On Call Principles and Protocols. ISBN 1437723713, 978-1437723717
On Call Principles and Protocols. ISBN 1437723713, 978-1437723717
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Principles
& Protocols
SHANE A. MARSHALL, md, frcpc
Consultant Cardiologist
King Edward VIIth Memorial Hospital
Paget, Bermuda
Director
The Cardiac Echo Lab
Paget, Bermuda
5 th
edition
1600 John F. Kennedy Blvd.
Suite 1800
Philadelphia, PA 19103-2899
Copyright © 2011, 2004, 2000, 1993, 1989 by Saunders, an imprint of Elsevier Inc.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is
the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or property as
a matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.
Last digit is the print number:â•… 9â•… 8â•… 7â•… 6â•… 5â•… 4â•… 3â•… 2â•… 1
To our families in
Bermuda and Canada
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Preface
vii
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Acknowledgments
Shane A. Marshall
John Ruedy
ix
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Structure of the Book
PHONE CALL
Questions
Pertinent questions that should be asked to assess the urgency
of the situation.
xi
xii Structure of the Book
Orders
Urgent orders to be carried out before you arrive at the
bedside.
Inform RN
The time you anticipate arriving at the bedside.
ELEVATOR THOUGHTS
The differential diagnosis that should be considered while
you are on the way to assess the patient (i.e., while in the
elevator).
BEDSIDE
Quick-Look Test
A rapid visual assessment to place the patient in one of three
categories: well, sick, or critical. This helps determine the
necessity for immediate intervention.
Airway and Vital Signs
Selective History
Selective Physical Examination
Management
The third section contains the common calls associated with
laboratory-related problems.
The appendixes consist of reference items that are useful
in managing calls.
The On Call Formulary is a compendium of commonly
used medications that are likely to be prescribed by the stu-
dent or resident on call. The alphabetically arranged formu-
lary serves as a quick reference for drug dosages, routes of
administration, side effects, contraindications, and modes of
action.
Commonly Used
Abbreviations
ABD Abdomen
ABG Arterial blood gas
AC Ante cibum (before meals)
ACE Angiotensin-converting enzyme
ACLS Advanced cardiac life support
ACS Acute coronary syndrome
ACTH Adrenocorticotropic hormone
ADH Antidiuretic hormone
AED Automated external defibrillation
AFB Acid-fast bacillus
AICD Automatic implantable cardioverter defibrillator
AIDS Acquired immunodeficiency syndrome
AMI Acute myocardial infarction
AMP Adenosine monophosphate
ANA Antinuclear antibody
AP Anteroposterior
aPTT Activated partial thromboplastin time
ARDS Adult respiratory distress syndrome
ASD Atrial septal defect
AV Atrioventricular
BBB Bundle branch block
BID Twice a day
xiii
xiv Commonly Used Abbreviations
Introduction
1 Approach to the Diagnosis and Management
of On-Call Problems . . . . . . . . . . . . . . . . . . . . . . . . . . 3
6 Chest Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
10 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
12 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
14 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
xxi
xxii Contents
23 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
26 Stroke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
27 Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Laboratory-Related Problems:
The Common Calls
29 Acid-Base Disorders. . . . . . . . . . . . . . . . . . . . . . . 365
30 Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
Appendixes
A Advanced Cardiovascular Life Support
Core Drugs and Therapy . . . . . . . . . . . . . . . . . . . 430
D Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . 479