Junior resident manual

2013 Junior resident manual60Ver.1.1(2016.1.8 Up-to-date) 20132016/01/07

1. (1) (2) Walk-in(3) (4) ABC(5) 2. (1) (2) (3) (4) (5) (6) (7) (8) (9) 3. (1) (2) (3) (4) Quick review(5) (6) (7)

1.(1) 1 2 Vital sign3 SAMPLE / GUMBA(1) Symptom(2) Allergy(3) Medication(4) Past Medical History(5) Last meal(6) Event1 3(1) K1 2 KCa(2) 52 (1) 1 2 3 BNP4 (2) (3) 3 CTER3300MRIDr. or 4 3599

(2) Primary surveyVital signSecondary survey and/or Advanced Life SupportJATECISLS etc1 (1) (2) (3) (4) 2 Primary surveyVital sign(1) (2) (3) (4) ABC(5) 3 Secondary survey(1) Head to toe approach(2) (3) 1 or 41 2 3 4 1. Vital sign2.

Walk-in(1) Vital sign103060(2) (1) 1 Vital sign etc and/or e.g.STEMIetce.g. etc2 (2) First touch or 1 1. 2. 2 1. or MCMC2. etc or MC3

1 JPTECSTARTTriageAirwayDysfunction of CNSAirwayBreathingCirculation1

2 Vital sign

AStridor

BRRSpO2CT

CHRBPRUSHFASTXp

DGCSJCSTRIAGE

EBT

Vital signTipsKussmaul(BPSBP4) or (BPSBP2) etcCushingBT 0.55HR10bpm

3 Pediatric Assessment TrianglePALS G2010AppearanceTICLSToneInteractivenessConsolabilityLook/GazeSpeech/CryEffort of BreathingCirculation of skin

4 Vital sign(/min)

30-60/min24-40/min22-34/min18-30/min12-16/min

(bpm)

33221010

85-205bpm100-190bpm60-140bpm60-100bpm

80-160bpm75-160bpm60-90bpm50-90bpm

(mmHg)

0-281-121-1010

60mmHg70mmHg70+2mmHg90mmHg

5 Essential MinimumOPQRSTAMPLEOnsetSudden / Acute / Subacute / ChronicSuddenAcuteSubacuteChronicPalliative / Provoking factorQuality / QuantityNRS10RadiationSiteTimeAllergyADLMedicationPast/ Present Medical HistoryPregnancyLast mealLast menstrual periodLMPLife styleEvent

MISTMechanismInjury siteSignV.S.Load & GoTreatment

6 StridorBruit(1)(2)(3)(4)Jolt accentuationNeck friction or Levine or or 10CVACRT2secGCS90.4mmBarreMingazzini

ABC1. ExIn 1ExInNaKCaCl

10154130040315410902800

3112908402000706620202.6%3.2%

1134353020000352020104.3%4.3%

125000005%

2. Holiday Segar4-2-1 Rulekg1mL/1mL/hrmEq/L

010100 4Na 30, K 20

11201,0001050 40102Na 30, K 20

201,0002025 60101Na 30, K 20

15002500mL/500mL/ 0.5-1.0mL/kg/hr FENa1FE(Cre)(Cre) 1.020500mOsm/L

1 2 25g/mL20mL5A10mL1mL1mL/hr10mL/hr0.3mg/1.5mL 0.3mg/1.5mL1A1mL iv0.5mL15mg/1mL15mg/1mL1A0.5mL0.5Aiv15300.5mL

2 51mg/cc1mg/mL50mL5A40mL2mL2mL/hr0.020.1mg/kg50kg1.05.0mL0.040.2mg/kg/hr50kg2.010.0mL/hrRASS 130.5mL/hrOff9mL/hr 10mg/mL1V500mg/50mL2mL2mL/hr0.251mg/kg50kg1.255.0mL0.34.5mg/kg/hr50kg1.522.5mL/hrRASS 130.5mL/hrOff5mL/hr4g/mL50mL1V48mL2.58.5mL /hr6g/kg/hr10min0.20.7g/kg/hr50kg2.58.5mL/hrRASS 130.5mL/hrOff5mL/hr

3 600600mg/200mL/3mg/mL200mL15mL/hr110g/kg/min50kg110mL/hrSBP 90mmHg0.5mL/hrOff10mL/hr3mg/cc3mg/mL200mL6A170mL5mL/hr315g/kg/min50kg315mL/hrSBP 90mmHg0.5mL/hrOff10mL/hr100.1mg/c0.1mg/mL50mL5A45mL1.5mL/hr0.050.3g/kg/min50kg1.59mL/hrSBP 90mmHg0.5mL/hrOff10mL/hr(10mg/10mL) 10mg/10mL(1A)1mL/hr1050g/kg/min50kg15mL/hr0.251g/kg/min50kg0.753mL/hrSBP 90mmHg0.5mL/hrOff3mL/hr

4 5mg/10mL0.5mg/1mL50mL5A2mL2mL/hr10mL/hrSBP 100140mmHg0.5mL/hrOff10mL/hr5mg/10mL0.5mg/1mL50mL5A2mL/hr10mL/hr0.1g/kg/min5150.10.2g/kg/min60kg0.1mL/hr0.1mL/hr12g/kg/min60kg1mL2mL/hrSBP 100140mmHg0.1mL/hrOff2mL/hr1mg/1mL96mL2V96mL2mL/hr10mL/hr0.2mg/kg/hr0.050.2mg/kg/ hr50kg10mL/hr2.510mL/hr26mL/hrSBP 100140mmHg0.5mL/hrOff10mL/hr1mg/1mL50mL5A2mL/hr10mL/hr0.510g/kg/min50kg1.530mL/hrSBP 100140mmHg0.1mL/hrOff10mL/hr50g/1mL40mL2V5%40mL3mL/hr12mL/hr0.510g/kg/min50kg1.530mL/hrSBP 100140mmHg3mL/hrOff12mL/hr

2.1 2 12L3 4

(+)

PCIPCPSTCP

FAST (+)IVCFAST (+)D-shapeLow EF

1. 2. Vital signRR20/minPR100bpmPR50bpm SBP90mmHg3. CRT2sec4.

