![]()
0 Comments
![]() 1) Always be able to explain anion gapped metabolic acidosis. 2) Remember K.I.L.R for causes of AG metabolic:
Think Tox •GI & small pupils = cholinergic •Old, Deaf, & acidosis = ASA •Bradycardia, Hypotension, & Elevated BS = CCB •Acute Hepatic Failure: APAP, Acute Hepatitis, Med list!!! •Sepsis in pump pt = consider withdrawal Don't forget the Tox triad for most exposures EKG, BMP, and APAP level ![]() - The “Chest” exam should include: Assessment of neck veins Search for paradoxical movement (flail) Respiratory distress Palpation for fractures Assessment for unequal breath sounds or decreased vocal fremitus - Needle decompression in the field for presumed tension pneumothorax is indicated when hypotension is present - Two most important studies in the first several minutes of evaluation are CXR and FAST Exam (to include a search for pleural sliding) - Up to 15% of patients with thoracic aortic injuries have a normal CXR - The treatment of traumatic aortic injury may include control of heart rate and blood pressure prior to transfer - Multiple rib fracture in the elderly trauma victim often requires admission to the ICU ![]()
![]() • Never assume that an airway will be straightforward!! • Upper airway edema is a common complication of supraglottic device use and should be expected • King LT’s can be safely exchanged in the emergency department • Bacterial meningitis has a high incidence of elevated intracranial pressure • Suspect herniation syndrome in any patient with acute mental status change and meningitis is a potential diagnosis • Hypertonic saline works rapidly to reduce intracranial pressure without significant downsides ![]()
![]() • Any penetrating wound between the base of the neck and the inguinal region is a considered thoracic • ACLS protocol has little to no role in trauma resuscitation • Resuscitation can be undertaken for organ donation- make sure to document your rationale • Consider aortic dissection in all presentations with chest pain with abdominal or back pain • Aortic dissection is rare however there is an increased risk among cocaine users • Calcified pericarditis is a form of restrictive pericarditis which can result in right sided heart failure. The treatment of choice is pericardectomy. ![]() Case 1: 1. Hyperkalemia may manifest as junctional escape rhythm 2. Do not underestimate dehydration as a cause for AKI and hypotension 3. Don't forget to fill the tank before you squeeze it Case 2: 1. Absolute Lymphocyte Count can be a poor man's CD4. ALC < 1000 cell/mm3 is predictive of CD4 <200cells/mm3 ALC >2000 is predictive of CD4 >200. 2. Bactrim is the treatment of choice for PCP Pneumonia 3. Steroids are indicated for PCP pneumonia with A-a gradient >35 or PaO2 < 70 ![]() 1) Use both EKG and absolute K value, in addition to clinical picture, to determine necessity for treatment of hyperkalemic emergency 2) Suspect HyperK in any renal patient who presents with arrhythmia, and correct before pursuing other interventions 3) Be aware of onset times and half-life of HyperK treatment meds (Ca, insulin, B-agonists), and redose as needed! 4) Glucose checks q30min or q1h in any patient treated with insulin for HyperK 5) "C BIG K Di" mnemonic (Calcium, bicarb/Beta agonist/Insulin/Glucose, Kayexelate/LasiKs, DIalysis) ![]() ARSENIC
MERCURY
LEAD
Remember that metals are caustics. |
Archives
August 2018
Categories
All
|