Learning thread (ER medicine)

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.

Humm.. opposite direction the head is turned? I think it might be that the eyes stay fixed looking straight ahead and do not go from side to side

someone correct me if I am wrong (please)

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.

OK.. EXCELLENT explanation.. THANKS

I'll bite.

What drug should you assess your male chest pain for BEFORE giving Nitro?

and

What is a "Horny Bull" and why is it a problem?

i'll bite.

what drug should you assess your male chest pain for before giving nitro?

i am guessing viagra because it is a vasodilator just as nitro is...

and

what is a "horny bull" and why is it a problem?

hummm... problem? we ain't got "no problom mon.." would love to know the answer though :)

Yep...Viagra it is and for the hypotension reason. Good to know since ED and MI are more prevalent in a certain age group.

No takers on the "Horny Bull"?

Okay. A "Horny Bull" is Viagra with a Red Bull chaser that seems to be the party choice for our local teen males. Problem with it is it causes severe priapism and most kids don't know that if "it" don't go away they are on the fast track to impotence. The other issue is that the Viagra can again cause hypotension and when the kid sees the giant needle heading for his most precious part they often try to run, vasovagal and then we have to had head injury to the list of problems.:smackingf

FlyingScot said:

What is a "Horny Bull" and why is it a problem?

I knew this.

I hate that I knew this ...

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.

I remember back in grade school doing an exercise like this... we all measured our armspan and our height. However, it will only give you an estimated height, as there are different proportions of people:

Height = Armspan --> "perfect square"

Height > Armspan --> "tall rectangle"

Height "short rectangle"

So only a handful of people will actually be "perfect squares" -- but that IS a good alternative when a patient is unable to stand upright... and probably just as accurate as attempting to measure someone's height lying in bed. (And definitely a great way to estimate the height of a bilateral aka/bka!)

I might have an answer for the strep and appy presentation question.

Could it be that untreated strep has migrated to a vessel or an organ in the abdomen much like it will migrate to the cells of the heart and cause rheumatic fever? Strep likes certain kinds of cells and that's why you need to treat it before it moves.

And for the answer to the anxiety level at 3-5pm, Could that be because of rush hour? Everyone's in traffic, no one's moving, it's hot, your ac won't work and the kids are screaming in the back seat. Kind of like how MI's supposedly take place on Monday due to Monday am stress and most babies C-sectioned are on Tuesdays so the doctor can sleep in on Mondays(or he's one of the people having an MI).

Now, you have a patient having a suspected MI, they are stabilized and you are waiting to send them to the floor. You've given them MONA but their BP is still high. What would you give them (looking for a specific drug here) and why? More than just "cuz it lowers the bp" of course.:uhoh21

HEy what happened? I was reading all the entries... and they stopped in 2007...

I am a new ED nurse....med surg experience 3 years. I am excited but scared. loved this thread...please keep it coming.

A 24 week fetus can be a viable fetus.

NurseTampa said:

A 24 week fetus can be a viable fetus.

may be viable, but will spend much time on a ventilator or some form of positive pressure breathing device due to the lack of surfactant in the lungs. may have to increase peep higher than on a normal infant also, to keep the alveoli expanded. (primary problem with being born at 24 weeks is resp. issues and increased risk for infection.)

" most babies C-sectioned are on Tuesdays so the doctor can sleep in on Mondays"...

while we're talking about babies...

on my OB unit, I could see more babies sectioned on Tues morning - because we don't schedule inductions (or repeat/planned cesareans) on the weekend... hence, disfunctional inductions/labors from Monday would be hitting their 24hour-ish limit & heading down the hall for a cesarean.

We are always slower on the weekend for this reason... many moms beg to be induced, and inductions happen during the week when MD's are in-house.