Learning thread (ER medicine)

insulin followed by iv glucose

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?

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.

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Here is one we were discussing today- a positive "dolls eyes"-maybe an out of date term?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.

I am unsure of this so I am goin to ask since you brought up the other medications besides the normal insulin and dextrose. Why do they not use digoxin in addition to protect the heart? If low K+ increases the effects of dig then why wouldnt a bolus of dig counter effect the K+ effects on rhythm untill the levels are lowered and then if needed give didibind?

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?

LOOOOVVVVVVE this thread! Ok, what type of "critter" bite can cause pancreatitis?

scorpion, black widow, and brown recluse venoms

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.

Endocarditis usually affects the aortic and mitral valves, so your murmur will depend on which valve is affected. It becomes important when a new murmur is detected in the pt. (Although a Carey-Coombs murmur can sometimes be appreciated as well.) Endocarditis also produces Osler's nodes and Roth's spots as well.

An Osborne wave is seen with severe hypothermia and it is a large notching-like wave at the end of the QRS complex. Small notching may occur in the precordial leads but be a normal variant.

Proventil use in hyperkalemia was a good one to bring up because a lot of people dont realize that. (PEA is my favorite station to teach!!)

Uno mas....

Why on Earth do some patients in or near arrest Smurf, yet plenty of pts never turn that nice, blue-ish hue??

QUOTE=taidan]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?

speaking of strep throat, why is important to know if a pt who is presenting like an appy recently had strep throat?

Okay, I realise this is an old thread, but I did a search for some info and found it a great read. And I didn't see the answer to this question, so I thought I would throw out there that a bout of betahemolytic strep can cause/be followed by acute glomeulonephritis, and the abdominal pain may present like an appy.

Great thread, had to bookmark it!:biggringi

WOOOO HOOOO!!! Love this thread. Thanks for starting it!!

Betablocker to decrease shearing effect of nipride. Reasearch shows you are better off with a gtt of esmolol then a repeated single dosing of other beta blockers.

Qanik

what does shearing effect mean? what's the mechanism? Thanks!

Just learned this from a visiting ER doc. When you have a child brought in by parents with the complaint that the child will not stop crying, what should you look for?

Corneal abrasions, scratches. Young children are always scratching at their faces and cannot see the long hair from their mothers or others holding them and this can result in scratches, very painful.

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?

They all got the answers right for this one, however one thing that has taken off in the UK particuly with london ambulance staff is using a leg vacum splint for the child, after all the child is not beig enough to put on an adult board (and we don't have small ones), this also makes it more comfortable for the child.

Exciting learning on night shift....

Why should you not give 1:1000 Epi IV for an allergic rx? (0.3 ml's slow push)