2. What are the rest of his vital signs? What is his usual BP? How does he feel? Was this found on routine vital sign check or is something wrong?

3. Cardiac:  –Tachyarythmia  –Bradycardia  –MI Physiologic:  –ESLD, CHF  –Young and asleep Sepsis Meds Hypovolemia:  –Dehydration  –Bleeding

4. See the patient Call your resident; Call MICU Recheck vital signs, check orthostatics IV Fluids Get Access Consider EKG, CBC, T&S, Broad spectrum ABx

5. What are her vital signs? How do her lungs sound? What are her IV Fluids?

6. Reactive Airway Disease/COPD PE Cardiogenic –MI, CHF Too much IV Fluid Pneumonia PTX Anxiety

7. Examine patient –listen to lungs, JVP, LE Edema CXR EKG; cardiac enzymes ABG I/Os On DVT prophylaxis?

8. Oxygen Diurese Chest CT r/o PE Nebulizer/BIPAP Head of bed up Nitro Call resident

9. What are his vital signs (check both arms)? How does he look? When did it start? Get an EKG

10. MI/aortic dissection GERD PE Anxiety MSK Pneumonia; cholecystitis; pancreatitis Pericarditis

11. Evaluate patient Treat as angina-tele, ASA, B-blocker, nitro, serial CKs, heparin, tell resident Treat as GERD-mylanta Treat as MSK-ibuprofen Treat as anxiety-reassure; ativan? Treat as PE –chest CT, heparin?, oxygen  Treat as dissection – CT chest, control BP