- Cardiovascular
Hemodynamic Profile: Cardiogenic Shock
CVP high, PAOP high, CO low, SVR high. Elevated PAOP with low output means pump failure.
- Respiratory
Driving Pressure
Plateau pressure minus PEEP. Keep it under 15 cm H2O to limit strain on functional lung units.
- Renal
BUN-to-Creatinine Ratio
Over 20:1 points to pre-renal AKI from hypoperfusion; near 10:1 suggests intrinsic tubular injury.
- Neurology
Cerebral Vasospasm after SAH
Arteries narrow 4 to 14 days after the bleed — the leading cause of delayed ischemic decline.
- Endocrine
Stress-Dose Hydrocortisone
50 mg IV every 6 hours, 200 mg per day — replaces cortisol to hold MAP above 65 off pressors.
- Multisystem
Hemodynamic Profile: Cardiac Tamponade
CVP, PA diastolic, and PAOP equalize within 2 to 5 mmHg — the classic diastolic equalization.
- Respiratory
ROME Rule for ABGs
Respiratory Opposite, Metabolic Equal — the fastest route to naming the primary disturbance.
- GI
Lactulose Titration Goal
Two to three soft stools a day — the bedside marker that ammonia is actually clearing.
- Cardiovascular
Aortic Dissection
Sudden tearing chest-to-back pain — an intimal tear letting blood track between arterial wall layers.
- Multisystem
Serum Anion Gap
Normal 8 to 16. Over 20 means added acids like lactate or ketones, not bicarbonate loss.
- Respiratory
Status Asthmaticus
An exacerbation unresponsive to first-line treatment. A silent chest is the alarm bell, not relief.
- Hematology
Tumor Lysis Syndrome
Mass cell die-off floods the blood — potassium, phosphate, and uric acid climb together.
- Neurology
Fosphenytoin
Water-soluble phenytoin prodrug — infuses faster and is compatible with glucose solutions.
- Endocrine
SIADH: Hyponatremia Priorities
Fluid restriction first. Hypertonic 3% saline is reserved for severe or neurologic cases.
- Multisystem
Dobutamine
Beta-1 inotrope — more contractility for the failing pump, with mild vasodilation alongside.
- Professional
Moral Distress
Knowing the right action but feeling unable to act. Name it, then work the 4 A's.
- Cardiovascular
Hemodynamic Profile: Cardiogenic Shock
CVP high, PAOP high, CO low, SVR high. Elevated PAOP with low output means pump failure.
- Respiratory
Driving Pressure
Plateau pressure minus PEEP. Keep it under 15 cm H2O to limit strain on functional lung units.
- Renal
BUN-to-Creatinine Ratio
Over 20:1 points to pre-renal AKI from hypoperfusion; near 10:1 suggests intrinsic tubular injury.
- Neurology
Cerebral Vasospasm after SAH
Arteries narrow 4 to 14 days after the bleed — the leading cause of delayed ischemic decline.
- Endocrine
Stress-Dose Hydrocortisone
50 mg IV every 6 hours, 200 mg per day — replaces cortisol to hold MAP above 65 off pressors.
- Multisystem
Hemodynamic Profile: Cardiac Tamponade
CVP, PA diastolic, and PAOP equalize within 2 to 5 mmHg — the classic diastolic equalization.
- Respiratory
ROME Rule for ABGs
Respiratory Opposite, Metabolic Equal — the fastest route to naming the primary disturbance.
- GI
Lactulose Titration Goal
Two to three soft stools a day — the bedside marker that ammonia is actually clearing.
- Cardiovascular
Aortic Dissection
Sudden tearing chest-to-back pain — an intimal tear letting blood track between arterial wall layers.
- Multisystem
Serum Anion Gap
Normal 8 to 16. Over 20 means added acids like lactate or ketones, not bicarbonate loss.
- Respiratory
Status Asthmaticus
An exacerbation unresponsive to first-line treatment. A silent chest is the alarm bell, not relief.
- Hematology
Tumor Lysis Syndrome
Mass cell die-off floods the blood — potassium, phosphate, and uric acid climb together.
- Neurology
Fosphenytoin
Water-soluble phenytoin prodrug — infuses faster and is compatible with glucose solutions.
- Endocrine
SIADH: Hyponatremia Priorities
Fluid restriction first. Hypertonic 3% saline is reserved for severe or neurologic cases.
- Multisystem
Dobutamine
Beta-1 inotrope — more contractility for the failing pump, with mild vasodilation alongside.
- Professional
Moral Distress
Knowing the right action but feeling unable to act. Name it, then work the 4 A's.