Learning thread (ER medicine)

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?

ERslave said:

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.) 

2. With each pint of blood given to a pt - how much can you expect the hct and hgb to rise?

Insulin IVP, calcium gluconate IVP and 2 amps of glucagon IVP: changes the biochemistry and K+ goes back into the cells where it belongs.

HGb will rise 1 pt for each unit; I expect the crit would rise similarly.

Something I can answer finally -- gee I hope I'm right 

libmi said:

This is a refreshing thread, thanks Chris. Got tired of threads about how nurses should speak "more" better English. I do have a question, after a pt has been intubated and placed on a vent, what is preferred oral or naso gastric tube and why?

Not sure if this is right in theory, but I always drop an oral gastric tube. I've seen way too many pts develop sinusitus when on the vent, and I am sure placing a naso gastric tube aggravates that potential, along with the unnecessary trauma.

Which one is it??

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.

OMG...thanks....that is going to help me alot. My manager has cracked down on us for not putting heights on our triage sheets.

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.

Insulin IVP, calcium gluconate IVP and 2 amps of glucagon IVP: changes the biochemistry and K+ goes back into the cells where it belongs.

HGb will rise 1 pt for each unit; I expect the crit would rise similarly.

Something I can answer finally -- gee I hope I'm right :imbar

You can use D50W instead of Glucagon too. :)

You can use D50W instead of Glucagon too. :)

v. cool. I'll remember that in my next experience of dangerous hyper K+.

Thanks

We had a pt come in in status asthmaticus tonight. After her her hour long nebs and solumedrol ivp, she wasnt much better (RR=32 sat93% on RA). The ER MD ordered Mag sulfate 2 grams iv over 30 minutes. I had never heard of that as a treatment for AE of asthma before. I looked it up in the med book and sure enough under indications, there it was: relaxes smooth muscles in AE asthma. We gave it to her and she got better almost immediately! (I'm sure the solumedrol was also kicking in too).

Learn something new every day!

Kevin

By Nightengale

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?

This is to maintain the airway. The head is disproportionate,true, but the airway will be occluded if you don't put something under the shoulders and that is the reason for the precaution.

By ERslave

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.

Why not just measure from the feet to the head? Like a big fish :chuckle

That way you could stay on the same side of the pt.

By ERslave

Why not just measure from the feet to the head? Like a big fish :chuckle

That way you could stay on the same side of the pt.

A lot of my patients are too contracted to use that method.

By ERslave

A lot of my patients are too contracted to use that method.

I suppose if you could somehow get one arm extended you could just measure to the manubrium and multiply by 2, but that's not likely without a block and tackle on a contracted pt............................so ,how do you do it?