PetERNurse

Even though your platelets are 65 or 50, they are still capable of forming a thrombus. This is why the doc ordered the hep drip. Heparin is not a "blood thinner", and does not decrease the viscosity of blood improving arterial flow. IT DOES potent...

CVP, PAP, and wedge will all be elevated.

The answer to these depends on what the current vent settings are and full assessment of ABG taking disease process into account.

It's not as simple as saying the pH is X and the PCO2 is Y, therefore the disorder is N. It's not like a hemoglobin, where if it is low the disorder is anemia. You need a complete ABG to evaluate acid-base (pH, PCO2, HCO3, AnGap, PO2, lytes, and pr...

Ketamine causes increased HR and myocardial oxygen demand, while decreasing ventricular filling time. Don't fall into the trap of thinking it doesn't "stress out hemodynamics". Given that the patient needed RSI, a little transient hypotension was th...

"521 is a babysit. When he goes to bite you just toss the pill in the back of his mouth."

I think we can all agree that it increases morbidity and hemodynamic sequalae as it increases the likelihood of vasopressor dependence in the PO period. Yes jury is still out on if it increases mortality. And yes the ventilator study is when used as...

Controversies surrounding the use o... [Ann Pharmacother. 2010 Jul-Aug] - PubMed - NCBI Etomidate versus ketamine for rapid sequence intubati... [Lancet. 2009] - PubMed - NCBI Acute adrenal insufficiency aft... [J Intensive Care Med. 2007 Mar-Apr] - ...

People used to think the etomidate did not increase m+m, but that is not the consensus now. Even a single dose has been shown to cause prolonged adrenal supression that increases m+m, especially in septic shock. Use of etomidate during mechanical ...

Dipravan causes significant myocardial depression and decreased CO. Definitely can effect BP especially in a CV compromised patient. I agree you may need to up your sedation/look to other meds (fentanyl/midazolam as others have said). Additionall...

Morphine is also more vasodilatory than fentanyl and will provide more of an increase in myocardial oxygen delivery. Additionally the increase in mortality with morphine demonstrated by the CRUSADE study was in non-STEMI patients. It's also a non-ra...

Your body wants to blow off the excess carbon dioxide so tachypnea is an early sign. Along with tachycardia as the heart tries to increase it's output to meet an inadequately supplied metabolic demand. You're mixing a couple different things here. ...

the problem here is that your answer to the op "original simple question" contains fundamentally incorrect material (see post 39 above). i'd be interested to see the clinician's reaction when you attempt to water/fluid restrict a hypovolemic patient ...

It's not so much that the kidneys separate Na, Cl, and H2O, but that it is an aqueous solution. NaCl does dissociate when in solution. It's just basic chemistry.

Right, 140, because that measurement is a measurement of CONCENTRATION, not a count of the absolute number of sodium molecules. Got that? If not, work on it, because you have to "get" it. If you have a concentration (140 meq/L) and a volume (blood v...

The OP was referencing this comment when they said that. I guess I just read the OP comment as hyPOvolemic. OP- Just to clarify, was the patient hypervolemic or hypovolemic?

Not an appreciable difference. Again, remember that the underlying disease process is still occurring, which means continued fluid retention. Yes if the patient is hypervolemic due to CHF, liver dz, etc. But there isn't a deficit in TBS in thes...

It sounds like what she meant was that even though there is sodium in the solution, there is enough water in the solution to dilute serum sodium levels even further. I'm not sure that is physically possible. If you are adding a solution that has...

There are a few different types of hyponatremia: 1- Hyponatremia w normal plasma osmolality (aka "pseudohyponatremia"). Usually due to hyperlipidemia/hyperproteinemia, which interferes with sodium measurement giving a falsely low sodium reading. 2- ...

Why is the patient bradycardic?

If there was bacteremia you would expect changes in the diff (bands at the very least, but frequently if WBC on way back down, P would be neutropenic/low normal neuts and you would see metamyelocytes due to severe left shift), as that is an advanced...

I would suspect the patient has inflammatory cellulitis secondary to the lymphedema. Abx are Rx because of the decreased barrier integrity and likelihood of infection. Like another poster said, the bacteria haven't solicited a WBC response, likely ...

Again I would say that there may not be an infection present. Just because you get a positive culture doesn't mean there is an infection. If we swabbed your hand we might grow strep, but that doesn't mean your hand is infected with strep (coloni...

Some patients just don't read the same books we do...

Might not be an infection. Was a culture submitted?