRS 1) Prepare • Full Set of Vital Signs • Establish IV/IO Access - 2-large bore (18-gauge) peripheral IV's, Consider IL NS/LR infusion • Room Setup - Ultrasound, code cart in rom - Patient on monitor, telemetry, 12-Lead EKG • Ensure adequate support - Call appropriate code - Notify Seniors 2) Readily Reversibles 3) Stabilize and Survey 4) Workup 5) Analyze and Reverse • Obstructive Shock - Distended neck veins, dilated IVC - Cardiac >> Constrictive pericarditis, Pericardial Tamponade - Pulmonary >> Acute PE, Tension Pneumothorax • Hypovolemic Shock - Dry, Flat, collapsible IVC - Hemorrhagic >> Transfuse to Hgb>7 - Non-hemorrhagic >> Aggressive volume resuscitation • Cardiogenic Shock - MI, arrhythmia, valvulopathy - Diffuse crackles, elevated JVP, echo abnormalities - Cath lab? Terminate arrhythmia? Cardiac surgery? • Distributive Shock - Septic Aggressive IVF , ABX - Anaphylactic >> IM Epinephrine - Neurogenic >> Vasopressors, Inotropes - Adrenal Insufficiency >> Corticosteroids Dr. Michael Jones @Jonesy_MA #Shock #Diagnosis #Management #Summary #criticalcare #treatment #workup

Non-Invasive Positive Pressure Ventilation Indications: • COPD exacerbation (↓ intubation, ↓ mortality), Cardiogenic pulmonary edema (↓ mortality), Other causes of respiratory failure, DNI status, Extubation to NIPPV Contraindications: • Unresponsiveness/coma, Inability to trigger breath, Inability to protect airway / remove mask, Risk of emesis / copious secretions, Recent head/neck surgery Interfaces: Helmet, Full Face, Partial Face, Nasal Modes: • CPAP - Continuous positive airway pressure • s/T - Spontaneous Time (a.k.a BiLevel, BiPAP) • AVAPS - Adaptive volume assured pressure (a.k.a. NAPS) by Nick Mark MD @nickmmark #NIVPPV #NonInvasive #Positive #Pressure #Ventilation #diagnosis #management #indications #pulmonary #interfaces

Coagulation Cascade - Anticoagulant Targets Here's the brief overview of where the main anticoagulants work on the cascade: - Warfarin - II, VII, IX, X (Protein C, Protein S) - Heparins - lla & Xa - Xa Inhibitors (-xaban's) - Xa - Dabigatran - lla Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Coagulation #Cascade #Anticoagulant #Targets #Anticoagulation #Pharmacology

Causes of Acute Liver Injury - Differential Diagnosis Hepatocellular - Liver Parenchyma • Infectious: Hepatitis C, A, E, B, D, EBV, CMV, HSV • Toxic: Alcohol, Medication, Recreational Drugs, Mushrooms • Hereditary: Hemochromatosis, Wilson's Disease, Alpha-1 Antitrypsin • Other: NAFLD, Autoimmune hepatitis, Acute biliary obstruction, HELLP Syndrome, Celiac Disease Hepatocellular - Vasculature • Hepatic Vein: Budd-Chiari, Congestion/CHF • Hepatic Artery: Shock Liver, Thrombus, Vasospasm Cholestatic - Intrahepatic • Obstructive: Malignancy, 1° PBC, 1° PSC, Cystic Fibrosis, Infiltrative Disease, Sickle Cell, VOD, GVHD • Toxic: Medication, Pregnancy, Alcoholic Hepatitis, TPN • Infectious: Sepsis, Viral Hepatitis, TB Cholestatic - Extrahepatic • Biliary: Choledocholithiasis, Stricture, Malignancy, Liver Fluke, Ascariasis, Choledochal Cyst • Pancreatic: Pancreatitis, Pancreatic Pseudocyst, Cancer - Sophia Hayes MD @Sophia_Hayes_MD #Liver #Injury #Differential #Diagnosis #Causes #Acute #algorithm #hepatology

Abnormal Lipid Profiles - Differential Diagnosis Algorithm Increased Cholesterol and Triglycerides - Genetic Causes • Familial Combined Hyperlipidemia • Familial Dysbetalipoproteinemia - Secondary Causes • Nephrotic Syndrome • Drugs • Diabetes • Hypothyroidism Decreased HDL - Genetic Causes • Apo-A1 Deficiency/ Variant • Tangier Disease • LCAT Deficiency • Primary Hypo-alphalippproteinemia - Secondary Causes • Sedentary Lifestyle • Smoking • Androgens Increased LDL Genetic Causes • Polygenic Hypercholesterolemia • Familial Hypercholesterolemia • Familial Defective ApoB-100 • LDLr deficiency Secondary Causes • Hypothyroid • Obstructive Liver Disease • Nephrotic Syndrome Increased Triglycerides - Genetic Causes • Familial Hypertriglyceridemia • Familial LPL Deficiency • Apo-Cll Deficiency - Secondary Causes • Diabetes • Alcohol • Increased Estrogen (e.g. Pregnancy, Hormone Replacement Therapy, Oral Contraceptive) #Dyslipidemia #Abnormal #Hyperlipidemia #LipidProfiles #Differential #Diagnosis #Algorithm #Causes #PrimaryCare