Re: Learning thread (ER medicine)

A 24 week fetus can be a viable fetus.

Re: Learning thread (ER medicine)

Originally Posted by NurseTampa

A 24 week fetus can be a viable fetus.

may be viable, but will spend much time on a ventilator or some form of positive pressure breathing device due to the lack of surfactant in the lungs. may have to increase peep higher than on a normal infant also, to keep the alveoli expanded. (primary problem with being born at 24 weeks is resp. issues and increased risk for infection.)

Re: Learning thread (ER medicine)

" most babies C-sectioned are on Tuesdays so the doctor can sleep in on Mondays"...

while we're talking about babies...

on my OB unit, I could see more babies sectioned on Tues morning - because we don't schedule inductions (or repeat/planned cesareans) on the weekend... hence, disfunctional inductions/labors from Monday would be hitting their 24hour-ish limit & heading down the hall for a cesarean.
We are always slower on the weekend for this reason... many moms beg to be induced, and inductions happen during the week when MD's are in-house.

Re: Learning thread (ER medicine)

I thought some ER nurses might find this interesting: Anyone ever heard of "pseudoseizures"?
About 6 months ago while working as a paramedic, I ran on a 30 year old male with a psychiatric & seizure hx. Upon our arrival he was actively seizing, and his girlfriend couldn't tell us much. He didn't respond immediately to IV Valium (the only benzo in our drug boxes) and when he DID stop seizing, he wasn't postictal at all. In fact, he was aggressive. He had seized multiple times. I, as well as 3 other paramedics and the hospital staff didn't believe he was faking it. I had never seen any seizure pt like that.
I explained this to a respected neurologist, who was in somewhat of a hurry, but he told me it sounded like pseudoseizres and told me to do an internet search on it, so I did. It is also known PNES, or Psychogenic, Non-Epileptic Seizures. The pt usually does not respond to seizure meds, the EEG is normal and a neuro assessment is usually normal. The only way to make a true dx is EEG monitoring and a video camera. Here are two links if anyone cares to read more.

http://www.med.umich.edu/opm/newspag...doseizures.htm
http://www.emedicine.com/Neuro/topic403.htm

Re: Learning thread (ER medicine)

Originally Posted by DoubleblessedRN

I thought some ER nurses might find this interesting: Anyone ever heard of "pseudoseizures"?
About 6 months ago while working as a paramedic, I ran on a 30 year old male with a psychiatric & seizure hx. Upon our arrival he was actively seizing, and his girlfriend couldn't tell us much. He didn't respond immediately to IV Valium (the only benzo in our drug boxes) and when he DID stop seizing, he wasn't postictal at all. In fact, he was aggressive. He had seized multiple times. I, as well as 3 other paramedics and the hospital staff didn't believe he was faking it. I had never seen any seizure pt like that.
I explained this to a respected neurologist, who was in somewhat of a hurry, but he told me it sounded like pseudoseizres and told me to do an internet search on it, so I did. It is also known PNES, or Psychogenic, Non-Epileptic Seizures. The pt usually does not respond to seizure meds, the EEG is normal and a neuro assessment is usually normal. The only way to make a true dx is EEG monitoring and a video camera. Here are two links if anyone cares to read more.

http://www.med.umich.edu/opm/newspag...doseizures.htm
http://www.emedicine.com/Neuro/topic403.htm

I had a similar incident earlier this week in the ER. A patient came in who was determined to have a seizure (witnessed by paramedics) but was not postictal at all. He was aggressive and ****** off that they brought him to the hospital. Some responses to questions made sense while others didn’t. his tox screen came back negative for everything. The pt had a psych history also. I was told that in some patients with psych history, that are taking psych meds, they may have a different postictal state than the normal person.
I found this very interesting… he said it had to do with the neuro make up and the use of psych meds.

Re: Learning thread (ER medicine)

Hi all,

I was helping another nurse with a pt presenting with the following:

• Hx of MS - pt became increasingly lethargic over a period of 2 days
• Mottling of trunk and flank, arms and legs that had been present for 3 days
• Cyanotic nail beds (hand/feet)/thready pulses
• COLD body/extremeties, cool face and neck
• VS WNL (incl temp) - including O2 sats (O2 monitor was on her earlobe)
• Above the neck - pale/waxy coloring w/flushed cheeks
• No JVD
• Pt could be roused upon arrival, then deteriorated with LOC, no "doll's eyes".
• vomiting of coffee ground emesis
• Unsure of hgb/hct labs at this point

Any ideas of what may have been going on (with just the info given)? What is most peculiar are the VS being within limits, esp BP, but the mottling and cold extremeties... Respirations 14/min...

Pt was intubated and placed on the vent. She was still mottled after 5 then 10 minutes after being on the vent. It was at that point I had another pt arrive and needed to attend to her, so I wasn't able to get any more info.

Still cogitating. Everything I can think of would have (I thought) resulted in a low BP... esp if there was a bleed somewhere, however, hers was normal. What am I missing?

I didn't have a chance to talk to her nurse before leaving at end of shift - and I've been thinking of this ever since.

Many MANY thanks for this thread!

River Nurse

Re: Learning thread (ER medicine)

Originally Posted by RN92

Ok, now Im serious..I have found a good way of keeping beligerant, intoxicated, maybe confused/maybe not..pts from leaving the ER undetected. (you know, sometimes, when they get mad that they arent getting the attention they deserve - they will just leave unnoticed).
ANSWER: I help them get undressed when they first get there - get them in a gown. Put their belongings in a bag. We keep their belongings at the desk. Pts arent going to leave the er without their wallet and clothes...and if they truly are confused and leave anyway - they wont get far in a gown without security or someone noticing them.

Funny as it is, working in an inner city City Hospital, its part of our protocol. We put drunks, confused, elopement risk patient to "yellow" gown instead of a regular blue gown that will alert every staff and the hospital police that they cannot let this person past the door. We have our own locker for each patient belonging so they won't get mixed up or people try to help themselves with their properties.

It is amazing that on Friday/ Saturday night, half of the ER is on yellow gown...

It started long time ago, but really, we have one incident that a drunk left to comeback few hours later still drunk, altered LOC, but CT was done with a bleed, the hospital can't rule out if this was before or after the elopement...

Re: Learning thread (ER medicine)

we need more!!!

Re: Learning thread (ER medicine)

What are vesiculations?

Re: Learning thread (ER medicine)

Originally Posted by amandaleebsn

What are vesiculations?

its really fasciculations


and they are localized, small, involuntary muscle twitches