Learning thread (ER medicine)

I'll bite...Beta blockers are contraindicated with cocaine induced MI.

Another easy one:

When is succinylcholine contraindated?

btw: good idea for a thread

Succinylcholine is also contraindicated in pts. with significant burns or crush injuries. Puts them at risk for hyperkalemia. Chronic renal failure patients would not be good candidates either.

Actually to be more specific it is contraindicated in those injurys outside the acute phase- ie if the injury just happened I've seen given and have had to give to like patients.

Elle2 said:

Succinylcholine is also contraindicated in pts. with significant burns or crush injuries. Puts them at risk for hyperkalemia. Chronic renal failure patients would not be good candidates either.

Why is it important to alkalinize the urine of an aspirin OD? I'm looking for the specific mechanism that leads to increased elimination from the body.

By Nightengale

This is to maintain the airway. The head is disproportionate,true, but the airway will be occluded if you don't put something under the shoulders and that is the reason for the precaution.

Newly trained TNCC instructor here to validate the fact of airway obstruction as the primary reason to use padding in a peds pt on the backboard. The head is larger and in order to maintain c-spine, and at the same time the airway, padding is needed under the shoulders of peds pts on back boards --

LOOOOVVVVVVE this thread! Ok, what type of "critter" bite can cause pancreatitis?

I 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.

C'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.

Hyperkalemia 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.

Another scenario:

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.

(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)

Beta 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).

Loving 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.)

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

All 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.

Kevin McHugh, CRNA