Conference Notes 1-10-2012 (sorry but they are abreviated due to lecture/admin responsibilities this day)
BAROUNIS/KONICKI ORAL BOARDS
Case 1: Hypothermia requiring active rewarming with cardiopulmonary bypass or cool guard catheter. The patient needed a low measuring bladder thermometer to accurately identify the patient’s temperature.
Case 3: Perilunate dislocation
JIM MALETICH VERTIGO
MAGGIE PUTMAN /NICK KETTANEH 5 MIN F/U’S
GIRZADAS NURO STUDY GUIDE
ALYSSA AV BLOCKS
Lyme disease can cause third degree heart block.
3rd degree is defined by AV dissociation.
Weinkebach is 1st degree type 2. PR progressively lengthens and then a qrs is dropped. The RR interval shortens as the pr lengthens.
INNAUGURAL EM-IM CASE CONFERENCE
Patient had critical Upper GI bleed due to varicies.
NG tube is not contraindicated by known varicies.
Give blood, octreotide,protonix,antibiotics, iv fluids, reverse INR with ffp/vitamin k if increased.
80+% of upper GI bleeds will be due to gastritis or pud. If you suspect varicieal bleeding (the minority) based on physical exam or lab testing, start octreotide.
Variceal bleeders with upper GI bleed have a 50% mortality.
Cirrhotics have a baseline hyperdynamic cardiovascular state. They may have low bp at baseline due to being chronically vasodilated.
Chronic treatment with any beta blocker in a patient with varicies lowers portal pressure and decreases chance of rebleeding of varicies. The target heart rate is bradycardia in these patients. Cipro is used prophylactically to decrease risk of SBP. Cipro does not worsen liver disease induced coagulopathy like it does for warfarin induced coagulopathy.
Give variceal bleed patients prophylactic antibiotics. It has been shown to decrease rebleeding an mortality.
Intubate these patients with ramped or head up position. Pre-oxygenation is critical. Use a neuromuscular blocker to optimize your view. You can also try using a meconium aspirator to improve your ability to suction. LMA can be a bridge device.
In coding cirrhotic patient be concerned about hypokalemia and hypomagnesemia.