Learning thread (ER medicine)

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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 know. you can even make it a trivia question.

ill start, what kind of med do you never give a cocaine induced MI? (that ones easy)

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

Another easy one:

When is succinylcholine contraindated?

btw: good idea for a thread

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

Beta blockers do just that, block beta receptors while the cocaine stimulates alpha receptors, which can cause more htn and other problems, and make the patient worse.

good job

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why does a bullet wound to the calf need a chest xray?

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I don't know, but would love to know the answer.

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because bullets, bullet fragments, and bone fragments can embolize.

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Okay, I just took TNCC for the 1st time and thought this was cool to know (don't stone me if it is too easy):

Why is it not okay to have a young child flat on a back board? What else do you need to do?

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Okay, I just took TNCC for the 1st time and thought this was cool to know (don't stone me if it is too easy):

Why is it not okay to have a young child flat on a back board? What else do you need to do?

i think its due to their proportionally larger sized head, so lying flat on a backboard will cause the c-spine to be out of line, and difficult to xray. i think there should be a towel under their shoulders. am i right?

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Quote

I think its due to their proportionally larger sized head, so lying flat on a backboard will cause the c-spine to be out of line, and difficult to xray. I think there should be a towel under their shoulders. am I right?

Yes and it is uncomfortable for them too.

Good job Chris (now I sound like my instructors... oh they were awesome)

oooo... who is next?

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Keep them coming; new-to-the-ED RN will take all the tips/tricks/new ideas she can get.

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

Beta blockers do just that, block beta receptors while the cocaine stimulates alpha receptors, which can cause more htn and other problems, and make the patient worse.

good job

yep. increased ICP is a relative contraindication for sux and the potential deleterious effects are ameliorated by premedicating w/ lido.

PLUS: Sux can increase K+ levels, thus is not given when the pt is hyperkalemic (such as ARF) or has potential to have hyperkalemia (e.g. crush injuries).

ALSO: Sux can trigger malignant hyperthermia in pts w/ a genetic disposition for that phenomenon. That is why our policy is to check temps q10 min for 1 hour after giving it...another reason to put in a rectal temp probe :) .

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Interesting tidbits I have learned recently about ketamine. My research was prompted by the current provocative "ketamine" thread and a recent incident w/ a new pediatrician who insisted on giving ketamine IV instead of IM. This, of course, meant we had to stick the kid 4 times to get the IV...sort of counterproductive: let me jab your child w/ a sharp needle a bunch of times for their "comfort". anywho...

1) Green et al. did a couple of studies recently that led the authors to conclude the IM route was as effective as IV.

2) ketamine not only provides amnesia and sedation, but analgesia as well!

there was some other interesting info but I'm too tired to remember details.

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