The ICU part 2

Since it's been a week since I've been in the ICU, I will be brief (due to short term memory). The good thing is that I took a few notes while in the ICU.

ACS protocol (acute coronary syndrome) - what to give to a patient you think is having a heart attack. I don't know if we learned this mnemonic, but here it is anyways.

MONA has Hep B.

Morphine, Oxygen, Nitroglycerin, Aspirin, Heparin (our hospital likes to use lovenox instead), Beta blocker.
Also, give ACEI & statin.

I also learned that DKA is very common here. And this city has the highest rate of amputations in the US. One thing I learned is how to admit a DKA patient and every patient who has DKA always goes to the ICU.
I asked the resident "how do you know when to transfer the patient from the ICU to the floor?" She said, "when the anion gap is between 8-12, is when the patient is out of DKA." One common pimp question is "what are the most common causes of DKA?" (note: these are also the MC causes of CHF exacerbation)
1. noncompliance
2. infection
3. MI

Here's an admit order: (one resident prefers this sequence - ADC VANDIMAL X)
admit to: ICU
diagnosis: 1. DKA 2. etc
condition: guarded (means that the nurses are constantly watching you)
vitals: don't remember, but every resident uses the green family medicine book by Chan (the newest edition is color blue)
Activity:
Nursing: fingersticks q 2h and alternate BMP q2h (you really want to monitor potassium)
Diet:
Ins: FLUIDS, FLUIDS, FLUIDS - these patients tend to be very dry (dry lips, dry mucous membranes, sunken in eyes). IV fluids bolus 2-3 L normal saline at 200-250 L/h, then switch to D5 NS when BG < 200-250. Add potassium when < 5 (b/c you lose a lot of potassium when in DKA, the K tends to shift out of the cells, & get excreted in the urine). (but DON'T give potassium if they can't urinate - you will kill the patient).
Meds: DKA protocol
Allergies:
Labs: amylase, lipase (rule out pancreatitis; note: excessive vomiting will also elevate lipase & amylase), CXR (check for lung infection), UA (check for UTI). HgbA1C.
Extras: EKG

Actually, after writing down this admit order, I realized that I didn't bother to copy it down verbatim, but it includes most of the important stuff.