Background:

info changes slowly, pre-assessed and synthesized material.

definition of medical term, disease description, classification

Foreground:

info changes rapidly, clinical reasoning, decision making

new therapy, diagnosis, risk and prognosis.

PICO

patient

intervention

 or comparison

outcome

Questions deal with what of PICO

in children with eczema

does antibiotic therapy vs. no antibiotic therapy

result in fewer infection

P

IC

O

identify ultimate object of tx

select specific treatment

specifying target and goal

what does experimental is measured

what do u measure for observational

efficacy

effectiveness

most important question:

what is the 2nd consideration:

validity

were the study sufficiently rigorous that the patients are truely randomized!!

results:was the study of sufficient size to demonstrate expected finding

when is the studied flawed:

in reali life patients are variably compliant. thus effectiveness vs. efficacy?

if more than 10-20% of patient is lost to floow up.

effectiveness < efficacy

warm, cold receptor

anterior hypothalamus

arachidonic acid metabolites

vasomotor center

elevated temp w/ elevated hypothalamic set point

hyperthermia: elevated temp w/ normal hypothalamic set point.

failed periphery

thyroid storm

malignant hyperthermia

pheochromosytoma

heat stroke

condition of fever must treat

5

seizure

Increase CP/stroke

Cardiac problem

hyperthyroidism

>40

what is fever pattern:

above normal on daily basis

most common, fever goes up/down, fails to return to normal

temp varies, but returns to fever

wide swing in temp >1.4

sustained/continuous: typhoid

remittent

inermittent

hectic: intraabdominal abscess, pyelonephritis, cholangitis

>3 week

documented

negative work

infection 30%: granuloma, abscess, IE

neoplasm: 20%

collagen-vascular: temporal arteritis, juvenile RA

mischellaneous: drug, sarcoidosis.

consider more common disease, continue observation, emperical trial should not be attempted

100-160

R

sinus

narrow

normal cond.

only treat with B blocker post MI

>100

R

inverted

narrow

normal

cchceck PR interval if >3 boxes

p wave is ectopic

increases sympathetic stimulation:

digitalis

theophylline

alcohol

MI

hypoxia

crack

100-300

R

N

2:1 or 3:1

N

undulating sawtooth pattern in 2, 3, aVF

macroentrant circuitin male with dilated atria + elev. LA pressure

pt. w/ tachycardia = 150 = A flutter until otherwise proven

systolic CHF w/ low EF

chronic HTN/LVH

MR

Tx: rate controller. warfarin, cardioversion.

>100

R

N

no P, P after adenosine

re-entry via AV node

slow = antegrade limb

fast = retrograde limb

give adenosine to see P wave

>100

R

narrow

P after QRS, short

re-entry via AV node as antegrade limb

>100

R

wide

P after QRS, short

re-entry via bundle of kent as antegrade limb

manifest WPW

vs/

concealed WPW

bipass AV node

at risk of tach

delta wave.

tx: vasovagal maneuver

via accessory pathway/bundle of kent

vs.

via normal AV node-his purkinje path.

100 - 300

IR

narrow

2:1, 3:1

N

>100

IR

narrow

N

presence of >3 P wave

hypoxia!!!!!!!!!!!

>350

IR, IR

narrow

no P wave

N

multiple re-entrant loop in both atria.

HTN,ischemia, CHF

hypoxia, PE

stress/infection/thyrotoxicosis

alcohol, coccain

Tx: rate controller. warfarin, cardioversion.

>100

IR

N

Sinus, no QRS follow early P

N

Tx: beta-blocker

?

IR

narrow QRS

no P wave, depressed T wave follow QRS

N

single, triplet, from escape.

>30s-sustained vs. not

R

wide QRS >2.5 box

P and QRS not in synch

only QS morphology in pre-cordial leads.

Tx: rate controller, cardioversion, suppression.

wide-narrow-wide shape

in prolonged QT syndrome

Tx: shock