HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour …
Algorithms
Stroke 2018 Update
In March New Stroke guidelines came out. Wow are they aggressive! tPA and endovascular therapy (EVT) for all… forget what the literature says! Well We NEED to know these so I’ve listed them here for reference. Sorry about the format. I’ll pretty it up soon! Stroke. 2018;49:e46–e99. DOI: 10.1161/STR.0000000000000158.) A primary goal of achieving door-to-needle (DTN) …
ATLS 10th Edition 2018 Update
Since summer is closing and “Fall” is upon us I thought it would be a good time to “drop” some Trauma knowledge especially since “Crash (2)” is in the ATLS update. Here are the major changes in the 10th Edition of ATLS. Luckily ATLS is getting closer to the evidence and what many of us …
Hyper K, The EBM Way: Protect, Push, and Purge
As we all know hyperkalemia is a life threatening condition. But how can something so basic be shrouded in such confusion? So many choices and everyone has their own recipe to fix it. Along with all the treatment choices, come pitfalls and side effects. Thus, we need to know what is the best way to …
TRAUMA IN PREGNANCY UPDATE 2018
Today’s algorithm is all about Trauma in pregnancy. Its a quick breakdown of the need-to-know basics! PRIMARY SURVEY 1. Oxygen supplementation should be given to maintain maternal oxygen saturation > 95% to ensure adequate fetal oxygenation 2. If needed, a thoracostomy tube should be inserted in an injured pregnant woman 1 or …
C. Diff-(iccile): Should the treatment B. Diff-(erent)? A 2018 Update
Table 1. Adult Treatment Strategies 1: Severity Severity Definition Treatment First time, non-severe WBC ≤15000 cells/mL and Cr <1.5 mg/dL • vancomycin PO 125 mg QID x 10 days, OR • fidoxamycin 200 mg BID x 10 days • Alternate: flagyl, 500 mg PO TIDx10 d First time, severe WBC ≥15000 cells/mL or Cr >1.5 …
The ABC’s of ABG’s or How to read a blood gas without the Hassel(bach)
A blood gas interpretation is often a fear inducing “pimp” question. Probably because there is a so much packed into them and at some point, some basic math is needed. So, let’s try to unpack it a little so we have more method and less madness. I’m going to divide this up into 4 parts: …
A “Simplified” DKA algorithm and its rationalization
THE NO-RUSH APPROACH Diabetic Ketoacidosis is a life-threatening condition with the possibility of cerebral edema that occurs in type 1 Diabetes Mellitus (T1DM) and occasionally in type 2 DM (T2DM). For many it is a difficult process to manage with many moving targets, time frames, and life-threatening consequences if mistakes are made. No wonder …
CHEST PAIN PROTOCOLS PART II
Chest pain pathway PROTOCOLS Ok here we are the main show, the reason for reading, the Trump of testing…well you get the idea. The whole goal of a protocol is to identify a low risk group of patients and then do something to make them even lower risk (<1%) to send them home without admitting …
CHEST PAIN PROTOCOLS PART I
INTRODUCTION Why have protocols? Well, so we don’t miss anything. Right?! But how many Myocardial infarctions (Heart attacks or “MI’s”) ARE we missing from the ED. Well any medical student knows that answer… anyone, anyone, Bueller?! Umm yes 2% (see note C), correct! That being said if we “do miss 2%” what should be an …