Proposed decision tree for the management of epiglottitis

The main consideration in management is airway maintenance. Patients without signs and symptoms of airway obstruction can be treated medically in a hospital unit with equipments and personnel available for airway management if required.
A second or third generation cephalosporin is the most effective antibiotic against beta lactamase producing organisms and should be considered as initial antibiotic therapy. Simultaneous treatment of the underlying condition is mandatory. Corticisteroids have not proven in a prospective randomized trial to reduce the need for airway intervention or hasten recovery in adult acute epiglottitis.
This algorithm shows the proposed decision tree for the management of epiglottitis.

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Algorithm for Examination of acute swollen knee

Algorithm for the assessment of a swollen knee. (IV = intravenous; WBC = white blood cell; ACL = anterior cruciate ligament)

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STOP Sepsis Bundle

STOP Sepsis(Strategy to Timely Obviate the Progression of Sepsis) Bundle

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Algorithm for Emergency Management of Complicated STEMI

STEMI = ST-elevation myocardial; IV = intravenous; SL = sublingual; SBP = systolic blood pressure; BP = blood pressure; ACE = angiotensin converting enzyme

Algorithm of the cause of Hypokalaemia

A history of vomiting, diarrhoea, or use of medications such as diuretics can be helpful in determining the cause of hypokalaemia. However, in some cases, the cause of hypokalaemia is not readily apparent. In these cases, measurements of BP and urinary potassium excretion, and assessment of acid-base balance are often helpful.

Serum potassium concentrations:
There is no strict correlation between the serum potassium concentration and total body potassium stores. In chronic hypokalaemia, a potassium deficit of 200 to 400 mmol (200 to 400 mEq) is required to lower the serum potassium concentration by 1 mmol/L (1 mEq/L). These estimates are good provided there is no concurrent acid-base abnormality (e.g., for diabetic ketoacidosis or severe non-ketotic hyperglycaemia).

In diabetic ketoacidosis patients may have a normal or even elevated serum potassium concentration at presentation, despite having a marked potassium deficit due to urinary and GI losses.

Spurious hypokalaemia can occur when blood with a high WBC count is left at room temperature due to extraction of potassium by the WBCs. It is therefore important to consider repeating the test for confirmation.

Assessment of Head injuries in children

Perform a primary survey and ensure that the child’s airway, cervical spine, breathing and circulation are secure.

Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.

* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :

•  Withdrawal/flexor response
•  Extensor response

* U Unresponsive
Assess pupil size, equality and reactivity and look for other focal neurological signs.

Perform a secondary survey looking specifically at:

* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries

Ambulation Algorithm

FOOTNOTES:
1. Non-weight bearing: Patient is unable to bear weight through both lower extremities or weight-bearing through both lower extremities is contraindicated.

2. Partial weight bearing: This will include situations where the patient may be allowed: a) Limited weight bearing on one lower extremity and full weight bearing on the other extremity; b) Partial weight bearing through both lower extremities.

3. Safety risks may include: decreased cognition; decreased ability to cooperate/ combativeness; medical stability.

4. Factors that contribute to low safety risk: a) Lack of combativeness; b) Ability to follow commands; c) Medical stability; d) Experience with the assistive device.

5. Factors that contribute to high safety risk: a) Combativeness; b) Lack of ability to follow commands; c) Medical instability; d) Lack of experience with
the assistive device, e) neurological deficits.

BLUNT ABDOMINAL TRAUMA(Surgery algorithm)

Diagnostic Algorithm for Evaluation of Acute Myelopathies and Myelitis.

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USMLE ALGORITHMS: Cushing Syndrome

This video explains the complete workup of Cushing Syndrome, the causes, the diagnosis, and the full management. It is very thorough. I hope you enjoy

Clinical Approach to Metabolic Alkalosis

History

Obtain historical data to pinpoint the nature of the disease causing metabolic alkalosis.

* Ask the patient about history of vomiting, other gastric fluid loss, and diuretic use. Loss of gastric fluid and HCl due to vomiting is the most common cause of metabolic alkalosis.

• Vomiting may be caused by pyloric stenosis or ulcers. Occasionally, it may be self-induced.
• Significant gastric fluid loss can occur via long-term nasogastric (NG) tube drainage.
• Diuretic use may lead to increased chloride losses.

* Obtain information about specific disease states such as primary hyperaldosteronism, reninism, hyperglucocorticoidism, Bartter syndrome, and deoxycorticosterone (DOC) excess syndromes.
* Because hypokalemia may lead to metabolic alkalosis, ask about the use of diuretics because these lead to potassium loss.

An algorithm for metabolic alkalosis

Physical

Increased neuromuscular excitability sometimes causes tetany or seizures. Generalized weakness may be noted if the patient also has hypokalemia. Signs and symptoms observed with metabolic alkalosis usually relate to the specific disease process that caused the acid-base disorder.

* Patients who develop metabolic alkalosis from vomiting can have symptoms related to severe volume contraction, with signs of dehydration that include tachycardia, dry mucous membranes, decreased skin turgor, postural hypotension, poor peripheral perfusion, and weight loss.
* Although diarrhea typically produces a hyperchloremic metabolic acidosis, diarrheal stools may rarely contain significant amounts of chloride, as in the case of congenital chloride diarrhea. Children with this condition present at birth with watery diarrhea, metabolic alkalosis, and hypovolemia.
* Weight gain and hypertension may accompany metabolic alkalosis that results from a hypermineralocorticoid state.

Treatment of Heat-Related Illnesses

Algorithm for the treatment of heat-related illnesses. (CNS = central nervous system; ABCs = airway, breathing, and circulation; EMS = emergency medical services.)

Von Hippel-Lindau - USMLE Study Songs

Algorithm for treatment of renal trauma

USMLE ALGORITHMS: Upper GI Bleeding

This Video Algorithm is going to discuss Upper GI Bleeding. Topics included:

- Mallory Weiss
- Boerhaave's Syndrome
- Esophageal Varices

We will be discussing the presentation of Upper GI bleeding, as well as the full management.

USMLE ALGORITHMS: DIABETES MELLITUS Type 1 and 2

This video clip is going to discuss Diabetes Type 1, and Type 2:
-The diagnosis, symptoms, management, complications, and management of complications
Topics that will be covered:
-Symptomology
-Diagnosis
-Treatment
-Long term Management of Disease
-Complications and Management of Complications: - DKA - HONK
-CCS Hits for DKA

Rabies : Post-exposure Algorithm

Algorithm for the therapeutic management of patients with venous ulcer

Algorithm for the diagnostic management of patients with chronic ulcer of L.L.

HYPERTHYROIDISM ALGORITHM

Topic is Hyperthyroidism and all the different types and how to distinguish between them:
Topics Include:
-Grave's Disease
-Silent Thyroiditis
-Subacute Thyroiditis
-Euthyroid Sick Syndrome
-Pituitary Adenoma
-Exogenous Administration