Learning thread (ER medicine)

NetSteff · Dec 27, 2004

OK.... I just recently found this out and thought I'd share.

Question: When performing a bladder scan on a female patient, is there ever an instance in which you would choose the "male" option? Why?

KRVRN, BSN, RN · Dec 27, 2004

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

mommatrauma, RN · Mar 6, 2005

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

You can also give a defassicualting dose of vec prior to Succs

mommatrauma, RN · Mar 6, 2005

You can use D50W instead of Glucagon too. :)

We use 10 u RHI, amp of D50, amp NaHCO3 (to correct the acidosis that usu goes hand in hand w/hyperkalemia)...also, the Ca is given to protect the heart...it has no effect on the potassium level itself...Also, Kayexcelate should not be given alone, as it does not acutely lower the potassium.

A good rule of thumb also....stop all NSAIDS, BETA BLOCKERS and ACE Inhibitors as they all increase potassium levels...

shadowflightnurse · Mar 16, 2005

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.

I would have thought it was because that is when the KIDS get home!! :chuckle

shadowflightnurse · Mar 16, 2005

Great thread!
Here is one I had last week.
Pt pressents with abd pain and htn (BP 230/120). Non-contrast Ct abd and pelvis shows non-disecting AAA. MD orders nipride to titrate for BP >160/90. What type of medication does this pt need prior to nipride and why?
Kevin

Good one.

Beta blockers-decreases shearing force and incr HR.

ernurseafterall · Mar 16, 2005

I loved this thread-keep it coming!

Here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term? What do the eyes do when you turn the patient's head and what is normal vs abnormal.

needsmore$ · Mar 16, 2005

i loved this thread-keep it coming!
here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term? what do the eyes do when you turn the patient's head and what is normal vs abnormal.

it's a neuro test-for lesion or loss of higher cerebral function- checking for deterioration

when you turn your head-your eyes should stay fixated on a certain point-that's normal

if abn-when you turn their head to one side-their gaze turns in the same direction-their eyes do not move , they're centered

anne

taidan · Mar 17, 2005

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

Depresed st and prolonged qt Bicarb, albuterol and glucose insulin then lasix

prolonged QRS/ sine waves Calcium chloride, then bicarb, then lasix.

THe calcium as mentioned before antagonises the myocardial affects of Hyper K, the neb and bicarb produce a temporary intra cellular shift of K and the lasix removes k into urine.

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

ernurseafterall · Mar 17, 2005

Thks Anne.

I knew you would know!

K

Compassionate_Nurse · Mar 17, 2005

I would like to add to this strep thing is something that happened to my 6yr old son. He got strep, 5th's disease, and mono all at the same time (don't ask me how because I'm still puzzled). He was treated for strep with pcn and had a reaction to the pcn because of the mono. He developed a macropapular rash that resembled a 2nd degree burn over most of his body! It was not scarlet fever, the rash from that feels like sandpaper. He has since then taken pcn abt's and had no adverse effects from it. It took us quite a while to figure out what this rash was from and was quite scary. Had me thinking of some really funky diseases like kawasaki (I think I spelled that right).

nightngale1998 said:

Quote:

What are the Centor criteria for empirically treating for Strep throat?

- I am not familiar with the Centor term but let me take a stab at the empirical treatment of strep; this makes for a great discussion. Here is a link and article that that I found:

https://www.medicinenet.com/strep_throat_diagnosis_and_treatment/views.htm

Sore Throat

Most sore throats (pharyngitis) are viral and will not respond to antibiotics. Bacterial causes of sore throat include group A streptococcus. The complications of strep throat include rheumatic fever, ear infections, mastoiditis, sinusitis, peritonsillar abscess, glomerulonephritis (a kidney disorder), and scarlet fever.

The medical challenges presented by a sore throat are not to treat the many that are viral, but to find the few that are strep throats and treat them promptly and effectively.

Diagnosis of Strep Throat

When a child has a sore throat, a rapid antigen test should be done for strep, according to Dr. Warren J. McIsaac and colleagues in Canada. If the rapid test is positive, the child (or adult) should be treated with an antibiotic. If the rapid test is negative, a throat culture may be done. (This takes more time, usually overnight.)

Treatment of Strep Throat

The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) are about three times more effective -- three times less likely to fail -- in eradicating strep than penicillin. This conclusion is based on a meta-analysis of 35 trials reported by Drs. Janet R. Casey and Michael E. Pichichero from the University of Rochester

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The Centor Score is a predictor measurement of the likelihood of a + strep diagnosis. Did I get that right?

Zen: increased anxiety between 3-5PM; could that be from the increased Catecholamenes?

Compassionate_Nurse · Mar 17, 2005

Maybee becaues of an enlarged spleen and resulting injury to it causing bleeding into the abd????????

Hmmm, specifically strep throat or just sore throat. Mono can cause sore throat and abdominal pain mimicing appy.