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[CK] Opioid withdrawal.

Heroin/Opioid overdose -> withdrawal.

Sx>
Anxiety,
Pain,
Diarrhea,
Lacrimination/Rhinorrhea,
N/V,
HTN

Objective eval> COW score(>7 will be indicated for treatment.)

AP>

1. Wait for previous opioid clearance(for 4times of half life. Oxy 3HR X4 = 12HR)
2. Restless and BP: Ativan + Clonidine
    N/V/Agitation: Compazine/Promethazine/Hydroxyzine + Benadryl
3. m. pain: Dicyclomine, Baclofen, Tylenol, NSAIDS
4. Diarrhea: Loperamide

And

5. Suboxone protocol(4mg Q12HR -> 8mg Qday -> 4mg Qday -> 2mg Qday)
6. Consult for methadone protocol: super long action. (10mg once - would not cause toxicity)


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[CK] Preventing aspiration.

960 × 720 저작권 보호를 받는 이미지일 수 있습니다.    자세히 알아보기 https://www.google.com/search?q=position+to+prevent+aspiration&rlz=1C1GCEV_enUS820US820&source=lnms&sa=X&ved=0ahUKEwjZ8NbnkoDfAhUs4YMKHZhrBM8Q_AUICSgA&biw=1177&bih=859&dpr=1 HOB 30-45 degree. => resting turn head to Rt. side. or lateral position => for seizing or unconsciousness. 
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[CK] STEMI_EKG learning.

892 × 548 저작권 보호를 받는 이미지일 수 있습니다.    자세히 알아보기 ECG - Common STEMI Mimics | Grays Integrative Physiology Grays Integrative Physiology Mimics will not produce reciprocal changes. If RCs in related leads, should consider it a STEMI. 방문 추가 컬렉션 공유
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[CK] LVAD parameter review. [ ] tree !!

Vital(BP): hypo, hyper. PEx(JVP): volume status -------------------------------- 1st. PI(3-7)= contractility and volume status(high volume only cause high PI) overload = high PI. low volume = low PI. (=low volume = low preload = RV failure, arrhythmia same thing) HTN = low PI low BP = low PI. (only overload cause high PI = with high preload, but otherwise, BP, volume => cause low PI) 2nd. Flow(4-6) overload, 3rd. Power(surge = only thrombus, 4-6) hypotension route (BP) => high VADFL = vasodilator, sepsis = R/O => low VADFL(most common)  with high JVP => RV failure, PE/tamponade, pneumothorax                                                                               , then adjust LVAD(higher)                ...
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