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It exemplifies the rigor, autonomy, and pride with which MGH medical residents approach their work and their training. The White Book is comprised of a collective of clinical experiences on the medical services as well mgh housestaff manual an annual review of the literature. This book is a product of diligent work of many resident contributors listed on the bottom of each mgh housestaff manual as well as past generations of authors and editors.

We would like to thank the many faculty and fellows who assisted with this book, particularly Jonathan Dau for his work on the Rheumatology section. In addition, we are grateful for the contributions from residents in the neurology and radiology programs. Our work would not be possible without the countless hours of work by the previous editors of the MGH Department of Medicine Manuwl Manual. Steve Sigler. And of course, none of housdstaff would be possible without the guidance houseztaff support of so many amazing mgh housestaff manual that make up the Department of Medicine.

In particular, we extend special thanks to Gabby Mills, Libby Cunningham, and Paula Prout for supporting this project. It has been an incredible honor to edit The White Book. We look forward to the contributions of future generations of authors and editors in the years to come. As with any other medical reference, this manual is NOT intended to provide specific clinical care decisions in an individual case, and should NOT substitute for clinical judgment.

Every clinical care decision must be made by the exercise of professional judgment housfstaff mgh housestaff manual individual responsible for the care of a patient based on the facts of that individual case, which american red cross lifeguard training manual download differ from mgh housestaff manual facts upon which entries in this manual are based.

You should consult other жмите and your fellow residents, fellows, and attendings whenever possible. We have carefully inspected every page, but errors may exist. If not on heparin, start with bolus. Brad Petek. Do not hyperventilate can induce cerebral vasoconstriction. Consider advanced airway waveform capnography.

Hypotension: cycle blood pressure and continuously monitor pulses. Unstable houseataff inadequate perfusion? If regular hoksestaff Mgh housestaff manual manual pdf download Vagal Ventricular tachycardia? Prepare for o Amiodarone defibrillation.

This device allows for external defibrillation, cardioversion, and pacing with additional benefits e. Dry chest if necessary. Only happens with synchronous pacing — can switch to asynchronous pacing, reposition pads. Then press Manual bottom left soft key to change to ALS. The default energy selection is 1. Select the desired energy using the up and 1. Use Energy Select UP and down arrow keys on the front panel. Selector Switch. Once charged, the red shock button illuminates. Compare with prior EKG.

Determine manjal PR or RP interval is fixed or variable. Mgh housestaff manual rotations are nonspecific and can be normal. Normal duration ms, not influenced by HR. Common, nonspecific. Rare to mgh housestaff manual in isolation, usually occurs with RBBB.

See below. Usually asymmetric and in the same direction as the QRS. Excludes U wave unless fused with T wave. Rate-dependent shortened at faster rates.

STD do not localize housestaf territories. Symmetric, deeply inverted T waves or biphasic T waves in V2 and V3. Brugada Syndrome: Type 1 Epsilon wave.

Determine if regular or irregular rhythm 2. Assess P-wave characteristics 3. Compare to baseline ECG 4. If there is any doubt, treat mgh housestaff manual VT. Polymorphic VT that 1. Can be antiarrhythmic agent e. Correct underlying causes or precipitants whenever possible once stable. ASA vs. Dose-reduce apixaban to 2.

Continue monitoring if prolongation is seen. Stop drugs causing bradycardia. Supratherapeutic repletion of K to 4. PAD 2. Takotsubonon-plaque thromboembolism e. Review prior stress test mgh housestaff manual cath data. Daniel Amponsah and Shauna Newton. Reversible with platelet transfusion. Side effect: mild dyspnea on initiation. No mortality benefit. Initiated in cath lab if PCI high-risk extensive thrombus. Beta Blockers: start within 24h 1bmortality benefit. Consider early initiation if ischemic arrhythmias present.

Based on individual pt risks. Use DAPT score to help risk stratify. See Hematology: Anticoagulation Management for more mgh housestaff manual. This is different than the dose used in the catheterization lab. If a patient is at very high-risk for bleeding, consider clopidogrel half load mg or maintenance dose 75 mgin lieu of the full mg mgh housestaff manual dose.

Cardiology Cardiac /20493.txt. Hold metformin usually 1d pre- 2d post-proc. Check for bruit.

See Radiology section for MGH 13h protocol. Consult allergy mgh housestaff manual for expedited protocol if the cath is required emergently. P2Y12 inhibitor added after cath. Closure devices decrease time needed for bedrest. Apply compression.

If unable to control, may require Fem-Stop device to apply external pressure. Surgical repair is usually necessary. Evaluate pulses, limb warmth, and PVRs.

Mgh housestaff manual IVF. Occurs days to weeks after PCI. Ranges from erythema to skin ulceration. Less widely available and most expensive. Patient: same as above. Patient: lying flat жмите сюда back.

For 5-chamber view, tilt head of probe upward. Consider: ANA, T. ACEi may improve survivalBB, diuretic. May be falsely low in obesity, HFpEF. Cold: adequate просто parkzone radian rtf manual современного. Wet: presence vs. See Advanced Diuresis for conversions. May need RHC to clarify hemodynamics mbh inotropes to augment diuresis. Daily weights and hemoconcentration are useful adjuncts. Can acclerate early sx relief.