Learning thread (ER medicine) - page 7

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

  1. by   ernurseafterall
    I loved this thread-keep it coming!
    Here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term? What do the eyes do when you turn the patient's head and what is normal vs abnormal.
  2. by   needsmore$
    Quote from ernurseafterall
    i loved this thread-keep it coming!
    here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term? what do the eyes do when you turn the patient's head and what is normal vs abnormal.
    it's a neuro test-for lesion or loss of higher cerebral function- checking for deterioration
    when you turn your head-your eyes should stay fixated on a certain point-that's normal

    if abn-when you turn their head to one side-their gaze turns in the same direction-their eyes do not move , they're centered

    anne
  3. by   taidan
    Another treatment for hyper K Is, wide tented T's Thiazide Diuretics
    Depresed st and prolonged qt Bicarb, albuterol and glucose insulin then lasix
    prolonged QRS/ sine waves Calcium chloride, then bicarb, then lasix.

    THe calcium as mentioned before antagonises the myocardial affects of Hyper K, the neb and bicarb produce a temporary intra cellular shift of K and the lasix removes k into urine.

    Also two questions what heart sound is associated with endocarditis (sp?) and what specifc ECG wave is seen in hypothermia?
  4. by   ernurseafterall
    Thks Anne.
    I knew you would know!
    K
  5. by   Compassionate_Nurse
    I would like to add to this strep thing is something that happened to my 6yr old son. He got strep, 5th's disease, and mono all at the same time (dont ask me how because I'm still puzzled). He was treated for strep with pcn and had a reaction to the pcn because of the mono. He developed a macropapular rash that resembled a 2nd degree burn over most of his body! It was not scarlet fever, the rash from that feels like sandpaper. He has since then taken pcn abt's and had no adverse effects from it. It took us quite a while to figure out what this rash was from and was quite scary. Had me thinking of some really funky diseases like kawasaki (I think I spelled that right).

    Quote from nightngale1998
    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
    --------

    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?
  6. by   Compassionate_Nurse
    Maybee becaues of an enlarged spleen and resulting injury to it causing bleeding into the abd????????

    Quote from RNCENCCRNNREMTP
    Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.
  7. by   Compassionate_Nurse
    insulin followed by iv glucose

    Quote from ERslave
    Here's an easy one:

    1.) Your unconscious pt has a k+ level of 7. Besides kayexelate, how else can you get the k+ level down quickly.? (except for dialysis pts - then you couldnt use this method.) :imbar :uhoh21:

    2. With each pint of blood given to a pt - how much can you expect the hct and hgb to rise?
  8. by   Compassionate_Nurse
    dolls eyes move in the oppisite direction the head is turned and indicated neuro damage unless the pt is a newborn. same as the bibinski reflex.

    Quote from ernurseafterall
    I loved this thread-keep it coming!
    Here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term? What do the eyes do when you turn the patient's head and what is normal vs abnormal.
  9. by   Compassionate_Nurse
    I am unsure of this so I am goin to ask since you brought up the other medications besides the normal insulin and dextrose. Why do they not use digoxin in addition to protect the heart? If low K+ increases the effects of dig then why wouldnt a bolus of dig counter effect the K+ effects on rhythm untill the levels are lowered and then if needed give didibind?

    Quote from taidan
    Another treatment for hyper K Is, wide tented T's Thiazide Diuretics
    Depresed st and prolonged qt Bicarb, albuterol and glucose insulin then lasix
    prolonged QRS/ sine waves Calcium chloride, then bicarb, then lasix.

    THe calcium as mentioned before antagonises the myocardial affects of Hyper K, the neb and bicarb produce a temporary intra cellular shift of K and the lasix removes k into urine.

    Also two questions what heart sound is associated with endocarditis (sp?) and what specifc ECG wave is seen in hypothermia?
  10. by   nikonos
    Quote from jaimealmostRN
    LOOOOVVVVVVE this thread! Ok, what type of "critter" bite can cause pancreatitis?
    scorpion, black widow, and brown recluse venoms
  11. by   jaimealmostRN
    Dolls' eyes (oculocephalic response) is:

    1. Normal reaction = eyes move in direction OPPOSITE to head movement when head is turned.

    2. Abnormal reaction (brain stem problems) = eyes remain in fixed position in skull when head is turned.

    This is from pg. 1909 of "Med-Surg Nursing: Clinical Mng't for Positive Outcomes" by Black, Hawks, Keene. 6th ed.

    This should only be done on unconscious pts without spinal injuries. But use of succs (or other neuromuscular drugs) or Meniere's disease can cause an absense of oculocephalic response.
  12. by   candyndel
    Endocarditis usually affects the aortic and mitral valves, so your murmur will depend on which valve is affected. It becomes important when a new murmur is detected in the pt. (Although a Carey-Coombs murmur can sometimes be appreciated as well.) Endocarditis also produces Osler's nodes and Roth's spots as well.
    An Osborne wave is seen with severe hypothermia and it is a large notching-like wave at the end of the QRS complex. Small notching may occur in the precordial leads but be a normal variant.

    Proventil use in hyperkalemia was a good one to bring up because a lot of people dont realize that. (PEA is my favorite station to teach!!)

    Uno mas....
    Why on Earth do some patients in or near arrest Smurf, yet plenty of pts never turn that nice, blue-ish hue??


    QUOTE=taidan]Another treatment for hyper K Is, wide tented T's Thiazide Diuretics
    Depresed st and prolonged qt Bicarb, albuterol and glucose insulin then lasix
    prolonged QRS/ sine waves Calcium chloride, then bicarb, then lasix.

    THe calcium as mentioned before antagonises the myocardial affects of Hyper K, the neb and bicarb produce a temporary intra cellular shift of K and the lasix removes k into urine.

    Also two questions what heart sound is associated with endocarditis (sp?) and what specifc ECG wave is seen in hypothermia?[/QUOTE]
  13. by   Lurksalot
    Quote from thanatos
    speaking of strep throat, why is important to know if a pt who is presenting like an appy recently had strep throat?
    Okay, I realise this is an old thread, but I did a search for some info and found it a great read. And I didn't see the answer to this question, so I thought I would throw out there that a bout of betahemolytic strep can cause/be followed by acute glomeulonephritis, and the abdominal pain may present like an appy.

    Great thread, had to bookmark it!

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