BOTH Step 2 "Trump Cards"

[res1cue]

I have been trying to come up with a list of high yield facts that are ALWAYS the correct answer for "what is the next best step in management" (if they are listed as an option)

Heres what I came up with so far, if anyone knows of anything I forgot, please let me know:




ABC's trump everything

2 large bore for any big bleed

CXR for positive PPD test

compare old CXR for new solitary pulmonary nodule

transvaginal ultrasound for 3rd trimester bleed (placenta previa)

head CT w/o contrast for new neurological deficits

fluids first for DKA

Ca gluconate for hyperkalemia (only if ECG changes)

heparin for high pretest probability of PE (comes before CT)

high dose steroids for high pretest probability of temporal arteritis

exlap for penetrating wound below nipple line

remove clothing for pesticide poisoning

intubate for singed airway in burn patients

fasciotomy for compartment syndrome

chemical gets in eye -irrigate

hypercalcemia next step is fluids

afib/aflutter/SVT with unstable vital signs - DC cardioversion

normalization of pH in asthma attack - intubate

high AFP in pregnant woman - redraw AFP

low AFP in pregnant woman - US to confirm date

Trauma pt is crumping and you suspect tension pneumo - needle decompression (before CXR, chest tube, etc)

variable decels - always place pt on left side and give O2 first

suspected bacterial meningitis - put pt in negative pressure room for isolation

someone made a mistake - admit to pt

HELLP - induce labor if 34 weeks

nonreactive NST - BPP

meconium ileus - gastrograffin enema

intusussception - air enema

positive murphy's sign - RUQ US

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[Melkor]

I could be wrong on this but I thought 3rd trimester bleed if suspecting previa would be a trans-abdominal instead of trans-vaginal US.

 

[res1cue]

I had thought so too, as multiple sources say different things. Uworld says transvaginal, thats what I am going with

 

[Melkor]

Fair enough, the rest of the list looks solid to me. Thanks!

 

[r4uforever]

i would like to add a few bits

BNP>100 pg/ml = chf (Helps differentiate cause of dysnoea)

bladder tumors r MCC of painless hematuria in adults ( rcc is less common)

dx of histoplasmosis by urine or serum antigen

BHCG >1500 BUT NO INTRAUTERINE PREGNANCY SEEN = Ectopic

Community acquired pneumonia ; INPATIENT Levo or moxi ***** Outpatient Azithromycin or Doxycyline



and a few pearls for Preventive

SCREEN FOR VISUAL IMPAIRMENT kids aged 0-5 for strabismus

NEVER screen for bladder CA (even in pt w risk factors)

Give vaccinations by Chronological age (not gestational age)

VACCINATION FOR TRAVELLERS = HAV

 

[res1cue]

Good ones!

Exception to vaccination at chronological age is hep B