Learning thread (ER medicine)

just read back in the thread and realized this had been answered, I gotta stop just trying to jump in at the end of the thread...LOL

I am really liking this thread....it is amazing how smart you people are!!!!

I went to ED rounds this am...amazed at the topic and interesting info...leads to a Q..

Syncope is 2% of ED population (when I was a kid it was called fainting)...50% of that 2 % we in the ED will not be able to figure out why they had a syncopal episode...... when do you need to worry?

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.

That is amazing! I had to try it on myself and DH! Thanks for the tip!

Yay! Thanks for this thread!!! :monkeydance:

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.

You shouldn't push Epi 1:1000 IV if you have to it should be diluted. Epi 1:1000 can cause MI, cerebral bleed, and arrhythmias when used IV on a non-coding pt. Maybe the pt above received too large of a dose or med was pushed too fast.

BTW this thread rocks!! Keep the questions coming!

I am relatively new to ER so this thread is awesome! I had a pt who came in diaphoretic, unable to follow commands, and pale in his 40's. The paramedics said that his friend reported him throwing up blood while at lunch, but they never saw any and we in the er saw only food particles on his clothing, shoes, etc. He was very restless, therefore difficult to get a bp but was was 121/70's with heart rate in the 80's. His extremeties were cool. His wife who was an RN called to say that his only history is hypothyroidism. He is in his forties. We took him for CT of his head, and then did a PE protocol on him.... any thoughts on the results? He also became more coherent while in CT. I was not able to get BP's on him there as he was still very restless, but his heart rate remained in the 80's. I learned a new rule of thumb for myself with this patient! Any thoughts as to what the CT showed?

Hmmm, do tell. My first thought was myxedema coma, but the head CT and PE protocol threw me off...

Don't know if this was placed anywhere, but I had a patient with a scorching genital herpes outbreak and she couldn't pee. The doc told me to NEVER cath a patient with active herpes d/t the risk of introducing the virus into the urethra-OUCH!!. Thought it was good advice to pass along...

Another treatment for hyper K Is, wide tented T's Thiazide Diuretics

Also two questions what heart sound is associated with endocarditis (sp?) and what specifc ECG wave is seen in hypothermia?

I'm gonna say a murmur, and "j" waves..

Danielle

Nope, 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.

What is ki???

Thanks

yvonnemuse said:

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!

SO funny you said that.. I also thought about kids and hubby.. (causing MY anxiety)

Ok, I've got a question. I had this 24yr old female come in last night. She is 5mths pregnant(>20weeks gestation) and she drank carbarator fluid. She has a know history of self mutilation, amphetamine abuse, huffing paint and drinking carbarator fluid in the past. Question is: Isn't this considered child abuse? Especially now she >20wk gestation. It's a viable pregnancy, correct? Any input on this would be great. We had a 2 1/2 mth old infant that we coded last night 2 to child abuse. I would like to prevent that from happening with this situation. Thanks

Oh so very sad indeed.. I know the world is made of all types, but This I may never understand

I am not sure but I think a viable fetus is 24 weeks or greater.

You choose the male option if the woman has had a hysterectomy.

why is that?