Chronic Hypertension (from JournalFeed)
- The new BP goal is < 130/80 mmHg.
- Measure BP using the arm with the higher read. Use the average BP from at least 2 separate occasions.
- Start therapy if BP is above 130/80 and patient meets either indication:
- Primary prevention: 10-year risk of atherosclerotic cardiovascular disease (ASCVD) is above 10%. If patient is older than 65 or has DM/CKD, you can assume risk is > 10%
- Secondary prevention: Patient has CAD, CHF, or prior CVA.
- Start therapy if BP is above 140/90 for all other lower risk patients.
- First line agents are thiazides, calcium channel blockers, and ACEi/ARB.
- For stage 2 HTN (>140/90), start with two agents.
- Thiazides seem to be the most health protective drug class followed by CCB. In particular, thiazides are superior at decreasing the risk of developing heart failure compared to other agents.
- If you use a thiazide, chlorthalidone (12.5-25mg daily) is preferred over HCTZ, as it is more potent and has a longer half life.
- Do NOT use beta-blockers unless there is another compelling indication, such as heart failure or prior MI.
- Clonidine is the last line agent.
Some additional tips:
If you click save as my defaults then your name and location will always come up when you open the form.
Hitting T when in either date window will bring up today’s date. Easier to adjust from there.
Hitting N when in the time window changes the time to now.
Don’t think it changes anything but I was told to use All ED beds + Checkout
Lastly the Discern Reports can be accessed from the tool bar just to the left of the quick orders (Lightening) icon.
Our Pacemaker Boxes
The department of cardiology have invested in new pacemakers. They work similarly to the old pacemakers just a newer version. They now run on AA batteries instead of 9Volt. When you turn the PM on it automatically goes to DDD. Typically when we insert a transvenous PM the setting the interventional team uses is VVI. Please lower the A output to 0…This will convert the setting to VVI. And then please in addition please turn the V output up to 20. I have attached pictures above for your reference. Please ask any additional questions you may have.
Dose 0.1-0.3 mg/kg
Copious data that 10-15 minute infusion of this dose is better than push
- RebelEM Summary
Conclusion is Ketamine at 0.3 mg/kg infused by a slow drip (no need for a pump) lowers side effects while allowing maximal analgesic dose. Put the dose in 100 mls and drip it in.