Originally Posted by TraumaInTheSlot

succs is contraindicated in head trauma with intercranial pressure. u dont want the vesiculations, you can premedicate with lido to reduce them. NEXT

Beta blockers do just that, block beta receptors while the cocaine stimulates alpha receptors, which can cause more htn and other problems, and make the patient worse.

good job

yep. increased ICP is a relative contraindication for sux and the potential deleterious effects are ameliorated by premedicating w/ lido.
PLUS: Sux can increase K+ levels, thus is not given when the pt is hyperkalemic (such as ARF) or has potential to have hyperkalemia (e.g. crush injuries).
ALSO: Sux can trigger malignant hyperthermia in pts w/ a genetic disposition for that phenomenon. That is why our policy is to check temps q10 min for 1 hour after giving it...another reason to put in a rectal temp probe .

Interesting tidbits I have learned recently about ketamine. My research was prompted by the current provocative "ketamine" thread and a recent incident w/ a new pediatrician who insisted on giving ketamine IV instead of IM. This, of course, meant we had to stick the kid 4 times to get the IV...sort of counterproductive: let me jab your child w/ a sharp needle a bunch of times for their "comfort". anywho...
1) Green et al. did a couple of studies recently that led the authors to conclude the IM route was as effective as IV.
2) ketamine not only provides amnesia and sedation, but analgesia as well!
there was some other interesting info but I'm too tired to remember details.

what are the Centor criteria for empirically treating for Strep throat?

speaking of strep throat, why is important to know if a pt who is presenting like an appy recently had strep throat?

Speaking of strep throat........how come nurses are not educating their patients to toss the toothbrush? I thought the nurse was to educate their patient. I have had a lady to come to the ER 5+ times for strep throat and when I was discharging her, I advised her to toss the toothbrush and go to the dollar store and buy the pack that has a few in a box for a dollar. I told her that after she used one toothbrush that day that she needed to toss it in the trash and the next day use a new one. Then after a few days she can get a more suitable toothbrush that she would like. She told me that no one has ever told her that. Well, I haven't seen her and it has been several weeks. Maybe I am a bit extreme with using a different toothbrush for a few days but strep throat is not a comfortable feeling and there are risks involved. I am a new ER nurse and I have found out that no one in my ER educates about tossing the toothbrush. So far, my advise has been very successful. No one that has followed my advised has had to return for reoccurring strep throat.

Why do many panic attacks occur during 3-5pm?

Hey, thanks for the toothbrush- tossing lesson! I always learn something new here.

As a student, this is a great thread to read too...thanks for starting it!

even the greatest all knowing er nurses (like me...lol) can still learn something! GOOD JOB EVERYONE! keep them coming.

i am going to toss my toothbrush right now!

Quote:
what are the Centor criteria for empirically treating for Strep throat?

- I am not familiar with the Centor term but let me take a stab at the empirical treatment of strep; this makes for a great discussion. Here is a link and article that that I found:

http://www.medicinenet.com/script/ma...ticlekey=31912

Sore Throat

Most sore throats (pharyngitis) are viral and will not respond to antibiotics. Bacterial causes of sore throat include group A streptococcus. The complications of strep throat include rheumatic fever, ear infections, mastoiditis, sinusitis, peritonsillar abscess, glomerulonephritis (a kidney disorder), and scarlet fever.

The medical challenges presented by a sore throat are not to treat the many that are viral, but to find the few that are strep throats and treat them promptly and effectively.

Diagnosis of Strep Throat

When a child has a sore throat, a rapid antigen test should be done for strep, according to Dr. Warren J. McIsaac and colleagues in Canada. If the rapid test is positive, the child (or adult) should be treated with an antibiotic. If the rapid test is negative, a throat culture may be done. (This takes more time, usually overnight.)

Treatment of Strep Throat

The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) are about three times more effective -- three times less likely to fail -- in eradicating strep than penicillin. This conclusion is based on a meta-analysis of 35 trials reported by Drs. Janet R. Casey and Michael E. Pichichero from the University of Rochester
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The Centor Score is a predictor measurement of the likelihood of a + strep diagnosis. Did I get that right?

Zen: increased anxiety between 3-5PM; could that be from the increased Catecholamenes?