Insulin pump

1. N/S 500 ml + HRI 50 U iv run 50 ml/hr, and
2. Check blood sugar by Glucometer Q2h without HRI:
If blood sugar    > 600 mg/dl,  run 60 ml/hr
If blood sugar  551-600 mg/dl,  run 55 ml/hr
If blood sugar  501-550 mg/dl,  run 50 ml/hr
If blood sugar  451-500 mg/dl,  run 45 ml/hr
If blood sugar  401-450 mg/dl,  run 40 ml/hr
If blood sugar  351-400 mg/dl,  run 35 ml/hr
If blood sugar  301-350 mg/dl,  run 30 ml/hr
If blood sugar  251-300 mg/dl,  run 25 ml/hr
If blood sugar  201-250 mg/dl,  run 20 ml/hr
If blood sugar  151-200 mg/dl,  run 15 ml/hr
If blood sugar  101-150 mg/dl,  run 10 ml/hr
If blood sugar   85-100 mg/dl,  run  5 ml/hr
If blood sugar     < 85 mg/dl,  run  0 ml/hr
If blood sugar     < 70 mg/dl,  50% G/W 2 Amp iv stat

# If blood sugar < 100 mg/dL, inform doctor

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Surestep Q4H
normal saline 100cc + HRI 100u keep rate as:

BS<90  hold 2 hr and follow up eyetone 2 hr later
101-130          0.5cc/hr
131-160          1cc/hr
161-190          2cc/hr
191-220          3cc/hr
221-250          4cc/hr
251-280          5cc/hr
281-310          6cc/hr
311-340          7cc/hr
341-370                    8cc/hr
371-400          9cc/hr
401-430                   10cc/hr
431-460         11cc/hr
>460  HRI 5u iv  st and run 10 cc/hr
eyetone q4h for 1 day then qid without HRI

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Amiodarone

Amiodarone 6amp + D5W (glass bot.) 1 bot IVD, run 34ml/hr x 6 hrs, then 17ml/hr x 18 hrs  
Loading Amiodarone 150mg in D5W IVF 10min.

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抽胸水的時機

1. loculated effusion
2. >1/2
3. Air-fluid level

3. Pus
4. stain +
5. culture +

6. pH<7.2
7. Glu<60

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Ranson

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CV Note

EXERCISE TREADMILL TESTING INDICATION

當病人出現疑似CAD的symptoms，resting ECG表現為正常，且自身條件足以進行，peak heart rate至少要達(220 − age) x 85%。若原本EKG已有不正常finding，可能sensitivity and specificity會下降。當ST-segment depression (horizontal or downsloping > 0.1 mV and lasting > 0.08 sec) 應強烈懷疑CAD。在女性、atypical 或 no chest pain、anemia的患者可能出現False positives的情形。

MYOCARDIAL PERFUSION IMAGING

注入nuclear medicine(dipyridamole or adenosine) induce coronary vasodilation,增加healthy coronary arteries flow，stenosis的血管flow相對減少，dipyridamole (Persantine) or adenosine會造成bronchoconstriction，COPD是一個重要的contraindicationas。

Functional Classification of Heart Disease

Class I: No limitation of physical activity. (正常人)

Class II: Slight limitation of physical activity. (輕微)

Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms. (明顯的症狀)

Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. (連休息也會有症狀)

Hypertension

First-line：diuretics, beta blockers, ACEI, ARB, CCB.

Goal is SBP<135–140 systolic, DBP<80–85 (<130/80 in patients with DM or CKD).

A、ACEI：Side effects include angioedema, hyperkalemia and azotemia (particularly in pts with elevated Cr), nonproductive cough-->substitute an ARB

B、Beta Blockers：Relative contraindi-cations include bronchospasm, CHF, AV block, bradycardia, and insulin-dependent diabetes.

C、CCB

1、DHP：

長效：Amlodipine, Nifedipine-MR

短效：Nifedipine, Nicardipine

降低 afterload, 擴張coronary artery, 減低inotropic(但Amlodipine可能在LVF使用)

2、NDPH：verapamil, diltiazem

減低inotropic更明顯，應避免在急性CHF使用

D、Diuretics：

Major side effects include hypokalemia, hyperglycemia, and hyperuricemia 

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主動脈剝離

胸部主動脈剝離--HTN(看到胸部血壓會高)
腹部主動脈剝離--atherosclerosis(粥喝到肚子)


先使用beta blocker

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DM Medication

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