1 V.S.CushingBPPR

2 SNOOPSystemic symptoms / singsNeurologic symptoms / signsOnset sudden5Onset after age 40 years40Pattern change

3 ERCO

11

CTCT

2CT

Call

1 2

Four chest killer pain1 Four killer chest painACSA. dissectionPETP2 or Vital3 10ECGSTEMI4 ACSSTEMIMONACall5 ACS

ACSA. dissectionPETP

O

P

Q

R

S1 or

T20

1220mmHgIIDVT

s/or/os/oCTr/oD-dimers/oCTBGAr/oD-dimers/or/o

1 IIIIV2

1 or Vital2 Surgical abdomen etc etc 3

2013

Junior resident manual

HSP()HUS

1ml/kg

1 2 3 Target sign4 5 22

6 90%Red flag Onset or TriggerERCP etc Risk factorMarfanDM etc Neurology

S/O

R/O

ERCP

50DM60AAAHT, DM, DL40s/oUTIr/o Afs/o r/o

s/or/oCVA

r/o

XCTMRICTCTCapHCT

1 V.S.BPCNSBP

2 etc..

Sick

BPPV1

MPPVTIA

HTHLDM

3 (1) 1. ()2. or 3. 6010%(2) (3) RombergFrenzelHead impulse test(4) 1CTMRI3MRI70% etc

1 V.S.

2 1. ECG2. CTCT3. 4.

3 SSituationalYVasovagalNNeurogenicTIACCardiogenicHEARTHeart attackEmbolismAortic dissection & ASRhythm disturbanceTamponadeOOrthostaticPPsychiatricEEverything else

1 2 CT1st step(1) V.S.GCSX(2) B1, 12(3) AMPLEADL2nd stepABCABCCTABCX3rd step(1) MRITriage or V.S.(2) MC

3

V.S.

AAKAWernicke%PT

IDKAHONKDM

UBUNCre

E

/Na,K,Ca,Mg

+Steroid

OSpO2cXp

ChEcXpTRIAGE

TFASTcXppXpCT

ICT

PArm drop

SCT

FALLS protocol

CushingMRI

Pivotal point+etcetc1. ABC2. 3. ECG4. 5.

(-)(+)IP

ShockShockShockWheezeFine crackle

ECG()CTD-dimerECGXCT

3. 1. JCS-ID2. 1. 2. AMPLE3. etcGCSBarreMingazzini etc4. CTMRIECG5. CT1. 1A 1A2. 1A20mLIV3. 2mg/2mL0.51ASBP 180mmHgMBP 130mmHgSBP 140mmHg5A50mg/50mL2mL2mL/hrTIA1. 2. ABCD2 scoreMRI2

A601

BSBP140mmHgDBP90mmHg1

C21

D60105921

D1

StanfordDeBakeyStanford A : B :DeBakey : tear : : tear a:b:ULPtear

CTCT CT

Stanford 100120mmHg 12ml2mL 0.5-1A or 0.5-1A A-line2 CVTriple lumen 30cm

Topics Stanford A D-dimer 0.5 ml/kg/minCS 1&2Nohria & StevensonCold 10mg 1mL>0.5 ml/kg/minCS 2Nohria & StevensonWetQuick review3. NaNa135mEq/LTGSIADHNa 125 mEq/L0.5mEq/L/hrNaNa145mEq/L700mOsm/L700mOsm/LKK5.5 mEq/L TPWide QRSK K free 2A(=20mL)5 1A100mL20 Mg 505mL100mL20 GI1/mL R 0.4mL50%40mL5 R 0.5mL10%49.5mL10mL/hr 1AKK3.0mEq/LECGTSTU or 5%500mLKCL 1A (20mEq)1

4. Whipple triadInsulinoma1. 2. BS80mg/dL3. 50%40mL2A1AAlcoholBacteremiaChildrenDrugSUEndocrineFasting & FailureDKAHHS1. HHSBS 600mg/dL2. DKAAGBS 300mg/dL1. 2. K5.5mEq/L(1) R 0.15/kg0.1/kg/hr(2) 100mg/mL/hrAG(3) 1 2.35.5mEq/L15mEq/hr2 2.3mEq/L25mEq/hr3. (1) 1,000mL/hrHHS(2)

Call110

(1)() (13)Call or 9 (13)Call mm CT()100CallCall (2)

1 2 Call

3 4 5 6 ()CTDr.(3) 1 (2L)2 3 Call (4) ()Call(5)22 !2 14Call() (6)40 Call

1 2

1 352

1 2 1%E(E)3 4 5 4.5mg/kgE7mg/kg

1 2 13.0~4.05.0~6.04.0~5.0 (3.0)5.0~6.03

or VG ()18G

1 2 3

181()X-PAP or PAPrimary surveyCPangleorSecondary surveyPATBEDDeep sulcus signX-PAPPrimary survey1 2 3 Secondary survey1 2 2.5cm3 L54 X-P3Alignment4BoneCartilageDistance of soft tissueADIC24:7mmC6:22mmC1C2

Resident Manual