SGARBOSSA'S CRITERIA POD

SGARBOSSA CRITERIA

• Used to diagnose a myocardial infarction in an ECG with LBBB or ventricular paced rhythm

• Score ≥3 90% specific for acute MI but only 36% sensitive.

  • Low score cannot rule out MI.

Original Criteria: less sensitive in detecting MI

• Concordant ST elevation > 1mm in leads with a + QRS complex (+5 points)

• Concordant ST depression > 1mm in V1-V3 (+3 points)

• Excessively discordant ST elevations > 5mm in leads with a negative QRS complex (+ 2 points)

Modified Criteria: more sensitive in detecting myocardial infarction

Eliminates the point system.

• ≥ 1 lead with ≥1 mm of concordant ST elevation

• ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression

• ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave

Thyroid Storm-POD

THYROID STORM PRESENTATION

• Fever

• Altered mental status

• Tachycardia

CAUSES

• Infection

• MI

• DKA

• Pregnancy

• Trauma

• Untreated thyroid disease

• Ingestion of thyroid hormone

TREATMENT

• Control body temperature

  • Cool IV fluids, external cooling

• IV Fluids

  • High output cardiac failure- preload dependent

  • Add glucose as they have low glycogen stores

• Beta Blocker

  • Propranolol 0.5- 1mg IV over 3-5 minutes

    • Prevents conversion of T4àT3

    • Non selective beta blocker

    • Titrate to HR<100

  • Stop Thyroid hormone synthesis

    • Propylthiouracil 1000mg PO/NG or PR

      • Preferred in pregnancy

      • Prevents conversion of T4àT3

    • Hydrocortisone 100mg IV q 8

      • Blocks T4àT3

      • Thyroid storm causes depression of hypothalamic- pituitary axis

    • Iodine

      • Inhibits thyroid hormone release

      • Do not give for at least 1 hour after starting PTU

    • Antibiotics

MASSIVE TRANSFUSION PROTOCOL- POD

MASSIVE TRANSFUSION PROTOCOL WHEN TO INITIATE IT?

• ABC (assessment of blood consumption) score >2- each assigned 1 point

  • Pulse >120

  • SBP <90

  • + FAST

  • penetrating torso injury

• Shock index >1.4 (HR/sBP)

• active bleeding requiring multiple transfusions

WHAT DOES IT CONSIST OF?

• 1:1:1 ratio of RBC:Plasma:Platelets

TO PREP FOR BLOOD ARRIVAL

• 2 large bore IVs

• baseline labs- cbc, type and screen, Pt/PTT/INR, fibrinogen, BMP with magnesium

• prepare the Belmont- rapid transfusion and warmer to prevent hypothermia

• If trauma patient give Tranexamic acid 1gm IV over 10 minutes and then 1gm IV over 8 hours.

DURING MTP

• Repeat labs every hour checking for electrolyte abnormalities. CORRECT THEM!

  • Hyperkalemia

  • Hypocalcemia

  • Hypomagnesemia

• Ensure patient is not hypothermic