# 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 ![](https://i.imgur.com/KXyRhkm.png) * 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