CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

M&M Extravaganza - Dr. KEller

10/3/2013

0 Comments

 
PictureAll that and then some...
Lip and facial swelling - Angioedema to the Max!
  • Call anesthesia and surgery at same time if difficult airway predicted.
  • Fiber optic intubation:
  1. Sitting up and Preoxygenate
  2. Prepare the Nare - glycopyrolate, afrin/phenylephrine spray, nebulized lidocaine 4ml of 4% lidocaine with 1ml of phenylephrine, visous lido soaked cotton balls in nares followed by viscous lido coated NP airway, hurricane spray
  3. Dilate the Nare with Nasopharyngeal airway.
  4. Put ET into the dilated Nare, then pass the fiberoptic scope through the tube.
  5. Advance scope, see carina, pass tube!

Our New Scope is found in Room 1 of pixis- "endoscopy storz'.
Attached to cmac to black plug,


Picture
29 yo bilateral leg pain

Lactic acidosis
  • Type A - decreased tissue oxygenation (shock, carbon monoxide, decreased tissue perfusion-bowel ischemia)
  • Type b - drugs (metformin, HAART therapy) and diseases such as AIDS, liver disease, renal fialure
In severe undifferentiated Anion Gap Metabolic Acidosis:

    1. Resusucitate/supportive care

    2. Identify cause with appropriate lab ordering

    3. Empirically give Thiamine 500mg IV

    4. Consider empiric Fomepizole after tox consult

    5. Sodium Bicarbonate is controversial

    6. When in doubt, call nephrology and dialyze


Alcoholic KetoAcidosis
    -- Heavy etoh use with a recent binge, sudden cessation with abd pain, N/V. GI symptoms seen in 80%.
    -- Present with Absent ETOH level and Anion Gap metabolic acidosis.
    -- Due to increased betahydroxybutyrate ketone body, UA does not pick up ketone bodies on dip.
    -- Rarely will see severe lactic acidosis and if present think sepsis, seizures or thiamine deficiency.

Tx:
  1. Dextrose - very important to promote ketone metabolism and decrease lactate,
  2. Thiamine
  3. IV fluids

Thiamine deficiency

Pyruvate cannot enter TCA cycle causing high lactic acidosis resulting in Dry (neurologic) and Wet (cardiac) Beriberi. Also causes Wernicke (triad of AMS, opthalmoplegia, and ataxia seen only in 10% of patients).
At risk- etoh, iatrogenic, aids, malignancy, gastric bypass, TPN


44yo fall from standing

  • Canadian Head CT Rule vs New Orleans Criteria
  • New Orleans Criteria - HA, vomiting, older than 60, intox, anterograde amnesia, sz, trauma above clavicle (can use only in patients with GCS 15, not on anticoagulation and >17 yo)
  • Canadian Head CT Rule - Can use in patients with GCS 13-15 and age >15 yo. Can not use on patients on anticoagulation.
  • Both 100% sensitive with regards to identifying lesions requiring NEUROSURGICAL INTERVENTION.
  • Canadian Head CT Rule is more specific.
  • Continue to diligently reexamine vs scan intoxicated patient with head trauma
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
Powered by Create your own unique website with customizable templates.
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction