By Conrad Fischer
Master the Wards: inner drugs Handbook improves your self assurance so that you can live on the clerkship and ace the shelf. With this in hand, you could arrive ready on day 1 of your drugs rotation. Written via a residency director who has been a clerkship director--and as soon as, in the past, a med scholar similar to you!--this guide provides a middle set of illnesses and problems from the perspective of ways sufferers current, and teaches you ways to evaluate sufferers starting with their leader lawsuits.
Special positive factors assist you appear like a rock celebrity and enhance sufferer safety:
- Organized via leader complaint
- Round-Saver tips assist you supply caliber care
- How to not Kill Your sufferer containers aspect you to severe "don't leave out" diagnoses and issues to seem out for
- Things you may be requested On Rounds bins prep you for attendings' questions
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Additional resources for Master the Wards: Internal Medicine Handbook, Third Edition
For LBBB, a chemical stress test with dipyridamole thallium or dobutamine echo is greatly preferred. Can't exercise? com Chapter 1: Cardiology Angiography Positive stress test = coronary angiography Those with a "reversible" defect need angiography. A reversible defect is a defect in perfusion with exercise, not visible at rest. The main purpose of angiography is to determine who should undergo bypass surgery. Only stenosis >70% in a vessel is significant. • 1- or 2-vessel disease: medical management and possible angioplasty (PCI) - Angioplasty may decrease symptoms compared with medications, but there is no clear mortality benefit with the use of angioplasty in chronic stable angina.
The goal is heart rate <100-110/min. com Chapter 1: Cardiology • Metoprolol: 5 mg IV every 5 minutes for 3 doses. Then start oral 50 mg bid. Maximum 200 bid. 35 mg/kg. Then start oral 30 mg qid. Maximum 120 qid. Both metoprolol and diltiazem should control the rate within 30 minutes. If one of these does not work and systolic BP is >90-100 mmHg, you can add the other. If BP is low or borderline, use digoxin. Digoxin is not a first choice in stable patients because it is not great at controlling the heart rate on exertion.
Warfarin is difficult to use. Maintaining an INR of 2-3 is problematic and it takes several days to achieve. There is no need for routine "bridging therapy" with heparin every time you use warfarin. Heparin causes bleeding and thrombocytopenia. com Chapter 1: Cardiology if the reason for the warfarin is only A-fib. Use heparin if a clot is present. Rivaroxaban, dabigatran, edoxaban, apixaban • • • • No INR monitoring necessary Therapeutic on the same day you start No treatment to reverse them if patient bleeds At least as effective or even better than warfarin Supraventricular Tachycardia (SVT) SVT presents with the sudden onset of palpitations or a "racing heart" that may lead to shortness of breath.