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Foot Drop

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FOOT DROP: WHAT TO DO IN THE ED? • First, establish course of disease, is it chronic or acute? • Chronic (~90% of cases): • Bilateral more common than Unilateral • Most likely doesn’t need an extensive work-up while in ED • Important for neurology follow-up for • Acute (~10% of cases): • Unilateral more […]

Low Risk Chest Pain

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The Shownotes on Low Risk Chest Pain The management of low risk chest pain in the US is founded on a number of tenets: If low risk chest pain patients are sent home and they have unstable angina, they will do worse than if we admitted them Provocative testing will identify patients who are safe […]

Atrial Fibrillation and Atrial Flutter

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  Chemical Cardioversion Ibutilide 1 mg over 10 minutes Avoid if EF<20% or QTc>480 must observe for 4 hours to make sure no QT prolongation augments electrical cardioversion (NEJM 1999;340(24):1849     ashman beats from variable repolarization of the bundles Holiday heart=etoh generated a-fib, can also be from withdrawal. Usually spontaneously resolves.   P-ulmonary Embolism […]

Alternative Anticoagulants

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Podiatry

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Athlete’s Foot prescribe products containing terbinafine such as lamisail AT Toenail Fungal Infections What’s the best treatment for toenail fungus? There’s no magic bullet. Lamisil (terbinafine) taken daily for 12 weeks works best. But, long-term success hovers only around 50%. It can cost upwards of $240 per month. It costs less if given in pulse […]

Hemophilia and von Willebrand’s Disease

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Hemophilia A x linked recessive causing defective VIII:c, Abnormal ptt. Replace c cryoprecipitate of factor VIII 1 unit=100 units VIII 1 cc of FFP=1 unit VIII and less of IX dDAVP raises factor VIII by causing release from endothelial cells, It has ADH-like effects.  Dose:  0.3 mcg/kg. Number of units=0.5 x (Desired Factor Level) x […]

Cardiothoracic Surgical Intensive Care

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best book: Manual of Perioperative Medicine by Bojar Post-CABG what was bypassed? discrete lesion vs. diffuse disease what was the graft material? art vs. vein, pedicle vs. free Looking for MAP 70-80 and DBP>50 First 6 hours, need CI>2.0 Hb 8.0 Fix acidosis CVP is actually a good monitor of RV failure Consider SWAN if […]

Oliguria and Urinary Electrolytes

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Post from Nickson on Life in the Fast Lane USES Oliguria UNa+ low (<10mmol/L) – extravascular volume depletion UNa+ high (>20) – tubular damage Hyponatraemia UNa+ low (<10) – extra-renal losses UNa+ high (>20) – renal salt losing states, SIADH, diuretic therapy Fractional excretion of Na+ = 100 x UNa+ x PCr / PNa+ x […]

ICU Management of Brain Tumor

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acutely bring NA up to 150 until post-op with 3% infusion and 23.4% boluses. After op, continue 3% or 2% to maintain sodium within 10 of plateau, keep weaning slowly over 48 hrs post-op at which point can transition to NS   Steroids Decadron 10 mg continue 8-32 mg/day posterior fossa will need slow wean […]

Toxic Shock Syndrome

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Toxic Shock Syndrome (TSS) Toxic shock syndrome presents with high fever, rash and hypotension.  Prodrome of malaise, low grade fever, myalgias and vomiting.  Sx may occur 2-3 days after tampon use, soft tissue infection, or within a week of other inciting factors. Rash is a diffuse, non-pruritic, blanching, macular erythroderma leading to desquamation. Clinical Criteria […]

Aortic Operative Stuff

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Posted by: “Dr.Mohamed El Tahan” on Anesthideas   However, did your surgeon prepare the bypass machine with extra reservoir !. In reality, as your description this is ATA III post traumatic aortic dissection and massive bleeding is normal. First, i would to clarify this missed point which raised by Dr. Bilal and you, this may […]

Alkalemia – Metabolic and Respiratory Alkalosis

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Alkalemia hypokalemia (and sensitization to dig related arrhythmias) reduction of ionized calcium leading to neurologic symptoms Stimulates anaerobic metabolism Metabolic Alkalosis Plasma bicarb>45 seek to lower it to Nasogastric Suction/Vomiting Diuretics-from increased loss of urinary electrolytes and water. Cl loss balanced by reabsorbtion of bicarb, H+ moves into cells to allow eflux of K. Mg […]

Sodium

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Emergency department (ED) critical care. We combine emergency medicine and intensive care to be the source for emergency physician intensivists.

Magnesium

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Emergency department (ED) critical care. We combine emergency medicine and intensive care to be the source for emergency physician intensivists.