Professional Documents
Culture Documents
FiO2 = 21%
PAO2 = 95% - 100%
95/21 or 200/21 = 4 to 5 %
A-a gradient = air from ATM into CIRCULATION
~ V/Q ratio approx. 1
Ex.
FiO2 = 40% / 40%
PaO2 = 160 % / 95%
160%/ 40% = 4 no A-a gradient
95% / 40% = 2.3 theres an A-a gradient
When do you have hypoxia with a NORMAL A-a Gradient?
GBS : V/Q ratio is a function of the INTRAPARENCHYMAL LUNG. Can still be hypoxia.
What is the current acid-base status?
7.20/80/42/32
I.
II.
2. Na (Cl + HCO3)
HAGMA:
Methanol
Uremia
Diabetic Ketoacidosis
Prophylene glycol
Isoniazid/ Iron
Lactic Acidosis
Ethanol
Salicylates
NAGMA:
RTA
GIT
132 (8+102) =
27 yo SEIZURE
Na 133
K 4.2
Cl 95
HCO3 18
pH 7.22
Lactic Acid 12.7 on ABG
Next step?
a. Infuse HCO3 IV ( for pH =/< 7.19
b. Begin NS at 200 cc/hour
c. Observation with apt chemistries in 2 hours
d. Dialysis ANS
URGENT DIALYSIS INDICATIONS:
1. Symptomatic/Persistent
a. Hyperkalemia
b. Acidosis
2. Refractory/ Symptomatic
a. Fluid overload
b. Uremia
c. Dialysible Toxins Lactate
23 yo man found with several bottles of rubbing alcohol opened near him
Na 141. K 4.2, Cl 106, HCO3 23, Glucose 127
a. Urine Na
b.
c.
d.
e.
TUB
PSEUDOMONAS
Malignant otitis externa
Endocarditis in IV drug user
Hot Tub Foliculitis
Ecthyma gangrenosum
1. Lyme
2. Ehrlicha
3. Babesia
Whats the treatment?
Babesa Azithromycin + Atovaquone
Varicella Valacyclovir, Acyclovir, Famcyclovir
Lyme Disease (+) facial palsy Doxycycline lyme of the face is not CNS
CNS / Cardiac === IV CEFTRIAXONE
DX wth splenectomy for ITP gets scratched by a pet dog? The ff day he us
hypotensive
CAPNOCYTOPHAGIA DOG BITE
Eikenella human
Pasteurella Cat
HIV px with INCREASED AST/ALT
CT: Liver with cystic spaces filled with blood (Peliosis hepatis)
Nodular lesions in extremities: BIOPSY: SILVER STAINS/WARYHIN STARRY Positive
looks like finger
Dx: Bacillary angiomatosis BARTONELLA SPP
TX: Doxycycline/ raise T cell level
Bartonella Quintana / TRENCH FEVER serologic diagnosis
ANTHRAX/ BLACK as COAL
Treatment DOXYCYCLINE/ CIPROFLOXACIN
Pentamidine leishmaniasis, PCP, Killing Pancrease DM
Amphotericin decrease RENAL TA, distal RTA, Dec K and RTA
Hepatosplenic candidiasis
REVERSE ISOLATION NEVER HELPS
HANDWASHING!
Stenotrophomonas Maltophilia
- Gram negative rod cured with SULFA DRUG TMP/SMZ