Timing & Intensity of Alcohol Withdrawal Symptoms - Delirium Tremens - Seizures - Hallucinosis - Minor Withdrawal "The Shakes" Dr. Melissa Bregger @MelBreggs #Diagnosis #Alcohol #Withdrawal #Timeline #Symptoms #Seizures #DeliriumTremens #DTs #Timing #Syndromes

Diagnosis Adrenal Insufficiency - Algorithm Step 1) Screening Test: 6-8AM Cortisol Level - Early morning cortisol levels < 5 have almost 100% specificity for AI (but low sensitivity). - Levels > 15 excludes AI in almost all patients, though some use a cutoff of > 18. - Intermediate levels (5 – 15), require Cosyntropin testing. Step 2) Confirmation Test: Cosyntropin Stimulation - Cosyntropin is an ACTH analogue. This test determines if the adrenal gland appropriately responds to a bolus of ACTH. - Check ACTH before administering cosyntropin (IV 250mcg). Then, check cortisol 30 min AND 60 min after administration. - Peak cortisol level should be > 18. If it is lower, you have diagnosed AI. Step 3) Differentiate primary vs secondary AI (by looking at the ACTH level checked in Step 2 above). - Low ACTH is consistent with secondary (i.e. problem with pituitary gland) - High ACTH is consistent with primary (i.e. problem with adrenal gland) #Adrenal #Insufficiency #Algorithm #Diagnosis #ACTH #Stimulation #Endocrinology

Penicillin Allergy Pathway for Antibiotic Prescription in Patients With Penicillin Allergy Mild Reaction - Itching, Minor rash (not hives), Maculopapular rash (mild type IV HSR), EMR lists allergy, but patient denies • Use full-dose third-/fourth-generation cephalosporin OR • Use penicillin or first-/second- generation cephalosporin by Test Dose Procedure OR • Use carbapenem Type I (lgE-Mediated) HSR - Anaphylaxis, Angioedema, Wheezing, Laryngeal edema, Hypotension, Hives/urticaria OR Unknown reaction WITHOUT mucosal involvement, skin desquamation, or organ involvement • Use third-/fourth-generation cephalosporins or carbapenems by Test Dose Procedure OR • Use alternative agent by microbial coverage OR • Aztreonam • If infectious disease consult determines that penicillin or a first-/second- generation cephalosporin is the preferred therapy, or that one of the alternative agents is substandard, consult Allergy Type II-IV HSR - Serum sickness, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Acute interstitial nephritis, Drug rash eosinophilia systemic symptoms syndrome, Hemolytic anemia • Avoid using penicillin or cephalosporin; use alternative agents by microbial coverage • If there is a strong clinical indication for use of penicillin or cephalosporin, please involve the Allergy and Infectious Disease services #Penicillin #Allergy #Pathway #Antibiotics #Prescription #algorithm #management

Antibiotics - Spectrum and Coverage Antibiogram #Antibiogram #Antibiotics #Classes #Bacterial #Spectrum #Coverage #Susceptibility #Susceptibilities #InfectiousDiseases #Pharmacology

Important Blood Pressure Targets in the ED Subarachnoid Hemorrhage: SBP < 140 - 160 - If ? raised ICP: MAP > 80 Spontaneous ICH: SBP < 140 - 180 If ? raised ICP: MAP > 80 Acute Ischemic Stroke - TPA Candidate: Before TPA: SBP < 185, DBP < 110: For 24 hours after TPA: SBP < 180, DBP < 105 Acute Ischemic Stroke - Not TPA Candidate: If SBP >220 or DBP > 120: ↓BP by 15% over 24 hours Hypertensive Encephalopathy: ↓BP by 20% in first hour Hemorrhagic Shock: Can tolerate lower BP (SBP>70-90, MAP>65) Neurogenic Shock MAP > 85 Traumatic Brain Injury Age 50-69: SBP > 100 Age <50, 70+: SBP > 110 If ?raised ICP: MAP > 80 If BP very high (>200): Treat pain Dr. Sarah Foohey @SarahFoohey #emergency #bloodpressure #targets #goals #management #hypertension #reduction

JNC8 blood pressure goals for the treatment of hypertension are a lot simpler than they may first seem! The first diagram shows the algorithm that JNC8 provides. When you look at the second diagram, you realize how simple it is! If your patient is 60 years or older and does NOT have diabetes or chronic kidney disease, then the BP goal is <150/90 mmHg. All other patients have a BP goal of <140/90 mmHg. There are newer recommendations from the 2017 ACC/AHA guidelines, but those remain controversial and some organizations have chosen not to endorse them. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #JNC8 #bloodpressure #goals #targets #treatment #hypertension #management #guidelines #primarycare #algorithm

JNC 8 Hypertension prescribing guidelines medication #hypertension