1. Isoproterenol (Isuprel) is the first-line medication for the heart transplant patient with symptomatic bradycardia. Atropine is not used because the vagus nerve is not reattached during the transplant.
2. Temporal Arteritis is more common in Caucasian females aged 50 or greater. S/S: headache, abrupt onset of visual disturbances, fever, and palpable cord-like artery. DX: increased ESR and C-reactive protein. TX: corticosteroids.
3. Myasthenia Gravis – ptosis, diplopia, dysphagia, speech difficulties, inability to smile, and progressive muscle weakness. TX: plasma exchange and IV immunoglobulins.
4. Carbon Monoxide – headache, vertigo, nausea, vomiting, “cherry-red” flushed skin, ST segment depression. TX: high-flow oxygen.
5. Central Retinal Artery Occlusion (CRAO) – “eye stroke” retinal ischemia. TX: fibrinolytics.
6. Tricyclic antidepressant (Elavil, Tofranil) overdose – TX: secure airway, serum alkalinization with sodium bicarbonate.
7. Cat Bites – high risk of Pasteurella infection from deep puncture wounds, so ensure antibiotics are ordered prior to discharge.
8. Bacterial Vaginosis – malodorous “fishy” gray vaginal discharge. TX: metronidazole or clindamycin.
9. Extension (decerebrate) posturing is seen in brain stem infarcts.
10. Gestational hypertension – TX: reduce blood pressure and administer magnesium sulfate to decrease the chance of seizures.
11. Urethral injury – DX: retrograde urethrogram.
12. Antidotes – Dimercaprol (BAL), DMSA, Edetate disodium for heavy metals such as lead.
13. Ludwig’s Angina – submandibular swelling, trismus, muffled voice, fever, drooling. Monitoring airway is the priority, administer antibiotics and corticosteroids.
14. Bleeding Esophageal Varices – TX: intravenous Vasopressin or Octreotide (Sandostatin).
15. Neonatal resuscitation – first steps are drying, warming, and stimulating.
16. Antipsychotic haloperidol (Haldol) may cause neuroleptic malignant hyperthermia.
17. The patient with suspected meningitis (fever, headache, and nuchal rigidity) is placed on droplet precaution.
18. Seizures - TX: benzodiazepines to stop seizure, phenytoin to prevent further seizures.
19. Schizophrenia and psychosis - safety is the priority, boundary-setting and therapeutic communication are ineffective.
20. Decontaminate patients in the "cold" zone.