# 內科值班03
[老胡的投影片](https://drive.google.com/drive/folders/1fQknlwaHUAu8FHacN5_64mroQA-XYm-t)

## VF & Pulseless VT & TdP
* 叫叫CAB ; CPR + Defib + Epinephrine (IV push)
* DDx between SHD & non-SHD
* Exclude AMI first
* 口訣:藥電CPR() ; EKG after ROSC
* Consider ECPR if available
* 30:2 → 10BVM/min after intubation
* Correct electrolyte + MgSO4 if TdP

## Torsades de pointes

* CPR if no pulse ; Correct lytes + Med? ; MgSO4
* Electrolyte imbalance( K,Ca,Mg↓), long QT syndrome
Medication(Abx, anti-psychotics) → R on T
* DC QT prolonged agent , correct lytes
Avoid amiodarone(if TdP)
MgSO4 2g IVP slowly
Over-drive pacing

## PEA
* CPR + Epinephrine + find cause ; 5H5T
* T: 二心二肺跟Toxin → Echo can help

> 主冠栓氣毒

VODKA- Volume, Oxygen, De-temperature
Kalemia, Acidosis
> 血氧鉀冷酸

EKG after ROSC ; Echo can help!
口訣: 藥CPR找原因- 5H5T
Treat underlying

## Tachycardia
Shock if unstable! VT vs SVT; 萬用Amio(除Af+WPW,TdP)

## Bradycardia
Check pulse! Vitals? Unstable→ Atropine/dopa/TCP
Survey for ACS, acidosis and hyperkalemia, Digoxin
Find the etiology and keep vital signs ; 12-lead ECG
IV/O2/Monitor
Atropine 0.5 mg IV ±dopamine ±TCP
Consult CV for TPM

## Intubation
Position! Pre-O2! Plan B & Prepare Video-assisted!
Find high-risk patient
Maintain airway(2 hands, C-shaped) 維持到麻醉科來!

## ACS
EKG! STEMI equivalent → call CV! Time is muscle!
Recognize STEMI equivalent
DAPT if no ongoing bleeding
STEMI
AMI?
AMI?
AMI?
AMI?
AMI?
AMI?

## Cardiac tamponade
Echo! Echo! Echo! Call CV
Signs of RA/RV collapse ; IVC plethora
Evaluating pericardiocentesis
Massive PE
CTA! Unstable → Echo + tPA ; Stable → DOAC/LMWH

## Tension pneumothorax
Vital signs; Unstable → needle + drain ; Echo: barcode
Trachea deviation? Jugular vein engorged?
Echo can confirm! CXR if not emergent
4th/5th anterior axillary line → Needle decompression

## Acute stroke
Check Sugar! Time is brain! tPA in 4.5hrs; IA前9後24