6/18/14 Wednesday Wrap Up

Brought to by Dr. Andrew Grock and Dr. Carl Alsup

Dr. Moran’s Lecture

Pt presents with mid-dilated non-reactive pupil. He has?

Diagnosis?

Acute angle glaucoma

Caused by?

Iris and ciliary body block trabecular outflow of vitreous leading to increased fluid buildup/pressure

Diagnosed by?

Intra-Ocular Pressure(IOP) >30

Treat With?

If IOP >30 and minimal visual changes, eye drops such as timolol, and pilocarpine. If significant decreased visual acuity, can give mannitol. Call Ophthalmology fast –they use lasers to fix the problem.

Dr. Nguyen’s Lecture

Case presentation for irregularly irregular tachycardia at a rate of 150. Diagnosis: atrial fibrillation. Rate control preferred over rhythm control unless patient < 48 hours out.

Can use metoprolol or diltiazem for rate control.
Always think about other causes: pe, sepsis, hyperthyroid, etc.

Dr. Adal’s Lecture

Case: 65 yo M with AML who just started chemotherapy. EKG: Wide complex @ 50s…

Pt with hyperkalemia, hypocalcemia and elevated creatinine on the shock panel…His phosphorus and uric acid comes back high later.

Diagnosis?

Tumor Lysis Syndrome!

Pathophysiology of this disease?

From cell breakdown secondary to chemotherapy in leukemia, lymphoma, or large, bulky tumors.

Treatment?

Treat Hyperkalemia with calcium gluconate, albuterol, insulin/D50, bicarb. Consult Renal and ICU. Give IV fluids for urine output goal of 2-3L/day while watching for signs of fluid overload. Can give allopurinol, but takes days to work. Can give Rasburicase for hyperuricemia but watch out for allergic reactions and anaphylaxis.