Learning thread (ER medicine) - page 6
Heres an idea. once you learn something new regarding ER medicine, post it here. it will become a nice discussion and we can all learn something. post something that you think most ER rns wont... Read More
Nov 5, '04I had a winner in triage who became outraged when I took back 2 other patients to their rooms to be seen before her. She had been in a MVC 3 days ago & was in pain. I asked her if she thought she was having a heart attack & she said her chest hurt. I repeated my question & then her husband intervened & they took their seats. When I took her into triage I explained the criteria I had to follow when picking the most critical patients & repeated to her several times about her MVC being 3 days ago. I think she eventually got the message. She was treated & streeted but no x-rays were done & they were gone in an hour. My chest pain pts. whom I took to see before her stayed to be evaluated overnight. there's nothing common about common sense.
Nov 15, '04C'mon all you expirenced ED nurses!!! More questions for us newbies! I read elseware that it is difficult/impossible to "capture" when pacing if the person has hyperkalemia. Is this true? I couldn't find more info on it anywhere. Thanks.
Nov 15, '04Hyperkalemia will cause the myocardium's cell to become more negative and thus harder to reach the depolarization threshold. A cell needs to become less negative in order to fire and causing a more negative environment (hyperkalemia) will cause an impulse not to fire or be continued.
When stopping someone's heart for open heart surgery, the surgeon will dump a cold solution very rich in potassium directly onto the heart. The combination of cold + potassium will stop conduction and the heartbeat will cease.
Nov 18, '04(this is not trauma or cardiac related but it happened one night of my er shift)
i recently questioned a doc about a Bhcg level ordered on a male. pt c/o groin pain radiating to testicles x2mos with increasing severity of pain. c/o 30lb wt loss in 2 mos. i didn't know this but a low level Bhcg in a case like this can mean testicular cancer! (sad but this 27yM DID have CA)
Nov 18, '04Beta HCG can also be used in testing for colon, lung, pancreas, stomach neoplasms, ovarian ca, and testicular ca and possbily bladder ca (bhcg increased). Its used to follow the status of neoplasms after surg or chemo. Hahaha, studying for my oncology exam.....(sigh).
Nov 18, '04Loving the "learning thread", kudos, TraumaInTheSlot! It's great to have access to so many sharp nurses. As an LTC RN some of this stuff is way out of my specialty; however, I like learning about what's happening on the front lines/cutting edge of medicine.
(I once saw a thread that was a case study of a pt with COPD. It was also very informative and a good refresher.)
Nov 18, '04Quote from TraumaInTheSlotAll correct. Fasciculations are not a small matter. Sux is a depolarizing muscle relaxant, causing a brief contraction of all skeletal muscles. Many patients paralyzed and intubated with sux wake up complaining of all over muscle pain. Fasciculations can be eliminated (usually) with a small pretreatment dose of a non-depolarizing medication, such as Zemuron or Vecuronium. 5 mg of Zem, or 0.5 mg of Vec, given about 30 seconds prior to administration of the sux will suppress the fasciculations.succs is contraindicated in head trauma with intercranial pressure. u dont want the vesiculations, you can premedicate with lido to reduce them.
Kevin McHugh, CRNA
Dec 27, '04OK.... I just recently found this out and thought I'd share.
Question: When performing a bladder scan on a female patient, is there ever an instance in which you would choose the "male" option? Why?
Mar 6, '05Quote from TraumaInTheSlotYou can also give a defassicualting dose of vec prior to Succssuccs 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.
Mar 6, '05Quote from magicmanWe use 10 u RHI, amp of D50, amp NaHCO3 (to correct the acidosis that usu goes hand in hand w/hyperkalemia)...also, the Ca is given to protect the heart...it has no effect on the potassium level itself...Also, Kayexcelate should not be given alone, as it does not acutely lower the potassium.You can use D50W instead of Glucagon too.
A good rule of thumb also....stop all NSAIDS, BETA BLOCKERS and ACE Inhibitors as they all increase potassium levels...
Mar 16, '05Quote from zenmanNope, 3-5pm is the time that ki is the strongest in the Bladder meridian. One of the psychological aspects of this meridian is anxiety/fear.
I would have thought it was because that is when the KIDS get home!! :chuckle
Mar 16, '05Quote from kevro1013Great thread!
Here is one I had last week.
Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why?
Beta blockers-decreases shearing force and incr HR.