CSWS, SIADH, ID

Spinal Cord Injury

American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification) :

• A = Complete: No sensory or motor function is preserved in sacral segments S4-S5
• B = Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
• C = Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3
• D = Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade that is greater than or equal to 3
• E = Normal: Sensory and motor functions are normal
  
  
  
  
  
  
  

JNC 8

9 RECOMMENDATIONs

Thrombolysis in STEMI

• Patients with STEMI and onset of symptoms within 12 hours if PCI delay > 120 minutes (class I)
• Patients with STEMI and onset of symptoms between 12-24 hours if continued symptoms or ECG changes and PCI unavailable (class IIa) 

 Door to needle time <30 minutes
 Not indicated for patients with ST depression

Absolute contraindications for fibrinolytic use in STEMI include the following:^[16]

• Prior intracranial hemorrhage (ICH)
• Known structural cerebral vascular lesion
• Known malignant intracranial neoplasm
• Ischemic stroke within 3 months
• Suspected aortic dissection
• Active bleeding or bleeding diathesis (excluding menses)
• Significant closed head trauma or facial trauma within 3 months
• Intracranial or intraspinal surgery within 2 months
• Severe uncontrolled hypertension (unresponsive to emergency therapy)
• For streptokinase, prior treatment within the previous 6 months

Relative contraindications for fibrinolytic use in STEMI include the following:^[16]

• History of chronic, severe, poorly controlled hypertension
• Significant hypertension on presentation (systolic blood pressure > 180 mm Hg or diastolic blood pressure > 110 mm Hg
• Traumatic or prolonged (> 10 minutes) cardiopulmonary resuscitation (CPR) or major surgery less than 3 weeks previously
• History of prior ischemic stroke not within the last 3 months
• Dementia
• Recent (within 2-4 weeks) internal bleeding
• Noncompressible vascular punctures
• Pregnancy
• Active peptic ulcer
• Current use of an anticoagulant (eg, warfarin sodium) that has produced an elevated international normalized ratio (INR) higher than 1.7 or a prothrombin time (PT) longer than 15 seconds

Well Score for DVT and Pulmonary Embolism

TIMI (Thrombolysis in Myocardial Infarction)

Modified Early Warning Score (MEWS)

Score	3	2	1	0	1	2	3
Systolic BP	<45%	30%	15% down	Normal for patient	15% up	30%	>45%
Heart rate (BPM)	—	<40	41-50	51-100	101-110	111-129	>130
Respiratory rate (RPM)	—	<9	—	9-14	15-20	21-29	>30
Temperature (°C)	—	<35	—	35.0-38.4	—	>38.5	—
AVPU	—	—	—	A	V	P	U

A score >= 5 is statistically linked to increased likelihood of death or admission to an ICU