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All Content by zzyzx

  1. plasma compatibility

    I've always thought that with a plasma transfusion, blood type is critical, just as with PRBC's, and that therefore a Type A patient, for example, must get only Type A or AB plasma. However, someone told me that in an emergency, a Type A plasma ...
  2. plasma compatibility

    Cool, thanks for the link! I did a whole bunch of Googling and couldn't find an answer.
  3. I know that the recommendation for treating hypertension in a subarachnoid bleed is to keep the BP below 140, but is there any accepted recommendation for traumatic subarachnoid bleeds? Would you treat a BP of 230/120 in a patient with a traumat...
  4. Brain bleeds: prophylactic care

    I'm wondering what protocols/decisions strategies the neurologists in your ICU/ER use for deciding to use Keppra prophylacticaly for seizures, and mannitol/hypertonic saline? I ask the question because I don't seem to see uniformity in how certain pa...
  5. capnography

    For a neonate, can waveform capnography be used for ET tube confirmation (post intubation and during transport)? I guess I don't see why it shouldn't be, but I don't see any reference to waveform capnography in my NRP book.
  6. capnography

    Thanks for your responses! What do you guys think is the best way to monitor tube placement during transport of a neonate? In adults waveform capnography is great because you get an immediate alert if the tube is dislodged (i.e., into the hypopharanx...
  7. Pedal pulses and posterior tibial

    If you can feel or Doppler a pedal pulse, is there really any need to find a posterior tibial pulse? Likewise, if you can get a posterior tibial pulse, any need to feel for a pedal pulse?
  8. Pedal pulses and posterior tibial

    I get that, but my understand is that an arterial occlusion of the leg is going to happen in the femoral artery, or in the popliteal artery proximal to the knee. In either case, you'd have no circulation to the lower leg, and thus neither a pedal pul...
  9. Pedal pulses and posterior tibial

    Thanks for the reply. My understanding is that we are mainly checking pedal or posterior tibial pulses to make sure the patient hasn't developed an arterial clot higher up in the leg, in which case we would find neither pulse. So, as long as we are f...
  10. hyponatremic seizure

    Has anyone ever seen a hyponatremic seizure in the ER? I'm just curious on how the patient presented, how long the seizure lasted, if you saw immediate relief from treatments, etc. details.
  11. hyponatremic seizure

    Thanks for your replies. I didn't realize I had gotten any messages, hence this late reply. I've worked in the ER for many years, but I've never seen a seizure due to hyponatremia. We're always ready to treat for this whenever the L.A. marathon comes...
  12. Taking a two-week paramedic course may certify you on paper, but it will not make you a competent paramedic. You need a bunch of experience working as a medic, not just a little bit of classroom time. I understand that flight programs look more favor...
  13. AF RVR + levophed

    How would you treat this patient in regards to rate control: Pt has been going in AF for a few days, and now they are in AF RVR with a rate of 130. The patient is also on Levophed at 5 mcg/min. BP is 100/60.
  14. AF RVR + levophed

    Thanks for your responses. We didn't want to do amio because she wasn't anticoagulated yet. The obvious thing to me was to do rate control, but I wasn't sure if Cardizem was the right thing to use since it would antagonize the Levophed. The doc didn'...
  15. ARDS patient, dialysis

    I had a patient with severe ARDS who had been anuric for 24 hours. She was in a respiratory acidosis, with a PaCO2 of 75 and a bicarb of 18. Her pH was 7.20. The fellow ordered CRRT, but the next day the attending d/c it saying that the pt didn't nee...
  16. Hemiplegia after BP reduction

    I recently heard of a case (if I remember it was the EmCrit podcast, but it may have been another) where a patient with asymptomatic HTN was given hydralazine IVP for a BP of 175/90 in the ED. The patient was admitted for an unrelated complaint (cell...
  17. hemiplegia after BP reduction

    I recently heard of a case (if I remember it was the EmCrit podcast, but it may have been another) where a pt with asymptomatic HTN was given hydralazine IVP for a BP of 175/90 in the ED. The pt was admitted for an unrelated complaint (cellulitis) an...
  18. ARDS patient, dialysis

    Ok, got it. Thanks for all the responses. I realize now that the dialysis could not have made a significant impact on reducing the respiratory acidosis. Makes sense. At one point after she was intubated, I had a chance to bag her for a little while. ...
  19. ARDS patient, dialysis

    The patient was perhaps hypotensive due to sepsis, though she could also have been volume down. She initially came in for chronic pancreatitis, then developed a GI bleed, then came to the ICU because she went into respiratory distress after she got b...
  20. What is the point of wearing a mask if you have a patient who is intubated and not coughing anyhow? Is it that you could touch something that has their respiratory secretions on it, and then touch your face?
  21. albumin and hypotension

    I have always thought that with hypotensive liver patients who also have low albumin levels, the correct treatment is to give albumin. This seems to make sense since they need the protein to maintain the osmotic gradient so that they can keep fluid i...
  22. albumin and hypotension

    Thanks. The fact that albumin does not stay in the vasculature makes it much easier to understand some of the other processes involved. I'm half way through the article now. Very interesting so far.
  23. albumin and hypotension

    Thanks for all the responses so far. One thing I don't understand is how the albumin gets out of the vasculature. Probably I'm forgetting something from physiology class. I understand how the water that's infused with the albumin goes out of the vasc...
  24. sodium amount in sodium bicarb

    How much sodium is in one amp (50 ml) of sodium bicarb? Is it 3735 mg?
  25. sodium amount in sodium bicarb

    Thanks for your reply. Since the sodium is not free but bound up with the bicarb, does it have the same effect as if you gave the patient 1150 of sodium only? In other words, would it immediately raise the sodium level, or would it take time for the ...