Learning thread (ER medicine)

reply to er julie

Shearing is just what it sounds like. A single structure ripped apart ie. a spleen or a brain, shearing from the lining....(very bad as they it ussually just results in little tiny bleeds that are not able to recover from...bad, bad, bad.....) it tears apart, not like nice neat stab wounds or bullet wounds, however sheared skin is treated like a burn Ie. road rash...

Am I right?

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.

Coming in late and this may have been answered, but you need to alkalinize the urine of an ASA overdose patient so the acid will transfer out through the urine. It is a concept called "pH partitioning" and based on the idea that particles will ionize in pH environment that is opposite of their current one. I am post final exam this morning so I'm a little muddly, but you can get the point.

Just read the whole thread, and not just the last page--did not realize you meant shearing regarding a nipride gtt, which thank god was answered because I have never heard of that.......LOL.....and I have been doing this a looooooonnnnnnggggg time!!!!!!! Mind, we do not use nipride often any more, don't even stock it......

Some one reply to the epi question....I am itching to tell about the 1 in 10,000 response that we saw........

FYI: Did you know that if you need the height of a patient( for instance, bedbound pts that cant stand), you have pt stretch arms out to side. The distance from fingertips (from left and right) is same as pts height. Try it on yourself.

Name the condition your patient has where this wouldn't work...and don't say "amputees" :roll

Name the condition your patient has where this wouldn't work...and don't say "amputees" :roll

Marfan's Syndrome

Just learned this from a visiting ER doc. When you have a child brought in by parents with the complaint that the child will not stop crying, what should you look for?

Corneal abrasions, scratches. Young children are always scratching at their faces and cannot see the long hair from their mothers or others holding them and this can result in scratches, very painful.

Also hair tourniquets on fingers, toes and member

Exciting learning on night shift....

Why should you not give 1:1000 Epi IV for an allergic rx? (0.3 ml's slow push)

Because you probably kill your patient ?!! Wrong strength. 1:1000 strength is always subQ, right ?

You can give it IV, but..... 1 in 10,000 will have an adverse reaction where their BP goes through the roof, and their head can literally explode--huge ICB. Ussually they get tachy, and fell flushed but it goes away quick. Someone gave it IV in our ED by mistake, pt started grabbing her head--her pressure had spiked to 240 (young girl with normal of about 110), got Labetolol in fast and dropped her pressure--did a CT, and all was good.

Name the condition your patient has where this wouldn't work...and don't say "amputees" :roll

OP, kyphosis, hmmm did not think about that.

zenman said:

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

This is very very bad of me but I am helpless to control Myself:The reason panic attacks are so great these hours is that the kids are home at 3 and DH is home at 430 and I have to start shift at 1900!

3-5 p in my house is the "witching hours"---I hate them!!! the kids get nuts, dinner needs to be made, you have to get someone somewhere by some time...the kids are hungry but you can't let them snack too much or they will not eat dinner, you can't let them lie on the couch or they will fall asleep (thus making 2300 the witching hour) and they can't get too involved in something because they have to eat--it is all about that dinner with the family thing---LOL, DH comes home and he wants to sit, and you then want to kill him because you are running like a headless chicken, or he is so depressed about other stuff....blah blah blah it just seems to be the bad time of the day---our ED goes nuts during these hours (more til 2000 or so before it starts to slow)

Has it got something to do with biorythms and this is the heightened brain time, or slow brain time (siesta?) Or just normal mon-fri 9-5 ers who stress on going home about their home being perfect?